Medical Jurisprudence, Forensic medicine and Toxicology. Vol. 1 (part 3 of 5)

Appendix

Statutory Regulations Concerning Dead Bodies.

The coroner has power to hold inquest and direct autopsy,

Ala., Code, sec. 4,801 et seq. Ariz., Pen. Code, sec. 2,309 et seq. Ark., R. S., sec. 692. Cal., Pen. Code; sec. 1,510. Col., Mill’s Stat., sec. 870. Conn., Gen. Stat., secs. 2,005, 2,008. Del., R. S., ch. 33. Fla., R. S., secs. 3,011, 3,019. Ga., Code, secs. 590, 591, 4,101 et seq. Idaho, R. S., sec. 8,377. Ill., S. & C. Am. Stat., v. 1, 606. Ind., R. S., secs. 5,878, 5,879. Iowa, McCl. Am. Code, sec. 487. Kan., Gen. Stat., secs. 1,780, 1,784. Ky., Gen. Stat., ch. 25, secs. 3, 11. La., Voorh. Rev. L., sec. 653. Me., R. S., ch. 139, sec. 1. Md., Code, art. 22, secs. 3, 4. Minn., Gen. Stat., sec. 1,011 et seq. Miss., Am. Code, sec. 816. Mo., R. L., sec. 2,438 et seq. Mont., Crim. L., secs. 869, 883. Neb., Consol. Stat., sec. 3,144. N. H., Pub. Stat., ch. 262, sec. 1 et seq. N. J., Rev. Stat., p. 170 et seq. N. C., Code, sec. 657. N. Dak., Comp. Laws, sec. 664 et seq. Ohio, R. L., sec. 1,221 et seq. Oklahoma, Stat., sec. 1,745 et seq. Ore., Crim. Code, sec. 453 et seq. Pa., Bright Pen. Digest, 1536, sec. 37. R. I., Pub. Laws, 1884, ch. 420, sec. 17. S. C., R. S., secs. 711, 2,664 et seq. Tenn., Code, sec. 6,139 et seq. Va., Code, sec. 2,928 et seq. Wash., Hill’s Am. Stat., v. 1, sec. 245 et seq. W. Va., Code, ch. 154. Wis., S. & B. Am. Stat., ch. 200. Wyo., R. S., sec. 1,879 et seq.

Medical examiner shall hold inquest and direct autopsy.

Mass., Pub. Stat., ch. 26, secs. 10, 11. R. I., Pub. Laws, 1884, ch. 420.

Justice of the peace shall hold inquest and direct autopsy.

Mich., How. Am. Stat., v. 2, sec. 9,583 et seq. Nev., Gen. Stat., sec. 225 et seq. N. M., Comp. L., sec. 443 et seq. Texas, Code Crim. P., art. 988 et seq. Vt., Rev. L., sec. 3,934 et seq. Wis., S. & B. Am. Stat., ch. 200.

And may order a body to be disinterred for the purpose of holding such inquisition.

Ark., R. L., sec. 718. Cal., Pen. Code, sec. 1,510. Del., R. L., ch. 33. Ga., Code, secs. 590, 591, 410 et seq. Idaho, R. L., sec. 8,377. S. C., R. S., sec. 2,687. Texas, Code Crim. P., art. 989.

And when not claimed by friends and relatives, to bury the body decently, and when the property of deceased is not sufficient to defray expenses, this may be done at public expense.

Cal., Pen. Code, sec. 3,094. Col., Mill’s Stat., sec. 882. Conn., Gen. Stat., sec. 2,015. Idaho, R. L., sec. 2,081. Ill., S. & C. Am. Stat., v. 1, 606. Iowa, McCl. Am. Code, sec. 501. Kan., Gen. Stat., sec. 1,792. Ky., Gen. Stat., ch. 25, sec. 6. La., Voorh. Rev. L., sec. 660. Me., R. S., ch. 139, sec. 11. Md., Code, art. 22, sec. 7. Mass., Laws, 1887, ch. 310. Mich., How. Am. Stat., v. 3, sec. 9,593. Minn., Gen. Stat., sec. 1,021. Miss., Am. Code, secs. 3,145, 3,146. Mo., R. L., sec. 2,456. Mont., Gen. Laws, sec. 881. Neb., Consol. Stat., sec. 3,144. Nev., Gen. Stat., sec. 2,269. N. H., Pub. Stat., ch. 262, sec. 16. N. J., Rev. Stat., p. 170, sec. 5. N. M., Comp. Laws, sec. 447. N. Dak., Comp. Laws, sec. 676. Ohio, R. L., sec. 1,227. Oklahoma, Stat., sec. 1,759. Ore., Crim. Code, sec. 462. R. I., Pub. Laws, 1884, ch. 420, sec. 24. Tenn., Code, sec. 6,150. Va., Code, sec. 3,946. Wash., Hill’s Am. Stat., v. 1, sec. 257. W. Va., Code, ch. 154, sec. 8. Wis., S. & B. Am. Stat., ch. 200. Wyo., R. S., sec. 1,886.

Removal or disinterment of a dead body without authority of law or consent of relatives, for the purpose of selling such body or for dissection or for mere wantonness, is—

(a) A felony.

Cal., Pen. Code, sec. 290. Ga., Laws, 1882, v. 2, p. 87. Ill., S. & C. Am. Stat., v. 1, p. 794. Ind., R. S., sec. 2,166. Mo., R. S., secs. 3,842, 3,845. Mont., Laws, 1889, p. 114. N. C., Laws, 1885, ch. 90.

(b) A misdemeanor.

Ark., R. S., secs. 1,902, 1,903. Del., Laws, 1883, ch. 234. Kan., Gen. Stat., sec. 2,372 et seq. Md., Code, art. 27, secs. 133, 134. Pa., Bright Pen. Digest, 229, sec. 11. Tenn., Code, secs. 5,659, 5,660.

(c) Is punishable by various sentences.

Ala., Code, secs. 4,023, 4,028. Ariz., Pen. Code, sec. 491. Col., Mill’s Stat., sec. 1,367. Conn., Gen. Stat., sec. 1,880. Fla., R. L., sec. 2,625. Iowa, McCl. Am. Code, sec. 5,328. Ky., Gen. Stat., ch. 29, art. 17, sec. 16. Me., R. S., ch. 124, sec. 27. Mass., Pub. Stat., ch. 207, secs. 47, 48. Mich., How. Stat., v. 2, sec. 9,297. Miss., Am. Code, secs. 1,023, 1,024. Neb., Consol. Stat., sec. 5,847. N. H., Pub. Stat., ch. 266, sec. 7. N Dak., Comp. Laws, sec. 6,559. Ohio, R. L., sec. 7,034. Oklahoma, Stat., sec. 2,198. Ore., Crim. Code, sec. 656. Texas, Pen. Code, art. 345. Vt., Rev. L., secs. 4,194, 4,196. Va., Code, sec. 208. W. Va., Code, ch. 149, sec. 13. Wis., S. & B. Am. Stat., sec. 4,592. Wyo., R. L., sec. 1,029.

(d) A high misdemeanor.

N. J., Rev. Stat., p. 249, sec. 122.

Bodies of criminals executed under sentence, and those dying in jail, poor-house, etc., when to be delivered over for dissection.

Ark., R. S., sec. 2,552. Cal., Pen. Code, sec. 3,094. Col., Mill’s Stat., secs. 1,547, 1,548, 1,204. Conn., Gen. Stat., secs. 1,729, 1,732. Ga., Laws, 1887, v. 2, p. 87. Ill., S. & C. Am. Stat., v. 1, 869. Ill., Crim. Code, sec. 503. Ill., S. & C. Am. Stat., v. 3, p. 867. Ind., R. L., sec. 4,258 et seq. Iowa, McCl. Am Code, sec. 5,329. Kan., Gen. Stat., sec. 3,758. Me., R. S., ch. 13, sec. 2. Me., Laws, 1893, ch. 254. Mass., Laws, 1891, ch. 185. Mass., Pub. Stat., ch. 202, sec. 8. Mich., How. Stat., v. 3, sec. 2,284. Minn., Gen. Stat., sec. 678. Mo., R. S., sec. 6,883. Neb., Consol. Stat., secs. 3,299, 3,301, 5,848. N. H., Pub. Stat., ch. 136. N. J., Rev. Stat., p. 239, sec. 69. N. C., Laws, 1891, ch. 129. N. Dak., Laws, 1890, ch. 92. Ohio, R. S., sec. 3,763. Ore., Hill’s Am. Laws, sec. 3,730 et seq. Pa., Bright Pen. Dig., p. 94, sec. 1 et seq. Vt., Laws, 1884, ch. 85. Va., Code, ch. 80. Wash., Hill’s Am. Stat., v. 1, sec. 2,428 et seq. Wash., S. & B. Am. Stat., sec. 1,437.

Duty of burial, etc.

Ariz., Pen. Code, sec. 493. Cal., Pen. Code, sec. 292. Minn., Gen. Stat., sec. 6,221. N. Dak., Comp. Laws, secs. 6,550, 6,556. Oklahoma, Stat., sec. 2,189.

Concealing birth of child which, if born alive, would be a bastard, is punishable.

Col., Mill’s Stat., sec. 1,195. Fla., R. L., sec. 2,393. Mass., Pub. Stat., ch. 207, sec. 11. Mich., How. Am. Stat., sec. 9,284. Mont., Crim. L., sec. 41. Neb., Consol. Stat., sec. 5,582. Nev., Gen. Stat., sec. 4,597. N. H., Pub. Stat., ch. 278, sec. 14. N. Dak., Comp. L., sec. 6,947. Oklahoma, Stat., sec. 2,179. Ore., Crim. Code, sec. 649. Pa., Bright Pen. Digest, 431, sec. 158. R. I., Pub. Stat., ch. 244, sec. 8. Wis., S. & B. Am. Stat., sec. 4,585.

Is a misdemeanor.

Minn., Gen. Stat., sec. 6,210. N. J., Rev. Stat., p. 241, sec. 83.

Is a felony.

Mo., R. S., sec. 3,479 (whether born dead or alive)

ALABAMA.

Removal of body wantonly for dissection or sale, purchase of a body unlawfully disinterred, violating grave with intent to steal body, etc., or wantonly mutilating body, is punishable by fine or imprisonment (Code, secs. 4,023, 4,028).

Coroner, or in his absence justice of the peace, to hold inquest and direct examination of body by surgeon, etc. (Code, sec. 4,801 et seq.).

ARIZONA.

Mutilation, etc., of dead body is a felony (Pen. Code, sec. 491).

Removal of a part of body unlawfully is punishable (Pen. Code, sec. 492).

Duty of burying body is, if a married woman, on husband; if not a married woman, on nearest of kin who is an adult possessed of sufficient means. If deceased has no relatives, on coroner holding inquest or overseers, etc., of poor (Pen. Code, sec. 493).

Refusal of one on whom duty of burial is imposed by law, is punishable (Pen. Code, sec. 494).

Arrest or attachment of a dead body is a misdemeanor (Pen. Code, sec. 496 et seq.).

Coroner to hold inquest and direct autopsy (Pen. Code, sec. 2,309 et seq.).

Person whose duty it is to bury is entitled to custody except where coroner holds it until inquest is completed (Pen. Code, sec. 495).

ARKANSAS.

Bodies of persons dying in alms-house, prison, house of correction, or jail shall be surrendered to a physician for dissection, etc., unless the deceased request to be buried or the body is claimed by relatives, or unless deceased died suddenly and unknown; and after such use for dissection it shall be decently buried (R. S., sec. 2,552).

Removal of dead body for the purpose of dissection, or stealing, or from wantonness, or receiving same knowing it to have been unlawfully disinterred, is a misdemeanor (R. S., secs. 1,902, 1,903).

Dead body can be transported out of county in which death occurred on permit of State board of health (R. S., sec. 480).

Coroner to hold inquest and direct autopsy, etc. (R. S., sec. 692).

And may order a body to be disinterred for inquisition (R. S., sec. 718).

CALIFORNIA.

Removal, mutilation, or disinterment of dead body without authority of law is a felony (Pen. Code, sec. 290).

Removal of part of body for sale, dissection maliciously or wantonly is punishable (Pen. Code, sec. 291).

Duty of Burial.—Of married woman, on husband; not a married woman, nearest of kin who is an adult with sufficient means; where no relatives, on coroner who held the inquest or overseers, etc., of poor (Pen. Code, sec. 292).

Refusal to bury by person on whom duty rests by law to bury, is a misdemeanor and he is liable for treble the expenses (Pen. Code, sec. 293).

Custody of body is on him on whom duty to bury is imposed by law, except where coroner detains remains for inquest (Pen. Code, sec. 294).

Arrest or attachment of dead body for any debt or demand is a misdemeanor (Pen. Code, sec. 295).

One who disinters or exhumes a body without permit of board of health, health officer, or mayor, or transports such exhumed remains through streets of town, city, etc., except in a sealed coffin, guilty of a misdemeanor (Laws, 1878, ch. 673).

