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diff --git a/19019-8.txt b/19019-8.txt new file mode 100644 index 0000000..4b52ca0 --- /dev/null +++ b/19019-8.txt @@ -0,0 +1,7026 @@ +The Project Gutenberg EBook of Aids to Forensic Medicine and Toxicology, by +W. G. Aitchison Robertson + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Aids to Forensic Medicine and Toxicology + +Author: W. G. Aitchison Robertson + +Release Date: August 10, 2006 [EBook #19019] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK AIDS TO FORENSIC MEDICINE *** + + + + +Produced by Suzanne Lybarger, Brian Janes, Annika Feilbach +and the Online Distributed Proofreading Team at +http://www.pgdp.net + + + + + + + + + + + + +AIDS + +TO + +FORENSIC MEDICINE AND TOXICOLOGY + +BY + +W.G. AITCHISON ROBERTSON + +M.D., D.Sc., F.R.C.P.E. + +LECTURER ON FORENSIC MEDICINE, SCHOOL OF MEDICINE, EDINBURGH; LATE +EXAMINER IN THE UNIVERSITIES OF EDINBURGH AND ST. ANDREWS; FOR THE +TRIPLE BOARD; DIPLOMA IN PUBLIC HEALTH, ETC. + + +NINTH EDITION + +TWENTIETH THOUSAND + + +LONDON + +BAILLIÈRE, TINDALL AND COX + +8, HENRIETTA STREET, COVENT GARDEN + +1922 + + + + +PREFACE TO NINTH EDITION + + +I trust that, having thoroughly revised the "Aids to Forensic Medicine," +it may prove as useful to students preparing for examination in the +future as it has been in the past. + + W.G. AITCHISON ROBERTSON. + +SURGEONS' HALL, + EDINBURGH, + _November_, 1921. + + + + + + +PREFACE TO EIGHTH EDITION + + +This work of the late Dr. William Murrell having met with such a large +measure of success, the publishers thought it would be well to bring out +a new edition, and invited me to revise the last impression. + +This I have done, and while retaining Dr. Murrell's text closely, I have +made large additions, in order to bring the "Aids" up to present +requirements. I have also rearranged the matter with the object of +making the various sections more consecutive than they were previously. + + W.G. AITCHISON ROBERTSON. + +SURGEONS' HALL, + EDINBURGH, + _June_, 1914. + + + + + + +CONTENTS + + +PART I + +FORENSIC MEDICINE + + PAGE + + I. Crimes 1 + II. Medical Evidence 2 + III. Personal Identity 10 + IV. Examination of Persons found Dead 12 + V. Modes of Sudden Death 13 + VI. Signs of Death 16 + VII. Death from Anæsthetics, etc. 19 + VIII. Presumption of Death; Survivorship 20 + IX. Assaults, Murder, Manslaughter, etc. 21 + X. Wounds and Mechanical Injuries 21 + XI. Contused Wounds, etc. 22 + XII. Incised Wounds 23 + XIII. Gunshot Wounds 24 + XIV. Wounds of Various Parts of the Body 26 + XV. Detection of Blood-Stains, etc. 30 + XVI. Death by Suffocation 34 + XVII. Death by Hanging 35 + XVIII. Death by Strangulation 35 + XIX. Death by Drowning 36 + XX. Death from Starvation 38 + XXI. Death from Lightning and Electricity 38 + XXII. Death from Cold or Heat 39 + XXIII. Pregnancy 40 + XXIV. Delivery 41 + XXV. Foeticide or Criminal Abortion 42 + XXVI. Infanticide 44 + XXVII. Evidences of Live-Birth 46 + XXVIII. Cause of Death in the Foetus 50 + XXIX. Duration of Pregnancy 50 + XXX. Viability of Children 51 + XXXI. Legitimacy 52 + XXXII. Superfoetation 53 + XXXIII. Inheritance 54 + XXXIV. Impotence and Sterility 54 + XXXV. Rape 55 + XXXVI. Unnatural Offences 59 + XXXVII. Blackmailing 60 +XXXVIII. Marriage and Divorce 60 + XXXIX. Feigned Diseases 63 + XL. Mental Unsoundness 67 + XLI. Idiocy, Imbecility, Cretinism 68 + XLII. Dementia 70 + XLIII. Mania, Lucid Intervals, Undue Influence, Responsibility, + etc. 71 + XLIV. Examination of Persons of Unsound Mind 76 + XLV. Inebriates Acts 78 + + +PART II + +TOXICOLOGY + + I. Definition of a Poison 80 + II. Scheduled Poisons 80 + III. Classification of Poisons 83 + IV. Evidence of Poisoning 85 + V. Symptoms and Post-Mortem Appearances of Different Classes + of Poisons 86 + VI. Duty of Practitioner in Supposed Case of Poisoning 89 + VII. Treatment of Poisoning 90 + VIII. Detection of Poison 91 + IX. The Mineral Acids 94 + X. Sulphuric Acid 95 + XI. Nitric Acid 97 + XII. Hydrochloric Acid 98 + XIII. Oxalic Acid 98 + XIV. Carbolic Acid 100 + XV. Potash, Soda, and Ammonia 101 + XVI. Potassium Salts, etc. 103 + XVII. Nitrate of Potassium, etc. 103 + XVIII. Barium Salts 104 + XIX. Iodine--Iodide of Potassium 104 + XX. Phosphorus 105 + XXI. Arsenic and its Preparations 107 + XXII. Antimony and its Preparations 112 + XXIII. Mercury and its Preparations 113 + XXIV. Lead and its Preparations 116 + XXV. Copper and its Preparations 117 + XXVI. Zinc, Silver, Bismuth, and Chromium 118 + XXVII. Gaseous Poisons 120 + XXVIII. Vegetable Irritants 123 + XXIX. Opium and Morphine 124 + XXX. Belladonna, Hyoscyamus, and Stramonium 127 + XXXI. Cocaine 128 + XXXII. Camphor 129 + XXXIII. Tetrachlorethane 129 + XXXIV. Alcohol, Ether, and Chloroform 130 + XXXV. Chloral Hydrate 134 + XXXVI. Petroleum and Paraffin Oil 134 + XXXVII. Antipyrine, Antefebrin, Phenacetin, and Aniline 135 +XXXVIII. Sulphonal, Trional, Tetronal, Veronal, Paraldehyde 137 + XXXIX. Conium and Calabar Bean 138 + XL. Tobacco and Lobelia 139 + XLI. Hydrocyanic Acid 140 + XLII. Aconite 143 + XLIII. Digitalis 144 + XLIV. Nux Vomica, Strychnine, and Brucine 145 + XLV. Cantharides 146 + XLVI. Abortifacients 147 + XLVII. Poisonous Fungi and Toxic Foods 148 + XLVIII. Ptomaines or Cadaveric Alkaloids 150 + + Index 152 + + + + + +AIDS TO FORENSIC MEDICINE AND TOXICOLOGY + + + + + +PART I + +FORENSIC MEDICINE + + + + +I.--CRIMES + + +Forensic medicine is also called Medical Jurisprudence or Legal +Medicine, and includes all questions which bring medical matters into +relation with the law. It deals, therefore, with (1) crimes and (2) +civil injuries. + +1. A _crime_ is the voluntary act of a person of sound mind harmful to +others and also unjust. No act is a crime unless it is plainly forbidden +by law. To constitute a crime, two circumstances are necessary to be +proved--(a) that the act has been committed, (b) that a guilty mind or +malice was present. The act may be one of omission or of commission. +Every person who commits a crime may be punished, unless he is under the +age of seven years, is insane, or has been made to commit it under +compulsion. + +Crimes are divided into _misdemeanours_ and _felonies_. The distinction +is not very definite, but, as a rule, the former are less serious forms +of crime, and are punishable with a term of imprisonment, generally +under two years; while felonies comprise the more serious charges, as +murder, manslaughter, rape, which involve the capital sentence or long +terms of imprisonment. + +An _offence_ is a trivial breach of the criminal law, and is punishable +on summary conviction before a magistrate or justices only, while the +more serious crimes (_indictable offences_) must be tried before a jury. + +2. _Civil injuries_ differ from crimes in that the former are +compensated by damages awarded, while the latter are punished; any +person, whether injured or not, may prosecute for a crime, while only +the sufferer can sue for a civil injury. The Crown may remit punishment +for a crime, but not for a civil injury. + + + + +II.--MEDICAL EVIDENCE + + +On being called, the medical witness enters the witness-box and takes +the oath. This is very generally done by uplifting the right hand and +repeating the oath (Scottish form), or by kissing the Bible, or by +making a solemn affirmation. + +1. He may be called to give _ordinary evidence_ as a _common witness_. +Thus he may be asked to detail the facts of an accident which he has +observed, and of the inferences he has deduced. This evidence is what +any lay observer might be asked. + +2. _Expert Witness._--On the other hand, he may be examined on matters +of a technical or professional character. The medical man then gives +evidence of a skilled or expert nature. He may be asked his opinion on +certain facts narrated--_e.g._, if a certain wound would be immediately +fatal. Again, he may be asked whether he concurs with opinions held by +other medical authorities. + +In important cases specialists are often called to give evidence of a +skilled nature. Thus the hospital surgeon, the nerve specialist, or the +mental consultant may be served with a subpoena to appear at court on a +certain date to give evidence. The evidence of such skilled observers +will, it is supposed, carry greater weight with the jury than would the +evidence of an ordinary practitioner. + +Skilled witnesses may hear the evidence of ordinary witnesses in regard +to the case in which they are to give evidence, and it is, indeed, +better that they should understand the case thoroughly, but they are not +usually allowed to hear the evidence of other expert witnesses. + +In civil cases the medical witness should, previous to the trial, make +an agreement with the solicitor who has called him with reference to the +fee he is to receive. Before consenting to appear as a witness the +practitioner should insist on having all the facts of the case put +before him in writing. In this way only can he decide as to whether in +his opinion the plaintiff or defendant is right as regards the medical +evidence. If summoned by the side on which he thinks the medical +testimony is correct, then it is his duty to consent to appear. If, +however, he is of opinion that the medical evidence is clearly and +correctly on the opposite side, then he ought to refuse to appear and +give evidence; and, indeed, the lawyer would not desire his presence in +the witness-box unless he could uphold the case. + +Whether an expert witness who has no personal knowledge of the facts is +bound to attend on a subpoena is a moot point. It would be safer for him +to do so, and to explain to the judge before taking the oath that his +memory has not been sufficiently 'refreshed.' The solicitor, if he +desires his evidence, will probably see that the fee is forthcoming. + +A witness may be subjected to _three_ examinations: first, by the party +on whose side he is engaged, which is called the 'examination in chief,' +and in which he affords the basis for the next examination or +'cross-examination' by the opposite side. The third is the +'re-examination' by his own side. In the first he merely gives a clear +statement of facts or of his opinions. In the next his testimony is +subjected to rigid examination in order to weaken his previous +statements. In the third he is allowed to clear up any discrepancies in +the cross-examination, but he must not introduce any new matter which +would render him liable to another cross-examination. + +The medical witness should answer questions put to him as clearly and as +concisely as possible. He should make his statements in plain and simple +language, avoiding as much as possible technical terms and figurative +expressions, and should not quote authorities in support of his +opinions. + +An expert witness when giving evidence may refer to notes for the +purpose of refreshing his memory, but only if the notes were taken by +him at the time when the observations were made, or as soon after as +practicable. + +There are various _courts_ in which a medical witness may be called on +to give evidence: + +1. =The Coroner's Court.=--When a coroner is informed that the dead body +of a person is lying within his jurisdiction, and that there is +reasonable cause to suspect that such person died either a violent or +unnatural death, or died a sudden death of which the cause is unknown, +he must summon a jury of not less than twelve men to investigate the +matter--in other words, hold an inquest--and if the deceased had +received medical treatment, the coroner may summon the medical attendant +to give evidence. By the Coroners (Emergency Provisions) Act of 1917, +the number of the jury has been cut down to a minimum of seven and a +maximum of eleven men. By the Juries Act of 1918, the coroner has the +power of holding a court without a jury if, in his discretion, it +appears to be unnecessary. In charges of murder, manslaughter, deaths of +prisoners in prison, inmates of asylums or inebriates' homes, or of +infants in nursing homes, he must summon a jury. The coroner may be +satisfied with the evidence as to the cause of a person's death, and may +dispense with an inquest and grant a burial certificate. + +Cases are notified to the coroner by the police, parish officer, any +medical practitioner, registrar of deaths, or by any private individual. + +Witnesses, having been cited to appear, are examined on oath by the +coroner, who must, in criminal cases at least, take down the evidence in +writing. This is then read over to each witness, who signs it, and this +forms his _deposition_. At the end of each case the coroner sums up, and +the jury return their verdict or _inquisition_, either unanimously or by +a majority. + +If this charges any person with murder or manslaughter, he is committed +by the coroner to prison to await trial, or, if not present, the coroner +may issue a warrant for his arrest. + +A chemical analysis of the contents of the stomach, etc., in suspected +cases of poisoning is usually done by a special analyst named by the +coroner. If any witness disobeys the summons to attend the inquest, he +renders himself liable to a fine not exceeding £2 2s., but in addition +the coroner may commit him to prison for contempt of court. In criminal +cases the witnesses are bound over to appear at the assizes to give +evidence there. The coroner may give an order for the exhumation of a +body if he thinks the evidence warrants a post-mortem examination. + +Coroners' inquests are held in all cases of sudden or violent death, +where the cause of death is not clear; in cases of assault, where death +has taken place immediately or some time afterwards; in cases of +homicide or suicide; where the medical attendant refuses to give a +certificate of death; where the attendants on the deceased have been +culpably negligent; or in certain cases of uncertified deaths. + +The medical witness should be very careful in giving evidence before a +coroner. Even though the inquest be held in a coach-house or barn, yet +it has to be remembered it is a court of law. If the case goes on for +trial before a superior court, your deposition made to the coroner forms +the basis of your examination. Any misstatements or discrepancies in +your evidence will be carefully inquired into, and you will make a bad +impression on judge and jury if you modify, retract, or explain away +your evidence as given to the coroner. You had your opportunity of +making any amendments on your evidence when the coroner read over to you +your deposition before you signed it as true. + +By the Licensing Act of 1902, an inquest may not be held in any premises +licensed for the sale of intoxicating liquor if other suitable premises +have been provided. + +The duties of the coroner are based partly on Common Law, and are also +defined by statute, principally by the Coroners Act of 1887 (50 and 51 +Vict. c. 71). They have been modified, however, by subsequent +Acts--_e.g._, the Act of 1892, the Coroners (Emergency Provisions) Act, +1917, and the Juries Act of 1918. + +The fee payable to a medical witness for giving evidence at an inquest +is one guinea, with an extra guinea for making a post-mortem examination +and report (in the metropolitan area these fees are doubled). The +coroner must sign the order authorizing the payment, and should an +inquest be adjourned to a later day, no further fee is payable. If the +deceased died in a hospital, infirmary, or lunatic asylum, the medical +witness is not paid any fee. Should a medical witness neglect to make +the post-mortem examination after receiving the order to do so, he is +liable to a fine of £5. + +In Scotland the Procurator Fiscal fulfils many of the duties of the +coroner, but he cannot hold a public inquiry. He interrogates the +witnesses privately, and these questions with the answers form the +_precognition_. More serious cases are dealt with by the Sheriff of each +county, and capital charges must be dealt with by the High Court of +Justiciary. In Scotland the verdicts of the jury may be 'guilty,' 'not +guilty,' or 'not proven.' + +2. =The Magistrate's Court or Petty Sessions= is also a court of +preliminary inquiry. The prisoner may be dealt with summarily, as, for +example, in minor assault cases, or, if the case is of sufficient +gravity, and the evidence justifies such a course, may be committed for +trial. The fee for a medical witness who resides within three miles of +the court is ten shillings and sixpence; if at a greater distance, one +guinea. + +In the Metropolis the prisoner in the first instance is brought before a +magistrate, technically known as the 'beak,' who, in addition to being a +person of great acumen, is a stipendiary, and thus occupies a superior +position to the ordinary 'J.P.,' who is one of the great unpaid. In the +City of London is the Mansion House Justice-Room, presided over by the +Lord Mayor or one of the Aldermen. The prisoner may ultimately be sent +for trial to the Central Criminal Court, known as the Old Bailey, or +elsewhere. + +3. =Quarter Sessions.=--These are held every quarter by Justices of the +Peace. All cases can be tried before the sessions except felonies or +cases which involve difficult legal questions. In London this court is +known as the Central Criminal Court, and it also acts as the Assize +Court. In Borough Sessions a barrister known as the _Recorder_ is +appointed as sole judge. + +4. =The Assizes= deal with both criminal and civil cases. There is the +_Crown Court_, where criminal cases are tried, and there is the _Civil +Court_, where civil cases are heard. Before a case sent up by a lower +court can be tried by the judge and petty jury, it is investigated by +the _grand jury_, which is composed of superior individuals. If they +find a 'true bill,' the case goes on; but if they 'throw it out,' the +accused is at liberty to take his departure. At the Court of Assize the +prisoner is tried by a jury of twelve. In bringing in the verdict the +jury must be unanimous. If they cannot agree, the case must be retried +before a new jury. At the Assize Court the medical witness gets a guinea +a day, with two shillings extra to pay for his bed and board for every +night he is away from home, with his second-class railway fare, if there +is a second class on the railway by which he travels. If there is no +railway, and he has to walk, he is entitled to threepence a mile for +refreshments both ways. + +5. =Court of Criminal Appeal.=--This was established in 1908, and +consists of three judges. A right of appeal may be based (1) solely on a +question of law; (2) on certificate from the judge who tried the +prisoner; (3) on mitigation of sentence. + +Speaking generally, in the Superior Courts the fees which may be claimed +by medical men called on to give evidence are a guinea a day if resident +in the town in which the case is tried, and from two to three guineas a +day if resident at a distance from the place of trial, this to include +everything except travelling expenses. The medical witness also receives +a reasonable allowance for hotel and travelling expenses. + +If a witness is summoned to appear before two courts at the same time, +he must obey the summons of the higher court. Criminal cases take +precedence of civil. + +A medical man has no right to claim privilege as an excuse for not +divulging professional secrets in a court of law, and the less he talks +about professional etiquette the better. Still, in a civil case, if he +were to make an emphatic protest, the matter in all probability would +not be pressed. In a criminal case he would promptly be reminded of the +nature of his oath. + +A medical man may be required to furnish a _formal written report_. It +may be the history of a fatal illness or the result of a post-mortem +examination. These reports must be drawn up very carefully, and no +technical terms should be employed. + +No witness on being sworn can be compelled to 'kiss the book.' The Oaths +Act (51 and 52 Vict., c. 46, § 5) declares, without any qualification, +that 'if any person to whom an oath is administered desires to swear +with uplifted hand, in the form and manner in which an oath is usually +administered in Scotland, he shall be permitted to do so, and the oath +shall be administered to him in such form and manner without further +question.' The witness takes the oath standing, with the bare right hand +uplifted above the head, the formula being: 'I swear by Almighty God +that I will speak the truth, the whole truth, and nothing but the +truth.' The presiding judge should say the words, and the witness should +repeat them after him. There is no kissing of the book, and the words +'So help me, God,' which occur in the English form, are not employed. It +will be noted that the Scotch form constitutes an oath, and is not an +affirmation. The judge has no right to ask if you object on religious +grounds, or to put any question. He is bound by the provisions of the +Act, and the enactment applies not only to all forms of the witness +oath, whether in civil or criminal courts, or before coroners, but to +every oath which may be lawfully administered either in Great Britain or +Ireland. + +A witness engaged to give expert evidence should demand his fee before +going into court, or, at all events, before being sworn. + +With regard to notes, these should be made at the time, on the spot, and +may be used by the witness in court as a refresher to the memory, though +not altogether to supply its place. All evidence is made up of +testimony, but all testimony is not evidence. The witness must not +introduce hearsay testimony. In one case only is hearsay evidence +admissible, and that is in the case of a _dying declaration_. This is a +statement made by a dying person as to how his injuries were inflicted. +These declarations are accepted because the law presumes that a dying +man is anxious to speak the truth. But the person must believe that he +is _actually_ on the point of death, with _absolutely_ no hope of +recovery. A statement was rejected because the dying person, in using +the expression 'I have no hope of recovery,' requested that the words +'at present' should be added. If after making the statement the patient +were to say, 'I hope now I shall get better,' it would invalidate the +declaration. To make the declaration admissible as evidence, death must +ensue. If possible, a magistrate should take the dying declaration; but +if he is not available, the medical man, without any suggestions or +comments of his own, should write down the statements made by the dying +person, and see them signed and witnessed. It must be made clear to the +court that at the time of making his statement the witness was under the +full conviction of approaching or impending death. + + + + +III.--PERSONAL IDENTITY + + +It is but seldom that medical evidence is required with regard to the +identification of the living, though it may sometimes be so, as in the +celebrated Tichborne case. The medical man may in such cases be +consulted as to family resemblance, marks on the body, nævi materni, +scars and tattoo marks, or with regard to the organs of generation in +cases of doubtful sex. Tattoo marks may disappear during life; the +brighter colours, as vermilion, as a rule, more readily than those made +with carbon, as Indian ink; after death the colouring-matter may be +found in the proximal glands. If the tattooing is superficial (merely +underneath the cuticle) the marks may possibly be removed by acetic +acid or cantharides, or even by picking out the colouring-matter with a +fine needle. With regard to scars and their permanence, it will be +remembered that scars occasioned by actual loss of substance, or by +wounds healed by granulation, never disappear. The scars of leech-bites, +lancet-wounds, or cupping instruments, may disappear after a lapse of +time. It is difficult, if not impossible, to give any certain or +positive opinion as to the age of a scar; recent scars are pink in +colour; old scars are white and glistening. The cicatrix resulting from +a wound depends upon its situation. Of incised wounds an elliptical +cicatrix is typical, linear being chiefly found between the fingers and +toes. By way of disguise the hair may be dyed black with lead acetate or +nitrate of silver; detected by allowing the hair to grow, or by steeping +some of it in dilute nitric acid, and testing with iodide of potassium +for lead, and hydrochloric acid for silver. The hair may be bleached +with chlorine or peroxide of hydrogen, detected by letting the hair grow +and by its unnatural feeling and the irregularity of the bleaching. + +Finger-print impressions are the most trustworthy of all means of +identification. Such a print is obtained by rubbing the pulp of the +finger in lampblack, and then impressing it on a glazed card. The +impression reveals the fine lines which exist at the tips of the +fingers. The arrangement of these lines is special to each person, and +cannot be changed. Hence this method is employed by the police in the +identification of prisoners. + +In the determination of cases of doubtful sex in the living, the +following points should be noticed: the size of the penis or clitoris, +and whether perforate or not, the form of the prepuce, the presence or +absence of nymphæ and of testicles or ovaries. Openings must be +carefully sounded as to their communication with bladder or uterus. +After puberty, inquiry should be made as to menstrual or vicarious +discharges, the general development of the body, the growth of hair, +the tone of voice, and the behaviour of the individual towards either +sex. + +With regard to the identification of the dead in cases of death by +accident or violence, the medical man's assistance may be called. The +sex of the skeleton, if that only be found, may be judged from the bones +of the female generally being smaller and more slender than those of the +male, by the female thorax being deeper, the costal cartilages longer, +the ilia more expanded, the sacrum flatter and broader, the coccyx +movable and turned back, the tuberosities of the ischia wider apart, the +pubes shallow, and the whole pelvis shallower and with larger outlets. +But of all these signs the only one of any real value is the roundness +of the pubic arch in the female, as compared with the pointed arch in +the male. Before puberty the sex cannot be determined from an +examination of the bones. + +Age may be calculated from the presence, nature and number of the +erupted teeth; from the cartilages of the ribs, which gradually ossify +as age advances; from the angle formed by the ramus of the lower jaw +with its body (obtuse in infancy, a right angle in the adult, and again +obtuse in the aged from loss of the teeth); and in the young from the +condition of the epiphyses with regard to their attachment to their +respective shafts. + +To determine stature, the whole skeleton should be laid out and +measured, 1-1/2 to 2 inches being allowed for the soft parts. + + + + +IV.--EXAMINATION OF PERSONS FOUND DEAD + + +When a medical man is called to a case of sudden death, he should +carefully note anything likely to throw any light on the cause of death. +He should notice the place where the body was found, the position and +attitude of the body, the soil or surface on which the body lies, the +position of surrounding objects, and the condition of the clothes. He +should also notice if there are any signs of a struggle having taken +place, if the hands are clenched, if the face is distorted, if there has +been foaming at the mouth, and if urine or fæces have been passed +involuntarily. Urine may be drawn off with a catheter and tested for +albumin and sugar. + +If required to make a post-mortem examination, every cavity and +important organ of the body must be carefully and minutely examined, the +seat of injury being inspected first. + + + + +V.--MODES OF SUDDEN DEATH + + +There are three modes in which death may occur: (1) Syncope; (2) +asphyxia; (3) coma. + +1. =Syncope= is death beginning at the heart--in other words, failure of +circulation. It may arise from--(1) _Anæmia_, or deficiency of blood due +to hæmorrhage, such as occurs in injuries, or from bleeding from the +lungs, stomach, uterus, or other internal organs. (2) _Asthenia_, or +failure of the heart's action, met with in starvation, in exhausting +diseases, such as phthisis, cancer, pernicious anæmia, and Bright's +disease, and in some cases of poisoning--for example, aconite. + +The symptoms of syncope are faintness, giddiness, pallor, slow, weak, +and irregular pulse, sighing respiration, insensibility, dilated pupils, +and convulsions. + +Post mortem the heart is found empty and contracted. When, however, +there is sudden stoppage of the heart, the right and left cavities +contain blood in the normal quantities, and blood is found in the venæ +cavæ and in the arterial trunks. There is no engorgement of either lungs +or brain. + +2. =Asphyxia=, or death beginning at the lungs, may be due to +obstruction of the air-passages from foreign bodies in the larynx, +drowning, suffocation, strangling, and hanging; from injury to the +cervical cord; effusion into the pleuræ, with consequent pressure on the +lungs; embolism of the pulmonary artery; and from spasmodic contraction +of the thoracic and abdominal muscles in strychnine-poisoning. + +The symptoms of this condition are fighting for breath, giddiness, +relaxation of the sphincters, and convulsions. + +Post mortem, cadaveric lividity is well marked, especially in nose, +lips, ears, etc.; the right cavities of the heart and the venæ cavæ are +found gorged with dark fluid blood. The pulmonary veins, the left +cavities of the heart, and the aorta, are either empty or contain but +little blood. The lungs are dark and engorged with blood, and the lining +of the air-tubes is bright red in colour. Much bloody froth escapes on +cutting into the lungs. Numerous small hæmorrhages (Tardieu's spots) are +found on the surface and in the substance of the internal organs, as +well as in the skin of the neck and face. + +3. =Coma=, or death beginning at the brain, may arise from concussion; +compression; cerebral pressure from hæmorrhage and other forms of +apoplexy; blocking of a cerebral artery from embolism; dietetic and +uræmic conditions; and from opium and other narcotic poisons. + +The symptoms of this condition are stupor, loss of consciousness, and +stertorous breathing. + +The post-mortem signs are congestion of the substance of the brain and +its membranes, with accumulation of the blood in the cavities of the +heart, more on the right side than on the left. + +It must be remembered that, owing to the interdependence of all the +vital functions, there is no line of demarcation between the various +modes of death. In all cases of sudden death think of angina pectoris +and the rupture of an aneurism. + +The following is a list of some of the commoner causes of sudden death: + +(a) =Instantaneously Sudden Death=-- + +1. Syncope (by far the commonest cause). + +2. Aortic incompetence. + +3. Rupture of heart. + +4. Rupture of a valve. + +5. Rupture of aortic aneurism. + +6. Embolism of coronary artery. + +7. Angina pectoris. + +(b) =Less Sudden but Unexpected Death=-- + +1. Cerebral hæmorrhage or embolism. + +2. Mitral and tricuspid valvular lesions if the patient exerts himself. + +3. Rupture of a gastric or duodenal ulcer; rupture of liver, spleen, or +extra-uterine gestation, or abdominal aneurism. + +4. Suffocation during an epileptic fit; vomited matter or other material +drawn into the trachea or air-passages; croup. + +5. Arterio-sclerosis may lead to thrombosis, embolism, or aneurism. + +6. Poisoning, as by hydrocyanic acid, cyanide of potassium, inhalation +of carbonic acid or coal gas, oedema of glottis following inhalation of +ammonia. + +7. Rapid onset of some acute specific disease, such as pneumonia or +diphtheria; collapse from cholera. + +8. Heat-stroke, lightning, shocks of electricity of high tension. + +9. Mental or physical shock. + +10. Exertion while the stomach is overloaded. + +11. Diabetic coma; uræmia. + +12. _Status lymphaticus._ This is a general hyperplastic condition of +the lymphatic structures in the body, and is seen in enlargement of +tonsils, thymus, spleen, as well as of Peyer's patches and mesenteric +glands. It is a frequent cause of death during chloroform anæsthesia for +slight operations in young people. + +In addition, it may be as well to remember that death sometimes occurs +suddenly in exophthalmic goitre, hypertrophy of the thymus, and in +Addison's disease. + +In some cases of sudden death nothing has been found post mortem, even +when the autopsy has been made by skilled observers, and the brain and +cord have been submitted to microscopical examination. + + + + +VI.