A sheriff, coroner, or keeper of county poor-house, public hospital, county jail, or State prison, etc., must surrender bodies of those who are to be buried at public expense, to any physician or surgeon for dissection, etc., unless deceased during his last sickness requested to be buried or body is claimed by relatives, etc., or deceased was a stranger or traveller, died suddenly (Pen. Code, sec. 3,094).

Coroner to bury body when no other person takes charge of same (Pen. Code, sec. 4,286).

Coroner to hold inquest, direct autopsy, and may exhume (Pen. Code, see. 1,510).

COLORADO.

Concealment of death of issue which, if born alive, would be a bastard, is punishable (Mill’s Stat., sec. 1,195).

Body of criminal executed for capital offence shall be delivered to a physician or surgeon unless claimed by relative or friend (Mill’s Stat., sec. 1,204).

Board of health, mayor, etc., or officer, etc., having control of any alms-house, prison, hospital, jail, etc., shall surrender bodies to be buried at public expense to any physician or surgeon for dissection, etc., unless deceased during last illness requested to be buried, or body is claimed by relatives or friends, or deceased was a stranger or traveller who died unknown (Mill’s Stat., secs. 1,547, 1,548).

Non-resident poor person to be decently buried (Mill’s Stat., sec. 3,391).

Coroner to hold inquest, etc., or, if none, bury it decently at expense of county (Mill’s Stat., secs. 870-882).

Removal of body unlawfully for sale, dissection, etc., punishable (Mill’s Stat., sec. 1,367).

Board of health may direct removal of dead bodies from cemetery within a city (Laws, 1893, ch. 113, sec. 54).

CONNECTICUT.

No body shall be buried or disinterred or removed beyond limits of any town unless a permit is obtained, and where deceased died of an infectious disease body shall be in a hermetically sealed case (Gen. Stat., secs. 106, 108, 113).

Custody of remains is in husband or wife or next of kin (Gen. Stat., sec. 536).

Coroner to hold inquest, etc. (Gen. Stat., secs. 2,005, 2,008). And deliver body to friends or, if none, to town authorities for burial (Gen. Stat., sec. 2,015).

Mayor, etc., may deliver bodies of those not buried within twenty-four hours after death to medical college for dissection, etc., unless relatives or friends do not consent, or deceased requested to be buried, or was a stranger or traveller (Gen. Stat., sec. 1,729).

Bodies of convicts dying in State prison and not having any known relatives, shall be delivered to medical institution of Yale College (Gen. Stat., sec. 1,732).

Body of one dying in a hospital shall not be examined unless father, etc., consent, or if none, within forty-eight hours after death (Gen. Stat., sec. 1,735).

Removal of body from grave unlawfully, or receiving, secreting, or dissecting same, is punishable (Gen. Stat., 1880).

Body of executed criminal shall be buried by sheriff (Gen. Stat., sec. 1,640).

DELAWARE.

Coroner to hold inquest, etc., or may cause body to be disinterred (R. L., ch. 33).

Removal of body from grave unlawfully, a misdemeanor (Laws, 1883, ch. 204).

FLORIDA.

Buying, selling, or having possession for purpose of buying or selling, a dead body is punishable (R. L., sec. 2,625).

Concealing birth of issue which, if born alive, would be a bastard, is punishable (R. L., sec. 2,393).

Coroner to hold inquest, etc. (R. L., secs. 3,011, 3,019).

GEORGIA.

Coroner to hold inquest or to disinter same for inquisition (Code, secs. 590, 591, 410 et seq.).

Public officers and their assistants, and their deputies of every county, city, town, or other municipality, or of every prison, chain gang, penitentiary, county morgue, public hospital, having control of dead body to be buried at public expense (not dying of infectious disease) shall deliver same to medical college for dissection, etc., unless claimed by friends or relatives or such friends or relatives request same to be buried, or unless deceased was a stranger or traveller (Laws, 1887, vol. 2, p. 77).

Removal of body from grave, etc., unlawfully for dissection or sale is felony, or receiving or purchasing it knowing it to have been so taken, or trafficking in dead bodies, or having them conveyed without the State for sale, etc., is a felony (Laws, 1882, vol. 2, p. 87).

IDAHO.

Coroner to hold inquest, etc., and may exhume it for that purpose (R. L., sec. 8,377).

Coroner to bury body decently when not claimed by relatives, etc., and if necessary, at expense of county (R. L., sec. 2,081).

ILLINOIS.

Removal of body unlawfully or aiding in such removal is punishable as a felony—one to ten years (S. & C. Am. Stat., vol. 1, p. 794).

Coroner to hold inquest, etc. (S. & C. Am. Stat., vol. 1, p. 606).

And to deliver body to friends or bury decently if no friends claim it, if necessary at county expense (S. & C. Am. Stat., vol. 1, p. 606).

Body of executed criminals may be delivered to any physician or surgeon for dissection unless friends object (S. & C. Am. Stat., vol. 1, p. 869; Crim. Code, sec. 503).

In cities and counties where population exceeds one hundred thousand, superintendents of penitentiaries, wardens of poor-houses, coroner, city undertaker, having body required to be buried at public expense, may deliver remains to medical college or any physician or surgeon for dissection, unless claimed by relatives (S. & C. Am. Stat., vol. 3, p. 867).

INDIANA.

Removal of dead body or part of same unlawfully is a felony (R. L., sec. 2,165).

Concealment of body or part thereof, which has been unlawfully used for dissection, is a felony (R. L., sec. 2,167).

Receiving or buying a body knowing it to have been unlawfully disinterred is a felony (R. L., sec. 2,168).

Dead body of one dying in a State, city, or county prison or jail, or county asylum or infirmary or public hospital, or dead body of an executed criminal, or dead body of a vagrant, or one killed while committing a felony or escaping from prison or officers, may be delivered to the faculty of a medical college in State for dissection, etc., unless deceased requested to be buried or body is claimed by next of kin (R. L., sec. 4,258 et seq.).

Dissecting or possessing body for dissection except as prescribed by law is a felony (R. L., sec. 4,271).

Coroner to hold inquest, etc. (R. L, secs., 5,878, 5,879).

IOWA.

Coroner to hold inquest, etc. (McCl. Am. Code, sec. 487).

To bury body decently at expense of county, if necessary, or deliver it to relatives (McCl. Am. Code, sec. 501).

Removal, etc., of dead body unlawfully, or aiding such removal or knowingly receiving body so removed, etc., is punishable (McCl. Am. Code, sec. 5,328).

Coroner, undertaker, superintendent of public asylum, hospital, poor-house, or penitentiary, may deliver body to medical college or physician for dissection, etc., unless relatives, etc., refuse or deceased desired to be buried (McCl. Am. Code, sec. 5,329).

Bodies of those executed, or dying in hospitals or prisons under sentence for crime, shall be delivered to medical college or association or any physician or surgeon for dissection, etc., unless relatives or friends do not consent, or body shall have been interred, or is not claimed by relatives, or deceased expressed a wish to be buried, and after such use the remains shall be interred (Gen. Stat., sec. 3,758).

State board of health shall issue permits for transportation of bodies beyond county where death occurred (Gen. Stat., sec. 6,030).

KANSAS.

Coroner to hold inquest, etc. (Gen. Stat., secs. 1,780, 1,794).

To bury body if not claimed by friends, etc., and at public expense, if necessary (Gen. Stat., sec. 1,792).

Removal of a body unlawfully for dissection or wantonly, or receiving body knowing it to have been so removed, is a misdemeanor (Gen. Stat., sec. 2,372 et seq.).

KENTUCKY.

Coroner to hold inquest, etc. (Gen. Stat., ch. 25, secs. 3, 11).

To bury the body or deliver to friends (Gen. Stat., ch. 25, sec. 6).

Body of one dying on a steamboat, or other craft, if not claimed by friends, shall be buried by master or officer in command on shore, at least four feet deep (Gen. Stat., ch. 29, art. 17, sec. 15).

Removal of body unlawfully from grave is punishable (Gen. Stat., ch. 29, art. 17, sec. 16).

LOUISIANA.

Coroner shall hold inquest, etc., and bury body when not claimed by friends (Voorh. Rev. L., secs. 653, 660).

MAINE.

Coroner to hold inquest, etc. (R. L., ch. 139, sec. 1).

To bury the body at State or town expense (R. L., ch. 139, sec. 11).

Seizure of body on execution, punishable (R. L., ch. 124, sec. 26).

Removal, etc., of body unlawfully, or receiving it knowingly, or exposing, etc., body, is punishable (R. L., ch. 124, sec. 27).

Bodies may be buried and the expense recovered from the town (R. L., ch. 24, sec. 34).

If any resident request or consent that his body be delivered to a physician or surgeon for dissection, it may be so delivered, unless kindred or family connection objects (R. L., ch. 13, sec. 1).

Body of criminal dying in State prison or jail, or who was executed, may be delivered to medical college or physician, etc., for dissection, unless deceased or kindred request to be buried (R. L., ch. 13, sec. 2).

Body of person dying in the State, which is not claimed by relatives, notice having been given, shall be delivered to medical school unless ten voters of the town object to such disposition in writing (Laws, 1893, ch. 254).

MARYLAND.

Coroner to hold inquest, etc. (Md. Code, art. 22, secs. 3, 4).

Shall bury the body when necessary at public expense (Md. Code, art. 22, sec. 7).

Removal, etc., from graveyard, etc. (except potter’s field), of a body is a misdemeanor (Md. Code, art. 27, secs. 133, 134).

MASSACHUSETTS.

Medical examiners shall hold inquest, etc. (Pub. Stat., ch. 26, secs. 10, 11).

And shall deliver it to relatives or friends, or if no one claims it, to overseer of poor etc., for burial (Laws, 1887, ch. 310).

Body shall not be buried in city or town or removed therefrom without a permit (Laws, 1888, ch. 306).

Body of one dying of infectious disease shall not be transported without permit, and only in a sealed case (Laws, 1883, ch. 124, sec. 2).

Body shall not be cremated without permit and inquest by medical examiner, or within forty-eight hours after death, unless death was occasioned by contagious disease (Laws, 1885, ch. 265, sec. 4).

Overseers of poor, mayor and alderman of city, or superintendent of State alms-house, may deliver body of person required to be buried at public expense, to any physician or surgeon or medical college unless deceased requested to be buried, or relative request burial or claim it, or deceased was a stranger or traveller (Laws, 1891, ch. 185).

Body of criminal executed shall be delivered for dissection to a medical college if requested; if not, to friends or relatives, or, if none, to any physician or surgeon (Pub. Stat., ch. 202, sec. 8).

Removal of body unlawfully from grave is punishable, or buying, selling, or possessing for such purpose, is punishable (Pub. Stat., ch. 207, secs. 47, 48).

Concealing birth of child which, if born alive, would be a bastard, is punishable (Pub. Stat., ch. 207, sec. 11).

Seizing dead body on execution is punishable (Pub. Stat., ch. 207, sec. 46).

Body of a prisoner shall be buried by sheriff at town expense if not claimed by relatives or friends (Pub. Stat., ch. 220, sec. 31).

MICHIGAN.

Justice of the peace to hold inquest, etc. (How. Am. Stat., vol. 2, sec. 9,583 et seq.).

And shall bury the body at the State or town expense (How. Am. Stat., vol. 3, sec. 9,593).

Woman concealing death of issue which, if born alive, would be a bastard, is punishable (How. Am. Stat., vol. 3, sec. 9,284).

Board of health, officers, sheriff, etc., of any prison, etc., poor-house, alms-house, having body required to be buried at public expense, shall, if not claimed by relatives, or if it have died of any infectious disease, deliver it to University of Michigan, etc., for dissection, etc. (How. Am. Stat., vol. 3, sec. 2,284).

Body shall not be shipped out of State nor used in State for any purpose but anatomical study (How. Am. Stat., vol. 3, sec. 2,286).

Removal of body unlawfully is punishable (How. Stat., vol. 2, sec. 9,297).

MINNESOTA.

Gen. Stat., secs. 6,220, 6,230, same as N. Y. P. C., secs. 305-315.

Concealing birth of child which died before or after birth is a misdemeanor (Gen. Stat., sec. 6,210).

Coroner to hold inquest, etc. (Gen. Stat., sec. 1,011 et seq.).

And cause body to be buried at expense of county (Gen. Stat., sec. 1,021).

Section 6,216, same as 303, N. Y. P. C.

Body must be buried within four days, and if death was from contagious disease, within twenty-four hours and in a tightly sealed coffin which must not be reopened (Gen. Stat., sec. 607).

Wardens, superintendents of poor, and other persons having control of bodies shall deliver same to medical college committee, for dissection, unless claimed by relatives or friends, or relatives or friends do not consent, or one detained as a witness or on suspicion of having committed a crime, or deceased requested to be buried (Gen. Stat., sec. 678).

MISSISSIPPI.

Body of paupers and strangers to be buried (Am. Code, secs. 3,145, 3,146).

Coroner to hold inquest, etc. (Am. Code, sec. 816).

Removal of body unlawfully and wantonly, for sale or receiving same, is punishable (Am. Code, secs. 1,023, 1,024).

MISSOURI.

Coroner to hold inquest, etc. (R. L., sec. 2,438 et seq.).

And shall bury the body, if not claimed by friends, at public expense (R. L., sec. 2,456).

And may direct a chemical analysis and microscopical examination of body (R. L., sec. 2,469).

Superintendents or wardens of penitentiary, houses of correction, insane asylums, poor-houses, and coroners, sheriffs, city and county undertakers, having charge of a body required to be buried at public expense, shall deliver the same to medical college for dissection unless claimed by relatives or friends, and trafficking in such bodies is a misdemeanor (R. L., sec. 6,883 et seq.).

Concealing birth of child, so that it may not be known whether it was born alive or dead, is a felony (R. L., sec. 3,479).

Removal of dead body from grave without authority (except that of criminal executed for crime), for purpose of sale, etc., or receiving such body knowingly, is a felony (R. L., secs. 3,842, 3,845).

MONTANA.

Concealing birth of child which, if born alive, would be a bastard, is punishable (Crim. Laws, sec. 41).

Coroner to hold inquest, etc. (Gen. Laws, secs. 869, 883).

And bury body at public expense if not claimed by relatives, etc. (Gen. Laws, sec. 881).

Removal, etc., of dead body from grave without authority, and for the purpose of sale or dissection, or from wantonness, is a felony (Laws, 1889, p. 114).

NEBRASKA.

Coroner to hold inquest, etc. (Consol. Stat., sec. 3,130 et seq.).

To bury body if not claimed by friends (Consol. Stat., sec. 3,144).

Removal of body from grave without authority for sale, dissection, etc., is punishable (Consol. Stat., sec. 5,847).

Fœticide is punishable (Consol. Stat., sec. 5,582).

Bodies of paupers or criminals unclaimed by friends or relatives may be delivered to medical college or physician for dissection, etc., and such body shall not be transported out of State (Consol. Stat., secs. 3,299, 3,301, 5,848).

NEVADA.

Justice of peace to hold inquest, etc. (Gen. Stat., sec. 2,256 et seq.).

And cause the body to be buried at public expense (Gen. Stat., sec. 2,269).

Body shall not be buried without certificate of physician or coroner (Gen. Stat., sec. 4,872 et seq.).

Body shall not be transported out of State without a permit (Gen. Stat., secs. 4,870, 4,871).

Concealing birth of child which, if born alive, would be a bastard, is punishable (Gen. Stat., sec. 4,597).

Non-resident, et al., to be buried at public expense (Gen. Stat., sec. 1,986).

NEW HAMPSHIRE.

Coroner to hold inquest, etc. (Pub. Stat., ch. 262, sec. 1 et seq.).

And bury body if a stranger, at public expense (Pub. Stat., ch. 262, sec. 16).

Concealing birth of child which, if born alive, would be a bastard, is punishable (Pub. Stat., ch. 278, sec. 14).

Body of person dying in a county, city, or town, or State prison or jail, required to be buried at public expense, shall be delivered to any physician or medical college for dissection, etc., unless deceased requested to be buried, or friends claimed it or request burial, or deceased was a stranger or traveller who died suddenly (Pub. Stat., ch. 136).

Body not to be buried without permit or disinterred (Pub. Stat., ch. 173, sec. 6).

Removal of dead body without authority, or concealing it, knowing it to have been so dug up, is punishable (Pub. Stat., ch. 266, sec. 7).

NEW JERSEY.

Coroner to hold inquest, etc. (Rev. Stat., p. 170 et seq.).

And bury body if not claimed by friends (Rev. Stat., p. 170, sec. 5).

Concealing birth of child which, if born alive, would be a bastard, is a misdemeanor (Rev. Stat., p. 241, sec. 83).

Body of executed criminal may be delivered to physician, etc., for dissection unless claimed by relatives (Rev. Stat., p. 239, sec. 69).

Removal of a body without authority for sale, dissection, etc., is a high misdemeanor (Rev. Stat., p. 249, sec. 122).

Exposing body of an executed murderer is a misdemeanor (Supp. Rev. Stat., p. 194, sec. 19).

Body must not be buried without a permit; nor body brought into the State without permit; nor taken out of State without permit (Laws, 1888, ch. 39, secs. 5-8).

NEW MEXICO.

Justice of the peace to hold inquest, etc. (Comp. Laws, sec. 443 et seq.).

And bury the body (Comp. Laws, sec. 447).

Body of one dying of a contagious disease shall not be carried in an open coffin, or be exposed (Laws, 1889, ch. 79, sec. 8).

Body shall not be buried within fifty yards of running stream (Laws, 1891, ch. 93).

NEW YORK.

Duty of burial, etc. (Pen. Code, sec. 305 et seq.).

Attempt at sexual intercourse with dead body is a crime against nature (Pen. Code, sec. 303).

Transfer of body of one who died of a contagious or infectious disease shall be in hermetically sealed casket (Laws, 1893, ch. 661, sec. 23).

Bodies of those dying in, or in custody of managers, etc., of any prison, asylum, morgue, hospital, or in possession of undertakers, shall be delivered to medical college of this State, etc., for purpose of medical study, unless claimed by relatives or friends, or friends or relatives do not assent to such disposal, or deceased requested during last illness to be buried (Laws, 1893, ch. 661, sec. 207).

In certain cases bodies of convicts, unless claimed, shall be delivered to certain medical colleges (R. S., pt. 4, ch. 3, secs. 132, 133).

District attorney may cause body to be exhumed, examined, etc. (Pen. Code, sec. 308).

NORTH CAROLINA.

Coroner to hold inquest, etc. (Code, sec. 657).

Concealing birth of child, by burying dead body, is a misdemeanor. Opening grave without authority for purpose of taking body is a felony (Laws, 1885, ch. 90).

Coroner may order a chemical analysis of remains (Laws, 1887, ch. 269).

Dead body of convict, unclaimed by friends, shall be delivered to medical college except such dying of contagious disease (Laws, 1891, ch. 129).

Body of one dying of contagious disease must not be transported by common carrier until disinfected, nor shall permit for removal be issued until such disinfection (Laws, 1893, ch. 214, sec. 16).

NORTH DAKOTA.

Coroner to hold inquest, etc. (Comp. Laws, sec. 664 et seq.).

And bury the body if not claimed by friends, etc. (Comp. Laws, sec. 676).

Concealing birth of child which, if born alive, would be a bastard, or of child dying within two years after birth, is punishable (Comp. Laws, sec. 6,947).

COMP. LAWS.

Sec. 6,549 same as 305 N. Y. P. C. ” 6,550 ” 306 ” ” 6,551 ” 307 ” ” 6,552 ” 308 (1-3) ” ” 6,553 ” 309 ” ” 6,554 ” 310 ” ” 6,559 ” 311 ” ” 6,560 ” 312 ” ” 6,563 ” 314 ”

Duty of burial of married woman, on husband. If not married woman, on nearest of kin who is an adult or has means sufficient (Comp. Laws, sec. 6,556).

Refusal to bury by one on whom duty is imposed by law, a misdemeanor (Comp. Laws, sec. 6,557).

Custody of body pertains to one whose duty it is to bury (Comp. Laws, sec. 6,558).

When cemetery is by law changed to other place, duty is on relative to move body (Comp. Laws, sec. 6,562).

Body of executed criminal, and those dying in State penitentiary or county jail under sentence, shall be delivered to medical college or any physician for dissection, unless deceased requested to be buried, or friends ask to have it buried, or deceased was a stranger or traveller (Laws, 1890, ch. 92).

OHIO.

Coroner to hold inquest, etc. (R. L., sec. 1,221 et seq.).

And bury body, etc. (R. L., sec. 1,227).

Body of pauper or unknown, not an inmate of any penal, charitable, or reformatory institution, and not claimed by relative or delivered for dissection according to law, shall be buried at public expense (Laws, 1890, p. 283).

Corpse shall not be conveyed to or from a city without a permit (R. L., sec. 2,119).

Bodies of those dying in city hospitals, city or county infirmaries, work-houses, asylums, charitable institutions, penitentiaries, or jails, which are required to be buried at public expense, shall be delivered to medical college or society for study, etc., unless claimed by relative, or deceased was a stranger or traveller (except tramps) (R. L., sec. 3,763).

Removing body from grave without authority for dissection or receiving such body is punishable (R. L., sec. 7,034).

Body of executed criminal, if not claimed by relative or friends, may be delivered for dissection, etc. (R. L., sec. 7,343, 1).

OKLAHOMA.

Coroner to hold inquest, etc. (Stat., sec. 1,745 et seq.).

And bury the body at public expense if not claimed by relatives (Stat., sec. 1,759).

Concealing birth of issue which, if born alive, etc., or dying within two years after birth, is punishable (Stat., sec. 2,179).

2,188-2,190 same as 305-307 N. Y. P. C. 2,191 ” 308 ” (except subd. 4) 2,192-2,193 ” 309-310 ” 2,198 ” 311 ” (ex. punishment) 2,199 ” 312 ” 2,202 ” 314 ”

Custody is in him whose duty it is to bury (Stat., secs. 21, 97).

Duty of burial of married woman, on husband; if not married woman, on nearest of kin who is an adult and has sufficient means (Stat., sec. 2,195).

Refusal to bury by one on whom duty rests, is a misdemeanor (Stat., sec. 2,196).

OREGON.

Coroner to hold inquest, etc. (Crim. Code, sec. 453 et seq.).

And bury body if not claimed by friends (Crim. Code, sec. 462).

Unmarried woman concealing birth of child so that it may not be known whether it was born alive or not, is punishable (Crim. Code, sec. 649).

Bodies of criminals executed, those dying in hospitals, insane asylums, alms-houses, or penitentiaries, may be delivered to medical college or physician for dissection, etc., unless they shall have been interred, or claimed by relatives, or relatives and friends do not consent, or deceased expressed a wish to be buried; and they shall be used for such purpose only and in this State (Hill’s Am. Laws, sec. 3,730 et seq.).

Removal of body without authority, etc., is punishable (Crim. Code, sec. 656).

PENNSYLVANIA.

Coroner to hold inquest in Philadelphia County only in case of a violent death (Bright Pen. Dig., 1536, sec. 37).

And may in Berks and Lancaster Counties order a post mortem (Bright Pen. Dig., 1536, sec. 38).

Concealing death of child which, if born alive, would be a bastard, is punishable (Bright Pen. Dig., 431, sec. 158).

Removal of body from grave without authority is a misdemeanor (Bright Pen. Dig., 229, sec. 11).

Bodies of those dying in alms-house, hospital, prison, or public institution, or those in morgue, which are required to be buried at public expense, shall be delivered to medical college, physician, etc., to be used for scientific purposes only, unless claimed by relatives or deceased was a traveller, and trafficking in such bodies is a misdemeanor (Bright Pen. Dig., p. 9, sec. 1 et seq.).

RHODE ISLAND.

Concealing death of child which, if born alive, would be a bastard, so that it may not be known, etc., is punishable (Pub. Stat., ch. 244, sec. 8).

Seizing dead body under execution is punishable (Pub. Stat., ch. 223, sec. 2).

Bodies of those dying in jail shall, if not claimed by relatives, be buried at public expense (Pub. Stat., ch. 201, sec. 30).

Medical examiner to make autopsy (Pub. Stat., 1884, ch. 420).

And bury body of stranger at State expense if necessary (Pub. Laws, 1884, ch. 420, sec. 24).

Coroner to hold inquest if, in opinion of medical examiner, death was caused by act of some one other than deceased (Pub. Laws, 1884, ch. 420, sec. 17).

SOUTH CAROLINA.

Coroner to hold inquest, etc. (R. L., secs. 711, 2,664 et seq.).

And may have body disinterred for inquisition (R. L., sec. 2,687).

TENNESSEE.

Coroner to hold inquest, etc. (Code, sec. 6,139 et seq.).

And may order a chemical analysis of remains, etc. (Code, sec. 6,150).

Body to be buried, if not claimed by relatives, etc., at public expense if necessary (Code, sec. 6,160).

Wilfully and improperly exposing or abandoning a dead body is a misdemeanor (Code, sec. 5,658).

Removing or purchasing dead bodies without authority is a misdemeanor (Code, secs. 5,659, 5,660).

Body of deceased convict to be buried unless claimed by friends (Code, sec. 6,402).

TEXAS.

Justice of the peace to hold inquest, etc. (Code Crim. P., art. 988 et seq.).

And may disinter the body for such inquisition (Code Crim. P., art. 989).

Removal, etc., of dead body from grave without authority is punishable (Code, art. 345).

Bodies of convicts to be buried (Rev. C. Stat., art. 3,561).

VERMONT.

Justice of the peace to hold inquest, etc. (Rev. Laws, sec. 3,934 et seq.).