--SIGNS OF DEATH + + +(1) Cadaveric appearance; ashy white colour. (2) Cessation of the +circulation and respiration, no sound being heard by the stethoscope. +Cessation of the circulation may be determined by (a) placing a ligature +round the base of a finger (Magnus' test); (b) injecting a solution of +fluorescin (Icard's test); (c) looking through the web of the fingers at +a bright light (diaphanous test); (d) the dulling of a steel needle when +thrust into the living body; (e) the clear outline of the dead heart +when viewed in the fluorescent screen. (3) The state of the eye; the +tension is at once lost; iris insensible to light, fundus yellow in +colour; cornea dull and sunken. (4) The state of the skin; pale, livid, +with loss of elasticity. (5) Extinction of muscular irritability. The +above signs afford no means of determining how long life has been +extinct. The following, however, do: + +=Cooling of the Body.=--The average internal temperature of the body is +from 98° to 100° F. The time taken in cooling is from fifteen to twenty +hours, but it may be modified by the kind of death, the age of the +person, the presence or absence of clothing on the body, the surrounding +temperature, and the stillness or otherwise of the air about the body. +Still, the body, other things being equal, may be said to be _quite +cold_ in about _twelve hours_. + +=Hypostasis= or =post-mortem staining= is due to the settling down of +the blood in the most dependent parts of the body while the body is +cooling. It is a sure sign of death, and occurs in all forms of death, +even in that due to hæmorrhage, although not so marked in degree. +Post-mortem staining (_cadaveric lividity_) begins to appear in from +eight to twelve hours after death, and its position on the body will +help to determine the length of time the body has lain in the position +in which it was found. The staining is of a dull red or slaty blue +colour. It must be distinguished from ecchymosis the result of a bruise, +by making an incision into the part; in the case of hypostasis a few +small bloody points of divided arteries will be seen, in the case of +ecchymosis the subcutaneous tissues are infiltrated with blood-clot. +Internally, hypostasis must not be mistaken for congestion of the brain +or lungs, or the results of inflammation of the intestines. If the +intestine is pulled straight, inflammatory redness is continuous, +hypostasis is disconnected. About the neck hypostasis must not be +mistaken for the mark of a cord or other ligature. When the blood is of +a bright red colour after death (as happens in poisoning by CO or HCN, +or in death from cold), the hypostasis is bright red also. + +=Cadaveric Rigidity--Rigor Mortis.=--For some time after death the +muscles continue to contract under stimuli. When this irritability +ceases--and it seldom exceeds two hours--rigidity and hardening sets in, +and in _all_ cases precedes putrefaction. It is caused by the +coagulation of the muscle plasma. It commences in the muscles of the +back of the neck and lower jaw, and then passes into the muscles of the +face, front of the neck, chest, upper extremities, and lastly to the +lower extremities. + +It has been noticed in the new-born infant, as well as in the foetus. It +lasts from sixteen to twenty hours or more. In lingering diseases, after +violent exertion, and in warm climates, it sets in quickly, and +disappears in two or three hours; in those who are in perfect health and +die from accident or asphyxia, it may not come on until from ten to +twenty-four hours, and may last three or four days. After death from +convulsions or strychnine-poisoning, the body may pass at once into +rigor mortis. Rigor mortis must be distinguished from _cadaveric spasm_ +or the _death clutch_; in the former, articles in the hands are readily +removable, in the latter this is not the case. In tetanic spasm the +limbs when bent return to their former position; not so in rigor mortis. + +=Putrefaction= appears in from one to three days after death, as a +greenish-blue discoloration of the abdomen; in the drowned, over the +head and face. This increases, becomes darker and more general, a strong +putrefactive odour is developed, the thorax and abdomen become distended +with gas, and the epidermis peels off. The muscles then become pulpy, +and assume a dark greenish colour, the whole body at length becoming +changed into a soft, semi-fluid mass. The organ first showing the +putrefactive change is the trachea; that which resists putrefaction +longest is the uterus. These putrefactive changes are modified by the +fat or lean condition of the body, the temperature (putrefaction taking +place more rapidly in summer than in winter), access of air, the period, +place, mode of interment, age, etc. Bodies which remain in water putrefy +more slowly than those in air. + +=Saponification.=--In bodies which are very fat and have lain in water +or moist soil for from one to three years this process takes place, the +fat uniting with the ammonia given off by the decomposition to form +_adipocere_. This consists of a margarate or stearate of ammonium with +lime, oxide of iron, potash, certain fatty acids, and a yellowish +odorous matter. It has a fatty, unctuous feel, is either pure white or +pale yellow, with an odour of decayed cheese. Small portions of the body +may show signs of this change in six weeks. + +=Post-Mortem Examination.=--Never make an autopsy in criminal cases +without a written order from the coroner or Procurator Fiscal. If +authorized, however, first have the body identified, then photographed +if it has not been identified. A medical man representing the accused +may be present, but only by consent of the Crown authorities or of the +Sheriff. Clothing should be examined for blood-stains, cuts, etc. + +Examine external surface of body and take accurate measurements of +wounds, marks, deformities, tattooings; note degree and distribution of +post-mortem staining, rigidity, etc. + +Examine brain by making incision from ear to ear across vertex, reflect +scalp forwards and backwards, and saw off calvarium. Examine brain +carefully externally and on section. + +Examine organs of chest and abdomen through an incision made from +symphysis menti to pubis, reflecting tissues from chest wall and cutting +through costal cartilages. + +In cases of suspected poisoning have several clean jars into which you +place the stomach with contents, intestines with contents, piece of +liver, kidney, spleen, etc., and seal each up carefully, attaching label +with name of deceased, date, and contained organs, and transmit these +personally to the analyst. + +=Exhumation.=--A body which has been buried cannot be exhumed without an +order from a coroner, fiscal, or from the Home Secretary. There is no +legal limit in England as to when a body may be exhumed; in Scotland, +however, if an interval of twenty years has elapsed, an accused person +cannot be prosecuted (_prescription of crime_). + + + + +VII.--DEATH FROM ANÆSTHETICS, ETC. + + +The coroner in England and Wales and Ireland must inquire into every +case of death during the administration of an anæsthetic. The +anæsthetist has to appear at the inquest, and must answer a long series +of questions relative to the administration of the drug. + +Before, therefore, giving an anæsthetic, and so as to furnish yourself +with a proper defence in the event of death occurring, you ought to +examine the heart, lungs, and kidneys of the patient to see if they are +healthy. Should a fatal result follow, the anæsthetist will require to +prove that it was necessary to give the anæsthetic, that the one +employed was the most suitable, that the patient was in a fit state of +health to have it administered, that it was given skilfully and in +moderate amount, that he had the usual remedies at hand in case of +failure of the heart or lungs, and that he employed every means in his +power to resuscitate the patient. + +The condition of the lungs is of more importance than the state of the +heart. + +The chloroformist ought always to use the best chloroform. + +An anæsthetic should never be administered except in the presence of a +_third person_. This applies especially to dentists who give gas to +females. + +=Malpractice.=--In every case where a medical man attends a patient, he +must give him that amount of care, skill, knowledge, or judgment, that +the law expects of him. If he does not, then the charge of malpractice +may be brought against him. It is most frequently alleged in connection +with surgical affections--_e.g._, overlooking a fracture or dislocation. +Before a major operation is performed, it is well to get a written +agreement. + + + + +VIII.--PRESUMPTION OF DEATH; SURVIVORSHIP + + +=Presumption of Death.=--If a person be unheard of for seven years, the +court may, on application by the nearest relative, presume death to have +taken place. If, however, it can be shown that in all probability death +had occurred in a certain accident or shipwreck, the decree may be made +much earlier. + +=Presumption of Survivorship.=--When two or more related persons perish +in a common accident, it may be necessary, in order to decide questions +of succession, to determine which of them died first. It is generally +accepted that the stronger and more vigorous will survive longest. + + + + +IX.--ASSAULT, MURDER, MANSLAUGHTER, ETC. + + +=Assault.=--This is an attempt or offer to do violence to another +person; it is not necessary that actual injury has been done, but evil +intention must be proved. When a corporal hurt has been sustained, then +_assault and battery_ has been committed. The assault may be aggravated +by the use of weapons, etc. + +=Homicide= may be _justifiable_, as in the case of judicial execution, +or _excusable_, as in defence of one's family or property. + +_Felonious homicide_ is murder. This means that a human being has been +killed by another maliciously and deliberately or with reckless +disregard of consequences. + +=Manslaughter= or =Culpable Homicide= (Scotland) is the unlawful killing +of a human being without malice--as homicide after great provocation; +signalman who allows a train to pass, and so collide with another in +front. + + + + +X.--WOUNDS AND MECHANICAL INJURIES + + +A wound may be defined as a 'breach of continuity in the structures of +the body, whether external or internal, suddenly occasioned by +mechanical violence.' The law does not define 'a wound,' but the _true +skin must be broken_. Wounds are dangerous from shock, hæmorrhage, from +the supervention of crysipelas or pyæmia, and from _malum regimen_ on +the part of the patient or surgeon. _Is the wound dangerous to life?_ +This question can only be answered by a full consideration of all the +circumstances of the case; a guarded prognosis is wise in all cases. + +=Burns= are caused by flames, highly heated solids, or very cold solids, +as solid carbonic acid; scalds, by steam or hot fluids. Burns may cause +death from shock, suffocation, oedema glottidis, inflammation of serous +surfaces, bronchitis, pneumonia, duodenal ulcer, coma, or exhaustion. A +burn of the skin inflicted during life is followed by a bleb containing +serum; the edges of this blister are bright red, and the base, seen +after removing the cuticle, is red and inflamed; if sustained after +death, a bleb, if present, contains but little fluid, and there are no +signs of vital reaction. There are six degrees of burns: (1) Superficial +inflammation; (2) formation of vesicles; (3) destruction of superficial +layer of skin; (4) destruction of cellular tissue; (5) deep parts +charred; (6) carbonization of bones. + +The larger the area of skin burnt, the more grave is the prognosis. +Burns of the abdomen and genital organs are especially dangerous. Young +children are specially liable to die after burns. + + + + +XI.--CONTUSED WOUNDS AND INJURIES UNACCOMPANIED BY SOLUTION OF +CONTINUITY + + +If a blow be inflicted with a blunt instrument, there is produced a +bruise, or _ecchymosis_, of which it is unnecessary here to describe the +appearance and progress. A bruise may be distinguished from a +post-mortem stain by the cuticle in the former often being abraded and +raised. When an incision is made into the bruise, the whole of the +subcutaneous tissues are found to be infiltrated with blood-clot, and +there is no clear margin. In the case of a post-mortem stain the edges +are sharply defined, not raised, and, on section, mere bloody points +are seen which are the cut ends of the divided blood vessels. + + + + +XII.--INCISED WOUNDS AND THOSE ACCOMPANIED BY SOLUTION OF CONTINUITY + + +These comprise incised, punctured, and lacerated wounds. In a recent +incised wound inflicted during life there is copious hæmorrhage, the +cellular tissue is filled with blood, the edges of the wound gape and +are everted, and the cavity of the wound is filled with coagula. + +Lacerated wounds combine the characters of incised and contused wounds. +They are caused by falls, being ridden over, machinery crushes, bites, +blows from blunt weapons, etc. The wounds heal by suppuration. + +_Punctured wounds_ come intermediate between incised and lacerated. They +are greater in depth than in length, being caused by sword or rapier +thrusts. They cause little hæmorrhage externally, but death may be due +to internal hæmorrhage. They may be complicated by (1) the introduction +of septic material adhering to the instrument; (2) the entrance of +foreign bodies which lodge in the wound, not only carrying in septic +matter, but acting as mechanical irritants; (3) injury to deeper parts, +which may at the time be difficult to detect. + +An apparently _incised wound_ may be produced by a hard, blunt weapon +over a bone--_e.g._, shin or cranium. It is often difficult to +distinguish between a wound of the scalp inflicted with a knife and one +made by a blow with a stick. A puncture with a sharp-edged, pointed +knife leaves a fusiform or spindle-shaped wound. A wound from a blow +with a stick might be of this character, or it might present a jagged, +swollen appearance at the margin, with much contusion of the surrounding +tissues. If the wound is seen soon after it is inflicted, examination +with a lens may disclose irregularities of the margins, or little +bridges of connective tissue or vessels running across the wound, and +so be inconsistent with its production by a cutting instrument. +_Lacerated wounds_ as a rule bleed less freely than those which are +incised. Symptoms of concussion would favour the theory of the injury +having been inflicted by a heavy instrument. Again, it is often +difficult to decide whether the injury which caused death was the result +of a blow or a fall. A heavy blow with a stick may at once cause fatal +effusion of blood, but this might equally result from fracture of the +skull resulting from a fall. The wound should be carefully examined for +foreign bodies, such as grit, dirt, or sand. The distinction between +incised wounds inflicted during life and after death is found in the +fact that a wound inflicted during life presents the appearances already +described, whereas in a post-mortem incised wound only a small quantity +of liquid venous blood is effused; the edges are close, yielding, +inelastic; the blood is not effused into the cellular tissue, and there +are no signs of vital reaction. The presence of inflammatory reaction or +pus shows that the wound must have been inflicted some time before +death, probably two or three days. + +_Self-inflicted wounds_ are made by the person himself in order to +divert suspicion, or in order to bring accusation against another. Such +wounds are always in front, not over vital organs, and superficial in +character. Note the condition of the clothes in such cases. + + + + +XIII.--GUNSHOT WOUNDS + + +These may be punctured, contused, or lacerated. Round balls make a +larger opening than those which are conical. Small shot fired at a short +distance make one large ragged opening; while at distances greater than +3 feet the shot scatter and there is no central opening. The Lee-Metford +bullet is more destructive than the Mauser. The former is the larger, +but the difference in size is not great. The Martini-Henry bullet +weighs 480 grains, the Lee-Metford 215, and the Mauser 173. Speaking +generally, a gunshot wound, unlike a punctured wound, becomes larger as +it increases in depth; the aperture of entrance is round, clean, with +inverted edges, and that of exit larger, less regular than that of +entrance, and with everted edges. + +In the case of high-velocity bullets from smooth-bore rifles, including +the Mauser and Lee-Metford, the aperture of entry is small; the aperture +of exit is slightly larger, and tends to be more slit-like. There is but +little tendency to carry in portions of clothing or septic material, and +the wound heals by first intention, if reasonable precautions be taken. +The external cicatrices finally look very similar to those produced by +bad acne pustules. + +The contents of all gunshot wounds should be preserved, as they may be +useful in evidence. A pocket revolver, as a rule, leaves the bullet in +the body. + +Wounds inflicted by firearms may be due to accident, homicide, or +suicide. Blackening of the wound, singeing of the hair, scorching of the +skin and clothing, show that the weapon was fired at close quarters, +whilst blackening of the hand points to suicide. Even when the weapon is +fired quite close there may be no blackening of the skin, and the hand +is not always blackened in cases of suicide. Smokeless powder does not +blacken the skin. Wounds on the back of the body are not usually +self-inflicted, but a suicide may elect to blow off the back of his +head. A wound in the back may be met with in a sportsman who indulges in +the careless habit of dragging a loaded gun after him. If a revolver is +found tightly grasped in the hand it is probably a case of suicide, +whilst if it lies lightly in the hand it may be suicide or homicide. If +no weapon is found near the body, it is not conclusive proof that it is +not suicide, for it may have been thrown into a river or pond, or to +some distance and picked up by a passer-by. + +A bullet penetrating the skull even from a distance of 3,000 yards may +act as an explosive, scattering the contents in all directions; but the +bullet from a revolver will usually be found in the cranium. + +The prognosis depends partly on the extent of the injury and the parts +involved, but there is also risk from secondary hæmorrhage, and from +such complications as pleurisy, pericarditis, and peritonitis. Death may +result from shock, hæmorrhage, injury to brain or important nervous +structures. + + + + +XIV.--WOUNDS OF VARIOUS PARTS OF THE BODY + + +1. =Of the Head.=--Wounds of the scalp are likely to be followed by (1) +erysipelatous inflammation; (2) inflammation of the tendinous +structures, with or without suppuration. A severe blow on the vertex may +cause fracture of the base of the skull. Injuries of the brain include +concussion, compression, wounds, contusion, and inflammation. Concussion +is a common effect of blows or violent shocks, and the symptoms follow +immediately on the accident, death sometimes taking place without +reaction. Compression may be caused by depressed bone or effused blood +(rupture of middle meningeal artery) and serum. The symptoms may come on +suddenly or gradually. Wounds of the brain present very great +difficulties, and vary greatly in their effect, very slight wounds +producing severe symptoms, and _vice versâ_. A person may receive an +injury to the head, recover from the first effects, and then die with +all the symptoms of compression from internal hæmorrhage. This is due to +the fact that the primary syncope arrests the hæmorrhage, which returns +during the subsequent reaction, or on the occurrence of any excitement. +Inflammation of the meninges or brain may follow injuries, not only to +the brain itself, but to the scalp and adjacent parts, as the orbit and +ear. Inflammation does not usually come on at once, but after variable +periods. + +2. =Injuries to the Spinal Cord= may be due to concussion, compression +(fracture-dislocation), or wounds. That the wound has penetrated the +meninges is shown by the escape of cerebro-spinal fluid. The cord and +nerves may be injured (1) by the puncture; (2) by extravasation of blood +and the formation of a clot; and (3) by subsequent septic inflammation. +Division or complete compression of the cord at or above the level of +the fourth cervical vertebra is immediately fatal (as happens in +judicial hanging). When the injury is below the fourth, the diaphragm +continues forcibly in action, but the lungs are imperfectly expanded, +and life will not be maintained for more than a day or two. When the +injury is in the dorsal region, there is paralysis of the legs and of +the sphincters of the bladder and rectum, but power is retained in the +arms and the upper intercostal muscles act, the extent of paralysis +depending on the level of the lesion. In injuries to the lumbar region +the legs may be partly paralysed, and the rectal and bladder sphincters +may be involved. + +_Railway spine_, or traumatic neurasthenia, may be set up by concussion +of the cord as a result of blows or falls. Passengers after railway +accidents, or miners, often suffer from this affection. + +3. =Of the Face.=--These produce great disfigurement and inconvenience, +and there is a risk of injury to the brain. The seventh nerve may be +involved, giving rise to facial paralysis. Punctured wounds of the orbit +are especially dangerous. Wounds apparently confined to the external +parts often conceal deep-seated mischief. + +4. =Of the Eye.=--The iris may be injured by sharp blows, as from the +cork of a soda-water bottle. It is usually followed by hæmorrhage into +the anterior chamber, and there may be separation of the iris from its +ciliary border. Wounds at the edge of the cornea are often followed by +prolapse of the iris. Acute traumatic iritis or irido-cyclitis may +supervene four or five days after the injury. The lens is frequently +wounded in addition to the cornea and iris. In dislocation of the lens +into the anterior chamber as the result of a blow, the lens appears like +a large drop of oil lying at the back of the cornea, the margin +exhibiting a brilliant yellow reflex. Partial dislocations of the lens +as the result of severe blows generally terminate in cataract. + +5. =Of the Throat.=--Very frequently inflicted by suicides. Division of +the carotid artery is fatal, and of the internal jugular vein very +dangerous on account of entrance of air. Wounds of the larynx and +trachea are not necessarily or immediately dangerous, but septic +pneumonia is very apt to follow. Wounds of the throat inflicted by +suicides are commonly situated at the upper part, involving the hyoid +bone and the thyroid and cricoid cartilages. The larynx is opened, but +the large vessels often escape. In most suicidal wounds of the throat +the direction is from left to right, the incision being slightly +inclined from above downwards. At the termination of a suicidal +cut-throat the skin is the last structure divided, the wound being +shallower as it reaches its termination; the wounds often show +parallelism. The weapon is often firmly grasped in the hand. Inquiry +should be made as to whether the patient is right or left handed, or +ambidextrous. + +Homicidal cut throat is usually very severe and situated low down in the +neck or far to the side. + +6. =Of the Chest.=--Incised wounds of the walls are not of necessity +dangerous; but severe blows, by causing fracture of the bones and +internal injuries, are often fatal. The symptoms of penetrating wounds +of the chest are--(1) The passage of blood and air through the wound; +(2) hæmoptysis; (3) pneumothorax; and (4) protrusion of the lung forming +a tumour covered with pleura. Fracture of the ribs may be due to direct +violence, as from a blow, when the ends are driven inwards, or to +indirect violence, as from a squeeze in a crowd, when the ends are +driven outwards. + +7. =Of the Lungs.=--These usually cause hæmorrhage, and are frequently +followed by pleurisy, either dry or with effusion, and by pneumonia. + +8. =Of the Heart.=--Penetrating wounds are fatal from hæmorrhage, of the +base more speedily than of the apex; but life may be prolonged for some +time even after a severe wound to the heart. Injury to the right +ventricle is the most fatal injury and the most frequent. Rupture from +disease usually occurs in the left ventricle; rupture from a crush is +usually towards the base and on the right side. + +9. =Of the Aorta and Pulmonary Artery.=--Fatal. + +10. =Of the Diaphragm.=--Generally fatal, owing to the severe injury of +the other abdominal organs. If the diaphragm be ruptured, hernia of the +organs may result. + +11. =Of the Abdomen.=--Of the walls, may be dangerous from division of +the epigastric artery; ventral hernia may follow, internal hæmorrhage, +etc. Blows on the abdomen are prone to cause death from cardiac +inhibition. + +12. =Of the Liver.=--May divide the large vessels. Venous blood flows +profusely from a punctured wound of the liver. Wounds of the +gall-bladder cause effusion of bile and peritoneal inflammation. +Laceration of the liver may result from external violence without +leaving any outward sign of the injury; it is commonly fatal. There is +rapid and acute anæmia from the pouring out of blood into the abdominal +cavity. This may also occur with injuries of other organs in the +abdomen. + +13. =Of the Spleen.=--Fatal hæmorrhage may result from penetrating +wounds or from rupture due to kicks, blows, crushes, especially if the +spleen be enlarged. + +14. =Of the Stomach.=--May be fatal from shock, from hæmorrhage, from +extravasation of contents, or from inflammation. The danger is +materially lessened by prompt surgical intervention. + +15. =Of the Intestines.=--May be fatal in the same way as those of the +stomach. More dangerous in the small than in the large intestines. + +16. =Of the Kidneys.=--May prove fatal from hæmorrhage, extravasation of +urine, or inflammation. + +17. =Of the Bladder.=--Dangerous from extravasation of urine. In +fracture of the pelvis the bladder is often injured, and extraperitoneal +infiltration of urine occurs, with frequently a fatal issue. + +18. =Of Genital Organs.=--Incised wounds of penis may produce fatal +hæmorrhage. Removal of testicles may prove fatal from shock to nervous +system. Wounds of the spermatic cord may be dangerous from hæmorrhage. +Wounds to the vulva are dangerous, owing to hæmorrhage from the large +plexus of veins without valves. + + + + +XV.--DETECTION OF BLOOD-STAINS, ETC. + + +Stains may require detection on clothing, on cutting instruments, on +floors and furniture, etc. The following are the distinctive characters +of blood-stains: + +(a) =Ocular Inspection.=--Blood-stains on dark-coloured materials, which +in daylight might be easily overlooked, may be readily detected by the +use of artificial light, as that of a candle, brought near the cloth. +Blood-spots when recent are of a bright red colour if arterial, of a +purple hue if venous, the latter becoming brighter on exposure to the +air. After a few hours blood-stains assume a reddish-brown or chocolate +tint, which they maintain for years. This change is due to the +conversion of hæmoglobin into methæmoglobin, and finally into hæmatin. +The change of colour in warm weather usually occurs in less than +twenty-four hours. The colour is determined, not entirely by the age of +the stain, but is influenced by the presence or absence of impurities +in the air, such as the vapours of sulphurous, sulphuric, and +hydrochloric acids. If recent, a jelly-like material may be seen by the +aid of a magnifying-glass lying between the fibres. If old, a +cinnabar-red streak is seen on drawing a needle across the stain. + +(b) =Microscopic Demonstration.