Removal, etc., of dead body without authority, is punishable (Rev. Laws, secs. 4,194, 4,196).

Bodies of those dying in poor-house or other public institution, which are required to be buried at public expense, may be delivered to any physician for dissection, etc., unless deceased requested to be buried, or friends or relations request burial, or deceased was a stranger or traveller. Such body shall not be removed from State, and shall be used for scientific purposes only (Laws, 1884, ch. 85).

VIRGINIA.

Coroner to hold inquest, etc. (Code, sec. 3,938 et seq.).

And to bury the body at public expense (Code, sec. 3,946).

Removal, etc., of dead body from grave without authority, is punishable (Code, sec. 3,794).

Bodies of those dying on vessels in State, shall be buried by master on the shore above high-water mark (Code, sec. 2,002).

Bodies of those dying in alms-house, prison, morgue, hospital, jail, or other public institution, which are required to be buried at public expense, and bodies of criminals executed for crime shall be delivered to medical college, etc., and physician or surgeon for anatomical study, unless (except criminals) relatives and friends claim the body or deceased was a stranger or traveller; and such bodies shall not be sent out of the State (Code, ch. 80).

WASHINGTON.

Coroner to hold inquest, etc. (Hill’s Am. Stat., vol. 1, sec. 245 et seq.).

And bury body, if not claimed by friends, at public expense (Hill’s Am. Stat., vol. 1, sec. 257).

Bodies of those dying in poor-house, public hospital, county jail, State prison, etc., which are required to be buried at public expense, shall be delivered to medical college, physician, surgeon, etc., for study, unless deceased requested to be buried, or it is claimed by friends or relatives, or deceased was a stranger or traveller; and such body shall be used only in the State (Hill’s Am. Stat., vol. 1, sec. 2,428 et seq.).

Removal, etc., of body from the grave without authority is punishable (Pen. Code, sec. 208).

WEST VIRGINIA.

Coroner to hold inquest, etc. (Code, ch. 154).

And bury the body at public expense, or if of a stranger, may forward it to its destination or bury it (Code, ch. 154, sec. 8).

Removal, etc., of a body from grave is punishable (Code, ch. 149, sec. 13).

WISCONSIN.

Justice of the peace or coroner to hold inquest, etc. (S. & B. Am. Stat., ch. 200).

And shall cause the body to be buried at public expense (S. & B. Am. Stat., ch. 200, sec. 4,877).

Dead body of convict shall, if not claimed by relatives or friends, be buried (S. & B. Am. Stat., sec. 4,926).

Removal, etc., of body from grave without authority is punishable (S. & B. Am. Stat., sec. 4,592).

Concealing death of child which, if born alive, would be a bastard, is punishable (S. & B. Am. Stat., sec. 4,585).

A public officer having in his charge a body required to be buried at public expense, shall deliver same to member of State or county medical society, etc., for anatomical study, unless claimed by relatives, or they consent to such disposal, or deceased requested to be buried, or was a stranger or traveller (S. & B. Am. Stat., sec. 1,437).

THE POWERS AND DUTIES

OF

CORONERS AND MEDICAL EXAMINERS.

BY

AUGUST BECKER, Of the Buffalo (N. Y.) Bar.

THE POWERS AND DUTIES

OF

CORONERS AND MEDICAL EXAMINERS.

BY

AUGUST BECKER, Of the Buffalo (N. Y.) Bar.

POWERS AND DUTIES OF CORONERS AND MEDICAL EXAMINERS.

I. THE CORONER AND HIS COURT.

Coroner an Ancient Officer.—The office of coroner is one of the most important and ancient known to the common law. A coroner, or coronator, was so called because he had principally to do with the pleas of the crown, or suit wherein the king was immediately concerned.[507] The office is first mentioned in a charter granted in the year 925 by King Athelstan, to the authorities of Beverley. The office as at present constituted was not clearly established until after the Norman conquest.

Under this head come the lord chief justice and puisne justices of the King’s Bench, who are supreme and sovereign coroners respectively.[508] The duties of the office of coroner involve questions of the greatest interest to society, to government, and to the rights and privileges of the individual citizen. The office has lost much of the honor and respect which formerly appertained to it. Its character and importance have been much diminished in latter times, making striking contrast with the high estimation it was held in by our ancestors in days when none but the gentry and knights of the shire were deemed eligible.

In fact so great was the dignity of this office in ancient times, that it was never presumed that coroners would condescend to be paid for their services.[509] They were chosen by all the freeholders of the county court for life or good behavior, and were liable to be removed for cause by the writ de coronatore exonerando. There were three kinds of coroners at common law: Virtute officii; virtute cartæ sive commissionis; and virtute electionis.[510] The office of coroner was brought to America by the colonists along with the institutions of the common law, and may be said to exist in the several States with all the common-law incidents, except so far as they may have been modified by statute. The present defined powers of coroners in Great Britain and the United States, unless modified by British statutes and American acts, are derived from the English Stat. de Officio Coronatoris, 4 Edward I., s. 2. Coroners virtute officii and virtute cartæ sive commissionis are unknown to our institutions. Here the office of coroner may be classed under the head of coroners virtute electionis. Generally speaking the coroner is a county officer.

CORONER’S DUTIES BOTH JUDICIAL AND MINISTERIAL.

By the common law his powers and duties are both judicial and ministerial. In his ministerial capacity he is merely a substitute for the sheriff, as when the sheriff is a party.[511] His powers and duties thereunder it is not the present purpose to state and define. His judicial authority relates to inquiries into cases of sudden death, by a jury of inquest, super visum corporis, or, as it is more commonly defined, an inquisition, with the assistance of a jury, over the body of any person who may have come to a sudden or violent death, or who may have died in prison.[512] It is not necessary that the death should be both violent and sudden, and that both these circumstances must concur to give the coroner jurisdiction. It is sufficient to give the coroner jurisdiction if the death occurs from any violence done to a person by another, although such violence may not have terminated the life of a party suddenly, and it is still the duty of the coroner to hold an inquest.[513] Indeed the presumption is that he has acted in good faith and on sufficient cause.[514] And so when several persons have been suddenly killed by the same violent cause, under circumstances proper to be inquired of by a coroner’s inquest, it is proper and necessary for the coroner, acting in good faith, to hold a separate inquest over each body.[515] A coroner’s inquest is a judicial investigation. The coroner cannot delegate his authority to any one. Neither can he appoint a deputy under the common law. He must act in person as any other judicial officer; and it may safely be said that a coroner has no power to appoint a deputy coroner, except where special provision is made therefor by statute.[516] In England, a coroner’s court is a court of record, and it has accordingly been held that trespass cannot be maintained for turning a person out of a room where the coroner is about to take an inquisition.[517] But in this country, it may safely be said that a coroner’s court is not one of record, but of inferior jurisdiction.[518] The performance of the functions of a coroner are judicial in their character; so judicial that he is protected under the principles which protect judicial officers from responsibility in a civil action brought by a private person. His proceedings amount to entries concerning matters of public interest, made under the sanction of an official oath, and in compliance or presumed compliance of the law.[519]

Of his Authority to Hold an Inquest.—His authority to hold an inquest is not confined to the body of a person who may have died within his territorial jurisdiction, but extends to all bodies brought within his jurisdiction, no matter where death may have taken place.[520] So in any case where, after burial, an inquest becomes necessary to determine the manner of the death of a person who, dying in one, is buried in another county, the coroner of the latter county is the proper officer to hold the inquest.[521] A coroner cannot hold a second inquest while the first is existing. As we have seen, in holding an inquest the coroner performs a judicial duty, and he is functus officio as soon as the verdict has been returned. He can hold no second inquest in the same case unless the first has been quashed by a court of competent jurisdiction, and a new inquiry ordered. He cannot set aside or quash his own inquest. If he were allowed to hold two inquests, not only might the greatest inconvenience arise from the inconsistent findings of the respective juries, but such a practice would be liable to great abuse, and as the object of the proceeding is merely preliminary, the main purpose being to ascertain whether it is probable that a crime has been committed, and to examine the facts and circumstances and preserve the evidence, all the ends of this inquiry are answered by one inquisition, super visum corporis. We believe no reported case is to be found in this country where a second inquisition has been held, the first remaining undischarged, nor is any such practice known to or recognized by our laws.[522]

THE INQUEST MUST BE HELD UPON VIEW OF THE BODY.

The coroner can in no case hold an inquest except upon view of the body. This is jurisdictional and cannot be waived by any one. He is not bound to hold an inquest before burial of the body takes place. When it has been buried, and he believes an inquest necessary, he is vested with authority to have the body disinterred and hold his inquest, and if necessary direct a post-mortem examination to be made, but after having done so, he must cause it to be reburied.[523] Deep interests are involved in the proper discharge of the duties of coroners; the character, liberty, and perhaps the life of a citizen accused of crime on the one hand, and on the other the aiding of public justice in establishing the guilt and securing the punishment of the actual criminal. Many of the questions which fall within the scope of a coroner’s inquisition are of an intricate and most perplexing character, a correct solution of which can only be arrived at by minds the best instructed and habituated to their investigation. In many cases some of these questions can be satisfactorily settled by the evidence of persons having cognizance more or less direct of the facts; in others, however, they can only be solved by the facts deduced from pathological anatomy, and other circumstances connected with the dead body, the cause of the extinction of life in which is the subject of the inquest.

In Massachusetts Office of Coroner Abolished.—Indeed, in Massachusetts the office of coroner was abolished in 1877, and the governor was invested with power, and it is his duty, to appoint, by and with the advice and consent of the council, able and discreet men, learned in the science of medicine, to be medical examiners, whose duties are to make examinations as provided in the statute upon the view of the dead bodies of such persons only as are supposed to have come to their death by violence.[524]

Coroner may Employ Professional Skill.—A thorough examination aided by professional skill is in general absolutely necessary to the proper administration of justice. It would no doubt be strange if a coroner had no authority to pledge the responsibility of the county for the compensation of all auxiliary services which are necessary to the proper execution of his office, and which he can by no other means command; for instance, when his duty requires him to disinter a body, he cannot be expected to do it with his own hands, or by hands paid for with his means. Indeed it has been said that, in this enlightened age, a coroner who would consign to the grave the body over which he had held an inquest, without availing himself of the lights which the medical science has placed within his reach, would in most cases fall short of what his official duty requires.[525] It is the generally accepted view of the law now that it is the duty of a coroner holding an inquest super visum corporis to avail himself of professional skill and aid, and his contract will bind the county to the payment of a reasonable compensation for making a post-mortem examination.[526]

POST-MORTEM EXAMINATION.

Whether such examination should take place before the coroner has empanelled a jury seems to be an open question. We would venture the opinion that it should not, inasmuch as the jury ought to see and view the body in the same condition, as near as may be, as it was when found, and not after it has been mutilated, as it must need be by a post-mortem examination. It is, however, settled that the post mortem should not be in the presence of the jury, and that they are to be instructed by the testimony of the physicians who are designated by the coroner to make the examination.[527] The coroner’s right to dissect the dead body of a human being does not extend to all cases. Such a power could be wielded with the most injurious effects upon a community. His power to dissect is confined to those cases where he is authorized by law to hold an inquest upon the body. But a post-mortem examination, conducted by surgeons employed by a coroner holding an inquest, is not a part of the inquest in such a sense as that every citizen has a right freely to attend it. At common law it was essential to the validity of a coroner’s inquisition that the jury should view the body. And so is our law. But it was never required that the body should be dissected in any case. It is discretionary with the coroner to cause a dissection to be made, and to select the surgeons. He has also a discretion to determine whether any person, and what persons, may be present besides the surgeons. Not even the jurors have a right to witness the examination. They are to be informed of what it discloses by the testimony of the surgeons. Indeed, no person has a right to be present at the post-mortem examination upon the ground that he is suspected of having caused the death. He loses no legal right by being excluded. He has no right to dissect the body. If the coroner’s jury pronounce him guilty, the inquest, like the indictment of a grand jury, simply makes him liable to arrest.[528]

MASSACHUSETTS STATUTORY PROVISIONS.

The statute law of Massachusetts has already been referred to. It has abolished the office of coroner and in its place put medical examiners, so called, who are presumed to be learned in the science of medicine. Their powers, however, are not co-extensive with those of coroners. A medical examiner cannot hold an inquest. He cannot hold an autopsy without being thereto authorized in writing by the district attorney, mayor, or selectmen of the district, city, or town where a dead body lies. He can only upon receiving notice that there has been found, or is lying within the county, the dead body of a person who is supposed to have come to his death by violence, repair to the place where such body lies, view and take charge of the same. If he deems a further examination necessary and is authorized so to do, he must make an autopsy in the presence of two or more discreet persons, whose attendance he may compel by subpœna if necessary, and he must then carefully reduce or cause to be reduced to writing every fact and circumstance tending to show the condition of the body and the cause and manner of death, together with the names and addresses of the witnesses. If he deems it necessary, he may employ a chemist to aid in the examination of the body or of substances supposed to have caused or contributed to the death,[529] the record of which he must subscribe.[530] Such an autopsy does not, however, upon the trial of an accused render other competent evidence, as to the condition and appearance of the dead body at the time of the autopsy, inadmissible.[531] The autopsy may be followed by an inquest held, not by the examiner, but by a justice of the district, police, or municipal court for the district or city in which the body lies, or a trial justice. One of these functionaries must hold an inquest upon being notified by a medical examiner that in his opinion a death was caused by violence, and after hearing the testimony draw up and sign a report and issue process for apprehension of a person charged by the report with the commission of an offence, if he is not in custody.[532] Even though a medical examiner reports that a death was not caused by violence, and the district attorney or the attorney-general is of a contrary opinion, either one may, notwithstanding such report, direct an inquest to be held in accordance with the provisions of the statute.[533]

NEW YORK’S STATUTORY PROVISIONS.

In New York the powers and duties of coroners are defined by statute. Coroners in the city of New York are governed by a special act relating to that city exclusively. For the State at large it is provided that whenever a coroner is informed that a person has been killed or dangerously wounded by another, or has suddenly died under such circumstances as to afford a reasonable ground to suspect that his death has been occasioned by the act of another by criminal means, or has committed suicide, he must go to the place where the person is, and forthwith inquire into the cause of the death or wounding, and summon not less than nine nor more than fifteen persons, qualified by law to serve as jurors, if such death or wounding be of a criminal nature, to appear before him forthwith at a specified place, to inquire into the cause of death or wound, and if it appears from the evidence taken or during the inquisition, that any person or persons are chargeable with the killing or wounding, or that there is probable cause to believe that any person or persons are chargeable therewith, and if they are not in custody the coroner must forthwith issue a warrant for the arrest of the person or persons charged with such killing or wounding, who must be arraigned before the coroner for examination, and the coroner has power to commit the person or persons so arrested to await the result of the inquisition. A coroner is disqualified from acting as such in any case where the person killed or dangerously wounded is a co-employee with the coroner of any person or persons, association or corporation, or where it appears that the killing or wounding has been occasioned, directly or indirectly, by the employer of the coroner.[534] It is further provided that whenever a convict shall die in any State prison, it shall be the duty of the inspector having charge of the prison and of the warden, physician, and chaplain of the prison, if they or either of them shall have reason to believe that the death of the convict arose from any other than ordinary sickness, to call upon the coroner having jurisdiction to hold an inquest upon the body of such deceased convict.[535] The New York Criminal Code further provides that when six or more of the jurors appear, they must be sworn by the coroner to inquire who the person was, and when, where, and by what means he came to his death or was wounded as the case may be, and into the circumstances attending the death or wounding, and to render a true verdict thereon according to the evidence offered to them or arising from the inspection of the body.[536] The coroner may issue subpœnas for and summon and examine as witnesses every person who in his opinion, or that of any of the jury, has any knowledge of the facts; and he must summon as a witness a surgeon or physician, who must, in the presence of the jury, inspect the body, and give a professional opinion as to the cause of the death or wounding.[537] The jury, after inspecting the body and hearing the testimony, must render their verdict, and certify it by an inquisition in writing, signed by them, and setting forth who the person killed or wounded is, and when, where, and by what means he came to his death or was wounded, and if he were killed or wounded, or his death were occasioned by the act of another by criminal means, who is guilty thereof, in so far as by such inquisition they have been able to ascertain.[538] The testimony of the witnesses examined before the coroner’s jury must be reduced to writing by the coroner, or under his direction, and must be forthwith filed by him, with the inquisition, in the office of the clerk of the court of sessions of the county, or of a city court having power to inquire into the offence by the intervention of a grand jury.[539]

If, however, the defendant be arrested before the inquisition can be filed, the coroner must deliver it with the testimony to the magistrate before whom the defendant is brought.[540] If the jury find that the person was killed or wounded by another under circumstances not excusable or justifiable by law, or that his death was occasioned by the act of another by criminal means, and the party committing the act be ascertained by the inquisition and is not in custody, the coroner must issue a warrant signed by him with his name of office, for the arrest of the person charged.[541] The coroner has power to compel the attendance of a witness and testify, and he may punish a witness for disobedience, as upon a subpœna issued by a magistrate.[542] The coroner’s warrant may be served in any county; and the officer serving it must proceed thereon, in all respects, as upon a warrant of arrest on an information, except that when served in another county it need not be indorsed by a magistrate of that county.[543] When the defendant is brought before the coroner, he must proceed to examine the charge contained in the inquisition or information, and hold the defendant to answer, or discharge him therefrom, in all respects as upon a warrant of arrest on an information.[544]

II. THE JURY AND INQUEST.

Jurors Must be Sworn by Coroner.—The jurors summoned by a coroner to attend an inquest must be from the county or jurisdiction wherein the coroner is empowered to act. He cannot proceed with the inquest until he has summoned and sworn the jury. The jurors are not challengeable, and therefore they should be carefully selected and sworn by the coroner himself. His duties are judicial and he can only take an inquest super visum corporis, and an inquest in which the jury is not sworn by himself is absolutely void and of no effect.[545]

They Must Investigate and Determine the Facts.—After being sworn by the coroner they must investigate and determine and are the sole arbiters of the facts; the coroner’s duty being to instruct them in the law. They must go, view, and examine the body together, and not separately. It is essential to the validity of the inquest that the jury should view the body.[546]

Coroner may Compel Attendance of Witnesses.—When the coroner sits to hold an inquest, he sits as a judicial officer, armed with all the ordinary powers possessed by judicial officers. He may compel the attendance of jurors whose qualifications are usually such as are required of jurors in a court of record. It is his duty to present before the jury all the material testimony within his power, touching the death as to the manner whereof the jury are to certify, and that which makes for as well as against the party accused. It is his duty to summon before his inquest every person whom he has any reason to believe possesses any knowledge relative to the death which he is investigating. He is to summon such persons to attend before him for examination. He has full authority to compel obedience to his subpœnas. He has this power by the common law.[547] If a post-mortem examination is made, the examining surgeons should testify before the jury as to the matters disclosed by the examination.[548] The witnesses produced must be sworn by the coroner, and their testimony reduced to writing by him or under his direction.

RIGHTS OF ACCUSED PARTY.

The coroner is not required to take the testimony of the witnesses who are examined before the jury in the presence of the party accused. The accused has not the right to be represented by counsel, or to cross-examine the witnesses.[549] He is not permitted to produce witnesses before the coroner to show himself innocent of the crime. The coroner is not required to examine any witnesses to establish the guilt of such party when brought before him by virtue of process issued after the finding of the inquisition.[550]

Deliberation by Jury and Return of an Inquisition.—After the evidence has been taken, and the jury instructed in the law by the coroner, the jury should retire to deliberate upon their verdict. During such deliberation and until they have arrived at their verdict the coroner should not be present in the room where the jury is deliberating. After they have agreed on their verdict it should be reduced to writing, and the coroner is bound to accept it as final in his court. The inquisition should then be signed by the coroner and jury.[551] If the inquest is signed by the coroner and duly certified by him, the jurors having signed by making their cross marks, and the whole being certified by the coroner, his certificate of the signatures of the jurors is sufficient and the inquisition is properly made.[552] If several jurors on the inquest have the same christian and surname, it is not necessary in the caption of the inquisition to distinguish them by abode or otherwise.[553] The law requiring the coroner to make a return of the testimony with the inquisition cannot be satisfied short of some official certificate indicating that the witnesses named were sworn before him, to the matter insisted on as evidence against a prisoner. At least if there be no formal authentication, there should be proof aliunde that the memorandum presents the testimony of the witness truly.[554]

III. THE EFFECT OF THE EVIDENCE AND VERDICT.

Under the common law formerly, a coroner’s inquisition was equivalent to an indictment by a grand jury upon which the accused might be tried. But in this country no person can be tried upon a coroner’s inquisition, yet the inquisition of a coroner’s jury finding a person guilty of murder has about the same force against him, until the grand jury passes upon his case, that an indictment found by them has thereafter, prior to his trial.

Coroner has Power to Issue Process of Apprehension.—If a person is charged with the crime in the inquisition, the coroner has power and he issues his process for the apprehension of the accused when not in custody solely upon the inquisition. The inquisition, though taken in the absence of the prisoner, and upon the testimony of witnesses he could not cross-examine, settles the question of his guilt until the grand jury passes upon the case. It justifies the commitment of the prisoner to jail, in the same manner that the testimony of witnesses does taken before a justice of the peace. The coroner can only examine the prisoner in the same manner as upon a warrant of arrest or on information, and is not authorized to examine witnesses either against the prisoner or for him, when he is apprehended by virtue of process issued subsequent to the finding of the inquisition by the jury, or in custody of the coroner without process at the time the same is found.

Privilege of Prisoner upon Arrest.—The prisoner has the privilege of telling his own story before the coroner, which is to be returned with the inquisition, and that is all. He cannot be discharged on it, however plausible it may be; and he has not the privilege of proving it true before the coroner. He should, therefore, not be discharged, and he cannot have the case investigated again before it is passed upon by the grand jury.[555]

Under the provisions of the New York Criminal Code the defendant against whom an inquisition has been found by a coroner’s jury is entitled to a hearing before a magistrate, whether he has been arrested before the inquisition has been filed or is arrested after such filing. Under the provisions of sec. 779, in the case of a defendant who has been arrested before the inquisition can be filed, the prisoner is entitled to be examined before the magistrate, before whom he may be brought, as provided in sec. 781, and in the case of a prisoner who has not been arrested until after the inquisition was filed, under secs. 781 and 783 the defendant is entitled to be heard before a magistrate in all respects as upon a warrant of arrest on an information. The magistrate must proceed to examine the charge contained in the inquisition, and hold the defendant to answer or discharge him therefrom.[556] The information is the allegation made to a magistrate that a person has been guilty of some designated crime.[557]

WHEN EVIDENCE TAKEN BEFORE CORONER OF A PARTY CHARGED WITH CRIME ADMISSIBLE IN EVIDENCE UPON HIS TRIAL SUBSEQUENTLY.

There is nothing which distinguishes between the proceedings of a coroner’s inquest and any other official proceedings taken and returned in the discharge of official duty as to their admissibility in evidence. A witness, therefore, may be contradicted by the production of a deposition thus given by him before a coroner.[558] But the line is sharply drawn in what cases the testimony of a witness examined before a coroner’s inquest can be used on his subsequent trial, and in what cases it cannot. When a coroner’s inquest is held before it has been ascertained that a crime has been committed, or before any person has been arrested charged with the crime, and a witness is called and sworn before the coroner’s jury, the testimony of that witness, should he afterward be charged with the crime, may be used against him on his trial, and the mere fact that at the time of his examination he was aware that a crime was suspected, and that he was suspected of being the criminal, will not prevent his being regarded as a mere witness, whose testimony may be afterward given in evidence against himself. If he desires to protect himself he must claim his privilege. But if, at the time of his examination, it appears that a crime has been committed, and that he is in custody as the supposed criminal, he is not regarded merely as a witness, but as a party accused, called before a tribunal vested with power to investigate preliminarily the question of his guilt, and he is to be treated in the same manner as if brought before a committing magistrate, and an examination not taken in conformity with the statute cannot be used against him on his trial for the offence.[559] So the doctrine as to silence being taken as an implied admission of the truth of allegations spoken or uttered in the presence of a person, does not apply to silence at a judicial proceeding or hearing, and since the proceedings at a coroner’s inquest are of a judicial character, what there transpired must be considered as a part of the proceedings.[560] The leading cases which have been before the New York Court of Appeals upon this important question, and from which that court has finally deduced that rule, may be here referred to.