=--With the aid of the microscope, blood +may be detected by the presence of the characteristic blood-corpuscles. +The human blood-corpuscle is a non-nucleated, biconcave disc, having a +diameter of about 1/3500 of an inch. All mammalian red corpuscles have +the same shape, except those of the camel, which are oval. The +corpuscles of birds, fishes, reptiles, and amphibians, are oval and +nucleated. The corpuscles of most mammals are smaller than those of man, +but the size of a corpuscle is affected by various circumstances, such +as drying or moisture, so that the medical witness is rarely justified +in going farther than stating whether the stain is that of the blood of +a mammal or not. Unfortunately, the corpuscles are usually so dried that +little information regarding their size can be given. + +(c) =Action of Water.=--Water has a solvent action on blood, fresh +stains rapidly dissolving when the material on which they occur is +placed in cold distilled water, forming a bright red solution. The +hæmatin of old stains dissolves very slowly, so employ a weak solution +of ammonia, and this will give a solution of alkaline hæmatin. Rust is +not soluble in water. + +(d) =Action of Heat.=--Blood-stains on knives may be removed by heating +the metal, when the blood will peel off, at once distinguishing it from +rust. Should the blood-stain on the metal be long exposed to the air, +rust may be mixed with the blood, when the test will fail. The solution +obtained in water is coagulated by heat, the colour entirely destroyed, +and a flocculent muddy-brown precipitate formed. + +(e) =Action of Caustic Potash.=--The solution of blood obtained in water +is boiled, when a coagulum is formed soluble in hot caustic potash, the +solution formed being greenish by transmitted and red by reflected +light. + +(f) =Action of Nitric Acid.=--Nitric acid added to a watery solution +produces a whitish-grey precipitate. + +(g) =Action of Guaiacum.=--Tincture of guaiacum produces in the watery +solution a reddish-white precipitate of the resin, but on addition of an +aqueous solution of peroxide of hydrogen, or of an ethereal solution of +the same substance (known as _ozonic ether_), a blue or bluish-green +colour is developed. This test is delicate, and succeeds best in dilute +solutions. It is not absolutely indicative of the presence of blood, for +tincture of guaiacum is coloured blue by milk, saliva, and pus. + +(h) =Hæmin Crystals (Teichman's Crystals).=--These are produced by +heating a drop of blood, or a watery solution of it, with a minute +crystal of sodium chloride on a glass slide and evaporating to dryness. +A cover-glass is placed over this, and a drop of glacial acetic acid +allowed to run in. It is again heated until bubbles appear. Crystals of +hæmin may now be detected by the microscope. They are dark brown or +yellow rhombic prisms. + +An improvement on this test is the use of formic acid alone; on slowly +evaporating it, numerous very small dark crystals are visible if +hæmoglobin has been present (Whitney's test). + +(i) =Spectroscopic Appearances.=--If a solution of a recent stain be +examined by the spectroscope, we get two absorption bands situated +between the lines D and E, the one nearer E being doubly as broad as the +other. These bands indicate _oxyhæmoglobin_. + +If we now add a little ammonium sulphide to this solution, we get the +spectrum of _reduced hæmoglobin_, which is a single broad absorption +band situated in the interval between the preceding oxyhæmoglobin +bands. By shaking the solution, oxyhæmoglobin is again reproduced, and +gives its special absorption bands. + +If ammonia be added to the original solution, _alkaline hæmatin_ is +produced, or if acetic acid be chosen, _acid hæmatin_ is produced, and +each gives its appropriate absorption bands. + +_Methæmoglobin_ is formed in stains which have been exposed to the air +for a few days, and _hæmatin_ is found in old stains. _Hæmochromogen_ +gives a very characteristic spectrum, and is obtained by reducing +alkaline hæmatin by ammonium sulphide. _Carbon monoxide hæmoglobin_ +gives a spectrum which resembles that of oxyhæmoglobin, but it is not +reduced by ammonium sulphide. + +(j) =Precipitin Test.=--This allows us to tell whether the blood is from +a human being or not. A specific serum must be obtained from a rabbit +which is sensitized as follows: 10 c.c. of human blood is injected into +its peritoneal cavity at intervals, until from three to five injections +have been given. The serum of this animal's blood will then give a white +precipitate only when brought into contact with dilute solutions of +human blood, but with the blood of no other animal. This is known also +as the 'biologic,' or Uhlenhuth's test. + +=Rust Stains.=--These are yellowish-red in colour, and do not stiffen +the cloth. The iron may be dissolved by placing the stain in a dilute +solution of hydrochloric acid, when, on adding ferrocyanide of +potassium, Prussian blue is produced. + +=Fruit Stains= are seldom so dark as blood-stains. Solutions of these do +not change colour or coagulate on boiling; ammonia changes the colour to +blue or green; acid brightens the original colour, while chlorine +bleaches it. + +=Hairs.=--Human hairs must be identified and distinguished from those of +the lower mammals. If the hair has been pulled out from the root, the +microscope will show that the bulbous root has a concave surface which +fitted over the hair papilla, or that the root is encased in a fatty +sheath. + +=Fibres of Clothing.=--Microscopically, wool fibres are coarse, curly, +and striated transversely; cotton fibres appear as flattened bands +twisted into spirals; linen fibres are round, jointed at frequent +intervals, with small root-like filaments; silk fibres are solid, +continuous, and highly glistening. + + + + +XVI.--DEATH BY SUFFOCATION + + +_Signs and Symptoms._--There are usually three stages: + +1. Exaggerated respiratory activity; air hunger; anxiety; congested +appearance of face; ringing in ears. + +2. Loss of consciousness; convulsions; relaxation of sphincters. + +3. Respirations feeble and gasping, and soon cease; convulsions of +stretching character; heart continues to beat for three to four minutes +after breathing ceases. + +_Post-Mortem Appearances--External._--Cadaveric lividity well marked; +nose, lips, ears, finger-tips almost black in colour; appearance may be +placid or, if asphyxia has been sudden, the tongue may be protruded and +eyeballs prominent, with much bloody mucus escaping from mouth and nose. + +_Internal._--The blood is dark and remains fluid; great engorgement of +venous system, right side of heart, great veins of thorax and abdomen, +liver, spleen, etc. Lungs dark purple in colour; much bloody froth +escapes on squeezing them; mucous lining of trachea and bronchi +congested and bright red in colour; air-cells distended or ruptured; +many small hæmorrhages on surface of lungs and other organs, as well as +in their substance (_Tardieu's spots_), due to rupture of venous +capillaries from increased vascular pressure. + + + + +XVII.--DEATH BY HANGING + + +In hanging, death occurs by asphyxia, as in drowning. Sensibility is +soon lost, and death takes place in four or five minutes. The eyes in +some cases are brilliant and staring, tongue swollen and livid, blood or +bloody froth is found about the mouth and nostrils, and the hands are +clenched. In other cases the countenance is placid, with an almost +entire absence of the signs just given. The mark on the neck, which may +be more or less interrupted by the beard, shows the course of the cord, +which in hanging is obliquely round the neck following the line of the +jaw, but straight round in strangulation. In judicial hanging, death is +not due to asphyxiation, but, owing to the long drop, the cervical +vertebræ are dislocated, and the spinal cord injured so high up that +almost instant death takes place. On dissection the muscles and +ligaments of the windpipe may be found stretched, bruised, or torn, and +the inner coats of the carotid arteries are sometimes found divided. In +ordinary suicidal hanging there may be entire absence of injury to the +soft parts about the neck, the length of the drop modifying these +appearances. The mark of the cord is not a sign of hanging, is a purely +cadaveric phenomenon, and may be produced some hours after death. + + + + +XVIII.--DEATH BY STRANGULATION + + +This differs from hanging in that the body is not suspended. It may be +effected by a ligature round the neck, or by direct pressure on the +windpipe with the hand, in which case death is said to be caused by +_throttling_. Strangulation is frequently suicidal, but may be +accidental. When homicidal, much injury is done to the neck, owing to +the force with which the ligature is drawn. In throttling, the marks of +the finger-nails are found on the neck. + + + + +XIX.--DEATH BY DROWNING + + +Death by drowning occurs when breathing is arrested by watery or +semi-fluid substances--blood, urine, etc. The fluid acts mechanically by +entering the air-cells of the lung and preventing the due oxidation of +the blood. The post-mortem appearances include those usually present in +death by asphyxia, together with the following, peculiar to death by +drowning: Excoriations of the fingers, with sand or mud under the nails; +fragments of plants grasped in the hand; water in the stomach (this is a +vital act, and shows that the person fell into the water alive); fine +froth at the mouth and nostrils; cutis anserina; retraction of penis and +scrotum. On post-mortem examination, the lungs are found to be increased +in size ('ballooned'); on section, froth, water mud, sand, in air-tubes. +The presence of this fine (often blood-stained) froth is the most +characteristic sign of drowning. Froth like that of soap-suds in the +trachea is an indication of a vital act, and must not be mistaken for +the tenacious mucus of bronchitis. The presence of vomited matters in +the trachea and bronchi is a valuable sign of drowning. The blood +collects in the venous system, and is dark and fluid. Tardieu's spots +are not so frequently met with in cases of drowning as in other forms of +asphyxia. The other signs of death by asphyxia are present. Wounds may +be present on the body, due to falling on stakes, injuries from passing +vessels, etc. + +The methods of performing artificial respiration in the case of the +apparently drowned are the following (the best and most easily performed +is Schäfer's prone pressure method): + +1. _Schäfer's._--Place the patient on his face, with a folded coat under +the lower part of the chest. Unfasten the collar and neckband. Go to +work at once. Kneel over him athwart or on one side facing his head. +Place your hands flat over the lower part of his back, and make +pressure on his ribs on both sides, and throw the weight of your body on +to them so as to squeeze out the air from his chest. Get back into +position at once, but leave your hands as they were. Do this every five +seconds, and get someone to time you with a watch. Keep this going for +half an hour, and when you are tired get someone to relieve you. + +Other people may apply hot flannels to the limbs and hot water to the +feet. Hypodermic injections of 1/50 grain of atropine, suprarenal or +pituitary extracts, may be found useful. + +2. _Silvester's._--In this method the capacity of the chest is increased +by raising the arms above the head, holding them by the elbows, and thus +dragging upon and elevating the ribs, the chest being emptied by +lowering the arms against the sides of the chest and exerting lateral +pressure on the thorax. The patient is in the supine position--but first +the water must have been drained from the mouth and nose by keeping the +body in the prone position. The tongue must be kept forward by +transfixing with a pin. + +3. _Marshall Hall's._--This consists in placing the patient in the prone +position, with a folded coat under the chest, and rolling the body +alternately into the lateral and prone positions. + +4. _Howard's._--This consists in emptying the thorax by forcibly +compressing the lower part of the chest; on relaxing the pressure the +chest again fills with air. Here the patient is placed in the supine +position. + +The objections to the supine position are that the tongue falls back, +and not only blocks the entrance of air, but prevents the escape of +water, mucus, and froth from the air-passages. + +5. _Laborde's Method._--This consists in holding the tongue by means of +a handkerchief, and rhythmically drawing it out fully at the rate of +fifteen times per minute. This excites the respiratory centre, and this +method may be employed along with any of the other methods. + + + + +XX.--DEATH FROM STARVATION + + +The post-mortem appearances in death from starvation are as follows: +There is marked general emaciation; the skin is dry, shrivelled, and +covered with a brown, bad-smelling excretion; the muscles soft, +atrophied, and free from fat; the liver is small, but the gall-bladder +is distended with bile. The heart, lungs, and internal organs are +shrivelled and bloodless. The stomach is sometimes quite healthy; in +other cases it may be collapsed, empty, and ulcerated. The intestines +are also contracted, empty, and translucent. + +In the absence of any disease productive of extreme emaciation (_e.g._, +tuberculosis, stricture of oesophagus, diabetes, Addison's disease), +such a state of body will furnish a strong presumption of death by +starvation. + +In the case of children there is not always absolute deprivation of +food, but what is supplied is insufficient in quantity or of improper +quality. The defence commonly set up is that the child died either of +marasmus or of tuberculosis. + +In cases where it is alleged that a child has been starved and ill-used, +one must examine the body for signs of neglect--_e.g._, dirtiness of +skin and hair, presence of vermin, bruises or skin eruptions. Compare +its weight with a normal child of the same age and sex. If the +disproportion be great and signs of neglect present, then the +probability is great (provided there be no actual disease present) that +the child has been starved. + + + + +XXI.--DEATH FROM LIGHTNING AND ELECTRICITY + + +The signs of death from lightning vary greatly. In some cases there are +no signs; in others the body may be most curiously marked. Wounds of +various characters--contused, lacerated, and punctured--may be +produced. There may be burns, vesications, and ecchymoses; arborescent +markings are not uncommon. The hair may be singed or burnt and the +clothing damaged. Rigor mortis is very rapid in its onset and transient. +Post mortem there are no characteristic signs, but the blood may be dark +in colour and fluid. The presence or absence of a storm may assist the +diagnosis. + +Injuries by electrical currents of high pressure are not uncommon; +speaking generally, 1,000 to 2,000 volts will kill. In America, where +electricity is adopted as the official means of destroying criminals, +1,500 volts is regarded as the lethal dose, but there are many instances +of persons having been exposed to higher voltages without bad effects. +The alternating current is supposed to be more fatal than the +continuous. Much depends on whether the contact is good (perspiring +hands or damp clothes). Death has been attributed in these cases to +respiratory arrest or sudden cessation of the heart's action. The best +treatment is artificial respiration, but the inhalation of nitrite of +amyl may prove useful. Rescuers must be careful that they, also, do not +receive a shock. The patient should be handled with india-rubber gloves +or through a blanket thrown over him. + + + + +XXII.--DEATH FROM COLD OR HEAT + + +=Cold.=--The weak, aged, or infants, readily succumb to low +temperatures. The symptoms are increasing lassitude, drowsiness, coma, +with sometimes illusions of sight. Post mortem, bright red patches are +found on the skin surface, and the blood remains fluid for long. + +=Heat.=--Death may result from syncope, the result of exposure to great +heat. + +=Sunstroke.=--The person loses consciousness and falls down insensible; +the body temperature may be 112° F., the pulse is full, and a peculiar +pungent odour is given off from the skin. Coma, convulsions with +(rarely) delirium, may precede death. _Treatment_ consists in lowering +the body temperature by application of cold cloths, stimulants, +strychnine or digitalin hypodermically. + + + + +XXIII.--PREGNANCY + + +The signs of the existence of pregnancy are of two kinds, uncertain and +certain, or maternal and foetal. Amongst the former class are +included--Cessation of menstruation (which may occur without pregnancy); +morning vomiting; salivation; enlargement of the breasts and of the +abdomen; quickening. It must be borne in mind that every woman with a +big abdomen is not necessarily pregnant. The tests which afford +conclusive evidence of the existence of a foetus in the uterus +are--Ballottement, the uterine souffle, intermittent uterine +contractions, foetal movements, and, above all, the pulsation of the +foetal heart. The uterine souffle is synchronous with the maternal +pulse; the foetal heart is not, being about 120 beats per minute. + +Evidence of pregnancy may also be afforded by the discharge from the +uterus of an early ovum, of moles, hydatids, etc. Disease of the uterus +and ovarian dropsy may be mistaken for pregnancy. Careful examination is +necessary to determine the nature of the condition present. Pregnancy +may be pleaded in bar of immediate capital punishment, in which case the +woman must be shown to be 'quick with child.' A woman may also plead +pregnancy to delay her trial in Scotland, and both in England and +Scotland, in civil cases, to produce a successor to estates, to increase +damages for seduction, in compensation cases where a husband has been +killed, to obtain increased damages, etc. A woman may become pregnant +within a month of her last delivery. + +In cases of rape and suspected pregnancy, it must be borne in mind that +a medical man who examines a woman under any circumstances against her +will renders himself liable to heavy damages, and that the law will not +support him in so doing. If, on being requested to permit an +examination, the woman refuse, such refusal may go against her, but of +this she is the best judge. The duty of the medical man ends on making +the suggestion. + + + + +XXIV.--DELIVERY + + +The signs of recent delivery are as follows: The face is pale, with dark +circles round the eyes; the pulse quickened; the skin soft, warm, and +covered with a peculiar sweat; the breasts full, tense, and knotty; the +abdomen distended, its integuments relaxed, with irregular light pink +streaks on the lower part. The labia and vagina show signs of distension +and injury. For the first three or four days there is a discharge from +the uterus more or less sanguineous in character, consisting of blood, +mucus, epithelium, and shreds of membrane. During the next four or five +days it becomes of a dirty green colour, and in a few days more of a +yellowish, milky, mucous character, continuing for two to three weeks. +The change in character of the lochial discharge is due to the quantity +of blood decreasing and its place being taken by fatty granules and +leucocytes. The os uteri is soft, patulous, and its edges are torn. The +uterus may be felt for two or three hours above the pubis as a hard +round ball, regaining its normal size in about eight weeks after +delivery. Most of these signs disappear about the tenth day, after which +it becomes impossible to fix the date of delivery. + +In the dead the external parts have the same appearance as given above. +The uterus will vary in appearance according to the time elapsed since +delivery. If death occurred immediately after delivery, the uterus will +be wide open, about 9 or 10 inches long, with clots of blood inside, and +the inner surface lined by decidua. + +The signs of a previous delivery consist in silvery streaks in the skin +of the abdomen, which, however, may be due to distension from other +causes; similar marks on the breast; circular and jagged condition of +the os uteri (the virgin os being oval and smooth); marks of rupture of +the perineum or fourchette; absence of the vaginal rugæ; dark-coloured +areola round the nipples, etc. The difference between the virgin _corpus +luteum_ and that of recent pregnancy is not so marked as to justify a +confident use of it for medico-legal purposes. + + + + +XXV.--FOETICIDE, OR CRIMINAL ABORTION + + +This consists in giving to any woman, or causing to be taken by her, +with intent to procure her miscarriage, any poison or other noxious +thing, or using for the same purpose any instruments or other means +whatsoever. It is a felony to procure or attempt to procure the +miscarriage of a woman, whether she be pregnant or not, and it is a +felony for the woman, if pregnant, to attempt to procure her own +miscarriage. It is a misdemeanour for any person or persons to procure +drugs or instruments for a like purpose. It is not necessary that the +woman be _quick_ with child. The offence is the intent to procure the +miscarriage of any woman, _whether she be or be not with child_. When +from any causes it is necessary to procure abortion, a medical man +should do so only after consultation with a brother practitioner. Even +in these cases there is no exemption legally. Any medical man who gives +even the most harmless medicine where he suspects the possibility of +pregnancy may render himself liable to grave suspicion should the woman +abort. + +In medicine, an _abortion_ is said to occur when the foetus is expelled +before the sixth month; after that it is _premature birth_. In law, +however, any expulsion of the contents of the uterus before the full +time is an _abortion_ or _miscarriage_. + +In deciding whether any substance expelled from the uterus is really a +foetus or a mole, and therefore the result of conception, or the coat of +the uterus, and unconnected with pregnancy, the examination of the +substances expelled must be carefully made. Moles are blighted foetuses. +An examination of the woman will be necessary, though it is not easy +during the early months of pregnancy, and especially in those who have +borne children, to say whether abortion has taken place or not. The +history must be inquired into; the regular or exceptional use of drugs +to promote menstruation is important, for in the former case no criminal +intent may exist, although pregnancy be present. The state of the +breasts, the hymen, and the os uteri, should all be carefully examined. +Putting a few apparently unimportant questions as to the frequent use of +purgatives, the presence or absence of constipation, will often assist +the diagnosis as showing that the woman has acted in an unusual manner. +Abortion may be procured by the introduction of instruments, by falls, +violent exercise, blows on the abdomen, etc. In the hands of ignorant +persons the use of instruments (sounds, bougies, skewers, etc.) is +attended with great danger. Perforation of the vaginal walls, bladder, +cervix, or uterus, may follow their use. Septic pelvic peritonitis may +ensue, and the woman may lose her life. The person who has employed such +means for inducing abortion is liable to be charged with the crime of +murder. There is no evidence to show that ergot, savin, bitter-apple, +pennyroyal, or any other drug administered internally, will cause a +woman to abort, except when taken in such large doses that actual +poisoning results, with inflammation of the contents of the true +pelvis. In such cases reflex uterine contractions may be set up, and +abortion may follow. Diachylon pills are largely employed to induce +abortion, and very often the woman taking them suffers severely from +lead-poisoning. + + + + +XXVI.--INFANTICIDE + + +Infanticide, or the murder of a new-born child, is not treated as a +specific crime, but is tried by the same rules as in cases of felonious +homicide. The term is applied technically to those cases in which the +mother kills her child at, or soon after, its birth. She is often in +such a condition of mental anxiety as not to be responsible for her +actions. It is usually committed with the object of concealing delivery, +and to hide the fact that the girl has, in popular language, 'strayed +from the paths of virtue.' The child must have had a separate existence. +To constitute 'live birth,' the child must have been alive after its +body was entirely born--that is, entirely outside the maternal +passages--and it must have had an independent circulation, though this +does not imply the severance of the umbilical cord. Every child is held +in law to be born dead until it has been shown to have been born alive. +Killing a child in the act of birth and before it is fully born is not +infanticide, but if before birth injuries are inflicted which result in +death after birth, it is murder. Medical evidence will be called to show +that the child was born alive. + +The methods of death usually employed are--(1) Suffocation by the hand +or a cloth. (2) Strangulation with the hands, by a tape or ribbon, or by +the umbilical cord itself. (3) Blows on the head, or dashing the child +against the wall. (4) Drowning by putting it in the privy or in a bucket +of water. (5) Omission: by neglecting to do what is absolutely necessary +for the newly-born child--_e.g._, not separating the cord; allowing it +to lie under the bed-clothes and be suffocated. + +With regard to the question of the maturity of a child, the differences +between a child of six or seven months and one at full term may be +stated as follows: + +Between the sixth and seventh month, length of child 10 to 14 +inches--that is, the length of the child after the fifth month is about +double the lunar months--weight 1 to 3 pounds; skin, dusky red, covered +with downy hair (lanugo) and sebaceous matter; membrana pupillaris +disappearing; nails not reaching to ends of fingers; meconium at upper +part of large intestine; testes near kidneys; no appearance of +convolutions in brain; points of ossification in four divisions of +sternum. + +At nine months, length of child 18 to 22 inches; weight, 7 to 8 pounds; +skin rosy; lanugo only about shoulders; sebaceous matter on the body; +hair on head about an inch long; testes past inguinal ring; clitoris +covered by the labia; membrana pupillaris disappeared; nails reach to +ends of fingers; meconium at termination of large intestine; points of +ossification in centre of cartilage at lower end of femur, about 1-1/2 +to 2-1/2 lines in diameter; umbilicus midway between the ensiform +cartilage and pubis. + +Owing to the difficulty of proving that the crime of infanticide has +been committed, the woman may in England be tried for _concealment of +birth_, and in Scotland for _concealment of pregnancy_, if she conceal +her pregnancy during the whole time and fail to call for assistance in +the birth. Either of these charges would only be brought against a woman +who had obviously been pregnant, and now the child is missing or its +dead body has been found. It is expected that every pregnant woman +should make provision for the child about to be born, and so should have +talked about it or have made clothes, etc., for it. The punishment for +concealment is imprisonment for any term not exceeding two years. The +charge of concealment is very often alternative to infanticide. To +substantiate the charge, however, it must be proved that there had been +a _secret disposition of the dead body_ of the infant, as well as an +endeavour to conceal its birth. + +A woman may be delivered of a child unconsciously, for the contractile +power of the womb is independent of volition. Under an anæsthetic the +uterus acts as energetically as if the patient were in the full +possession of her senses. + +Nowadays a woman is rarely hanged for infanticide, and it is a mere +travesty of justice to pass on her the death sentence, well knowing that +it will never be executed. + + + + +XXVII.