Hendrickson Case.—In the first case the wife of the defendant died suddenly in the morning, and in the evening of the same day a coroner’s inquest was held. The defendant was called and sworn as a witness upon the inquest. At that time it did not appear that any crime had been committed, or that the defendant had been charged with any crime, or even suspected, except so far as the nature of some of the questions asked of him might indicate such a suspicion. On his subsequent trial on an indictment for the murder of his wife, the statements made by him at the coroner’s inquest were held admissible, on the ground that he was not examined as a party charged with the crime, that it had not appeared even that a crime had been committed, and that he had simply testified as a witness on the inquiry as to the cause of the death.[561]

McMahon Case.—Following this came the McMahon Case, in which it appeared that the defendant was arrested by a constable, without warrant, on a charge of having murdered his wife. The constable took him before the coroner, who was holding an inquest on the body, by whom he was sworn and examined as a witness. It was held that the evidence thus given was not admissible on the prisoner’s trial for the murder, and his conviction was reversed upon that ground.[562]

Teachout Case.—The doctrine of this case was more clearly defined and somewhat limited in a later case, the Teachout Case. In that case the defendant appeared at the coroner’s inquest in pursuance of a sub-pœna to testify, and voluntarily attended; he was not under arrest, but was informed by some one that it was charged that his wife had been poisoned and that he would be arrested for the crime. Before he was sworn he was informed by the coroner that there were rumors that his wife came to her death by foul means and that some of those rumors implicated him, and that he was not obliged to testify unless he chose. He said he had no objection to telling all he knew. The Court in delivering its opinion preludes it by a reference to these facts as showing that the statements made were voluntary in every legal sense, and held that a mere consciousness of being suspected of a crime did not so disqualify him that his testimony, in other respects freely and voluntarily given before the coroner, could not be used against him on his trial on a charge subsequently made of such crime. On that ground it held the evidence properly admitted, at the same time referring with approval to the McMahon Case, and distinctly limiting the rule of exclusion to cases within its bounds.[563]

Mondon Case.—Then followed the Mondon Case, where on the finding of the body of the deceased, the defendant was arrested without warrant as the suspected murderer. While he was thus in custody the coroner empanelled a jury and held an inquest, and the defendant was called as a witness before the inquest and was examined by the district attorney and by the coroner. The prisoner was an ignorant Italian laborer unfamiliar with the English language. He was unattended by counsel, and it did not appear that he was in any manner informed of his rights, or that he was not bound to answer questions tending to criminate him He was twice examined; on the first occasion the examination was taken by questions put either by the district attorney or by the coroner, and the result written down by the coroner, who then read the evidence over to him, line by line, and asked him if he understood it and if it was the truth, and he said it was, and the coroner then reswore him to the deposition. The coroner, after taking the defendant’s testimony on the first day, came to the conclusion that the defendant did not understand English well enough to be examined, and that it ought to be taken through an interpreter, which was done, in order that they might get it a little better and a little fuller. It was held that the defendant’s testimony was not admissible upon his trial on the indictment.[564] It will be seen that this latter case follows in direct line with the rule announced in the McMahon Case and clearly distinguishes another case, the McGloin Case, upon the authority of which the trial court held the testimony of the prisoner in the Mondon Case admissible.

McGloin Case.—The case of McGloin was not that of the examination of a prisoner on oath before a magistrate before whom he was taken involuntarily, while in custody, and interrogated by the magistrate, who to all appearance had power to require him to answer, but while under arrest the prisoner said to the inspector of police who had him in charge that he would make a statement. The inspector then said that he would send for a coroner to take it. The coroner was then sent for and came to police headquarters and took down in writing the confession dictated by the prisoner, the coroner asking no questions and not acting in any official capacity, but as a mere amanuensis to take down the confession and prove the contents. It was held that the confession of the prisoner was admissible in evidence upon his trial for murder.[565]

Rule in Pennsylvania.—The rule in Pennsylvania is substantially that when the testimony given by the prisoner under oath before a coroner’s inquest, previous to him being charged or suspected of the murder of the individual upon whose body the inquest was sitting, may afterward be given in evidence against him, on his trial for the murder of such person.[566]

Rule in Nebraska.—The statements of a prisoner to be competent evidence must have been voluntarily made. In cases of declaration made on an examination before a coroner’s inquest by a person under arrest or charged with the crime and also under oath, they are not admissible. But when the person, although he be subsequently charged with the offence, appears voluntarily, and gives testimony, before any accusation has been made against him, his statements are admissible in evidence against him on the trial of an indictment for the crime.[567]

MEDICO-LEGAL AUTOPSIES.

BY

H. P. LOOMIS, A.M., M.D.,

Professor of Pathology in the University of the City of New York; Visiting Physician and Curator to Bellevue Hospital, New York; Pathologist to the Board of Health, New York City; President New York Pathological Society, etc., etc.

AUTOPSIES.

A MEDICAL examiner before proceeding with an autopsy, especially if called before the body has been removed from the place where it was found, should carefully note certain facts. These should be entered by himself or an assistant with great care, in a note-book, as this book can be introduced as evidence in any trial. A satisfactory way is to dictate to the assistant as the examination proceeds, and at the conclusion the assistant reads the notes taken, and the examiner verifies them.

SURROUNDING OBJECTS—POSITION OF THE BODY.

These should be first noted. The character of the soil; the condition of the ground, and whether it shows footprints; if so, their direction; the evidence of any struggle; the presence of any weapon; and finally, the exact position in which the body lies, especially the position of the hands and feet. This is important, for the body may be found in a position which the deceased could not have assumed on the supposition of the wound or injury having been accidental or homicidal. If possible a photograph should be taken of the body in the exact position in which it is found. If it is absolutely necessary to remove the body, it should be done with great care, keeping the body in as horizontal a position as possible.

The character of the surrounding soil should be noted. This is of special importance when the body to be examined has been exhumed: for the question of preservation of the body and the ability to recognize pathological changes may be brought up at a trial. This was an important point raised in the Buchanan case (New York, 1893).

If a body be found in the water, examine the character of the water and the temperature, and if found near the shore, the character of shore and bottom.

=Blood.=—The situation of blood-stains, and their number and extent, on clothing or surrounding objects should be noted. This will often show whether a struggle has taken place after receiving the fatal wound, and is also of medico-legal importance if made at the time the body is found, for it may be so situated as to show that the body has been interfered with after death.

Again, spots of blood found upon articles of clothing or upon surrounding objects should be noted as to their form and direction, for they may serve to furnish an indication of the position of the person with respect to them when the wound was inflicted. For example, if the spot was oval, the presumption is that the person was placed obliquely with respect to the stain while the hemorrhage was occurring. The force with which the blood was thrown out will in some measure be indicated by the obliquity or length of the spot. The amount of blood will also often indicate whether the person has died suddenly, the exact spot where death occurred, whether a struggle took place, and will also preclude the possibility of a person moving after receiving the fatal injury. When we examine a body, especially when found in a room, care must be taken not to be misled by the accidental diffusion of blood by persons going in and out, or touching the body (see BLOOD-STAINS, Vol. II.)

=Clothing.=—The examination of the clothing should be thorough. A description of each article should be noted, and the order in which it is removed; for often it is important to prove that the garments were worn by or belonged to the deceased. If any blood is on the clothing, note whether the blood is in large patches, or whether it is sprinkled over the garment: the amount of the blood and what garments are stained by it. Note and examine whether the blood has flowed down the front of the clothing, whether it has soaked the inner garments, or again, whether it has collected along the back; for these appearances will sometimes demonstrate whether a wound was inflicted while the person was sitting, standing, or lying down. For example, if the throat is cut while the person is lying down, the blood will be found on each side of the neck along the back and not down the front of the body. Few suicides cut their throats in a recumbent position, and this distribution of the blood may serve to distinguish a suicidal from a homicidal wound.

The condition of the clothing may also serve to show whether there has been any struggle, and the presence of dry spots or mud on it may sometimes serve to connect an accused person with an act of murder. This is well illustrated in the case of Reg. v. Snipe, reported in Beck’s “Medical Jurisprudence,” where evidence was adduced to show that some spots of mud on the boots and clothing of the prisoner, when examined microscopically, contained infusoria, shells, and some rare aquatic vegetables. The mud of the ditch close to where the body was found, as also the mud on the clothing of the dead body, presented the same microscopical appearances. The medical expert who gave this evidence swore that in his opinion the mud spots on the body and on the prisoner’s boots were derived from the same ditch, for the mud of all the other ditches in the locality was found, on microscopical examination, to be different. The well-known case which occurred in New York a few years ago, known as the “Shakespeare case,” furnishes an example of the importance of carefully examining all stains on the clothing found on bodies.

If there are several stabs or cuts on the body involving the dress, it should be noted whether they are blood-stained, and if so, whether the stain is on the inside or outside of the garments, for sometimes in simulated personal injury a stain of blood may be inadvertently applied to the outside of the dress, as in wiping a weapon.

=Weapons.=—If a weapon is found, the character of the weapon and its exact position should be noted. This is frequently of importance in telling whether a person has died from an accidental or self-inflicted wound. In a case where death occurs immediately or within a few minutes, the weapon is found near the body, or often so tightly grasped in the hand that it can be with difficulty removed. If the weapon is found near the body it should be noted on which side and at what distance, and it must be questioned whether it could have fallen on the spot or been thrown there by the deceased. It is compatible with suicide that the weapon should be found at some distance from the body. An instance has been recorded where an individual was discovered in bed with his throat cut, and the bloody razor was found closed and in the pocket of the deceased. If a weapon cannot be discovered, or is concealed, it is strong presumptive evidence of homicide; especially when the wound is such as to produce speedy death.

Note whether the weapon is sharp or blunt, straight or curved. If a knife, the handle and inner portion should be examined, for the blade may have been washed.

If the wound has involved any large vessels, it is improbable that the weapon can have been thrown any distance from the body, and when it is, there are always fair grounds to expect interference with the original position of the body. One circumstance which always strongly points to suicide is the finding of the weapon firmly grasped in the hand of the cadaver. The hand of a dead person cannot be made to grasp or retain a weapon as does the hand which has grasped it at the last moments of life. The amount of blood on the weapon should be noted, but it must be remembered that a knife may have produced a fatal stab wound and still no blood be found on it. This is explained by the fact that in a rapid plunge the vessels were compressed, and only after the drawing of the knife and relieving of the pressure blood began to flow, or possibly the blood may have been wiped off the knife by the elasticity of the skin.

When a person has died of a gunshot wound, especially at close range, it is important to look for any wadding or paper found in the wound, as in a number of instances the finding of such has led to the detection of the criminal. For example, handwriting has been found on the paper, or it has formed part of a printed page the rest of which has been found in possession of the accused. When a gun is discharged near the body, a portion of the wadding is almost always found in the irregular wound produced.

POST-MORTEM EXAMINATION.

Having completed the examination of the surroundings, one next proceeds with the post-mortem examination, which should be conducted according to a well-defined plan, following which the results obtained will always be satisfactory.

If possible the body should be removed to a large, well-ventilated, and especially well-lighted room. No artificial light, if it can possibly be avoided, should be used when performing the autopsy; artificial light is especially bad on account of its yellowness and its power to modify natural color. Many diseased conditions cannot be satisfactorily determined by artificial light. The body should be placed on a high table, and the facility with which the autopsy is made will often depend on having the table high enough to render stooping unnecessary. Never make an autopsy, if it can possibly be avoided, on a body while in a coffin, as the examination is always unsatisfactory. The size and surroundings of the room, and how it is lighted, should be entered in the note-book.

=Instruments.=—If possible the following instruments should be at hand before proceeding with an examination, although some of them may be dispensed with:

(1) Large section knife; (2) scalpels; (3) enterotome (for opening intestines and stomach); (4) costotome, or large bone forceps (for cutting ribs); (5) scissors, large and small (one blade blunt); (6) saw; (7) chisel; (8) dissecting forceps; (9) probe; (10) blowpipe; (11) curved needles and strong twine; (12) measuring and graduated glass; (13) small scales.

Besides the above instruments, some basins containing water; sponges, bottle of flexible collodion, Lugol’s solution of iodine for the amyloid test, will be needed.

=Post-Mortem Wounds.=—Various plans have been proposed to protect the operator’s hands from the post-mortem wounds which are often so dangerous, such as wearing rubber gloves, smearing the hands with carbolized vaselin, both of which have their disadvantages: the gloves being too clumsy, and the vaselin rendering it almost impossible to hold the knife steady. Gloves should always be worn, however, where the body has undergone much decomposition, or where the person may have died from any septic disease. A method which I have found satisfactory is to cover all cuts and hangnails with flexible collodion, and then to have a basin of clean water at hand, and from time to time to rinse one’s hands in the water. It is from bathing the hands in the cadaveric fluids and not from cuts that most of the danger comes. If possible an absolutely new board, large enough upon which to examine the organs, should be at hand, for it may be claimed at a trial that the organs and tissues, if placed and examined on surrounding objects, have become contaminated.

=Toxicological.=—If a chemical analysis of the various organs and tissues is to be made, and it is impossible to have the chemist present, the medical examiner should obtain some new glass jars of suitable size, with close-fitting glass covers. These jars should be rinsed with distilled water, and in them the various organs are to be placed; if possible with no preserving fluid on them. But if it is found impossible to deliver the jars to the chemist at once, alcohol may be poured over the organs in the jars, but it is specially important that a sample of this alcohol should be retained, that a chemist may at a future date test the same for any impurities. After the organs and tissues have been placed in the jars, the mouths should be closed and sealed, and the seal remain in the custody of the examiner until the jars are delivered to the chemist.

=Parts to be Preserved for the Chemist.=—In cases of suspected poisoning, it is not sufficient that the stomach and intestines alone should be preserved for the chemist as has been indicated, each part by itself; for it should be remembered that the portion of poison remaining in the alimentary tract is but the residue of the dose which had been sufficient to destroy life, and if the processes of elimination have been rapid no trace of the poison will be found in the alimentary canal but can readily be detected in other organs. Again, the poison may not have been introduced by the mouth, in which case none may be found in the digestive tract.

The chemist should receive, besides the stomach and entire intestinal canal, the liver, one or both kidneys, the spleen, a piece of muscle from the leg, the brain, and any urine found in the bladder.