--EVIDENCES OF LIVE BIRTH + + +The signs of live birth prior to respiration are negative and positive. +A negative opinion may be formed when evidence is found of the child +having undergone intra-uterine maceration. In this case the body will be +flaccid and flattened; the ilia prominent; the head soft and yielding; +the cuticle more or less detached, and raised into large bullæ; the skin +of a red or brownish-red colour; the cavities filled with abundant +bloody serum; the umbilical cord straight and flaccid. + +A positive opinion is justified when such injuries are found on the body +as could not have been inflicted during birth, and are attended with +such hæmorrhage as could only have occurred while the blood was +circulating. Fractures of the cranium from accidental falls (precipitate +labour) are as a rule stellate, and are situated on the vertex or in the +parietal protuberance. The fractures from violence are more extensive, +usually depressed, and accompanied by laceration of the scalp. + +The evidences of live birth after respiration has taken place are +usually deduced from the condition of the lungs, though indications are +also found in other organs. The diaphragm is more arched before than +after respiration, and rises higher in the thorax in the former case +than in the latter. The lungs before respiration are situated in the +back of the thorax, and do not fill that cavity; they are of a dark, +red-brown colour and of the consistence of liver, without mottling. +After respiration they expand and occupy the whole thorax, and closely +surround the heart and thymus gland. The portions containing air are of +a light brick-red colour, and crepitate under the finger. The lungs are +mottled from the presence of islands of aerated tissue, surrounded by +arteries and veins. The weight of the lungs before respiration is about +550 grains, after an hour's respiration 900 grains; but this test is of +little value. The ratio of the weight of the lungs to that of the body +(Ploucquet's test), which is also unreliable, is, before respiration, +about 1 to 70; after, 1 to 35. Lungs in which respiration has taken +place float in water; those in which it has not, sink. There are +exceptions to this rule, on which, however, is founded the _hydrostatic +test_. As originally performed, this test consisted merely in placing +the lungs, with or without the heart, in water, and noticing whether +they sank or floated. The test is now modified by squeezing, and by +cutting the lungs up into pieces. + +The objections to the test as originally performed are--(1) That the +lungs may sink as the result of disease--_e.g._, double pneumonia. (2) +That respiration may have been so limited in extent that the lungs may +sink, owing to large portions of lung tissue remaining unexpanded +(_atelectasis_). (3) Putrefaction may cause the lungs to float when +respiration has not taken place. (4) The lungs may have been inflated +artificially. Few of these objections apply, however, when the +hydrostatic test, modified by pressure, is employed. To take these +objections in detail, it may be stated: (1) If the lungs sink from +disease, the question of live birth is answered. (2) This objection is +too refined for practical use. The lungs sink, there is an absence of +any of the signs of suffocation, and the matter ends. The examiner has +only to describe the conditions which he finds, and is not required to +indulge in conjectures as to the amount of respiration which may or may +not have taken place. (3) Gas due to putrefaction collects under the +pleural membrane, and can be expelled by pressure, and is not found in +the air cells. The lungs decompose late, hence in a fresh body +putrefaction of the lungs is absent; in a putrefied child, if the lungs +sink, it must have been stillborn. The so-called _emphysema pulmonum +neonatorum_ is simply incipient putrefaction. + +The lung test simply shows that the child has breathed, but affords no +proof that the child has been born alive. The child may have breathed as +soon as its head protruded, the rest of the body being in the maternal +passages. The child is not born alive until it has been completely +expelled, although it is not necessary that the umbilical cord should +have been cut. + +In addition to these tests, live birth may be suspected from the +following conditions: The _stomach_ may contain milk or food, recognized +by the microscope and by Trommer's test for sugar; the _large +intestines_ in stillborn children are filled with meconium, in those +born alive they are usually empty; the _bladder_ is generally emptied +soon after birth; the _skin_ is in a condition of exfoliation soon after +birth. The _organs of circulation_ undergo the following changes after +birth, and the extent to which these changes have advanced will give an +idea of how long the child has lived: The _ductus arteriosus_ begins to +contract within a few seconds of birth; at the end of a week it is about +the size of a crow quill, and about the tenth day is obliterated. The +_umbilical arteries and vein_: the arteries are remarkably diminished in +calibre at the end of twenty-four hours, and obliterated almost up to +the iliacs in three days; the umbilical vein and the ductus venosus are +generally completely contracted by the fifth day. The _foramen ovale_ +becomes obliterated at extremely variable periods, and may continue open +even in the adult. + +Importance of late has been attached to the _stomach-bowel test_. If the +stomach and duodenum contain air, and consequently float in water, the +chances are that the child did not die immediately after birth; this is +known as Breslau's second life test, and the lower the air in the +intestinal canal, the greater is the probability that the child survived +birth. + +The umbilical cord in a new-born child is fresh, firm, round, and bluish +in colour; blood is contained in its vessels. The cord may be ruptured +by the child falling from the maternal parts in a precipitate labour, +and the ruptured parts present ragged ends. It is seldom that a child +bleeds to death from an untied or cut umbilical cord, and the chances in +a torn cord are still more remote. The changes in the cord are as +follows: First it shrinks from the ligature towards the navel; this +change may begin early, and is rarely delayed beyond thirty hours; the +cord becomes flabby, and there is a distinct inflammatory circle round +its insertion. The next change is that of desiccation or mummification; +the cord becomes reddish-brown, then flattened and shrivelled, then +translucent and of the colour of parchment, and falls off about the +fifth day. The third stage, that of cicatrization, then ensues about the +tenth to the twelfth day. The bright red rim round the insertion of the +cord, with inflammatory thickening and slight purulent secretion, may be +considered as evidence of live birth, and the stage at which the +separation of the cord by ulcerative process has arrived will point to +the probable duration of time the child has existed after birth. + +There are many fallacies in the application of any of these tests, and +the whole subject bristles with difficulties. The medical witness would +do well to exhibit a cautious reserve, for if the child dies immediately +after birth it is almost impossible to prove that it was born alive. + + + + +XXVIII.--CAUSE OF DEATH IN THE FOETUS + + +The death of the foetus may be due to--(1) Immaturity or intra-uterine +malnutrition, or simply from deficient vitality; (2) complications +occurring during or immediately after birth, which may either be +unavoidable or inherent in the process of parturition, or may be induced +with criminal intent. + +In the latter category come such accidents as the pressure of tumours in +the pelvic passages, or disease of the bones in the mother, or pressure +on the cord from malposition of the child during labour, asphyxiation +from the funis being twisted tightly round the neck or limbs, or from +injuries due to falls on the floor in sudden labours. Where the death of +the foetus has been induced with criminal intent, it may be due to +punctured wounds of the fontanelles, orbits, heart, or spinal marrow; +dislocation of the neck; separation of the head from the body; fracture +of the bones of the head and face; strangulation; suffocation; drowning +in the closet pan or privy, or from being thrown into water. + +Under the head of infanticide by _commission_, we have injuries of all +kinds; under infanticide by _omission_, neglecting to tie the cord, +allowing it to be suffocated by discharges in the bed, neglect to +provide food, clothes, and warmth, for the new-born child. + + + + +XXIX.--DURATION OF PREGNANCY + + +The natural period of gestation is considered as forty weeks, ten lunar +months, or 280 days. A medical witness would have to admit the +possibility of gestation being prolonged to 300 days, and if this time +were not very materially exceeded it would be well to give the woman +the benefit of the doubt. It may be mentioned that 300 days is the +extreme limit fixed by the French and Scottish law. No fixed period is +assigned in English or American law to the duration of pregnancy, though +it is allowed that utero-gestation may be greatly prolonged. In a recent +case decided, the Lord Chancellor accepted a case where it was alleged +pregnancy had extended to 331 days. A child only five months old may +live, for a short time at all events. There is considerable difficulty +in many cases in fixing the date of conception. The data from which it +is calculated are the following: (1) _Peculiar sensations attending +conception_, which are not sufficiently defined to be recognized by +those conceiving for the first time. (2) _Cessation of the catamenia._ +Other causes may, however, cause this; and, on the other hand, a woman +may menstruate during the whole period of her pregnancy. This datum also +gives a variable period, and may involve an error of several days or a +month, for the menses may be arrested by cold, etc., at one monthly +period, and the woman become pregnant before the next. (3) _The period +of quickening._ This, when perceived (which is not always the case), +also occurs at variable periods from the tenth to the twenty-sixth week. +(4) _A single coitus._ This does not, however, correspond to the time of +fertilization. Several days may elapse before the spermatozoa meet with +an ovum and fertilize it. + +In Scotland a child born six months after marriage is legitimate, which +is allowing an ample margin. + + + + +XXX.--VIABILITY OF CHILDREN + + +A child may be born alive, but may not be viable, by which is meant that +it is not endowed with a capacity of maintaining its life. Speaking +generally, 180 days represents the lowest limit at which a child is +viable, but prolonged survival under these circumstances is the +exception. Many cases, however, have been recorded in which children +born at six months have been reared. The signs of immaturity and +maturity may be thus tabulated: + + + IMMATURITY. MATURITY. + +Centre of body high; head Strong movements and cries as soon +disproportionate in size; membrana as born; body clear, red colour, +pupillaris present; testicles coated with sebaceous matter; mouth, +undescended; deep red colour of nostrils, eyelids, and ears, open; +parts of generation; intense red skull somewhat firm, and fontanelles +colour, mottled appearance, and not far apart; hair, eyebrows, and +downy covering, of skin; nails not nails, perfectly developed; +formed; feeble movements; testicles descended; free discharge +inability to suck; necessity for of urine and meconium; power of +artificial heat; almost unbroken suction, indicated by seizure on the +sleep; rare and imperfect nipple or a finger placed in the +discharges of urine and meconium; mouth. +closed state of mouth, eyelids, +and nostrils. + + + + +XXXI.--LEGITIMACY + + +A child born in wedlock is presumed to have the mother's husband for its +father. This may, however, be open to question upon the following +grounds: Absence or death of the reputed father; impotence or disease in +the husband preventing matrimonial intercourse; premature delivery in a +newly-married woman; want of access; and the marriage of the woman again +immediately on the death of her husband. In the last case, where either +husband might have been the father, the child at the age of twenty-one +is at liberty to select its father from the possible pair. + +A child born of parents before marriage is in Scotland rendered +legitimate by their subsequent marriage, but in England the offspring +remains illegitimate whether the parents marry or not after its birth. +The offspring of voidable or invalid marriages may be made legitimate +by application to the courts. + +There is a difference between being legitimate and lawfully begotten. A +child born in wedlock is legitimate, but if the parents were married +only a week previously it could not have been lawfully begotten. + +The Acts and rulings relating to Marriage and Legitimacy are extremely +complicated. It is not putting it too strongly to say that a very large +number of people in this country who believe themselves to be legally +married are not married at all, and that thousands of children who have +not the slightest doubt as to their legitimacy are in the eyes of the +law bastards. + + + + +XXXII.--SUPERFOETATION + + +By superfoetation is meant the conception, by a woman already pregnant, +of a second embryo, resulting in the birth of two children at the same +time, differing much in their degree of maturity, or in two separate +births, with a considerable interval between. The possibility of the +occurrence of superfoetation has been doubted, but there are +well-authenticated cases which countenance the theory of a double +conception. It has been shown that the os uteri is not closed, as was +once supposed, immediately _on conception_. Should an ovum escape into +the uterus, it may become impregnated a month or so after a previous +conception. The most probable explanation is that the case has been one +of twins, one being born prematurely; or, on the other hand, the uterus +may have been double, and conception may have taken place in one cornu +at a later period than in the other cornu. + + + + +XXXIII.--INHERITANCE + + +In order to inherit, the child must be born alive, must be born during +the lifetime of the mother, and must be born capable of inheriting--that +is to say, monsters are incapable of inheriting. There is a mode of +inheritance called 'tenancy by courtesy.' When a man marries a woman +possessed of an estate or inheritance, and has, by her, issue born alive +in her lifetime capable of inheriting her estate, in this case he shall, +on the death of his wife, hold the lands for his life as tenant by the +courtesy of England. The meaning of the words 'born alive' in this +instance is not the same as in cases of infanticide. In Civil law any +motion of the child's body, however slight, or the fact of it having +been heard to cry by witnesses, is held to be sufficient proof of the +child having been born alive. It may die immediately afterwards, and it +is not necessary that the child be viable. + + + + +XXXIV.--IMPOTENCE AND STERILITY + + +In the male, impotence may arise from physical or mental causes. The +physical causes may be--too great or too tender an age; malformation of +the genital organs; _crypsorchides_, defect or disease in the testicles; +constitutional disease (diabetes, neurasthenia, etc.); or debility from +acute disease, as mumps. Masturbation, and early and excessive sexual +indulgence, are also causes. The mental causes include--passion, +timidity, apprehension, aversion, and disgust. The case will be +remembered of the man who was impotent unless the lady were attired in a +black silk dress and high-heeled French kid boots. + +If a man is impotent when he marries, the marriage may be set aside on +the ground that it had never been consummated. The law requires that the +impotency should have existed _ab initio_--that is, before +marriage--and should be of a permanent or incurable nature; marriage, +as far as the law goes, being regarded as a contract in which it is +presupposed that both the contracting parties are capable of fulfilling +all the objects of marriage. In the case of the Earl of Essex the +defendant admitted the charge as regards the Countess, but pleaded that +he was not impotent with others, as many of her waiting-maids could +testify. When a man becomes impotent _after_ marriage, his wife must +accept the situation, and has no redress. A man may be _sterile_ without +being impotent, but the law will not take cognizance of that. The wife +may be practically impotent, but the law will not assist the husband. He +must continue to do his best under difficult circumstances. In former +times in case of doubt a husband was permitted to demonstrate his +competency in open court, but this custom is no longer regarded with +favour by the judges. + +The removal of the testicles does not of necessity render a man +impotent, although it deprives him of his procreative power. Eunuchs are +capable of affording illicit pleasure, whilst the male sopranos, or +_castrati_, are often utilized for that purpose. + +In the female, impotence may be caused by the narrowness of the vagina, +adhesion of the vulva, absence of vagina, imperforate hymen, and tumours +of the vagina. + +Sterility in women may occur from the above-named causes of impotence, +together with absence of the uterus and ovaries, or from great debility, +syphilis, constant amenorrhoea, dysmenorrhoea, or menorrhagia. + + + + +XXXV.--RAPE + + +Rape is the carnal knowledge of a woman by force and against her will. +The resistance of the woman _must be_ to the utmost of her power, but if +she yield through fear or duress it is still rape. The woman is a +competent witness, but her statements may be impugned on the ground of +her previous bad character, and evidence may be called to substantiate +the charge. The perpetrator must be above the age of fourteen years. + +The definition of rape which we have given is not altogether +satisfactory. Take, for example, the case of a woman who goes to bed +expecting her husband to return at a certain hour. The lodger, let us +say, takes advantage of this fact, and, getting into bed, has connection +with her, she not resisting, assuming all the while that it is her +husband. This is rape, but it is not 'by force,' and it is not 'against +her will,' but it is 'without her consent,' as she has not been fully +informed as to all the circumstances of the case. + +In all cases of rape in which there is no actual resistance or +objection, consent may be assumed. It is not essential that the woman +should state in so many words that she does not object. The force used +may be moral and not physical--_e.g._, threats, fear, horror, syncope. + +By 48 and 49 Vict., c. 49, the carnal knowledge of a girl under thirteen +is technically rape. The consent of the girl makes no difference, since +she is not of an age to become a consenting party. + +An attempt at carnal knowledge of a girl under thirteen is a +misdemeanour. Her consent makes no difference, and even the solicitation +of the act on the part of the child will not exonerate the accused. + +Intercourse with a girl between thirteen and sixteen, even with her +consent, is a misdemeanour. + +This Act is a favourite with the blackmailer. The child is sent out to +solicit, dressed like a woman, but appears in the witness-box in a much +more juvenile costume. + +To constitute rape there must be _penetration_, but this may be of the +slightest. There may be a sufficient degree of penetration to constitute +rape without rupturing the hymen. Proof of actual emission is now +unnecessary. + +The subject of carnal knowledge (C.K.) or its attempt may be summed up +as follows: + + +Under thirteen C.K. Felony. +Under thirteen Attempt Misdemeanour. + +Consent no defence. + +From thirteen to sixteen C.K. Misdemeanour. +From thirteen to sixteen Attempt Misdemeanour. + +Consent and even solicitation no defence. +Reasonable cause to believe the girl over sixteen is a good defence. +Charge must be brought within three months. + +Over sixteen C.K. with consent Nil. + +Subject to civil action for loss of girl's services by father. + +Idiot or imbecile C.K. with violence Rape. +Idiot or imbecile C.K. without violence Misdemeanour. +Personation of husband Rape. + +Tacit consent no defence, for obtained by fraud. + +Married woman C.K. with consent Adultery. +Mother, sister, daughter, C.K. consent immaterial; Incest. + grand-daughter born in wedlock or not +Females Indecent assaults Misdemeanour. + + +It is a misdemeanour to give to a woman any drug so as to stupefy her, +and so enable any person to have unlawful connection with her. + +False charges of rape are very often made. The motive may be to extort +blackmail, revenge, or mere delusion. On examining such cases bruises +are seldom found, but scratches which the woman has made on the front of +her body may be discovered, and the local injuries to the generative +organs are slight, if present at all. + +_Physical Signs._--In the adult the hymen may be ruptured, the +fourchette lacerated, and blood found on the parts, together with +scratches and other marks and signs of a struggle. In the child there +may be no hæmorrhage, but there will be indications of bruising on the +external organs, with probably considerable laceration of the hymen, the +laceration in some cases extending into the rectum. Severe hæmorrhage, +and even death, may follow the rape of a young child. The patient will +have difficulty in walking, and in passing water and fæces. After some +hours the parts are very tender and swollen, and a sticky +greenish-yellow discharge is present. These signs last longer in +children than in adults; but as a rule--in the adult, at least--all +signs of rape disappear in three or four days. Young and delicate +children may suffer from a vaginal discharge, with swelling of the +external genitals, simulating an attempt at rape. Infantile leucorrhoea +is common, and many innocent people have been exposed to danger from +false charges of rape on children, instituted as a means of levying +blackmail. A knowledge of these facts suggests the necessity of giving a +guarded opinion when children are brought for examination in suspected +cases. Pregnancy may follow rape. + +_Seminal stains_ render the clothing stiff and greyish-yellow in colour, +with translucent edges. On being moistened they give the characteristic +seminal odour. + +Semen may be found on the linen of the woman and man, and will be +recognized under the microscope by the presence in it of spermatozoa, +minute filamentary bodies with a pear-shaped head; but it must not be +forgotten that the non-detection of spermatozoa is no proof of absence +of sexual intercourse, for these bodies are not always present in the +semen of even healthy adult young men. Spermatozoa must not be mistaken +for the _Trichomonas vaginæ_ found in the vaginæ of some women. The +latter have cilia surrounding the head, which is globular. + +_Florence's Micro-Chemical Test for Spermatic Fluid._--If a drop of the +fluid obtained by wetting a supposed spermatic stain be mixed with a +drop of the following solution (KI, parts 1.65; pure iodine, 2.54; +distilled water, 30) in a watch-glass, brownish-red pointed crystals +resembling hæmin crystals are obtained. + +_Barberio's Test._--Mix a drop of the spermatic stain with a drop of a +saturated solution of picric acid, when needle-shaped yellow rhombic +crystals are formed. + +_Gonorrhoeal Stains._--A cover-glass preparation stained with methylene +blue reveals the gonococci lying in pairs within the leucocytes. + + + + +XXXVI.--UNNATURAL OFFENCES + + +Trials for =sodomy= and =bestiality= are common at the assizes, but, as +they are rarely reported, they fail to attract attention. Sodomy is a +crime both in the active and passive agent, unless the latter is a +non-consenting party. The evidence of either associated may be received +as against his colleague. If the crime is committed on a boy under +fourteen, it is a felony in the active agent only. As in cases of rape, +emission is not essential, and penetration, however slight, answers all +practical purposes. + +There can be no doubt that in the majority of these cases there exists a +congenitally abnormal condition of the sexual instinct, these +individuals from their childhood manifesting a perverted sexual +instinct. The man is physically a man, but psychically a woman, and +_vice versâ_. The tendency nowadays is not to charge these people with +the more serious offence, but to deal with them under Section 11 of the +Criminal Law Amendment Act, 1885 (48 and 49 Vict., c. 69). This section, +which is sufficiently comprehensive, runs as follows: 'Any male person +who in public or private commits or is a party to the commission, or +attempts to procure the commission by any male person, of any act of +gross indecency with another male person, shall be guilty of a +misdemeanour.' The penalty is imprisonment for two years, with or +without hard labour. It is provided by Section 4 of the same Act that a +boy under sixteen may be whipped. + +=Incest.=--This crime is dealt with under the Punishment of Incest Act, +1908 (8 Edward VII., c. 45). Carnal knowledge with mother, sister, +daughter, or grand-daughter, is a misdemeanour, provided the +relationship is known. It also applies to the half-brother and +half-sister. It is equally an offence whether the relationship can or +cannot be traced through lawful wedlock. Consent is no defence. A woman +may be charged under the Act if she, being above the age of sixteen, +with consent permits her grandfather, father, brother, or son, to have +carnal knowledge of her. + + + + +XXXVII.--BLACKMAILING + + +There are in London and every large city scores of men and women who +live by blackmailing or chantage. There are many different forms of this +industry. There is the man who knows something about your past life, +which he threatens to reveal to your friends or colleagues unless you +buy him off. There is the breach-of-promise blackmailer, and there is +the female patient, who threatens to charge you with improper conduct or +indecent assault. Medical men from their position are often selected as +victims. The introduction of corridor carriages on many of our railways +has done much to stamp out one particular form of blackmailing, but +public urinals are still a source of danger. + +It is the worst possible policy to temporize with a blackmailer. If you +give him a single penny, you are his for life. It is as well to remember +that it is just as criminal to attempt to extract money from a guilty as +from an innocent person. It is of no use attempting to deal with these +cases single-handed. You must not only deny the allegation, but 'spurn +the allegator.' Put the matter into the hands of a good sharp criminal +solicitor, and instruct him to rid you of the nuisance by taking +criminal proceedings. + + + + +XXXVIII.--MARRIAGE AND DIVORCE + + +Marriage may be accomplished in many ways: (1) By the publication of +banns; (2) by an ordinary licence; (3) by a special licence; (4) by the +Superintendent-Registrar's licence; (5) by a special licence granted by +the Archbishop of Canterbury in consideration of the payment of the sum +of £25. Then, for persons having a domicile in Scotland, there is the +marriage by repute. The consent of the parties, which is the essence of +the contract, may be expressed before witnesses, and it is not requisite +that a clergyman should assist, but it is essential that the expressions +of consent must be for a matrimonial intent. 'Habit and repute' +constitute good evidence, but the repute must be the general, constant, +and unvarying belief of friends and neighbours. The cohabitation must be +in Scotland. + +Any irregularity in the marriage ceremony or the non-observance of any +formality will not invalidate the marriage, unless it were known to both +the contracting parties. If a man were married in a wrong name the +contract would still be valid if the wife were unacquainted with the +deception at the time. If the person who officiated were a bogus +clergyman, the marriage would hold good if the contracting parties +supposed him to be a properly ordained priest. In a case in which a +marriage was solemnized in a building near the church at a time when the +church was undergoing repairs, and where during such alterations Divine +service had been performed, it was held that the ceremony was good. To +all intents and purposes marriage comes under the 'Law of Contract' (see +Anson, W.R., Bart.), and the law looks to the _intention_ rather than to +the actual details. All marriages between persons within the prohibited +degrees of consanguinity or affinity are null and void. This prohibition +extends both to the illegitimate as well as the legitimate children of +the late wife's or husband's parents. A marriage with a deceased wife's +sister is now legal in Great Britain and the Colonies, and is recognized +in most foreign countries. A common device with people within the +prohibited degrees is to get married abroad, but such marriage is +strictly speaking inoperative, and the children of such union are +illegitimate. Practically, however, it is a matter of no importance, for +when people live together and say they are married, they are accepted at +their own estimate. + +A man can obtain a divorce from his wife if he can prove that she has +been guilty of adultery since her marriage. This may be established by +inference. Obviously, it is difficult in the majority of cases to +establish by ocular demonstration that adultery has been committed. But +given evidence of familiarity and affection with opportunity and +suspicious conduct, a jury will commonly infer it. + +A woman cannot obtain a divorce from her husband for adultery alone. She +must prove adultery plus cruelty, or adultery plus desertion without +reasonable cause. Failing this, she may be able to prove either bigamy +or incestuous adultery. Legal cruelty is a very comprehensive term, and +does not of necessity mean physical violence. If the husband as the +result of his infidelity were to give his wife a contagious disease, +that would constitute cruelty. Taking a more extreme case, if a husband +were to have connection in her house with his wife's maid, that would +probably be held to constitute cruelty, as it would tend to lower her in +the eyes of her servants. + +A wife can obtain a judicial separation if she can prove (1) adultery, +(2) cruelty, or (3) desertion without reasonable cause for two years. If +a husband is away on his business, as, for example, the case of an +officer ordered abroad, that is not desertion. For a woman to get a +judicial separation, it is sufficient if she can prove one variety of +matrimonial offence, but for a divorce she requires more than one. + +The jury may find that Mrs. A. has committed adultery with Mr. B., but +that Mr. B. has not committed adultery with Mrs. A. The explanation is, +that a wife's confession is evidence against herself, but not against +another person. You can confess your own sins, but not another's. + +The Divorce Law of Scotland differs materially from that of England. In +Scotland there is no decree nisi, no decree absolute, and no +intervention by the King's Proctor. Instead there is a single and final +judgment, and when a decree of divorce is pronounced the successful +litigant at once succeeds to all rights, legal and conventional, that +would have come to him or her on the death of the losing party. If the +husband is the offender, the wife in such circumstances may claim her +right to one-third of his real estate; and if there are children, to +one-third of his personal property, and to one-half if there are none. + +=Voidable Marriages.=--If a man and woman go through the marriage +ceremony, such a contract is null and void under the following +circumstances: (1) Where bigamy has been committed; (2) if one of the +parties were insane at the time of marriage; (3) where the plaintiff is +under sixteen years of age; (4) when the marriage has not been +consummated or followed by cohabitation; (5) when one of the parties was +incapable of performing the marital act (impotent, and such not known by +the other at the time); (6) when drunkenness had been induced so as to +obtain consent; (7) concealment of pregnancy at the time of marriage. + + + + +XXXIX.--FEIGNED DISEASES + + +Malingering in its various forms is by no means uncommon, and by many is +regarded as a disease in itself. It is necessary, however, to +distinguish between those cases in which it is feigned for some definite +purpose--for example, to escape punishment or avoid public service--and +those in which there is adequate motive, and the patient shams simply +with the view of exciting sympathy, or from the mere delight of giving +trouble. It is not uncommon for individuals summoned on a jury, or to +give evidence in the law courts, to apply to their doctor for a +certificate, assigning as a cause of exemption neuralgia, or some +similar complaint unattended with objective symptoms. In such cases it +is well to remind the patient that in most courts such certificates are +received with suspicion, and are often rejected, and that the personal +attendance of the medical man is required to endorse his certificate on +oath. + +Malingering has become much more common since the National Health +Insurance Act has been passed. The possibility of obtaining a fair sum +each week without the necessity of working for it induces many persons +either to feign disease or to make recovery from actual disease or +accident much more tedious than it ought really to be. + +The feasibility of successfully malingering is greatly enhanced by the +possession of some chronic organic disease. An old mitral regurgitant +murmur is useful for this purpose. + +It is not flattering to one's vanity to overlook a case of malingering, +but should this occur little harm is done. It is a much more serious +matter to accuse a person of malingering when in reality he may be +suffering from an organic disease. + +Here are some of the diseases which are most frequently feigned: + +=Nervous Diseases=, as headache, vertigo, paralysis of limbs, vomiting, +sciatica, or incontinence or suppression of urine, spitting of blood; +others, again, simulate hysteria, epilepsy, or insanity. + +On the other hand, the malingerer may actually produce injuries on his +person either to excite commiseration or to escape from work. Thus, the +beggar produces ulcers on his legs by binding a penny-piece tightly on +for some days; the hospital patient, in order to escape discharge, +produces factitious skin diseases by the application of irritants or +caustics. + +It is much more difficult to decide whether certain symptoms are due to +a real disease which is present, or whether they are merely +exaggerations of slight symptoms or simulations of past ones. The miner, +after an injury to his back, recovers very slowly, if at all. He is +suffering from 'traumatic neurasthenia'--a condition only too often +simulated, and a disease very difficult to diagnose accurately. The +miner takes advantage of our ignorance, and continues to draw his +compensation. A workman during his work receives a fracture; instead of +being able to resume work in six weeks, he asserts that the pain and +stiffness prevent him, and this disability may persist for months. Such +cases as these frequently come before the courts when the employer has +discontinued to pay the weekly compensation for the injury. Medical men +are called to give evidence for or against the injured workman. + +=Epilepsy= is often simulated. The foaming at the mouth is produced by a +piece of soap between the gums and the cheek. The true epileptic, +especially if he suspects that a fit is imminent, takes his walks abroad +in some secluded spot, whilst the impostor selects a crowded locality +for his exertions. The epileptic often injures himself in falling, his +imitator never; one bites his tongue, but the other carefully refrains +from doing so. The skin of an epileptic during an attack is cold and +pallid, but that of the exhibitor is covered with sweat as the result of +his exertions. In epilepsy the urine and fæces are passed involuntarily, +but his colleague rarely considers it necessary to carry his deception +to this extent. In true epilepsy the eyes are partly open, with the +eyeballs rolling and distorted, whilst the pupils are dilated and do not +contract to light; the impostor keeps his eyes closed, and he cannot +prevent the iris from contracting when a bicycle-lamp is flashed across +his face. A useful test is to give the impostor a pinch of snuff, which +promptly brings the entertainment to an end. + +=Lumbago= is often feigned, and the imposture should be suspected when +there is a motive, and when physical signs, such as nodes and tender +spots, are absent. A simple test is to inadvertently drop a shilling in +front of him, when he will promptly stoop and pick it up. The same +principles apply to spurious sciatica. + +=Hæmorrhages= purporting to come from the lungs, stomach, or bowels, +rarely present much difficulty. The microscope is of use in all cases of +bleeding. Possibly the gums or the inside of the cheeks may have been +scratched or abraded with a pin. + +=Skin Diseases= are excited artificially, especially those which may be +produced by mechanical and chemical irritants. The most commonly +employed are vinegar, acetic acid, carbolic acid, nitric acid, and +carbonate of sodium; but tramps frequently use sorrel and various +species of ranunculus. The lesions simulated are usually inflammatory in +character, such as erythema, vesicular and bullous eruptions, and +ulceration of the skin. They may be complicated by the presence of +pediculi and other animal and vegetable parasites. Chromidrosis of the +lower eyelids in young women often owes its origin to a box of paints. +Factitious skin diseases are seen most commonly on the face and +extremities, especially on the left side--in other words, on the most +accessible parts of the body. + +Feigned menstruation, pregnancy, abortion, and recent delivery are +common, and should give rise to no difficulty. The same may be said of +feigned insanity, aphonia, deaf-mutism, and loss of memory. + +The following hints may be useful to a medical man when called to a +supposed case of malingering: Do not be satisfied with one visit, but go +again and unexpectedly; see that the patient is watched between the +visits; make an objective examination, compare the indications with the +statements of the patient, noting especially any discrepancies between +his account of his symptoms and the real symptoms of disease; ask +questions the reverse of the patient's statements, or take them for +granted, and he will often be found to contradict himself; have all +dressings and bandages removed; suggest, in the hearing of the patient, +some heroic methods of treatment--the actual cautery, or severe surgical +operation, for example; finally, chloroform will be found of great use +in the detection of many sham diseases. + + + + +XL.--MENTAL UNSOUNDNESS + + +The presumption in law is in favour of a person's sanity, even though he +may be deaf, dumb, or blind. + +The terms 'insanity,' 'lunacy,' 'unsoundness of mind,' 'mental +derangement,' 'madness,' and 'mental alienation or aberration,' are +indifferently applied to those states of disordered mind in which the +person loses the power of regulating his actions and conduct according +to the ordinary rules of society. The reasoning power is lost or +perverted, and he is no longer fitted to discharge those duties which +his social position demands. In some cases of insanity, as in confirmed +idiocy, there is no evidence of the exercise of the intellectual +faculties. It is probable that no standard of sanity as fixed by nature +can be said to exist. The medical witness should decline to commit +himself to any definition of insanity. There is no practical advantage +in attempting to classify the different forms of insanity. + +According to English law, madness absolves from all guilt, but in order +to excuse from punishment on this ground it must be proved that the +individual was not capable of distinguishing right from wrong in +relation to the particular act of which he is accused, and that he did +not know at the time of committing the crime that the offence was +against the laws of _God_ and _nature_. + +Lunatics are competent witnesses in relation to testimony, as in +relation to crime, if they understand the nature of an oath and the +character of the proceedings in which they are engaged. The judge, as in +the case of children, examines the lunatic tendered as a witness as to +his knowledge of the nature and obligation of an oath, and, if +satisfied, he allows him to be sworn. + +A person, if suffering from such a state of mental unsoundness as to be +unable to take care of his property, may be placed under the care of the +Court of Chancery. The Court then administers his property, and +otherwise allows him entire freedom of action. + +With regard to the care of lunatics, no person is allowed to receive +more than one lunatic into his house unless such house is licensed and +the proper certificates have been signed. One patient may be taken +without the house being licensed, but the usual certificates must in all +cases be signed, and the Lunacy Commissioners communicated with. If a +person receives another not of unsound mind into his house, and such +person becomes subsequently insane, the person so keeping him renders +himself liable to heavy penalties, unless the legal certificates are at +once procured and the Commissioners of Lunacy communicated with. + +At common law it appears that a lunatic cannot be placed in an asylum +unless dangerous to himself or to others, but under the Lunacy Acts the +placing of a madman in an asylum is considered as a part of the +treatment with a view to the cure of the patient. + + + + +XLI.--IDIOCY, IMBECILITY, CRETINISM + + +=Idiocy= is not a disease, but a congenital condition in which the +intellectual faculties are either never manifested or have not been +sufficiently developed to enable the idiot to acquire an amount of +knowledge equal to that acquired by other persons of his own age and in +similar circumstances with himself. Idiots, as a rule, are deformed in +body as well as deficient in mind. Their heads are generally small and +badly-shaped, and their features ill-formed and distorted. The teeth are +few in number and very irregular. The hard palate has a very deep arch, +or may even be cleft. The complexion is sallow and unhealthy, the limbs +imperfectly developed, and the gait is awkward, shambling, and unsteady. +In his legal relations an absolute idiot is civilly disabled and +irresponsible, but in regard to crime, or as a witness, see remarks made +above. + +=Imbecility= is a form of mental defect not usually congenital, but +commencing in infancy or in early life. The line of demarcation between +the imbecile and the idiot may be found in the possession by the former +of the faculty of speech, in distinction from the mere parrot-like +utterance of a few words which can be taught the idiot. Imbecility may +be intellectual, moral, or general. Questions frequently arise as to +their responsibility for actions done by them, or as to their ability to +manage their own affairs. + +=Cretinism= is a form of amentia, which is endemic in certain districts, +especially in some of the valleys of Switzerland, Savoy, and France. The +malady is not congenital, but its symptoms usually appear within a few +months of birth. The characteristics of this form of idiocy are an +enlarged thyroid gland constituting a goitre or bronchocele, a +high-arched palate, dwarfed stature, squinting eyes, sallow complexion, +small legs, conical head, large mouth, and indistinct speech. + +=Feeble-Minded.=--These are persons who are capable of earning a living +under favourable circumstances, but are incapable, from mental defect +which has existed from birth or from an early age, of (a) competing on +equal terms with their normal fellows, or (b) of managing themselves +and their affairs with ordinary prudence. Feeble-mindedness may affect +the moral nature only, rendering the person selfish, untruthful, +obscene, or unemployable. The Act of 1899 controls feeble-minded +children; many such become paupers, criminals, prostitutes, etc. + +=Mental Deficiency and Lunacy Act, 1913.=--Those included under this Act +are idiots, imbeciles, feeble-minded persons, and moral imbeciles. The +parents or guardians of such children between the ages of five and +sixteen years must provide for them education and proper care. If they +are unable to do so, the School Boards or Parish Councils must do so. + + + + +XLII.--DEMENTIA: ACUTE, CHRONIC, SENILE, AND PARALYTIC + + +In dementia the mental aberration does not occur until the mind has +become fully developed, thus differing from amentia, which is congenital +or comes on very early in life. + +=Acute Dementia.=--This is a condition of profound melancholy or stupor, +which arises from sudden mental shock, the mind being, as it were, +arrested and fixed in abstraction on the event. + +=Chronic Dementia= is generally caused by the gradual action on the mind +of grief or anxiety, by severe pain, mania, apoplexy, paralysis, or +repeated attacks of epilepsy. + +=Senile Dementia= is a form which is incidental to aged persons, and +commences gradually with such symptoms as loss of memory for recent +events, dulness of perception, and inability to fix the attention. Later +on the reasoning powers begin to fail, and finally, memory, reason, and +power of attention, are quite lost, the muscular power and force +remaining intact. In the last stage there is simply bare physical +existence. + +=General Paralysis of the Insane, Paralytic Dementia.=--This is a most +interesting form of dementia. It is closely allied to, if not identical +with, locomotor ataxy. Its most prominent and characteristic symptom +consists in delusions of great power, exalted position, and unlimited +wealth--megalomania. The exaltation is universal, and the patient may +maintain at one and the same time that he is running a theatrical +company, that he is the Prince of Wales, and that he is the Almighty. +Moral perversion is a common symptom, and the patient is often guilty of +criminal assaults, indecent exposures, bigamous marriages, and the like. +It is accompanied with progressive bodily and mental decay. Women are +comparatively rarely affected by it, and it generally commences in men +about middle age, and its duration is from a few months to three years. +It is commonly parasyphilitic in origin. Paralytic symptoms first appear +in the tongue, lips, and face; the speech becomes thick and hesitating. +The paralytic symptoms gradually go on increasing, the sphincters refuse +to act, and death may occur from suffocation and choking. Sometimes, +during the earlier stages especially, there may be maniacal paroxysms or +epileptic fits. The delusions remain the same throughout, the patient +always expresses himself as being happy, and his last words will +probably have reference to money and other absurd delusions. + +When a person of hitherto blameless life is charged with an act of +indecency, he should be examined for G.P.I. The condition of his +prostate should also be investigated. He may be suffering from either +mental or physical disease, or both (see p. 59). + + + + +XLIII.--MANIA + + +Under the term 'mania' are included all those forms of mental +unsoundness in which there is undue excitement. It is divided into +general, intellectual, and moral, and each of the two latter classes +again into general and partial. + +=General Mania= affects the intellect as well as the passions and +emotions. Mania is usually preceded by an incubative period in which the +patient's general health is affected. The duration of this period may +vary from a few days to fifteen or twenty years. When the disease is +established, the patient has paroxysms of violence directed against +himself as well as others. He tears his clothes to pieces, either +abstains from food and drink or eats voraciously, and sustains immense +muscular exertion without apparent fatigue. The face becomes flushed, +the eye wild and sparkling; there is pain, weight, and giddiness in the +head, with restlessness. + +=General Intellectual Mania=, attacking the intellect alone, is rare; +but some one emotion or passion, as pride, vanity, or love of gain, may +obtain ascendancy, and fill the mind with intellectual delusions. + +A _delusion_ may be defined as a perversion of the judgment, a +chimerical thought; an _illusion_, an incorrect impression of the +senses, counterfeit appearances; hence we speak of a delusion of the +mind, an illusion of the senses. Lawyers lay great stress on the +presence of delusions as indicative of insanity. An _hallucination_ is a +sensation which is supposed by the patient to be produced by external +impressions, although no material object acts upon his senses at the +time. + +=Partial Intellectual Mania=, or =Monomania=, also called =Melancholia=, +is a form of the disease in which the patient becomes possessed of some +single notion, contradictory alike to common-sense and his own +experience. + +=General Moral Mania.=--This is a morbid perversion of the natural +feelings, affections, inclinations, temper, habits, moral dispositions, +and natural impulses, without any remarkable disorder or defect of the +intellect, or knowing and reasoning faculties, and particularly without +any insane illusion or hallucination. It is often difficult to +distinguish this form of mania from the moral depravity which we +associate with the criminal classes. + +=Partial Moral Mania--Paranoia--Delusional Insanity.=--In this form one +or two only of the moral powers are perverted. Delusions are always +present, and very frequently are those of persecution. The patient's +conduct is dominated by his delusion; thus murder and suicide may be +committed. There are several forms: + +_Kleptomania_, a propensity to theft; common in women in easy +circumstances. _Dipsomania_, or _Oinomania_, an insatiable desire for +drink. _Morphinomania_, a craving for morphine or its preparations. +_Erotomania_, or amorous madness. When occurring in women this is also +called _Nymphomania_, and in men _Satyriasis_. It consists in an +uncontrollable desire for sexual intercourse. _Pyromania_, an insane +impulse to set fire to everything. _Homicidal mania_, a propensity to +murder. _Suicidal mania_, a propensity to self-destruction. Some +consider suicide as always a manifestation of insanity. + +=Insanity of Pregnancy.=--This may show itself after the third month of +pregnancy in the form of melancholia. It is not recovered from until +after delivery. + +=Puerperal Mania.=--This form of mania attacks women soon after +childbirth. There is in many cases a strong homicidal tendency against +the child. + +=Insanity of Lactation= comes on four to eight months after parturition, +either as mania or melancholia. The mother may repeatedly attempt +suicide. + +=Mania with Lucid Intervals.=--In many cases mania is intermittent or +recurrent in its nature, the patient in the interval being in his right +mind. The question of the presence or absence of a lucid interval +frequently occurs where attempts are made to set aside wills made by +persons having property. In these cases the law, from the reasonableness +of the provisions of the will, may assume the existence of the lucid +interval. A will made during a lucid interval is valid. When an attempt +is made to set aside the provisions of a will on the ground of insanity +in a person not previously judged insane, the plaintiff must show that +the testator was mad; when the provisions of the will of a lunatic are +attempted to be upheld, the plaintiff must show that the will was made +during a lucid interval. + +A testator is capable of making a valid will when he has (1) a knowledge +of his property and of his kindred; (2) memory sufficient to recognize +his proper relations to those about him; (3) freedom from delusions +affecting his property and his friends; and (4) sufficient physical and +mental power to resist undue influence. The fact of a man being subject +to delusions may not affect his testamentary capacity. He may believe +himself to be a tea-kettle, and yet be sufficiently sound mentally to +make a valid will. + +=Undue Influence.=--Persons of weak mind or those suffering from senile +dementia are often said to have been unduly influenced in making their +wills, and subsequently their dispositions are disputed in court. Before +witnessing the will made by such a person, the medical man should +satisfy himself that the testator is of a 'sound disposing mind.' This +he will do by questioning, and his knowledge of the home-life of the +patient will either confirm or set aside the idea of influence. + +A person who is aphasic may be competent to make a will. He may not be +able to speak, but may understand what is said to him, and may be able +to indicate his wishes by nods and shakes of the head. Ask him if he +wishes to make a will, then inquire if he has £10,000 to leave, then if +he has £100, and in this way arrive approximately at the sum. Then ask +him if he wishes to leave it all to one person. If he nods assent, ask +if it be to his wife or some other likely person. If he wishes to divide +it, ascertain his intention by definite questions, and, having +ascertained his views, commit them to writing, read the document over to +him, and ask if it expresses his intentions. That being settled, a mark +which he acknowledges in the presence of two witnesses, preferably men +of standing, will constitute a valid document. + +In certain forms of neurasthenia, the 'phobias' are common, but must not +be regarded as evidence of insanity. 'Agoraphobia' is the fear of +crossing an open space, 'batophobia' is the fear that high things will +fall, 'siderophobia' is the fear of thunder and lightning, 'pathophobia' +is the fear of disease, whilst 'pantophobia' is the fear of everything +and everybody. + +=Epilepsy in Relation to Insanity.=--The subjects of this disease are +often subject to sudden fits of uncontrollable passion; their conduct is +sometimes brutal, ferocious, and often very immoral. As the fits +increase in number, the intellect deteriorates and chronic dementia or +delusional insanity may supervene. (1) Before a fit the patient may +develop paroxysms of rage with brutal impulses (_preparoxysmal +insanity_), and may commit crimes such as rape or murder. (2) Instead of +the usual epileptic fit, the patient may have a violent maniacal attack +(_masked epilepsy_, _epileptic equivalent_, _psychic form of epilepsy_). +(3) After the fit the patient may perform various automatic actions +(_post-epileptic automatism_) of which he has no subsequent +recollection. Thus the patient may urinate or undress in a public place, +and may be arrested for indecent exposure. Epileptics who suffer from +both petit and grand mal attacks are specially liable to maniacal +attacks. Such insanity differs from ordinary insanity in its sudden +onset, intensity of symptoms, short duration and abrupt ending. To +establish a plea of epilepsy in cases of crime, one must show that the +individual really did suffer from true epilepsy, and that the crime was +committed at a period having a definite relation to the epileptic +seizure. + +=Alcoholic Insanity.=--This may occur in three forms: + +1. _Acute Alcoholic Delirium_ (_mania a potu_), due to excessive amount +of alcohol consumed. + +2. _Delirium Tremens_, due to long-continued over-drinking. The patient +suffers from horrible dreams, illusions, and suspicions, which may lead +him to attack people or commit suicide. + +3. _Chronic Alcoholic Insanity._ Loss of memory is the chief symptom, +with paralysis of motion, hallucinations and delusions of persecution. + +=Responsibility for Criminal Acts.=--To establish a defence on the +ground of insanity, it must be proved that the prisoner at the time when +the crime was committed did not know the nature and quality of the act +he was committing, and did not know that it was wrong. At the present +time, however, the _power of controlling his actions_ is usually made +the test. + +The plea of insanity is brought forward, as a rule, only in capital +charges, so that the prisoner, if found guilty, will escape hanging. If +proved 'guilty, but insane,' the person is sentenced to be kept in a +criminal lunatic asylum 'during His Majesty's pleasure.' + + + + +XLIV.--EXAMINATION OF PERSONS OF UNSOUND MIND + + +The following hints with regard to the examination of patients supposed +to be insane will be useful: The general appearance and shape of head, +complexion, and expression of countenance, gait, movements, and speech, +should be noted; the state of the general health, appetite, bowels, +tongue, skin, and pulse, should be inquired into; and in women the state +of the menstrual function should be ascertained. The family history must +be traced out, and the personal history taken with care, especially as +to whether the unsoundness came on late in life or followed any physical +cause. Ascertain whether it is a first attack, whether the patient has +suffered from epilepsy, has squandered his money, grown restless, has +absurd delusions, etc. In order to ascertain the capacity of the mind, +questions should be asked with regard to age, birthplace, profession, +number of family, and common events, such as the day of week, month, and +year. The power of performing simple arithmetical operations may be +tested. It may be necessary to pay more than one visit. The examiner +should be careful to ask questions adapted to the station of life of the +supposed lunatic; a man is not necessarily mad because he cannot perform +simple arithmetical operations, or does not know about things with which +his questioner is well acquainted. The opinion of a supposed lunatic +that his examiner's feet _were large_ was not considered by the +Commissioners among the facts indicating insanity, yet statements quite +as absurd are made by medical men as 'facts of insanity' observed by +themselves. 'Reads his Bible and is anxious about the salvation of his +soul' is another example of a bad certificate. Some well-marked delusion +should be recorded. + +For a lunacy certificate (_Reception Order on Petition_ or _Judicial +Reception Order_), except in the case of a pauper patient, there are +required the signatures of two independent medical men and of a relation +or friend. The medical men must not be in partnership or in any way +interested in the patient; they must make separate visits at different +times, and write on the proper forms the facts observed by themselves +and those observed by others, giving the name of the informer. A +certificate is valid only for seven days. In very urgent non-pauper +cases the signature of one medical man is sufficient, but such +certificate (_Emergency Certificate_ or _Urgency Order_) is only valid +for two days, and, as the patient can only be detained in the asylum +under this order for seven days in England or three in Scotland, it must +be supplemented by another signed as above directed. The medical +certificate must contain a statement that it is expedient for the +alleged lunatic to be placed forthwith under care, with reasons for +making such statement. The certifying medical practitioner must have +personally examined the patient not more than two clear days before his +reception. In London and other large towns, where an expert opinion is +readily obtainable, it is not expedient to resort to such urgency +orders. Medical men should be careful how they sign certificates of +insanity. No medical man is bound to certify, but if he does so he must +be prepared to take the responsibility of his acts. There must be no +reasonable ground for alleging want of 'good faith' or 'reasonable +care.' The practitioner must exercise that amount of care and skill +which he may reasonably be expected to possess. + + + + +XLV.--THE INEBRIATES ACTS + + +It is somewhat difficult to define an inebriate, but for the moment the +following will suffice, and will ultimately, in all probability, be +officially adopted: + +An inebriate is a person who habitually takes or uses any intoxicating +thing or things, and while under the influence of such thing or things, +or in consequence of the effects thereof, is--(a) dangerous to himself +or others; or (b) a cause of harm or serious annoyance to his family or +others; or (c) incapable of managing himself or his affairs, or of +ordinary proper conduct. + +Under the provisions of the Habitual Drunkards Acts (42 and 43 Vict., c. +19, and 51 and 52 Vict., c. 19), any habitual drunkard may voluntarily +place himself under restraint. He must make an application to the owner +of a licensed retreat, stating the time during which he undertakes to +remain. His application must be accompanied by a statutory declaration +of two persons stating that they knew the applicant to be a confirmed +drunkard. Without this testimony as to moral character his application +cannot be entertained. His signature must also be attested by two +justices, who must state that he understands the effect of his +application, and that it has been explained to him. The limit to the +term of restraint is twelve months, after which he must resume his +former habits if he wishes to qualify for another period. The Act works +automatically, and, when it has been set for a certain time, the patient +cannot release himself until the period has expired. The Inebriates' +Retreat must be duly licensed, and the licensee incurs distinct +obligation in return for the powers entrusted to him. It is an offence +against the Act to assist any habitual drunkard to escape from his +retreat, and should he succeed in effecting his escape he may be +arrested on a warrant. A drunkard who does not obey orders and conform +to the rules of the establishment may be sent to prison for seven days. +It may be as well to mention that it is an offence to supply any +drunkard under the Act with any intoxicating drink or sedative or +stimulant drug without authority, and that the penalty is a fine of £20 +or three months' imprisonment. The Act is a good one, but might be +carried farther with advantage. It has been ruled that a crime committed +during drunkenness is as much a crime as if committed during sobriety. A +person is supposed to know the effect of drink, and if he takes away his +senses by drink it is no excuse. He is held answerable both for being +under the influence of alcohol or of any other drug, and for the acts +such influence induces. + +=Inebriates Act= (1898-1900).--If an habitual drunkard be sentenced to +imprisonment or penal servitude for an offence committed during +drunkenness, or if he has been convicted four times in one year, the +court may order him to be detained for a term not exceeding three years +in an inebriate reformatory. + + + + +PART II + +TOXICOLOGY + + + + +I.