When it is impossible for any reason to obtain the whole of any organ, the part removed should be carefully weighed and its proportion to the rest of the organ noted.

It is also of extreme importance to preserve in sealed and labelled jars those parts of a body which may show the evidence of disease, or on the appearance of which one’s evidence is founded.

ORDER OF AUTOPSY.

In making the autopsy, the operator should stand on the right side of the body and make the incision by grasping the knife firmly in the hand, and cutting with the whole of the blade and not with the point. The knife should be swept along from the shoulder rather than from the wrist, thus making a long, smooth, deep cut; never a jagged one.

The method of examining the human body after death will vary somewhat according to the objects in view. These objects may be threefold: (1) To ascertain whether a person has died from violence or poison; (2) to establish the cause of death, especially if it has been sudden; and (3) to ascertain the lesion of a disease, or to confirm a diagnosis.

The only difference between a medico-legal and pathological autopsy is that in the former case everything which might subserve the ends of justice should be carefully noted, and the changes found most accurately described; especially any abnormalities found on the external examination of the body. A photograph should be taken of the body.

The head should be opened and the brain examined first, and not last, as is often done in the ordinary autopsy.

Careful notes should be taken during each step of the examination, to be reread, verified, and signed at the completion of the autopsy.

It must be remembered that most of the lesions of disease which are found, indicate the disease rather than the cause of death; that often the lesion found will seem hardly extensive enough to cause death, and that from accidents and injuries apparently trivial, death may result. It must often be acknowledged that no sufficient cause of death can be found, but the more accurate and careful the examinations (especially when a microscopical examination of the organs is made) the fewer will be the number of such cases. If no apparent lesion is found, it must not be forgotten that many poisons destroy life and leave no trace that the pathologist can discover.

Care should always be exercised not to mistake the ordinary post-mortem appearance which we find at autopsies for the lesions of disease.

The examination of the human body, whether it be made from a medico-legal or pathological standpoint, is divided into two main divisions:

(1) The external examination, and

(2) The internal examination.

EXTERNAL EXAMINATION.

Its minuteness will depend on the character of the case, as when the person is unknown, or when suspected to have died from unnatural causes. In such cases the external examination is very important.

The following are the steps to be followed:

(1) Give a =general description= of the body; apparent age, height, and weight of the individual; color of the hair and eyes; condition of the teeth; and the evidence of any personal peculiarities or abnormalities.

(2) Note the =color of the skin= and observe whether there are any spots of CADAVERIC LIVIDITY, and if present where situated.

(3) =Contusions.=—Note whether there are any contusions, and, if present, their character, situation, length, breadth, and depth should be described, and whether they are accompanied by inflammation or by the evidences of gangrene.

It is often important to determine whether a contusion has been inflicted before or after death. This is to be done by cutting into the ecchymoses and if the extravasated blood or the coloring matter of the blood is found free in the tissues, one can be almost certain that it is an ante-mortem injury. In post-mortem discolorations the blood is found in the congested vessels. The situation of ante-mortem contusions will not generally correspond to the discolorations produced by decomposition; the latter being confined to the most dependent parts. It should be remembered that the contusions produced by blows on a body dead only a few hours cannot be distinguished from those which were received during life; and also that putrefactive changes make it well-nigh impossible to distinguish between ante-mortem and post-mortem injuries. It should also be borne in mind that blows or falls sufficient to fracture bones or rupture organs may leave no mark on the skin (see WOUNDS, Vol. I., pp. 467, 474, et seq.).

(4) =Wounds.=—The situation, depth, extent, and direction of any wound should be recorded, as also the condition of its edges; the changes in the surrounding tissues, and whether inflicted by a cutting, pointed, or rounded instrument; or by a bullet. In the latter case the course and direction of the ball should be ascertained by dissection rather than by the use of the probe, and the character of foreign bodies, if any are found in the wound, should be noted. What nerves or blood-vessels, particularly arteries, have been injured, should be ascertained. It is often important to determine whether a wound was made before or after death. The following may serve as a differential point: In all wounds made after death there is slight bleeding, non-contraction of the edges, and absence of blood in the tissues. This is the opposite of ante-mortem wounds. Again, wounds inflicted within two hours after death cannot be differentiated from those made during life (see GUNSHOT WOUNDS, Vol. I., p. 610 et seq.; WOUNDS, Vol. I., p. 476 et seq.).

(5) =Fractures.=—If there are any evidences of fractures, the situation of the bones involved should be noted, and whether they are accompanied by contusions of the soft parts. Fractures which are inflicted during life are always accompanied by much more extravasation of blood, more injury to the soft parts, and more evidences of reaction than those occurring after death. It is a well-known fact that it is much more difficult to produce a fracture in a dead than a living body (see WOUNDS, Vol. II., p. 482 et seq.).

(6) =The temperature= of the body should be taken.

(7) =The rigidity and flexibility= of the extremities should be ascertained.

(8) =The state of the eyes= should be noticed, and the relative size of the pupils.

(9) Attention should be paid to the condition of the cavities of the mouth and nose. The neck should be specially examined for marks of external injury, or signs of ecchymosis or compression.

(10) =Genitals.=—The external genitals should be very carefully examined for evidence of injury, the presence of syphilitic lesions, and in the female the condition of the vagina should be particularly ascertained.

(11) =Œdema of the Feet.=—If there is evidence of œdema in any part of the body, especially about the ankles, its situation and extent should be noted.

(12) =Ulcers and Abscesses.=—The situation and extent of any ulcer found on the body should be recorded, as also the presence and situation of any abscess.

(13) =Burns.=—The extent of a burn, as also the state of the parts involved, should be noted. For example, whether they are inflamed or show blisters, etc. (see HEAT AND COLD, Vol. I., p. 647 et seq.).

(14) =Hands.=—In medico-legal cases the hands of a dead person should always be examined for the presence of cuts, excoriations, or foreign substances found upon them; especially should the dorsal extremities be examined. This examination will often indicate that there has been a mortal struggle before death. The impression of a hand or of some of the fingers is often found on the skin of a dead body. The exact situation where found should be noted. This may be of importance, as when it occurs where it would have been impossible or improbable for the deceased to have caused it.

For appearances in death from lightning or electricity, see Vol. I., p. 701 et seq., and in death from hanging, strangulation, and garroting, see Vol. I., pp. 713, 746, 781, et seq.

INTERNAL EXAMINATION.

Having completed the examination of the external parts of the body, the next proceeding is to open the body and make an internal examination.

This should be done by following a regular method, so as to examine the relations of parts and not to injure one organ while removing another.

In opening the various organs an incision should be made which will expose the greatest amount of surface at one cut. Never make a number of small and always unsatisfactory incisions in an organ. In opening certain organs like the brain and heart, the incisions are so planned that the parts of the organ may be folded together, and, if necessary, their relations to one another and the whole organ studied. Such organs are opened as one would open a book to examine its pages.

It is important to remember that after death the blood leaves the arteries and left side of the heart, and collects in the veins and the right cavities of the heart. Especially does it collect in the vessels of the most dependent portions of the body and of the various organs, so that local congestions may often disappear after death; and again, they may be found at an autopsy where they were not present during life. Especially is this true of the mucous membranes such as those of the trachea and bronchi, and also of the blood in the sinuses of the dura mater.

In making autopsies it is a cardinal rule that all the cavities of the body should be examined, and not alone the one where one might expect to find a lesion. At medico-legal autopsies, the great cavities—the head, the thorax, and the abdomen—should be examined in their successive order from above downward. The reason for beginning with the head is that the amount of blood in the brain and its membranes may be determined accurately; for, if the heart and great vessels of the neck are opened first, the blood will drain away from the brain and local congestions disappear. In pathological autopsies, the opening of the head first is not so important, and often the vertebral column need not be opened at all, for it is a complicated process and takes time; but in medico-legal cases, especially where a question as to the cause of death may arise, and has not satisfactorily been determined, after all the other cavities are examined the vertebral column should always be opened and the cord removed.

THE HEAD.

Make an incision across the vertex of the skull from ear to ear. Dissect the anterior flap forward until within about three inches of the bridge of the nose, and the posterior flap backward to the external occipital protuberance. Examine the internal surface of the scalp for ecchymosis and evidences of injury. A circular incision is then made with a saw through the cranium as far backward and forward as the flaps have been reflected. An incision through the temporal muscle is necessary so that the teeth of the saw may not become clogged by the muscle fibres. When the cranium has been sawed through, a stout hook is inserted under its upper edge and it is removed with a quick jerk. If the dura mater is very adherent to the calvaria, it may be necessary to remove it with the bone, by cutting through it at the level of the cranial incision. Examine the calvaria as also the other bones of the skull after the brain has been removed and the dura stripped off, for evidence of fracture.

Note the symmetry, thickness, and density of the cranial bone, and remember that depressions along the sagittal suture are for the Pacchionian bodies, and are not pathological.

=Dura Mater.=—The dura mater may be slightly adherent to the bone of the cranium. This is especially seen in old people and does not indicate disease. The Pacchionian bodies are seen along the longitudinal sinus. Examine the internal surface of the dura mater for the presence of clots, tumors, or inflammatory lesions. Open the longitudinal sinus and examine for thrombi. Remove the dura mater by an incision following the cranial incision, the falx cerebri between the anterior lobes being drawn back and divided. Note whether the dura mater is adherent to the pia mater, and the condition of its internal surface.

=Pia Mater.=—The brain, covered by the pia mater, is now exposed. Note the degree of congestion of the membrane, its adherence, and the existence of pus, blood, or serum on its surface or in its meshes. Remember that a considerable amount of serum may be present within normal limits, especially in cachectic subjects, without indicating disease, but when the serum is so extensive as to raise the pia mater and to depress the convolutions, we have a pathological amount which may be a simple dropsy due to some general cause, or the result of a chronic meningitis. Enough serous effusion in the pia mater to produce a condition which has been called by some writers “serous apoplexy,” I believe never occurs as a primary condition.

Loss of transparency and thickening of the pia mater, especially along the longitudinal fissure, is often seen in old people and does not indicate disease.

=Brain.=—Remove the brain by raising the anterior lobes with the fingers of the left hand and cutting through the nerves, vessels, and the tentorium as they appear. The medulla is cut as low down as possible, and the brain as it rolls out is caught in the left hand.

After being placed on a clean board or in a large clean dish, it is minutely examined. The average weight of an adult male brain is forty-nine and one-half ounces; of the female, forty-four ounces. Its proportional weight to that of the rest of the body is as 1 to 45.

Lay the brain first upon its convex surface and examine the arteries at the base for atheroma, thrombi, emboli, and aneurisms. Examine the pia mater of the base, especially for the evidences of hemorrhage, tumors, tubercles, and inflammatory lesions. Next turn the brain over on its base, and proceed to open its various cavities and examine its internal structure. Separate the two halves of the cerebrum, until the corpus callosum is exposed. Make an incision downward and outward at the junction of the corpus callosum with the cerebrum, and the roof of the lateral ventricles will be cut through and their cavities exposed. Prolong the incision forward and backward so as to expose the cornua. The size and contents of the ventricles should be noted, as also the condition of the ependyma. The floor of the lateral ventricles being the most frequent spot of hemorrhage, if one is found its extent and the parts involved by it should be noted; especially its relation to the internal capsule.

Transverse incisions (about one-sixteenth of an inch apart) are made through the ganglia seen on the floor of the lateral ventricles. Thus any lesions in the substance of the ganglia will be disclosed. Three or four longitudinal incisions are now made outward into the hemispheres nearly to the pia mater. These will divide the hemispheres into long, prism-shaped pieces held together by the pia mater and a little of the cortex, thus enabling the brain afterward to be folded together, and the relations of lesions to the brain as a whole studied. The third ventricle is now examined by cutting through the fornix and corpus callosum at the foramen of Monroe. Next, the fourth ventricle is opened by a longitudinal incision through the lower portion of the vermiform process; its contents, the condition of its vessels and ependyma noted. Then the floor of the fourth ventricle is divided by transverse incisions one-sixteenth of an inch apart, and careful examination made for the presence of minute hemorrhages: for here is a place in the body where almost a microscopical lesion (hemorrhage) may cause sudden death. Each hemisphere of the cerebellum is now opened by a number of incisions starting from the fourth ventricle and passing outward into its substance. The presence of any tumors or hemorrhage in the cerebellum will now be recognized.

In opening the brain, when clots, areas of softening, tumors, etc., are discovered, their exact location in relation to surrounding parts should be noted and the blood-vessels examined for areas of degeneration or aneurism. This examination can be facilitated by allowing a stream of water to flow over the affected part. This will wash out the affected area and allow the vessels to appear.

=Eye.=—In rare cases it may be necessary to remove the eye. This can be done by breaking through the roof of the orbit with a saw or chisel and dissecting away the muscles so as to expose the optic nerve and the posterior portion of the organ.

THORAX AND ABDOMEN.