--DEFINITION OF A POISON + + +Though the law does not define in definite terms what a poison really +is, it lays stress on the _malicious intention_ in giving a drug or +other substance to an individual. It is a _felony_ to administer, or +cause to be administered, any poison or other destructive thing with +intent to murder, or with the intention of stupefying or overpowering an +individual so that any indictable offence may be committed. It is a +_misdemeanour_ to administer any poison, or destructive or noxious +thing, merely to aggrieve, injure, or annoy an individual. For a working +_definition_ we may state that a poison is a substance which, when +introduced into or applied to the body, is capable of injuring health or +destroying life. A poison may therefore be swallowed, applied to the +skin, injected into the tissues, or introduced into any orifice of the +body. + + + + +II.--SALE OF POISONS; SCHEDULED POISONS + + +The sale of poisons is regulated by various Acts, but chiefly by the +Pharmacy Act, 1868, and by the Poisons and Pharmacy Act, 1908. Only +registered medical practitioners and legally qualified druggists are +permitted to dispense and sell scheduled poisons. They are responsible +for any errors which may be committed in the sale of poisons. If a +druggist knows that a drug in a prescription is to be used for an +improper purpose, he may refuse to dispense it. The practitioner who +carelessly prescribes a drug in a poisonous dose is not held +responsible, but the dispenser would be if he dispensed it and harmful +or fatal consequences followed on its being swallowed. When a dispenser +finds an error in a prescription, it is his duty to communicate with the +prescriber privately pointing out the mistake. + +A great responsibility rests on the medical man who does his own +dispensing, as there is no one to check his work. + +If a doctor prescribes a drug with the intention of curing or preventing +a disease, but that, contrary to expectation and general experience, it +causes illness or even death, no responsibility can rest with the +prescriber. It has to be proved that actual injury has been sustained by +the complainant before an action for damages can be commenced, and that +the plaintiff was free from all contributory negligence. + +=Scheduled Poisons.=--By the Pharmacy Act of 1868 two groups of poisons +are scheduled. Part I. contains a list of those which are considered +very active poisons--_e.g._, arsenic, alkaloids, belladonna, +cantharides, coca (if containing more than 1 per cent. alkaloids), +corrosive sublimate, diachylon, cyanides, tartar emetic, ergot, nux +vomica, laudanum, opium, savin, picrotoxin, veronal and all poisonous +urethanes, prussic acid, vermin killers, etc. Such poisons must not be +sold to strangers, but only to persons known to or introduced by someone +known to the druggist. If sold, the latter must enter into the 'Poison +Register' the name of the poison, the name of the person to whom it is +sold, the quantity and purpose for which it is to be used, and date of +sale. The entry must be signed by the purchaser and by the introducer. +The word 'Poison' must be affixed to the bottle or package, and also +the name and address of the seller. + +Part II. contains a list of poisons supposed to be less active. These +may only be sold if on the bottle, box, or package there is affixed a +label with the name of the article, the word 'Poison,' and the name and +address of the seller. It is not necessary to enter the transaction in a +register. + +Chemists are required to keep poisons in specially distinguishable +bottles, and these in a special room or locked cupboard. + +=Dangerous Drugs Act, 1920.=--The regulations restrict the manufacture +and sale of opium, morphine, cocaine, and heroin so as to prevent their +abuse. Preparations containing less than 1/5 per cent. of the first two +or less than 1/10 per cent. of the last two are excluded. Prescriptions +containing the above drugs must be dated and signed with the full name +and address of the prescriber, and must have also those of the patient. +The total amount of the drug to be supplied must be stated, and it must +not be dispensed more than once; the dispenser retains the prescription. +Special books must be kept recording the purchase and sale of these +drugs. + +=Proprietary Medicines Bill= (introduced in 1920, and likely soon to +become law).--The sale of any unregistered proprietary medicine +purporting to cure certain diseases or produce abortion is made an +offence. A register of proprietary medicines, etc., is established. The +object is to protect the public against quack remedies. + +=Notification of Poisoning.=--Every case of poisoning which occurs in +any industry (lead, arsenic, anthrax, etc.) must be notified by the +medical attendant to the Chief Inspector of Factories (Factory and +Workshops Act, 1895). + + + + +III.--ACTION OF POISONS; CLASSIFICATION OF POISONS + + +=Action of Poisons.=--They may act either locally or only after +absorption into the system. + +1. _Local Action_, as seen in (a) corrosive poisons; (b) irritant +poisons, causing congestion and inflammation of the mucous +membranes--_e.g._, metallic and vegetable irritants; (c) stimulants or +sedatives to the nerve endings, as aconite, conium, cocaine. + +2. _Remote Action._--This may be of reflex character, as seen in the +shock produced by the pain caused by corrosive poisons, or the poison +may exert a special action on certain structures, as belladonna on the +cells of the brain, strychnine on the motor nerve cells of the spinal +cord. + +3. _In Both Ways._--Certain poisons, as carbolic or oxalic acids, act in +this way. + +Age, idiosyncrasy, tolerance, and disease, all exert modifying +influences on the action of a poison. The form in which the poison is +swallowed and the quantity also determine its action. In the gaseous +form, poisons act most rapidly and fatally. When in solution and +injected hypodermically, they also act very rapidly. In the solid form +they act as a rule slowly, and may even set up vomiting, and so may be +entirely ejected by vomiting. Poisons act most energetically when the +stomach is empty. If taken when the stomach already contains food, +solution and absorption may be greatly delayed. + +Some poisons are cumulative in their action, and thus, even if +infinitesimal doses be swallowed each day, there is a certain amount of +storage in the tissues (though a certain percentage of the poison is +being constantly eliminated), and at last symptoms of poisoning show +themselves. + +=Classification of Poisons.=--As an aid to memory, the following +classification is perhaps the best: + + + I. _Inorganic._ + + 1. Corrosive acids and alkalies, and caustic salts (carbolic and + oxalic acids also). + 2. Irritant--practically all the metals and the metalloids (I. Cl. + Br. P.). + + II. _Organic._ + + { Animal--venomous bites, food poisoning, cantharides. + 1. Irritant { Vegetable--all strong purgatives, hellebores, savin, + { yew, ergot, hemlock, laburnum, bryony, etc. + + 2. Neuronic. + + (a) Somniferous--opium and its alkaloids. + (b) Deliriant--belladonna, hyoscyamus, stramonium, cannabis, + cocaine, cocculus, camphor, fungi. + (c) Inebriants--alcohol, ether, chloral, carbolic acid (weak), + benzol, aniline, nitro-glycerine. + + 3. Sedative or depressant. + + (a) Neural--conium, lobelia, tobacco, physostigma. + (b) Cerebral--hydrocyanic acid. + (c) Cardiac--aconite, digitalis, colchicum, veratrum. + + 4. Excito-motory or convulsives--nux vomica, strychnine. + + 5. Vulnerants--powdered glass. + + +III. _Asphyxiants._ + + Poisonous and irrespirable gases. + + + + +IV.--EVIDENCE OF POISONING + + +It may be inferred that poison has been taken from consideration of the +following factors: Symptoms and post-mortem appearances, experiments on +animals, chemical analysis, and the conduct of suspected persons. + +1. _Symptoms_ in poisoning usually come on suddenly, when the patient is +in good health, and soon after taking a meal, drink, or medicine. Many +diseases, however, come on suddenly, and in cases of slow poisoning the +invasion of the symptoms may be gradual. + +2. _Post-Mortem Appearances._--These in many poisons and classes of +poisons are characteristic and unmistakable. The post-mortem appearances +peculiar to the various poisons will be described in due course. + +3. _Experiments on Animals._--These may be of value, but are not always +conclusive. + +4. _Chemical Analysis._--This is one of the most important forms of +evidence, as a demonstration of the actual presence of a poison in the +body carries immense weight. The poison may be discovered in the living +person by testing the urine, the blood abstracted by bleeding, or the +serum of a blister. In the dead body it may be found in the blood, +muscles, viscera--especially the liver--and secretions. Its discovery in +these cases must be taken as conclusive evidence of administration. If, +however, it be found only in substances rejected or voided from the +body, the evidence is not so conclusive, as it may be contended that the +poison was introduced into or formed in the material examined after its +rejection from the body, or if the quantity be very minute it will be +argued that it is not sufficient to cause death. A poison may not be +detected in the body, owing to defective methods, smallness of the dose +required to cause death, or to its ejection by vomiting or its +elimination by the excretions. + +5. _Conduct of Suspected Persons._--A prisoner may be proved to have +purchased poison, to have made a study of the properties and effects of +poison, to have concocted medicines or prepared food for the deceased, +to have made himself the sole attendant of the deceased, to have placed +obstacles in the way of obtaining proper medical assistance, or to have +removed substances which might have been examined. + + + + +V.--SYMPTOMS AND POST-MORTEM APPEARANCES OF DIFFERENT CLASSES OF POISONS + + +Whilst recognizing the fact that toxic agents cannot be accurately +classified, the following grouping may for descriptive purposes be +admitted with the view of saving needless repetition: + +1. =Corrosives.=--Characterized by their destructive action on tissues +with which they come in contact. The principal inorganic corrosives are +the mineral acids, the caustic alkalies, and their carbonates; the +organic are carbolic acid, strong solutions of oxalic acid, and acetic +acid. + +_Symptoms._--Burning pain in mouth, throat, and gullet, strong acid, +metallic or alkaline taste; retching and vomiting, the discharged +matters containing shreds of mucus, blood, and the lining membrane of +the passages. Inside of mouth corroded. There are also dysphagia, +thirst, dyspnoea, small and frequent pulse, anxious expression, shock. +Death may result from shock, destruction of the parts--_e.g._, +perforation of stomach or duodenum, suffocation; or some weeks +subsequently death may be due to cicatricial contraction of the gullet, +stomach, or pylorus. + +_Post-Mortem Appearances._--Those of corrosion, with corrugation from +strong contraction of muscular fibres, and followed by inflammation and +its consequences. The mouth, gullet, and stomach, and in some cases the +intestines, may be white, yellow, or brown, shrivelled and corroded. The +corrosions may be small, or may extend over a very large surface. +Sometimes considerable portions of the lining membrane of the gullet or +stomach may be discharged by vomiting or by stool. Beyond the corroded +parts the textures are acutely inflamed. The stomach is filled with a +yellow, brown, or black gelatinous liquid or black blood, and may in +rare cases be perforated. + +2. =Irritants.=--These are substances which inflame parts to which they +are applied. The class includes mineral, animal, and vegetable +substances, and contains a larger number of poisons than all the other +classes together. Irritants may be divided into two groups: (1) Those +which destroy life by the irritation they set up in the parts to which +they are applied; (2) those which add to local irritation peculiar or +specific remote effects. The first group includes the principal +vegetable irritants, some alkaline salts, some metallic poisons, etc.; +and the second comprises the metallic irritants, the metalloids +(phosphorus and iodine), and one animal substance, cantharides. + +_Symptoms._--Burning pain and constriction in throat and gullet, pain +and tenderness of stomach and bowels, intense thirst, nausea, vomiting, +purging and tenesmus, with bloody stools, dysuria, cold skin, and feeble +and irregular pulse. The vomit consists at first of the food, then it +becomes bile-stained, and later dark coffee-grounds in appearance, due +to extravasation of blood from the over-distended vessels in the gastric +mucous membrane. Death may occur from shock, convulsions, collapse, +exhaustion, or from starvation on account of chronic inflammation of the +gastro-intestinal mucous membrane. + +_Post-Mortem Appearances._--Those of inflammation and its consequences. +Coats of stomach, fauces, gullet, and duodenum, may be thickened, +black, ulcerated, gangrenous, or sloughing. Vessels filled with dark +blood ramify over the surface. Acute inflammation is often found in the +small intestines, with ulceration and softening of mucous membrane. The +rectum is frequently the seat of marked ulceration. + +3. =Poisons Acting on the Brain.=--Three classes: The opium group, +producing sleep; the belladonna group, producing delirium and illusions; +and the alcohol group, causing exhilaration, followed by delirium or +sleep. + +_Symptoms._--Of the opium group, giddiness, headache, dimness of sight, +contraction of the pupils, noises in the ears, drowsiness and confusion, +passing into insensibility. Of the belladonna group, delirium, illusions +of sight, dilated pupils, dry mouth, thirst, redness of skin, coma. Of +the alcohol group, excitement of circulation and of cerebral functions, +want of power of co-ordination and of muscular movement, double vision, +mania, followed by profound sleep and coma. In the chronic form, +delirium tremens. + +_Post-Mortem Appearances._--In the opium group, fulness of the sinuses +and veins of the brain, with effusion of serum into the ventricles and +beneath the membranes. In the belladonna group, nil. In the alcohol +group, signs of inflammation, congestion of brain and membranes, +fluidity of blood, long-continued rigor mortis. + +4. =Poisons Acting on the Spinal Cord.=--Strychnine, brucine, thebaïne. +The leading symptom is tetanic spasm. + +5. =Poisons Affecting the Heart.=--These kill by sudden shock, syncope, +or collapse. They comprise prussic acid, dilute solution of oxalic acid +and oxalates, aconite, digitalis, strophanthus, convallaria, and +tobacco. + +6. =Poisons Acting on the Lungs.=--These have for their type carbonic +acid gas and coal gas. The fumes of ammonia are intensely irritating, +and may give rise to laryngitis, bronchitis, and even pneumonia. Nitric +acid fumes sometimes produce no serious symptoms for an hour or more, +but there may then be coughing, difficulty of breathing, and tightness +in the lower part of the throat, followed by capillary bronchitis (see +p. 120). + + + + +VI.--DUTY OF PRACTITIONER IN SUPPOSED CASE OF POISONING + + +If called to a case supposed or suspected to be one of poisoning, the +medical man has two duties to perform: To save the patient's life, and +to place himself in a position to give evidence if called on to do so. +If life is extinct, his duty is a simple one. He should make inquiries +as to symptoms, and time at which food or medicine was last taken. He +should take possession of any food, medicine, vomited matter, urine, or +fæces, in the room, and should seal them up in clean vessels for +examination. He should notice the position and temperature of the body, +the condition of rigor mortis, marks of violence, appearance of lips and +mouth. He should not make a post-mortem examination without an order in +writing from the coroner. In making a post-mortem examination, the +alimentary canal should be removed and preserved for further +investigation. A double ligature should be passed round the oesophagus, +and also round the duodenum a few inches below the pylorus. The gut and +the gullet being cut across between these ligatures, the stomach may be +removed entire without spilling its contents. The intestines may be +removed in a similar way, and the whole or a portion of the liver should +be preserved. These should all be put in separate jars without any +preservative fluid, tied up, sealed, labelled, and initialled. All +observations should be at once committed to writing, or they will not be +admitted by the court for the purpose of refreshing the memory whilst +giving evidence. If the medical practitioner is in doubt on any point, +he should obtain technical assistance from someone who has paid +attention to the subject. + +In a case of attempted suicide by poisoning, is it the duty of the +doctor to inform the police? He would be unwise to do so. He had much +better stick to his own business, and not act as an amateur detective. + + + + +VII.--TREATMENT OF POISONING + + +The modes of treatment may be ranged under three heads: (1) To eliminate +the poison; (2) to antagonize its action; (3) to avert the tendency to +death. + +1. The first indication is met by the administration of emetics, to +produce vomiting, or by the application of the stomach-tube. The best +emetic is that which is at hand. If there is a choice, give apomorphine +hypodermically. The dose for an adult is 10 minims. It may be given in +the form of the injection of the Pharmacopoeia, or preferably as a +tablet dissolved in water. Apomorphine is not allied in physiological +action to morphine, and may be given in cases of narcotic poisoning. +Sulphate of zinc, salt-and-water, ipecacuanha, and mustard, are all +useful as emetics. Tickling the fauces with a feather may excite +vomiting. + +In using the elastic stomach-tube, some fluid should be introduced into +the stomach before attempting to empty it, or a portion of the mucous +membrane may be sucked into the aperture. The tube should be examined to +see that it is not broken or cracked, as accidents have happened from +neglecting this precaution. The bowels and kidneys must also be +stimulated to activity, to help in the elimination of the poison. + +2. The second indication is met by the administration of the appropriate +antidote. Antidotes are usually given hypodermically, or, if by mouth, +in the form of tablets. In the absence of a hypodermic syringe, the +remedy may be given by the rectum. In the selection of the appropriate +antidote, a knowledge of pharmacology is required, especially of the +physiological antagonism of drugs. Antidotes may act (1) chemically, by +forming harmless compounds, as lime in oxalic acid poisoning; (2) +physiologically, the drug which is administered neutralizing more or +less completely the poison which has been absorbed; (3) physically, as +charcoal. Every doctor should provide himself with an antidote case. The +various antidotes will be mentioned under their respective poisons. + +3. To avert the tendency to death, we must endeavour to palliate the +symptoms and neutralize the effects of the poison. Pain must be relieved +by the use of morphine; inflamed mucous membrane soothed by such +_demulcents_ as oils, milk, starch; stimulants to overcome collapse; +saline infusions in shock, etc. In the case of narcotics and depressing +agents, stimulants, electricity, and cold affusions, may be found +useful. We should endeavour to promote the elimination of the poison +from the body by stimulating the secretions. + + + + +VIII.--DETECTION OF POISONS + + +Notice the smell, colour, and general appearance, of the matter +submitted for examination. The odour may show the presence of prussic +acid, alcohol, opium, or phosphorus. The colour may indicate salts of +copper, cantharides, etc. Seeds of plants may be found. + +This examination having been made, the contents of the alimentary canal, +and any other substances to be examined, must be submitted to chemical +processes. + +Simple filtration will sometimes suffice to separate the required +substance; in other cases dialysis will be necessary, in order that +crystalloid substances may be separated from colloid bodies. + +In the case of volatile substances distillation will be required. The +poisons thus sought for are alcohol, phosphorus, iodine, chloral, +ether, hydrocyanic acid, carbolic acid, nitro-benzol, chloroform, and +anilin. The organic matters are placed in a flask, diluted with +distilled water if necessary, and acidulated with tartaric acid. The +flask is heated in a water-bath, and the vapours condensed by a Liebig's +condenser. In the case of phosphorus the condenser should be of glass, +and the process of distillation conducted in the dark, so that the +luminosity of the phosphorus may be noted. + +For the separation of an alkaloid, the following is the process of +Stas-Otto. This process is based upon the principle that the salts of +the alkaloids are _soluble in alcohol and water_, and _insoluble in +ether_. The pure alkaloids, with the exception of morphine in its +crystalline form, are _soluble_ in ether. Make a solution of the +contents of the stomach or solid organs minced very fine by digesting +them with acidulated alcohol or water and filtering. The filtrate is +shaken with ether to remove fat, etc., the ether separated, the watery +solution neutralized with soda, and then shaken with ether, which +removes the alkaloid in a more or less impure condition. The knowledge +of these facts will help to explain the following details, which may be +modified to suit individual cases: (1) Treat the organic matter, after +distillation for the volatile substances just mentioned, with twice its +weight of absolute alcohol, free from fusel oil, to which from 10 to 30 +grains of tartaric or oxalic acid have been added, and subject to a +gentle heat. (2) Cool the mixture and filter; wash the residue with +strong alcohol, and mix the filtrates. _The residue may be set aside for +the detection of the metallic poisons, if suspected._ Expel the alcohol +by careful evaporation. On the evaporation of the alcohol the resinous +and fatty matters separate. Filter through a filter moistened with +water. Evaporate the filtrate to a syrup, and extract with successive +portions of absolute alcohol. Filter through a filter moistened with +alcohol. Evaporate filtrate to dryness, and dissolve residue in water, +the solution being made distinctly acid. Now shake watery solution with +ether. (3) Ether from the acid solution dissolves out _colchicin_, +_digitalin_, _cantharidin_, and _picrotoxin_, and traces of _veratrine_ +and _atropine_. Separate the ethereal solution and evaporate. Hot water +will now dissolve out _picrotoxin_, _colchicin_, and _digitalin_, but +not cantharidin. (4) The remaining acid watery liquid, holding the other +alkaloids in solution or suspension, is made strongly alkaline with +soda, mixed with four or five times its bulk of ether, chloroform, or +benzole, briskly shaken, and left to rest. The ether floats on the +surface, holding the alkaloids, except morphine, in solution. (5) A part +of this ethereal solution is poured into a watch-glass and allowed to +evaporate. If the alkaloid is volatile, oily streaks appear on the +glass; if not volatile, crystalline traces will be visible. If a +volatile alkaloid, add a few pieces of calcium chloride to ethereal +solution to absorb the water; draw off the ethereal solution with a +pipette, allow it to evaporate, and test the residue for the alkaloids, +conine and nicotine. + +If a fixed alkaloid, treat the acid solution with soda or potash and +ether, evaporate ethereal solution after separation, when the solid +alkaloid will be left in an impure state. To purify it, add a small +quantity of dilute sulphuric acid, and, after evaporating to +three-quarters of its bulk, add a saturated solution of carbonate of +potash or soda. Absolute alcohol will then dissolve out the alkaloid, +and leave it on evaporation in a crystalline form. + +_General Reactions for Alkaloids._--(1) Wagner's reagent (iodine +dissolved in a solution of potassium iodide) yields a reddish-brown +precipitate; (2) Mayer's reagent (potassio-mercuric iodide) gives a +yellowish-white precipitate; (3) phospho-molybdic acid gives a yellow +precipitate; (4) platinic chloride, a brown precipitate; (5) tannic +acid, etc. + +In order to isolate an inorganic substance from organic matter, +Fresenius's method is adopted. Boil the finely divided substance with +about one-eighth its bulk of pure hydrochloric acid; add from time to +time potassic chlorate until the solids are reduced to a straw-yellow +fluid. Treat this with excess of bisulphate of sodium, then saturate +with sulphuretted hydrogen until metals are thrown down as sulphides. +These may be collected and tested. From the acid solution, hydrogen +sulphide precipitates copper, lead, and mercury, _dark_; arsenic, +antimony, and tin, _yellowish_. If no precipitate, add ammonia and +ammonium sulphide, iron, _black_, zinc, _white_, chromium, _green_, +manganese, _pink_. The residue of the material after digestion with +hydrochloric acid and potassium chlorate may have to be examined for +silver, lead, and barium. + +For the detection of minute quantities, the microscope must be used, and +Guy's and Helwig's method of sublimation will be found advantageous. +Crystalline poisons may be recognized by their characteristic forms. + + + + +IX.--THE MINERAL ACIDS + + +These are sulphuric, nitric, and hydrochloric acids. + +_Symptoms of Poisoning by the Mineral Acids._--Acid taste in the mouth, +with violent burning pain extending into the oesophagus and stomach, and +commencing immediately on the poison being swallowed; eructations, +constant retching, and vomiting of brown, black, or yellow matter +containing blood, coagulated mucus, epithelium, or portions of the +lining membrane of the gullet and stomach. The vomited matters are +strongly acid in reaction, and stain articles of clothing on which they +may fall. There is intense thirst and constipation, with scanty or +suppressed urine, tenesmus, and small and frequent pulse; the lips, +tongue, and inside of the mouth, are shrivelled and corroded. Exhaustion +succeeds, and the patient dies either collapsed, convulsed, or +suffocated, the intellect remaining clear to the last. After recovering +from the acute form of poisoning, the patient may ultimately die from +starvation, due to stricture of the oesophagus, stomach, etc. + +_Post-Mortem Appearances Common to the Mineral Acids._--Stains and +corrosions about the mouth, chin, and fingers, or wherever the acid has +come in contact. The inside of the mouth, fauces, and oesophagus, is +white and corroded, yellow or dark brown, and shrivelled. Epiglottis +contracted or swollen. Stomach filled with brown, yellow, or black +glutinous liquid; its lining membrane is charred or inflamed, and the +vessels are injected. Pylorus contracted. Perforation, when it takes +place, is on the posterior aspect; the apertures are circular, and +surrounded by inflammation and black extravasation. The blood in the +large vessels may be coagulated. + +Avoid mistaking gastric or duodenal ulcer, with or without perforation, +for the effects of a corrosive poison. + +_Treatment._--Calcined magnesia or the carbonate or bicarbonate of +sodium, mixed with milk or some mucilaginous liquid, are the best +antidotes. In the absence of these, chalk, whiting, milk, oil, +soap-suds, etc., will be found of service. The stomach-pump should not +be used. If the breathing is impeded, tracheotomy may be necessary. +Injuries of external parts by the acid must be treated as burns. + + + + +X.--SULPHURIC ACID + + +=Sulphuric Acid=, or oil of vitriol, may be concentrated or diluted. It +is frequently thrown over the person to disfigure the features or +destroy the clothes. Parts of the body touched by it are stained, first +white, and then dark brown or black. The presence of corrosion of the +mouth is as important as the chemical tests. Black woollen cloths are +turned to a dirty brown, the edges of the spots becoming red in a few +days, due to the dilution of the acid from the absorption of moisture; +the stains remain damp for long, owing to the hygroscopic property of +the acid. + +_Method of Extraction from the Stomach._--The contents of the stomach or +vomited matter should, if necessary, be diluted with pure distilled +water and filtered. The stomach should be cut up into small pieces and +boiled for some time in water. The solution, filtered and concentrated, +is now ready for testing. Blood, milk, etc., may be separated by +dialysis, and the fluid so obtained tested. A sulphate may be present. +Take a portion of the liquid, evaporate to dryness, and incinerate; a +sulphate, if present, will be obtained, and may be tested. + +_Caution._--Sulphuric acid may not be found even after large doses, due +to treatment, vomiting, or survival for several days. In all cases every +organ should be examined. Vomited matters and contents of stomach should +not be mixed, but each _separately_ examined. This rule holds good for +all poisons. On _cloth_ the stain may be cut out, boiled in water, the +solution filtered, and tested with blue litmus and other tests. + +_Post-Mortem Appearances._--Where the acid has come in contact with the +mucous membranes there are dark brown or black patches. The stomach is +greatly contracted, the summits of the mucous membrane ridges being +charred and the furrows greatly inflamed; the contents are black or +brown. + +_Tests._--Concentrated acid chars organic matter; evolves heat when +added to water, and sulphurous fumes when boiled with chips of wood, +copper cuttings, or mercury. Dilute acid chars paper when the paper is +heated; gives a white precipitate with nitrate or chloride of barium, +and is entirely volatilized by heat. Dilute solutions give a white +precipitate with barium nitrate, insoluble in hydrochloric acid even on +boiling. + +_Fatal Dose._--In an adult, 1 drachm. + +_Fatal Period._--Shortest, three-quarters of an hour; average period +from onset of primary effects, eighteen to twenty-four hours. + + + + +XI.--NITRIC ACID + + +=Nitric Acid=, or aqua fortis, is less frequently used as a poison than +sulphuric acid. The fumes from nitric acid have caused death from +pneumonia in ten or twelve hours. + +_Method of Extraction from the Stomach._--The same as for sulphuric +acid. In beer, etc., the mixture may be neutralized with carbonate of +potassium, dialyzed, the fluid concentrated and allowed to crystallize, +when crystals of nitrate of potassium may be recognized. + +_Post-Mortem Appearance._--The mucous membranes are rendered yellow or +greenish if bile be present; they are also thickened and hardened. + +_Tests._--Concentrated acid gives off irritating orange-coloured fumes +of nitric acid gas. When poured on copper, it gives off red fumes and +leaves a green solution of nitrate of copper. It gives a red colour with +brucine, turns the green sulphate of iron black, and with hydrochloric +acid dissolves gold. A delicate test for the acid, free or in +combination, is to dissolve in the suspected fluid some crystals of +ferrous sulphate, and then to gently pour down the test-tube some strong +sulphuric acid. Where the two liquids meet, if nitric acid be present, a +reddish-brown ring will be formed. It turns the skin bright yellow, and +does the same with woollen clothes, from the formation of _picric_ acid. + +_Fatal Dose._--Two drachms. + +_Fatal Period._--Shortest, one hour and three-quarters in an adult; in +infants in a few minutes, from suffocation. + + + + +XII.--HYDROCHLORIC ACID + + +=Hydrochloric Acid=, muriatic acid, or spirit of salt, is not uncommonly +used for suicidal purposes, being fifth in the list. + +_Method of Extraction from the Stomach._--The same as for sulphuric +acid. As hydrochloric acid is a constituent of the gastric juice, the +signs of the acid must be looked for. + +_Post-Mortem Appearances._--The mucous membranes are dry, white, and +shrivelled, and often eroded. + +_Tests._--The concentrated acid yields dense white fumes with ammonia. +When warmed with black oxide of manganese and strong sulphuric acid it +gives off chlorine, recognized by its smell and bleaching properties. +Diluted it gives with nitrate of silver, a white precipitate, which is +insoluble in nitric acid and in caustic potash, but is soluble in +ammonia, and when dried and heated melts, and forms a horny mass. Stains +on clothing are reddish-brown in colour. + +_Fatal Dose._--Half an ounce. + +_Fatal Period._--Shortest, two hours; average, twenty-four hours. Death +may occur after an interval of some weeks from destruction of the +gastric glands and inability to digest food. + + + + +XIII.--OXALIC ACID + + +=Oxalic Acid= is used by suicides, though not often by murderers. The +crystals closely resemble those of Epsom salts or sulphate of zinc; +oxalic acid has been taken in mistake for the former. It is in common +use for cleansing brass, in laundry work, for dyeing purposes, and +especially for bleaching straw hats. + +_Symptoms._--If a concentrated solution be taken, it acts as a +corrosive, causing a burning acid, intensely sour taste, which comes on +immediately, great pain and tenderness and burning at pit of stomach, +pain and tightness in throat. Vomiting of mucus, bloody or dark +coffee-ground matters, purging and tenesmus, followed by collapse, +feeble pulse, cyanosis and pallor of the skin; also swelling of tongue, +with dysphagia. In some cases cramps and numbness in limbs, pain in head +and back, delirium and convulsions. May be tetanus or coma. If taken +freely diluted, the nervous symptoms predominate, and may resemble +narcotic poisoning. Sometimes almost instant death. + +_Post-Mortem Appearances._--Mucous membrane of mouth, throat, and +gullet, white and softened, as if they had been boiled; there are often +black or brown streaks in it. Stomach contains dark, grumous matter, and +is soft, pale, and brittle. Intestines slightly inflamed, stomach +sometimes quite healthy. + +_Treatment._--Warm water, then chalk, carbonate of magnesium, or +lime-water, freely. Not alkalies, as the oxalates of the alkalies are +soluble and poisonous. Castor-oil. Emetics, but not stomach-pump. + +_Fatal Dose._--One drachm is the smallest, but half an ounce is usually +fatal. + +_Method of Extraction from the Stomach._--Mince up the coats of the +stomach and boil them in water, or boil the contents of the stomach and +subject them to dialysis. Concentrate the distilled water outside the +tube containing the vomited matters, etc., and apply tests. + +_Tests._--White precipitate with nitrate of silver, soluble in nitric +acid and ammonia. When the precipitate is dried and heated on +platinum-foil, it disperses as white vapour with slight detonation. +Sulphate of lime in excess gives a white precipitate, soluble in nitric +or hydrochloric acid, but insoluble in oxalic, tartaric, acetic, or any +vegetable acid. + +=Oxalate or Binoxalate of Potash= (salts of sorrel or salts of lemon) is +almost as poisonous as the acid itself. + + + + +XIV.--CARBOLIC ACID + + +=Carbolic Acid, Phenic Acid, or Phenol=, is largely employed as a +disinfectant, and is often supplied in ordinary beer-bottles without +labels. + +_Symptoms._--An intense burning pain extending from the mouth to the +stomach and intestines. Indications of collapse soon supervene. The skin +is cold and clammy, and the lips, eyelids, and ears, are livid. This is +followed by insensibility, coma, stertorous breathing, abolition of +reflex movements, hurried and shallowed respiration, and death. The +pupils are usually contracted, and the urine, if not suppressed, is dark +in colour, or even black. Patients often improve for a time, and then +die suddenly from collapse. When the poison has been absorbed through +the skin or mucous membranes, a mild form of delirium, with great +weakness and lividity, are the first signs. + +_Post-Mortem._--If strong acid has been swallowed, the lips and mucous +membranes are hardened, whitened, and corrugated. In the stomach the +tops of the folds are whitened and eroded, while the furrows are +intensely inflamed. + +_Treatment._--Soluble sulphates which form harmless sulpho-carbolates in +the blood should be administered at once. An ounce of Epsom salts or of +Glauber's salts dissolved in a pint of water will answer the purpose +admirably. After this an emetic of sulphate of zinc may be given. White +of egg and water or olive-oil may prove useful. Warmth should be applied +to the body. + +_Fatal Dose._--One drachm, but recovery has taken place after much +larger quantities, if well diluted or taken after a meal. + +_Tests_ are not necessary, as the smell of carbolic acid is +characteristic. + +_Local action_ of carbolic acid produces anæsthesia and necrosis. +Accidents sometimes happen from too strong lotions applied as surgical +dressings. + +=Lysol= is a compound of cresol and linseed-oil soap, and is much less +toxic than carbolic acid. + + + + +XV.--POTASH, SODA, AND AMMONIA + + +=Caustic Potash= occurs in cylindrical sticks, is soapy to the touch, +has an acrid taste, is deliquescent, fusible by heat, soluble in water. +=Liquor Potassæ= is a strong solution of caustic potash, and has a +similar reaction. =Carbonate of Potassium=, also known as potash, +pearlash, salt of tartar, is a white crystalline powder, alkaline and +caustic in taste, and very deliquescent. The bicarbonate is in +colourless prisms, which have a saline, feebly alkaline taste, and are +not deliquescent. + +_Symptoms._--Acrid soapy taste in mouth, burning in throat and gullet, +acute pain at pit of stomach, vomiting of bloody or brown mucus, colicky +pains, bloody stools, surface cold, pulse weak. These preparations are +not volatile, so that there is not much fear of lung trouble. In chronic +cases death occurs from stricture of the oesophagus causing starvation. + +_Post-Mortem Appearances._--Soapy feeling, softening, inflammation, and +corrosion of mucous membrane of mouth, pharynx, oesophagus, stomach, and +intestines. Inflammation may have extended to larynx. + +_Method of Extraction from the Stomach._--If the contents of the stomach +have a strong alkaline action, dilute with water, filter, and apply +tests. + +_Tests._--The carbonates effervesce with an acid. The salts give a +yellow precipitate with platinum chloride, and a white precipitate with +tartaric acid. They are not dissipated by heat, and give a violet colour +to the deoxidizing flame of the blowpipe. Stains on dark clothing are +red or brown. + +_Treatment._--Vinegar and water, lemon-juice and water, acidulated +stimulant drinks, oil, linseed-tea, opium to relieve pain, stimulants in +collapse. Do not use the stomach-tube. The glottis may be inflamed, and +if there is danger of asphyxia, tracheotomy may have to be performed. + +=Carbonate of Sodium= occurs as _soda_ and _best soda_, the former in +dirty crystalline masses, the latter of a purer white colour. It is also +found as 'washing soda.' + +_Symptoms, Post-Mortem Appearances, Treatment, and Extraction from the +Stomach._--As for potash. + +_Tests._--Alkaline reaction, effervesces and evolves carbonic acid when +treated with an acid; crystallizes, gives yellow tinge to blowpipe +flame. No precipitate with tartaric acid, nor with bichloride of +platinum. + +=Ammonia= may be taken as _liquor ammoniæ_ (harts-horn), as carbonate of +ammonium, as 'Cleansel,' or as 'Scrubb's Cloudy Ammonia.' + +_Symptoms._--Being volatile, it attacks the air-passages, nose, eyes and +lungs, being immediately affected; profuse salivation; lips and tongue +swollen, red, and glazed. The urgent symptoms are those of suffocation. + +Inhalation of the fumes of strong ammonia may lead to death from +capillary bronchitis or broncho-pneumonia. Death may result from +inflammation of the larynx and lungs. When swallowed in solution, the +symptoms are similar to those of soda and potash. + +_Post-Mortem Appearances._--Similar to other corrosives. + +_Method of Extraction from the Stomach._--The contents of the stomach, +etc., must be first distilled, the gas being conveyed into water free +from ammonia. + +_Tests._--Nessler's reagent is the most delicate, a reddish-brown colour +or precipitate being produced, but ammonia may be recognized by its +pungent odour, dense fumes given off with hydrochloric acid, and strong +alkaline reaction. + +_Treatment._--Vinegar and water. Other treatment according to symptoms. + +_Fatal Dose._--One drachm of strong solution. + +_Fatal Period (Shortest)._--Four minutes. + + + + +XVI.--INORGANIC IRRITANTS + + +=Nitrate of Potassium (Nitre, Saltpetre)--Bitartrate of Potassium (Cream +of Tartar)--Alum (Double Sulphate of Alumina and Potassium)--Chlorides +of Lime, Sodium, and Potassium.=--All these are irritant drugs, and give +the usual symptoms. + + + + +XVII.--CHLORATE OF POTASSIUM, ETC. + + +=Chlorate of Potassium= produces irritation of stomach and bowels; +hæmaturia; melæna; cyanosis, weakness, delirium, and coma. + +_Post-Mortem._--Blood is chocolate-brown in colour, and so are all the +internal organs; gastro-enteritis; nephritis. + +_Tests._--Spectroscope shows blood contains methæmoglobin; the drug +discharges the colour of indigo in acid solution with SO_{2}. + +_Treatment._--Transfusion of blood or saline fluid; stimulants. + +=Sulphuret of Potassium= (liver of sulphur) occurs in mass or powder of +a dirty green colour; has a strong smell of sulphuretted hydrogen. + +_Symptoms._--Of acute irritant poisoning, with stupor or convulsions. +Excreta smell of sulphuretted hydrogen. + +_Post-Mortem Appearances._--Stomach and duodenum reddened, with deposits +of sulphur. Lungs congested. + +_Treatment._--Chloride of sodium or lime in dilute solution, and +ordinary treatment for irritant poisoning. + +_Fatal Period (Shortest)._--Fifteen minutes. + + + + +XVIII.--BARIUM SALTS + + +=Chloride of Barium= occurs crystallized in irregular plates, like +magnesium sulphate, soluble in water and bitter in taste. =Carbonate of +Barium= is found in shops as a fine powder, tasteless and colourless, +insoluble in water, but effervescing with dilute acids, and readily +decomposed by the free acids of the stomach. =Nitrate of Barium= occurs +in octahedral crystals, soluble in water. + +_Method of Extraction from the Stomach._--Dialysis as for other soluble +poisons. + +_Tests._--Precipitated from its solutions by potassium carbonate or +sulphuric acid. Burnt on platinum-foil, it gives a green colour to the +flame. + +_Symptoms._--Besides those of irritants generally, violent cramps and +convulsions, headache, debility, dimness of sight, double vision, noises +in the ears, and beating at the heart. The salts of barium are also +cardiac poisons. + +_Post-Mortem Appearances._--As of irritants generally. Stomach may be +perforated. + +_Treatment._--Wash out stomach with a solution of sodium or magnesium +sulphate, or of alum, and give stimulants by the mouth and +hypodermically. + + + + +XIX.--IODINE--IODIDE OF POTASSIUM + + +=Iodine= occurs in scales of a dark bluish-black colour. It strikes blue +with solution of starch, and stains the skin and intestines +yellowish-brown. Liquid preparations, as the liniment or tincture, may +be taken accidentally or suicidally. + +_Symptoms._--Acrid taste, tightness of throat, epigastric pain, and then +symptoms of irritant poisons generally. Chronic poisoning (iodism) is +characterized by coryza, salivation, and lachrymation, frontal headache, +loss of appetite, marked mental depression, acne of the face and chest, +and a petechial eruption on the limbs. + +_Post-Mortem Appearances._--Those of irritant poisoning with corrosion, +and staining of a dark brown or yellow colour. + +_Treatment._--Stomach-pump and emetics, carbonate of sodium, amylaceous +fluids, gruel, arrowroot, starch, etc. + +_Analysis of Organic Mixture containing Iodine._--Add bisulphide of +carbon, and shake. The iodine may be obtained on evaporation as a +sublimate. It will be recognized by the blue colour which it gives with +starch. + +=Iodide of Potassium.=--Colourless, generally opaque, cubic crystals, +soluble in less than their weight of cold water. + +_Symptoms._--Not an active poison, but even small doses sometimes +produce the effects of a common cold, including those symptoms already +mentioned as occurring with iodine. + +_Analysis._--Iodide of potassium in solution gives a bright yellow +precipitate with lead salts; a bright scarlet with corrosive sublimate; +and a blue colour with sulphuric or nitric acid and starch. + + + + +XX.--PHOSPHORUS + + +=Phosphorus= is usually found in small, waxy-looking cylinders, which +are kept in water to prevent oxidation. It may also occur as the +amorphous non-poisonous variety, a red opaque infusible substance, +insoluble in carbon disulphide. Ordinary phosphorus is soluble in oil, +alcohol, ether, chloroform, and carbon disulphide; insoluble in water. +It is much used in rat poisons, made into a paste with 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. + +_Symptoms._--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, diarrhoea, 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.' + +_Post-Mortem Appearances._--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. + +_Treatment._--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. + +_Fatal Dose._--One grain and a half. + +_Fatal Period._--Four hours; more commonly two to four days. + +_Detection of Phosphorus in Organic Mixtures._--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 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. + + + + +XXI.--ARSENIC AND ITS PREPARATIONS + + +=Arsenic= 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. + +=Arsenious Acid= (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. + +_Symptoms._--Commence in from half to one hour. Faintness, nausea, +incessant vomiting, epigastric pain, headache, diarrhoea, 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 diarrhoea. In others the patient falls +into a deep sleep, while in the fourth class the symptoms resemble +closely those of English cholera. The vomited 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. + +The symptoms of _chronic_ poisoning by arsenic are loss of appetite, +silvery tongue, thirst, nausea, colicky pains, diarrhoea, 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. + +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. + +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. + +_Post-Mortem Appearances._--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 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 _post-mortem_ signs. Putrefaction of the body is +retarded by arsenic. + +_Treatment._--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. + +_Fatal Dose (Smallest)._--Two grains. Exceptionally, recovery from very +large doses if rejected by vomiting. + +_Fatal Period (Shortest)._--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. + +_Method of Extraction from the Stomach._--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. + +_Tests._--In _solution_, arsenic may be detected by the liquid 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. + +_Marsh's Process._--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. + +_Reinsch's Process._--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. + +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. + +_Biological Test._--Put the substance to be tested into a flask with +some small pieces of bread, sterilize for half an hour at 120° C. When +cold, inoculate with a culture of _Penicillium brevicaule_, 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. + +=Other Preparations of Arsenic.=--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. + +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. + +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. + +=Arseniuretted Hydrogen= (arsine, AsH_{3}) is an extremely poisonous +gas, and is evolved in various chemical and manufacturing processes. +When damp, _Ferro-silicon_ evolves AsH_{3} and PH_{3}, both very lethal +gases. _Ferrochrome_ is used in making steel, and it also evolves +PH_{3}, and in such extreme dilution as 0.02 per cent. may cause death. + + + + +XXII.--ANTIMONY AND ITS PREPARATIONS + + +=Tartar Emetic= (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. + +_Symptoms._--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 _chronic +poisoning_, 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. + +_Post-Mortem Appearances._--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. + +_Treatment._--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. + +_Fatal Dose._--In an adult 2 grains (same as arsenic). + +_Fatal Period._--Death follows in eight to twelve hours, from +exhaustion. + +_Method of Extraction from the Stomach._--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 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. + +_Tests._--Soluble in water, but not in alcohol. + +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. + +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. + +=Chloride of Antimony= (Butter of Antimony).--A light yellow or dark red +corrosive liquid. + +_Symptoms._--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. + +_Treatment._--As for tartar emetic; magnesia in milk. + + + + +XXIII.--MERCURY AND ITS PREPARATIONS + + +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. + +=Corrosive Sublimate= (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. + +_Symptoms_ 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 foetor 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 +_eczema mercuriale_ and periostitis. Profound anæmia often a prominent +symptom; neuritis not uncommon. If fumes of mercury inhaled, mercurial +tremors develop. + +_Post-Mortem Appearances._--Corrosion, softening, and sloughing +ulceration of stomach and intestines. The mucous membrane of the +oesophagus 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. + +_Treatment._--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. + +_Fatal Dose._--Three grains in a child. + +_Fatal Period._--Half an hour the shortest. + +_Method of Extraction from the Stomach._--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. + +_Tests._--The following table gives the action of corrosive sublimate +with reagents: + +1. With iodide of potassium Bright scarlet colour. +2. With potash solution Bright yellow colour. +3. With hydrochloric acid and First a yellowish and then a black + sulphuretted hydrogen colour. +4. Heated in a reduction-tube Melts, boils, is volatilized, and forms + a white crystalline sublimate. +5. With ether Freely soluble; the ethereal solution, + when allowed to evaporate + spontaneously, deposits the salt in + white prismatic crystals. +6. Heated with carbonate of Globules of metallic mercury are + sodium in a reduction-tube produced. + +A very simple process for detecting corrosive sublimate is to put a drop +of the suspected solution on a sovereign and touch the gold through the +solution with a key, when metallic mercury will be deposited on the +gold. + + + + +XXIV.--LEAD AND ITS PREPARATIONS + + +=Acetate of Lead= (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. + +_Symptoms._--Metallic taste, dryness in throat, intense thirst, +vomiting, colicky pains, cramps, cold sweat, _constipation_ and scanty +urine, severe headache, convulsions. + +_Chronic lead-poisoning_ is liable to occur in those who handle lead in +any form--white-lead workers, paint manufacturers, plumbers, pottery +workers, etc. + +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 _saturnine encephalopathies_, +of which intense headache, optic neuritis, and epileptiform convulsions, +are the most common. Albumin in urine, tendency to gout, and in women to +abortion. + +_Post-Mortem Appearances._--Inflamed mucous membrane of stomach and +intestines, with layers of white or whitish-yellow mucus, impregnated +with the salt of lead. + +_Treatment._--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 is +most useful both as regards cure and also prevention of chronic +poisoning by lead. + +_Fatal Dose and Fatal Period._--Uncertain. + +_Method of Extraction from the Stomach._--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. + +_Tests._--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. + +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. + +Diachylon, or lead-plaster, is largely used as an abortifacient. + + + + +XXV.--COPPER AND ITS PREPARATIONS + + +Poisoning with copper salts is rare. The most important are the +sulphate, subacetate, and arsenite. + +=Sulphate of Copper= (bluestone, blue vitriol) in half-ounce doses is a +powerful irritant. Has been given to procure abortion. + +=Subacetate of Copper= (verdegris) occurs in masses, or as a greenish +powder. Powerful, astringent, metallic taste. Half-ounce doses have +proved fatal. + +_Symptoms._--Epigastric pain, vomiting of bluish or greenish matter, +diarrhoea. Dyspnoea, depression, cold extremities, headache, purple line +round the gums. Jaundice is common. A _chronic_ form of poisoning may +occur, with symptoms closely resembling those of lead. + +_Post-Mortem Appearances._--Inflammation of stomach and intestines, +which are bluish or green in colour. + +_Treatment._--Encourage vomiting. Give albumin or very dilute solution +of ferrocyanide of potassium. + +_Method of Extraction from the Stomach._--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. + +_Tests._--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. + + + + +XXVI.--ZINC, SILVER, BISMUTH, AND CHROMIUM + + +The salts of zinc requiring notice are the sulphate and chloride. + +=Sulphate of Zinc= has been taken in mistake for Epsom salts. In large +doses it causes dryness of throat, thirst, vomiting, purging, and +abdominal pain. + +_Post-Mortem Appearances._--Those of inflammation of digestive tract. + +_Treatment._--Tea, decoction of oak-bark, carbonate of potassium or +sodium as antidote. + +=Chloride of Zinc.=--A solution containing this substance (230 grains to +the ounce) constitutes 'Burnett's disinfecting fluid.' It is a corrosive +poison. + +The symptoms are burning sensation in the mouth, throat, stomach, and +abdomen, followed by vomiting, diarrhoea, 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 _treatment_ 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. + +_Method of Extraction from the Stomach._--Dry and incinerate the tissues +in a porcelain crucible, digest ash in water, apply tests. + +_Tests._--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. + +=Silver.=--Nitrate of silver is a powerful irritant. + +_Tests._--Black precipitate with sulphuretted hydrogen; white with +hydrochloric acid. + +_Treatment._--Common salt. + +Chronic nitrate of silver poisoning is characterized by _argyria_. The +gums show a blue line, which is darker than that produced by lead, and +the skin presents a greyish hue, which is permanent. + +=Bismuth.=--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. + +=Chromic Acid, Chromate, Bichromate of Potassium.=--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 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. + +_Tests._--Yellow precipitate with salts of lead, deep red with those of +silver. + +_Treatment._--Emetics, magnesia, and diluents. Washing out of the +stomach with weak solution of nitrate of silver. + + + + +XXVII.--GASEOUS POISONS + + +=Carbon Dioxide.=--Carbon dioxide is a product of combustion and +respiration, and is generated in many ways during fermentation. It is a +constituent of _choke damp_ 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. + +_Symptoms._--Inhalation of the _pure_ gas causes spasm of the glottis, +insensibility, and death from asphyxia, at once; _diluted_, 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. + +_Post-Mortem Appearances._--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. + +_Treatment._--Pure air, cold affusion, stimulants, artificial +respiration, galvanism, inhalation of oxygen, venesection, transfusion. + +=Carbonic Oxide.=--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. + +_Symptoms._--When in _large amount_, insensibility comes on at once; +when in _very small amounts_, 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. + +_Post-Mortem Appearances._--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. + +_Treatment._--Ammonia to the nostrils, inhalation of oxygen, cold douche +in moderation, artificial respiration, transfusion of blood. + +=Coal Gas.=--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. + +_Symptoms._--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. + +_Post-Mortem Appearances._--Pallor of skin and internal tissues; florid +colour of neck, back, and muscles, if much CO present in the coal gas; +fluid florid blood; infiltration of lungs. + +_Treatment._--Fresh air, artificial respiration, cold affusion, +diffusible stimulants; inhalation of oxygen freely. + +=Sulphuretted Hydrogen= is characterized by its odour, like that of +rotten eggs. It is extremely poisonous. + +_Symptoms._--Giddiness, pain and oppression in stomach, nausea, loss of +power; delirium, tetanus, and convulsions. + +_Post-Mortem Appearances._--Fluid and black blood (sulph-hæmoglobin), +smell of H_{2}S on opening the body; loss of contractility of muscles, +rapid putrefaction. + +_Treatment._--Fresh air, stimulants, inhalation of chlorine. + +_Tests._--Acetate of lead throws down a brown or black precipitate +according to the quantity of the gas. + +=Sewer Gas.=--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. + +_Symptoms._--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. + +_Treatment._--Fresh air, oxygen, with artificial respiration. +Stimulants, hypodermic of strychnine, and alternate hot and cold douche. + +=Irritant Gases= 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. + +=Sulphurous Acid Gas.=--One of the products of combustion of common +coal. + +=Hydrochloric Acid Gas.=--Irrespirable when concentrated, and very +irritating when diluted. Very destructive to vegetable life. + +=Chlorine.=--Used in bleaching, and as a disinfectant. Greenish-yellow +colour, suffocating odour. In poisoning, inhalation of sulphuretted +hydrogen gives relief. + + + + +XXVIII.--VEGETABLE IRRITANTS + + +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. + +_Symptoms._--Vomiting, purging, tenesmus, etc., followed by cold sweats, +collapse, or convulsions. + +_Post-Mortem Appearances._--Inflammation of alimentary canal; +ulceration, softening, and submucous effusion of dark blood. + +_Treatment._--Diluents, opium, stimulants, abdominal fomentations, etc. + +Certain of these irritant poisons exert a marked influence on the +central nervous system, as the following: + +=Laburnum= (_Cytisis Laburnum_).--All parts of the plant are poisonous; +the seeds, which are contained in pods, are often eaten by children. +Contains the alkaloid _cytisine_, 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. + +=Yew= (_Taxus baccata_) contains the alkaloid _taxine_. 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. + +=Arum= (_Arum Maculatum_).--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. + +Many plants have an intensely irritating action on the skin, and when +absorbed act as active poisons. + +=Rhus toxicodendron= 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 oedema 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, +diarrhoea, and pains in the abdomen. The effects may last a week, and +the skin may desquamate. + +=Primula obconica= 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. + + + + +XXIX.--OPIUM AND MORPHINE + + +=Opium.=--The inspissated juice of the unripe capsules of the _Papaver +somniferum_. 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, 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 (_e.g._, 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. + +The most important active principles of opium are the alkaloids morphine +and codeine. + +_Symptoms_ 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. + +_Diagnosis_ is not always easy, and one has to differentiate poisoning +from _cerebral apoplexy_. In the latter one can seldom rouse the +patient, the pupils are often unequal, and hemiplegia is present. In +_compression of the brain_, fracture of the skull may be present, +subconjunctival hæmorrhages may be seen, the pupils are unequal and +dilated, and the paralysis increases. In _uræmic or diabetic coma_ the +urine must be examined. + +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 body, withered yellow countenance, stooping posture, and +glassy, sunken eyes. + +_Post-Mortem Appearances._--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. + +_Fatal Period._--Usually nine to twelve hours; but in many cases, if +life is prolonged for eight hours, recovery takes place. + +_Fatal Dose._--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. + +_Treatment._--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. + +_Method of Extraction from the Stomach._--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 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. + +_Tests._--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. + +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. + +=Morphine Habit.=--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. + + + + +XXX.--BELLADONNA, HYOSCYAMUS, AND STRAMONIUM + + +=Belladonna.=--The root, leaves, and berries, of the _Atropa belladonna_ +are poisonous from the presence of alkaloid atropine. + +_Symptoms._--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 scarlatina, have been noticed. Dilatation of the pupil occurs, +whether the poison be taken internally or applied locally to the eye. + +_Post-Mortem Appearances._--Congestion of cerebral vessels, dilated +pupils, red patches in alimentary canal. + +_Treatment._--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. + +_Tests._--Atropine may be recognized by its action on the pupil. The +chloro-iodide of potassium and mercury precipitates it from very dilute +solutions. + +=Hyoscyamus= (Henbane).--_Hyoscyamus niger._ + +=Stramonium= (Thorn-Apple).--_Datura stramonium._ + +_Symptoms._--Identical with those of belladonna and hyoscyamus, the +_post-mortem appearances_ and _treatment_ being also the same. + +=Cannabis Indica= (Indian Hemp).--When smoked, produces intoxication and +mania. _Hashish_, used in the East as a narcotic, may cause persons to +run 'amok' and commit murder. + + + + +XXXI.--COCAINE + + +=Cocaine.=--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 +dyspnoea, 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--_e.g._, ammonia--and the hypodermic injection of brandy or +ether may be necessary, with the inhalation of nitrite of amyl. + +For care in the prescribing of cocaine see under the 'Dangerous Drugs +Act, 1920' (p. 82). + +The =Cocaine Habit= consists in the self-administration 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'). + + + + +XXXII.--CAMPHOR + + +The liniment, oil, and spirit have been poisonous in large dose. + +_Symptoms._--Odour of breath, languor, giddiness, faintness, dimness of +vision, difficulty of breathing, delirium, convulsions, with hot skin, +flushed face, and dilated pupils. + +_Fatal Dose._--Thirty grains. + +=Cocculus Indicus.=--The fruit of _Anamirta cocculus_. Contains a +poisonous active principle, picrotoxin; used to adulterate beer, and by +poachers to stupefy fish. + +_Symptoms._--Convulsions, followed by stupor and complete loss of +voluntary power. + + + + +XXXIII.--TETRACHLORETHANE, ETC. + + +=Tetrachlorethane= ('Cellon').--Acetylene tetrachloride; vapour has +caused poisoning in aeroplane ('dope') and cinema film works. + +_Symptoms._--Gastric symptoms and marked jaundice. This may be followed +in days or weeks by stupor, coma, death. + +_Post-Mortem._--Fatty degeneration of internal organs, chiefly liver. + +=Trinitrotoluene (T.N.T.).=--An explosive solid which stains the skin an +orange colour; may be absorbed through skin or be inhaled. + +_Symptoms._--Shortness of breath, headache, drowsiness. Later, skin +irritation, gastritis, jaundice, blood degeneration. + +_Treatment._--Remove from work, rest in bed, diuretics, purgatives, +alkalies. + + + + +XXXIV.--ALCOHOL, ETHER, AND CHLOROFORM + + +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. + +=Alcohol.=--Absolute alcohol is ethyl hydroxide (C_{2}H_{5}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. + +_Symptoms._--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. + +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. + +_Post-Mortem Appearances._--Deep red colour of lining membranes of +stomach. Sometimes congestion of cerebral vessels and meninges. Lungs +congested, blood fluid. Rigor mortis persistent. + +_Fatal Dose._--Death from 1/2 pint of gin and from two bottles of port, +but recovery from larger quantities. + +_Fatal Period._--Average about twenty-four hours. + +_Treatment._--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. + +_Method of Extraction from the Stomach._--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. + +_Tests._--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. + +=Methyl Alcohol: Wood Naphtha.=--Used to produce intoxication by +painters, furniture-polishers, etc. + +_Symptoms_ 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. + +The following table gives the points of distinction between concussion +of brain, alcoholic poisoning, and opium poisoning: + + CONCUSSION OF BRAIN. ALCOHOL. OPIUM. + +1. Marks of violence 1. No marks of violence, 1. As alcohol. + on head. unless person has + fallen. History will + be of use. + +2. Stupor, sudden. 2. Excitement precedes 2. Symptoms slow. + sudden stupor. Drowsiness, stupor, + lethargy. + +3. Face pale, cold; 3. Face flushed; pupils 3. Face pale; pupils + pupils sluggish, generally dilated. contracted. + sometimes dilated. + +4. Remission rare. 4. Partial recovery may 4. Remission rare. + Patient recovers occur, followed by + slowly. death. + +5. No odour of alcohol 5. Odour of alcohol 5. Odour of opium in + in breath. in breath. breath. + +=Ether= is a volatile liquid prepared from ethylic alcohol by +interaction with sulphuric acid. It contains 92 per cent. of ethyl oxide +(C_{2}H_{5})O. It was formerly called 'sulphuric ether.' It is a +colourless, inflammable liquid, having a strong and characteristic +odour, specific gravity 0.735. =Purified ether= 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. + +_Symptoms._--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. + +_Post-Mortem Appearances._--Brain and lungs congested. Cavities of heart +full of dark, liquid blood. Vessels at upper part of spinal cord +congested. + +_Treatment._--Exposure to pure air, cold affusion, artificial +respiration, galvanism. + +_Method of Extraction from the Contents of the Stomach._--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. + +_Tests._--Vapour burns with smoky flame, depositing carbon. Sparingly +soluble in water. With bichromate of potash and sulphuric acid same as +alcohol. + +=Chloroform.=--A colourless liquid, specific gravity 1.490 to 1.495, +very volatile, giving off dense vapour. Sweet taste and pleasant odour. + +_Symptoms._--When swallowed, characteristic smell in 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. + +_Delayed Chloroform-Poisoning._--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. + +_Post-Mortem Appearances._--Cerebral and pulmonary congestion. Heart +empty, or right side distended with dark blood. + +_Treatment._--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. + +_Fatal Dose._--When swallowed, from 1 to 2 ounces. + +_Method of Extraction from the Stomach._--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. + +_Tests._--Taste, colour, weight; burns with a green flame; dissolves +camphor, guttapercha, and caoutchouc. + +=Iodoform.=--Poisoning may result from its use in surgery. It produces +delirium, sleepiness, and coma. It may lead to mental weakness or optic +neuritis. + + + + +XXXV.--CHLORAL HYDRATE + + +It was formerly largely used as a hypnotic, and many fatal consequences +ensued. It is prepared from alcohol and chlorine. + +_Symptoms._--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. + +_Method of Extraction from the Stomach._--By distillation in strongly +alkaline solutions, when it may be obtained as chloroform and tested as +such. + +_Treatment._--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. + +_Tests._--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. + + + + +XXXVI.--PETROLEUM AND PARAFFIN-OIL + + +Cases of poisoning by petroleum and paraffin are common, and occur +chiefly in children. + +=Petroleum= 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, +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. + +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. + +=Paraffin=, also known as kerosene and mineral oil, is a mixture of +saturated hydrocarbons obtained by the distillation of shale. + +By the retailer the terms 'petroleum' and 'paraffin' oil are used +indifferently, and each is sold for the other without prejudice. + +_Symptoms._--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. + +_Fatal Dose._--In the case of an adult, 1/2 pint should not prove +lethal, and patients have recovered after drinking a pint. + +_Treatment._--Emetics, purgatives, and stimulants. + + + + +XXXVII.--ANTIPYRINE, ANTIFEBRIN, PHENACETIN, AND ANILINE + + +Many of the synthetical coal-tar products now so largely employed as +analgesics are powerful toxic agents. + +=Phenazone, Antipyrine, or Analgesin=, 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. + +_Tests._--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. + +_Treatment._--Stimulants freely, inhalation of oxygen, patient to be +kept in the recumbent position. + +=Acetanilide, Antifebrin, Phenylacetamide= (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. + +_Tests._--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. + +_Treatment._--Emetics, stimulants, inhalation of ether, recumbent +position. + +=Phenacetin, Phenacetinum=, 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. + +_Treatment._--As for the other members of this group. + +=Exalgin, Aspirin, etc.=, 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. + +_Symptoms_ (more or less common to all).--Nausea, vomiting, hurried +respiration, marked cyanosis, syncope. Persistent sneezing and +widespread urticaria may be present; collapse. + +=Aniline= 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 of bleaching-powder gives with solution of the sulphate a +purple colour changing to red-brown. + +_Symptoms._--Nausea, vomiting, giddiness, intoxication, drowsiness, +gasping for breath, feeble pulse, and marked cyanosis. In its +_industrial use_ 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. + +_Fatal Dose._--About 6 drachms. + +_Treatment._--Wash out stomach; stimulants, artificial respiration, +inhalation of oxygen, transfusion. + +=Nitro-benzol= (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. + +_Fatal Dose._--Eight to ten drops have caused death. + +_Treatment._--Emetics, stimulants, transfusion of saline or blood, +pituitrin, strychnine, or digitalin hypodermically. + +=Nitroglycerine= 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. + +=Dinitrobenzene= causes symptoms resembling nitro-benzol poisoning, and +when acting as a chronic poison gives rise to weakness, jaundice, +peripheral neuritis. + + + + +XXXVIII.--SULPHONAL, TRIONAL, TETRONAL, VERONAL, PARALDEHYDE + + +These are dangerous drugs. The ordinary _symptoms_ of the group are +noises in the ears, headache, vertigo, inability to stand or to walk +properly, insensibility, and cyanosis. + +The most interesting point is the condition of the urine. In cases of +poisoning it is dark or reddish-brown in colour, due to the presence of +_hæmatoporphyrin_. 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. + +_Treatment._--In an ordinary case emetics, strong coffee, hypodermic +injections of strychnine, saline injections, and transfusion. + +Cases of chronic poisoning from the 'als' are not uncommon, and are +increasing in frequency. Hypnogen is apparently identical with veronal. + +All the above-named aniline derivatives are included in Part I. of the +scheduled poisons. + + + + +XXXIX.--CONIUM AND CALABAR BEAN + + +=Conium Maculatum= (Spotted Hemlock).--All parts of the plant are +poisonous, often mistaken for parsley. Contains the poisonous principle +_coniine_, a volatile liquid alkaloid with a mousy smell; insoluble in +water; soluble in alcohol, ether, and chloroform. It also contains +methyl coniine. + +_Symptoms._--Dryness of throat, headache, dilated pupil, dysphagia, loss +of muscular power, passing into complete paralysis. Delirium, coma, and +convulsions, occasionally. + +_Post-Mortem Appearances._--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. + +_Treatment._--Emetics, tannic acid or gallic acid. Diffusible +stimulants. + +_Method of Extraction from the Stomach._--Use Stas-Otto process. + +_Tests._--The mousy odour. Deepened colour and dense white fumes with +nitric acid. Pale red, deepening, with hydrochloric acid. + +There are several other umbelliferous plants which are poisonous. The +water hemlock (_Cicuta virosa_) produces symptoms not unlike those of +hemlock; it has been mistaken for parsnip and celery. It contains an +active principle, _cicutoxin_, which in some respects is allied to +strychnine and picrotoxin. The fool's parsley, or lesser hemlock +(_Æthusa cynapium_), is another member of this group, although doubt has +been expressed as to whether it is really poisonous. The water dropwort +(_Oenanthe crocata_) is undoubtedly poisonous, especially to cattle. In +man it produces abdominal pain with diarrhoea 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. + +=Calabar Bean or Physostigma.=--The bean of _Physostigma venenosum_ +contains the alkaloid physostigmine or eserine, with the antagonistic +alkaloid calabarine. + +_Symptoms._--Vomiting, giddiness, irregular cardiac action, contraction +of the pupils, paralysis of lower extremities, and death from asphyxia. + +_Treatment._--Emetics; hypodermic injection of 1/50 grain sulphate of +atropine, repeated if necessary. + +_Method of Extraction from the Stomach._--Use Stas-Otto process. + +_Test._--The contraction of the pupil which it causes. + + + + +XL.--TOBACCO AND LOBELIA + + +=Tobacco.=--_Nicotiana tabacum_ 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. + +_Symptoms._--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. + +_Post-Mortem Appearances._--Not uniform or characteristic. General +relaxed condition of muscles; engorgement of cerebral and pulmonary +vessels. Congestion of gastric mucous membrane. + +_Treatment._--Emetics, stimulants, hypodermic injection of 1/25 grain of +strychnine. Warmth to the surface by hot bottles, hot blankets. + +_Method of Extraction from the Stomach._--Digest the contents of the +stomach in cold distilled water and _very dilute_ 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. + +_Tests._--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. + +=Lobelia Inflata= (Indian Tobacco).--Much used in America by the +Coffenite practitioners, and a valuable remedy for asthma. + +_Symptoms._--Nausea, vomiting, giddiness, cold sweats, prostration. +Headache, giddiness, tremors, insensibility, and convulsions. + + + + +XLI.--HYDROCYANIC ACID + + +=Prussic Acid= is the most active of poisons. The diluted hydrocyanic +acid of the Pharmacopoeia contains 2 per cent. of hydrocyanic acid, +Scheele's 4 per cent. It is a colourless liquid, feebly acid, with +odour of bitter almonds. + +=Cyanide of Potassium= 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. + +=Oil of Bitter Almonds=, used as a flavouring agent, may contain (when +improperly prepared) from 5 to 15 per cent. of the anhydrous acid. + +_Symptoms._--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. + +_Post-Mortem Appearances._--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. + +_Treatment._--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 _ad +libitum_. If patient cannot swallow, inject hypodermically either brandy +or ether. Hypodermic injection of 1/50 grain atropine. Douche to the +face, alternately hot and cold. Death commonly occurs so rapidly that +there is no time for treatment. + +_Fatal Dose (Smallest)._--Half a drachm of the B.P. acid, equal to 0.6 +grain of the anhydrous. _Recovery_ 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. + +_Fatal Period._--From two to five minutes after a large dose, but may be +less. + +_Method of Extraction from the Stomach._--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. + +_Tests._--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 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. + + + + +XLII.--ACONITE + + +=Aconite= (_Aconitum Napellus_, monkshood).--Root and leaves. Poisonous +property depends upon an alkaloid, aconitine. Aconite is one of the +constituents of St. Jacob's Oil. + +_Symptoms._--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. + +_Post-Mortem Appearances._--Venous congestion, engorgement of brain and +membranes. + +_Treatment._--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. + +_Fatal Dose._--Of root or tincture, 1 drachm. + +_Fatal Period._--Average, less than four hours. + +_Method of Extraction from the Stomach, etc._--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. + +_Tests._--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. + +The Indian aconite, _Aconitum ferox_, 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. + +=Aconitine= 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 _A. ferox_. + + + + +XLIII.--DIGITALIS + + +All parts of the plant _Digitalis purpurea_ (purple foxglove) are +poisonous. Contains the glucoside digitalin and other active principles. + +_Symptoms._--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. + +_Post-Mortem Appearances._--Congested condition of brain and membranes; +inflammation of gastric mucous membrane. + +_Treatment._--Emetics freely; infusions containing tannin, as coffee, +tea, oak-bark, galls, etc. Stimulants. Hypodermic injection of 1/120 +grain of aconitine. + +_Method of Extraction from the Stomach, etc._--Use Stas-Otto process. + +_Tests for Digitalin._--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 pharmacological methods would be wiser to keep +to his chemical tests. + + + + +XLIV.--NUX VOMICA, STRYCHNINE, AND BRUCINE + + +=Nux Vomica= consists of the seeds of the _Strychnos nux vomica_. 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. + +=Strychnine= 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. + +_Symptoms._--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. + +In _Tetanus_ 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. + +_Post-Mortem Appearances._--Heart empty, blood fluid, rigor mortis +persistent. Hands usually clenched; feet arched and inverted. Congestion +of brain, spinal cord, and lungs. + +_Treatment._--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. + +_Fatal Dose (Smallest)._--Quarter of a grain. + +_Fatal Period (Shortest)._--Ten minutes; usually two to four hours. + +_Method of Extraction from the Stomach._--The alkaloid may be separated +by the process of Stas-Otto. + +_Tests._--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. + +=Brucine.=--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. + + + + +XLV.--CANTHARIDES + + +=Cantharides.=--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. + +_Symptoms._--Burning sensation in the throat and stomach, with +salivation, pain and difficulty in swallowing. Vomiting of mucus mixed +with blood. Tenesmus, diarrhoea, 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. + +_Post-Mortem._--Gastro-intestinal mucous membrane inflamed, with +gangrenous patches. Genito-urinary tract inflamed. Acute nephritis. + +_Treatment._--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. + +_Tests._--The vomited matter often contains shining particles of the +powder. The urine will probably be albuminous. + + + + +XLVI.--ABORTIFACIENTS + + +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 _there is no evidence to show that any drug +possesses this property_. 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 amenorrhoea, but will not produce abortion. The +vegetable substances frequently used as abortives are savin and ergot. + +=Savin= (_Juniperus Sabina_).--Leaves and tops of the plant yield an +acrid oil having poisonous properties, and which has even produced +death. + +_Symptoms._--Those of irritant poisons. Purging not always present, but +tenesmus and strangury. + +_Post-Mortem Appearances._--Acute inflammation of alimentary canal. +Green powder found. This, washed and dried and then rubbed, gives odour +of savin. + +_Test._--A watery solution of savin strikes deep green 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. + +=Ergot= (_Secale Cornutum_).--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. + +_Symptoms._--Lassitude, headache, nausea, diarrhoea, anuria, +convulsions, coma. Small quantities frequently repeated have in the past +produced gangrene of the extremities, or anæsthesia of fingers and toes. + +_Tests._--Lake-red colour with liquor potassæ; this liquid filtered +gives a precipitate of same colour with nitric acid. + + + + +XLVII.--POISONOUS FUNGI AND TOXIC FOODS + + +=Fungi.=--Of the poisonous mushrooms, the _Amanita phalloides_ and the +fly agaric, or _Agaricus muscarius_, are the most potent. The active +principle of the former is _phallin_, and of the latter _muscarine_. The +_Amanita phalloides_ is distinguished from the common mushroom +(_Agaricus campestris_) by having permanent white gills and a hollow +stem. The _Agaricus muscarius_ 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. + +_Edible fungi_ have an agreeable taste and smell, and are firm in +substance. _Poisonous fungi_ have an offensive smell and bitter taste, +are often of a bright colour, and soon become pulpy. + +_Symptoms._--These may be of the narcotic or irritant types. Usually, +however, there is violent colic, with thirst, vomiting, and diarrhoea, +mental excitement, followed by delirium, convulsions, coma, slow pulse, +stertorous breathing, cyanosis, cold extremities, and dilated pupils. + +_Post-Mortem._--In phallin-poisoning the blood remains fluid; numerous +hæmorrhages are present, with fatty degeneration of the internal organs. + +_Treatment._--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. + +=Foods.=--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 diarrhoea, 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 _tyrotoxicon_. Ergotism from eating bread made with +ergotized wheat is now rare, but _pellagra_ from the consumption of +mouldy maize, and _lathyrism_, due to the admixture with flour of the +seeds of certain kinds of vetch, are still common in Southern Europe. + +_Symptoms._--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. + +_Treatment._--Emetics, purgatives, stimulants, with hypodermic +injections of strychnine and atropine along with stimulants. + + + + +XLVIII.--PTOMAINES OR CADAVERIC ALKALOIDS + + +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 _Bacillus botulinus_, the _B. enteritidis_ of +Gärtner, the _B. proteus vulgaris_, or the _B. ærtrycke_ (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, +diarrhoea, vertigo, coldness, faintness, and collapse. The symptoms of +_botulism_ 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. + +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. + + + + +INDEX + + +Abdomen, injuries of, 29 + +Abortifacients, 147 + +Abortion, criminal, 42 + +Acetanilide, 136 + +Acetate of lead, 116 + +Aconite, 143 + +Adipocere, 18 + +Adultery, 62 + +Age, determination of, 12 + +Alcohol, 130 + +Alcoholic insanity, 76 + +Alkaloids, 93 + +Alum, 103 + +Ammonia, 102 + +Anæsthetics, death from, 19 + +Aniline, 136 + +Antifebrin, 136 + +Antimony, 112 + +Antipyrine, 135 + +Aqua fortis, 97 + +Arsenic, 107 + +Arsenious acid, 107 + +Artificial oil of bitter almonds, 137 + +Arum, 124 + +Asphyxia, 13 + +Assaults, 21 + +Assizes, 7 + +Atropine, 127 + + +Barberio's test, 58 + +Barium salts, 104 + +Belladonna, 127 + +Bestiality, 59 + +Bichromate of potassium, 119 + +Bismuth, 119 + +Blackmailing, 60 + +Bladder, injuries of, 30 + +Blood-stains, 30 + +Born in wedlock, 52 + +Botulism, 151 + +Brain, injuries to, 26 + +Breslau's life test, 49 + +Brucine, 146 + +Bruises, 22 + +Bullet wounds, 24 + +Burnett's fluid, 119 + +Burns, 22 + + +Cadaveric alkaloids, 150 + rigidity, 17 + +Calabar bean, 139 + +Camphor, 129 + +Cantharides, 146 + +Carbolic acid, 100 + +Carbonic acid gas, 120 + oxide, 121 + +Carnal knowledge, 55 + +Cellon, 129 + +Chemical analysis, 91 + +Chest injuries, 28 + +Chloral, 134 + +Chlorate of potassium, 103 + +Chloride of zinc, 119 + +Chlorine, 122 + +Chloroform, 19, 132 + +Choke-damp, 121 + +Chromium, 119 + +Chronic lead-poisoning, 117 + +Clothing, fibres of, 34 + +Coal-gas, 121 + +Cocaine, 128 + +Cocculus indicus, 129 + +Cold, death from, 39 + +Coma, 14 + +Common witness, 2 + +Concealment of birth, 45 + of pregnancy, 45 + +Conium, 138 + +Contused wounds, 24 + +Cooling, rate of, 16 + +Copper, 117 + +Coroners, 4 + +Coroner's court, 4 + +Corrosive sublimate, 113 + +Corrosives, 86 + +Cretinism, 69 + +Crimes, 1 + +Criminal abortion, 42 + +Criminal Appeal Court, 8 + courts, 7 + +Cross-examination, 3 + +Crown Court of Assize, 7 + +Culpable homicide, 21 + +Cut throat, 28 + + +Dangerous Drugs Bill, 82 + +Death in the foetus, 50 + signs of, 16 + +Delivery, 41 + +Dementia, 70 + +Depositions, 6 + +Determination of sex, 11 + +Diachylon pills, 117 + +Diaphragm, wounds of, 29 + +Digitalis, 144 + +Dinitrobenzene, 137 + +Divorce, 60 + +"Dope," 129 + +Drowning, 36 + +Duration of pregnancy, 50 + +Dyeing of hair, 11 + +Dying declarations, 10 + + +Ecchymosis, 22 + +Electricity, 38 + +Epilepsy, 65, 75 + +Ergot, 148 + +Ether, 132 + +Evidence, giving of, 2 + +Examination-in-chief, 3 + +Experiments on animals, 85 + +Experts, 2 + +Eye injuries, 27 + + +Face injuries, 27 + +Feeble-minded, 69 + +Fees for medical witness, 5, 7 + +Feigned diseases, 63 + +Felony, 1 + +Ferro-silicon, 111 + +Finger prints, 11 + +Florence's test, 58 + +Foeticide, 42 + +Foods, poisonous, 150 + +Found dead, 5 + +Fruit stains, 33 + +Fungi, 148 + + +Gaseous poisons, 120 + +General paralysis, 71 + +Genital organs, wounds of, 30 + +Grand jury, 8 + +Gunshot wounds, 24 + + +Hæmin crystals, 32 + +Hair, detection of, 33 + dyeing of, 11 + +Hanging, 35 + +Head injuries, 26 + +Heart, injuries of, 29 + +Heat, death from, 39 + +Hemlock, 138 + +Henbane, 128 + +Homicide, 21 + +Hydrochloric acid, 98 + gas, 122 + +Hydrocyanic acid, 140 + +Hyoscyamus, 128 + +Hypostasis, 16 + + +Identification of dead, 12 + +Identity, personal, 10 + +Idiocy, 68 + +Imbecility, 69 + +Impotence, 54 + +Incest, 59 + +Incised wounds, 23 + +Indecent assault, 57 + +Indictable offences, 2 + +Inebriates Act, 78 + +Infanticide, 44 + +Inheritance, 54 + +Injuries, 21 + +Insanity, 67-76 + +Intestines, wounds of, 30 + +Iodide of potassium, 104 + +Iodine, 104 + +Irritants, 87 + gases, 122 + vegetable, 123 + + +Judicial separation, 62 + +Jury, coroner's, 4 + + +Kidney, injuries of, 30 + +Kleptomania, 73 + + +Laborde's method, 37 + +Laburnum, 123 + +Lacerated wounds, 24 + +Lead, 116 + +Lee-Metford bullet, 24 + +Legitimacy, 52 + +Lightning, 38 + +Live-birth, 44-46 + +Liver, injuries of, 29 + +Lobelia, 140 + +Lucid intervals, 73 + +Lumbago, 66 + +Lunacy, 67 + certification, 77 + +Lungs, injuries of, 29 + evidences of live-birth from, 47 + + +Magistrate's court, 7 + +Malingering, 63 + +Malpractice, 20 + +Malum regimen, 21 + +Mania, 71 + +Manslaughter, 21 + +Marriage, 60 + +Marsh's process, 110 + +Martini-Henry bullet, 25 + +Maturity of infant, 45 + +Mauser bullet, 25 + +Medical evidence, 2 + +Mentally deficients, 70 + +Mercury salts, 113 + +Methyl alcohol, 131 + +Mineral acids, 94 + +Misdemeanour, 1 + +Monkshood, 143 + +Monomania, 72 + +Morphine, 127 + +Murder, 21 + +Muriatic acid, 98 + + +Naphtha, 135 + +Nitrate of silver, 119 + +Nitric acid, 95 + +Nitro-benzol, 137 + +Notes, 9 + +Nux vomica, 145 + + +Oaths Act, 9 + +Oil of bitter almonds, 141 + +Opium, 124 + +Oxalate of potash, 99 + +Oxalic acid, 98 + + +Paraffin oil, 135 + +Paranoia, 73 + +Personal identity, 10 + +Petroleum, 134 + +Petty Sessions, 7 + +Phenacetin, 136 + +Phenol, 100 + +Phosphorus, 105 + +Phossy-jaw, 106 + +Physostigma, 139 + +Picrotoxin, 129 + +Poison, definition of, 80 + +Poisonous foods, 149 + +Poisons acting on the brain, 88 + classification of, 84 + detection of, 91 + evidence, 85 + scheduled, 81 + symptoms and post-mortem appearances, 86 + treatment of, 90 + +Potash, 101 + +Precipitin test for blood, 33 + +Pregnancy, 40, 50 + insanity of, 73 + +Presumption of death, 20 + survivorship, 21 + +Primula, 124 + +Privilege, 8 + +Procurator Fiscal, 7 + +Prussic acid, 140 + +Ptomaines, 150 + +Puerperal mania, 73 + +Punctured wounds, 23 + +Purgatives, 123 + +Putrefaction, 18 + + +Quarter Sessions, 7 + + +Railway spine, 27 + +Rape, 55 + +Reception orders, 77 + +Rectified spirit, 130 + +Re-examination, 3 + +Reinsch's process, 110 + +Reports, medical, 9 + +Responsibility, 76 + +Resuscitation, 36 + +Rhus, 124 + +Rigor mortis, 17 + +Rust stains, 33 + + +Sale of arsenic, 111 + +Saponification, 18 + +Satyriasis, 73 + +Savin, 147 + +Scars, 11 + +Schiller's method of resuscitation, 36 + +Scheduled poisons, 81 + +Scotch oath, 9 + +Secrets, professional, 8 + +Self-inflicted wounds, 24 + +Seminal stains, 58 + +Sewer-gas, 122 + +Sex, determination of, 11 + +Signs of death, 16 + +Silver, 118 + +Skin diseases, 66 + +Soda, 101 + +Sodomy, 59 + +Spanish-fly, 146 + +Spectroscopic examination of blood, 32 + +Spinal cord injuries, 27 + +Spleen, injuries of, 29 + +Staining, post-mortem, 16 + +Starvation, 38 + +Stas-Otto process, 92 + +Status lymphaticus, 15 + +Sterility, 54 + +Stomach, injuries of, 29 + +Stramonium, 128 + +Strangulation, 35 + +Strychnine, 145 + +Sudden death, 13, 15 + +Suffocation, 34 + +Sugar of lead, 116 + +Sulphonal, 137 + +Sulphuretted hydrogen, 122 + +Sulphuric acid, 95 + +Sulphurous acid gas, 122 + +Summary offences, 2 + +Sunstroke, 39 + +Superfoetation, 53 + +Syncope, 13 + + +Tartar emetic, 112 + +Tattoo marks, 10 + +Teichman's crystals, 32 + +Tetanus, 145 + +Tetrachlorethane, 129 + +Tetronal, 137 + +Throat injuries, 28 + +Tobacco, 139 + +Treason, 1 + +Trinitrotoluene, 129 + +Trional, 137 + +True bill, 8 + + +Undue influence, 74 + +Unnatural offences, 59 + +Unsound mind, 67 + + +Veronal, 137 + +Viability, 51 + +Vitriol, 95 + +Voidable marriage, 63 + + +Witnesses, 2 + +Wounds, 21 + + +Yew, 124 + + +Zinc, 118 + + + +PRINTED IN GREAT BRITAIN BY +BILLING AND SONS, LTD., GUILDFORD AND ESHER + + + + +BAILLIÈRE, TINDALL & COX'S + + +MANUALS FOR STUDENTS + +=Blair Bell's The Principles of Gynæcology.= Third Edition. 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