The body being placed on its back, and the operator standing on the right side, an incision is made through the skin, fascia, and muscles from the top of the sternum to the pubic bone, passing to the left of the umbilicus and dividing everything down to the sternum and the subperitoneal tissue. A small incision is now made through the peritoneum below the ensiform cartilage. Into this opening two fingers of the left hand are inserted, and by spreading the fingers and holding the knife horizontally the peritoneum can be divided to the pubes without injuring the intestines. The skin and muscles are now dissected from the chest as far back as the false ribs. This dissection may be facilitated by keeping the skin and muscles on the stretch and cutting with the flat part of the knife. In order to better expose the abdominal cavity, the recti muscles are divided beneath the skin at their insertion in the pubic bone. Examine the cut surface of the chest and abdominal muscles, and note their color, amount, and consistency. Observe whether the chest muscles show the evidence of any parasitic disease such as trichinosis. The mammary glands are now examined from behind and opened if necessary.

=Superficial Examination of Abdominal Cavity.=—This should be done before opening the chest cavity, because the position of organs may become modified, and blood and other fluids are liable to find their way from one cavity into another; and again, the blood in the presenting portion of the abdominal organs will change its color after exposure to the air.

NOTE THE FOLLOWING POINTS: (a) The relative position and general condition of the abdominal organs.

(b) The color and amount of blood in the presenting parts.

(c) Whether there are any signs of inflammation or the evidence of foreign bodies or tumors.

(d) Examine the vermiform appendix.

(e) The amount of fluid in the abdominal cavity. Normally a small quantity of reddish serum will be found, particularly in warm weather, at the most dependent portion of the abdominal cavity. If the quantity is small it can only be ascertained by raising the intestines from the pelvis. When the fluid is considerable, the exact amount should be ascertained and its character noted.

(f) Perforation, invagination, and hernia of the intestines should be looked for.

(g) Determine the height of the diaphragm. Normally, on the right side, it is at the junction of the fifth rib with the sternum, and on the left it reaches as high as the sixth. A variety of pathological conditions change its position. For instance, it may be raised when the contents of the abdomen are greatly increased in volume, and in new-born children who have never breathed. It may be depressed by enlargement of the lungs, disease of the heart, or fluid in the pleural or pericardial cavities. The presence of air or gas in the pleural cavity can be determined either by filling the abdomen with water and puncturing the diaphragm beneath the fluid so that the air will bubble up, or a puncture may be made through the thorax between the ribs, and the flame of a match will be deflected by the escaping air.

THORAX.

The thorax is opened by cutting the sterno-costal cartilages as close to the end of the ribs as possible, the cut being made downward, outward, and backward, and the knife held obliquely so as not to injure the underlying parts. Quite often the cartilages will be found ossified and it will be necessary to divide them by a costotome. Next, separate the clavicles by a semi-lunar incision at their attachment to the sternum.

Raise the sternum with the left hand and separate it from the underlying parts. If there is any adherence of the sternum a slight twist will be sufficient to remove it.

=Superficial Examination of Thorax.=—Observe the position, color, and degree of distention of the lungs. It should be remembered that healthy lungs, as soon as the chest is opened, owing to their inherent elasticity, will collapse, and when this normal collapse is not seen it is generally due to a loss of elasticity as occurs in emphysema, to inflammatory diseases binding the lung to the chest wall, or to the alveoli being filled with solid or fluid substances or pent-up air. Most complete distention is seen when death is due to drowning or suffocation.

The area of the heart uncovered will vary according to the degree of collapse of the lungs and to the abnormal size of the heart. Normally the cardiac area exposed is quadrangular in shape, and about three and a half inches in its longest diameter. Examine the pleural cavities for the presence of adhesions, foreign bodies, or fluid. If fluid is found it should be removed, measured, and its character noted. It is to be remembered that in warm weather, or when putrefaction has commenced, a moderate amount of reddish serum is found in the pleural cavities which has no pathological significance. Lastly, examine the mediastinum as to the condition of the thymus gland and great vessels outside the pericardium.

=Pericardium.=—Open the pericardium by an oblique incision along the anterior wall, and prolong this incision downward and outward toward the diaphragm and upward to its reflection from the great vessels. Normally, about a drachm of clear serum, sometimes, however, blood-stained from decomposition, will be found in the pericardial sac. The amount is best ascertained by raising the heart. Note next the contents of the pericardium and whether there is any serous, fibrous, or purulent exudation. If an abnormal amount of fluid is present, remove, measure, and note its character. Observe whether there are any adhesions between the two surfaces of the pericardium. White patches are often seen on the visceral surface of the pericardium, especially over the ventricles. These have no pathological significance and are due to slight thickenings of the pericardium.

=The Heart.=—Having passed the hand over the arch of the aorta and noticed whether there is any evidence of aneurism or dilatation, we grasp the heart firmly by the apex, raising and drawing it forward. We remove it by cutting through the vessels at its base. Test the sufficiency of the aortic and pulmonary valves by allowing a stream of water to flow into these vessels, the heart being held in a horizontal position and care being taken not to pull the valves open.

To apply the water test to the mitral and tricuspid valves, the auricles are first opened so as to expose the upper surface of these valves, and by allowing a stream of water to flow through the aortic and pulmonary valves into the cavities of the ventricles, the degree of sufficiency of these valves can readily be ascertained.

Another rough test is what is known as the “finger test.” The mitral valve will normally allow two fingers, held flat and in contact, to pass through its opening. The tricuspid in the same way allows, normally, three fingers to pass; or if a more accurate test of the degree of insufficiency is desired, the valvular orifices should be measured. Normally, the aortic orifice is one inch across; the mitral, one and eight-tenths inches; pulmonary, one and two-tenths inches; and the tricuspid about two inches.

We open first the cavity of the right ventricle by making an incision over its anterior border close to the septum. Prolonging the incision downward to the apex and upward through the pulmonary artery, the cavity of the ventricle will be fully exposed. The left ventricle is similarly opened by an incision through its anterior wall which is prolonged upward through the aortic valve. The cavities of the auricle and ventricle, especially those of the right side, will often contain blood-clots. These clots are usually post-mortem clots formed during the last hours of life or after death. It may sometimes be necessary to distinguish these post-mortem clots from what are known as ante-mortem clots. The latter are usually of firm consistency, dry, of a whitish color, and closely entangled in the trabeculæ, while the former are succulent, moist, of a reddish-yellow color, and are easily detached from the walls of the heart cavities. Ante-mortem clots are rarely seen, and the medical examiner should be careful not to attribute the cause of death to the post-mortem clots which are so often seen. After the heart is opened we can with more care and greater accuracy examine the condition of the valves and recognize the extent of valvular lesions.

The condition of the endocardium should now be examined and any abnormality noted. Often it will be seen stained a deep red color. This is not due to disease, but is caused by the absorption of the coloring matter of the blood which has been set free by decomposition. The size of the heart cavity and the thickness of the heart walls should be noted, as also their consistency and color. It should be remembered that the heart walls may appear unusually flabby as the result of decomposition, or apparently thickened when death occurs in extreme systole. The interior of the heart can be further examined by passing the enterotome into each auricle, carrying the incision through the mitral and tricuspid valves to join at the apex with the previous incision, which has been prolonged through the ventricles to the apex. Thus the auriculo-ventricular valves are completely exposed.

Having removed the blood from the heart it is next weighed. The average normal weight of the human heart is about twelve ounces in the male, and a little less in the female: its size roughly corresponding to the closed hand of the individual. Normally, the thickness of the walls of the left ventricle about its middle is five-eighths to two-thirds of an inch, and of the right ventricle one-eighth to one-quarter of an inch.

Note the condition of the aorta above the heart, whether it is dilated, atheromatous, or shows calcareous deposits. Examine the coronary arteries by opening them with a blunt-pointed scissors. Disease of these vessels with thrombosis is one of the causes of sudden death which is often overlooked.

=The Lungs.=—The lungs are removed by lifting them from the pleural cavity and cutting through the vessels and bronchi at their base. If a lung is very adherent it is sometimes better to remove the organ with the costal pleura attached so as not to tear the lung substance. Examine the external surface of the lung as to its shape, color, and consistency. Next open the large bronchi with a blunt-pointed scissors, and prolong the incision into the pulmonary substance along the minute bronchi. Observe the contents of the bronchial tubes, the appearance of the mucous membrane, and their relative thickness. Remember that it is very difficult to tell the condition in which the mucous membrane was during life on account of the early post-mortem changes which affect it, and also because the contents of the stomach may have been forced after death up the œsophagus and down the bronchi, giving the tubes a peculiar reddish and gangrenous appearance.

Having examined the bronchi, the lung is turned over and its base grasped firmly in the left hand. An incision is made from apex to base, which will expose at a single cut the greatest extent of pulmonary surface. Note the color of the lung substance, and whether the alveoli contain blood, serum, or inflammatory products. Blood and serum can easily be forced from the lungs by pressure between the fingers, while inflammatory exudations cannot. Examine carefully for the presence of miliary tubercles.

If a question should arise whether a portion of a lung is consolidated, this part can be removed, placed in water, and if the air cells are consolidated the portion will sink; if there is only congestion it will float. By squeezing the lung between the fingers an inflammation of the smaller bronchi (bronchitis) can be recognized by the purulent fluid which will exude at different points. It should be remembered that in normal condition the lower lobes and posterior aspect of the lungs will apparently be very much congested as a result of gravity.

=Neck, Larynx, and Œsophagus.=—Throw the head well backward, and place a block beneath the neck. Make an incision from the chin to the upper part of the sternum. Dissect the soft parts away on each side from the larynx and thyroid body, then cut along the internal surface of the lower jaw from the symphisis to its angle. Through this incision introduce the fingers into the mouth, and grasp and draw down the tongue. By dividing the posterior wall of the pharynx and pulling downward these parts, the trachea and œsophagus can readily be removed together, a ligature having been first placed around the lower portion of the œsophagus. Open now the pharynx and œsophagus along their posterior border. Examine the mucous membrane carefully for the evidences of inflammation, caustic poison, tumors, foreign bodies, or strictures. With an enterotome open the larynx and trachea along their posterior wall. Observe if there is any evidence of œdema of the glottis, and note the condition of the mucous membrane. Remember that redness of the larynx is very commonly the result of post-mortem changes and is also seen in bodies which have been kept cold. Dissect off and examine the thyroid gland.

ABDOMEN.

Having completed the examination of the organs of the thorax, we next proceed to examine those contained in the abdominal cavity. We first raise and,dissect off the omentum, noting if it is abnormally adherent.

The first organs to be removed are:

=The Kidneys.=—Drawing the intestines aside we cut through the peritoneum over the kidneys, and introducing our left hand we grasp the organs with their suprarenal capsules attached. Raising first one kidney and then the other, we easily divide the vessels and the ureters as close to the bladder as possible. The kidneys are often found imbedded in a mass of fat which must first be removed. Their surface is sometimes of a greenish color owing to the beginning of putrefaction. We note the size of the organ, its color and weight. A normal kidney weighs from four and one-half to five ounces. Grasping the kidney firmly in the left hand, we make an incision in its capsule along its convex border, and with a forceps strip off the capsule and note its degree of adherence and the condition of the surface of the organ; whether it is smooth or granular. Prolonging our incision already made through the cortex of the organ, inward toward the pelvis, we divide the organ into two halves and now closely examine the internal structure. The average thickness of the cortex, which should be about one-third of an inch, is noted; as also its degree of congestion, and whether the normal light (tubes) and reddish (vessels and tufts) lines are seen running through it. If these alternate light and dark markings are lost and the organ has not undergone decomposition, the presence of some of the forms of Bright’s disease may be suspected. If the cut surface of the organ presents a waxy appearance, the amyloid test should be applied by first washing the cut surface of the organ and dropping upon it a few drops of Lugol’s solution of iodine, when the amyloid areas will appear as dark mahogany spots on a yellow background.

The pelvis of the kidneys should be examined for calculi and the evidence of inflammatory lesions. The suprarenal capsules readily decompose, but if the autopsy is not made too late hypertrophy, tuberculosis, tumors, and degeneration in them may be recognized.

=The Spleen.=—This organ will be found in an oblique position at the left side of the stomach. Grasping it firmly in the left hand and drawing it forward, it can easily be detached. Normally in the adult it is about five inches in length by three inches in breadth by one inch in thickness, and weighs about seven ounces. The size, color, and consistency of the organ should be noted, as well as abnormal thickenings of its capsule and the presence of any tubercles or tumors in its substance. The spleen softens very early as the result of decomposition, and this decomposition should not be mistaken for a pathological condition.

=The Intestines.=—In cases of suspected poisoning the greatest care should be taken in the removal of the intestines and the stomach. Double ligatures should be placed in the following situations so as to preserve the contents of the organs intact: (1) at the end of the duodenum; (2) at the end of the ilium; and (3) at the lower portion of the rectum; and an incision should be made with a pair of scissors between these ligatures. The jejunum and ilium should first be removed together by seizing the gut with the left hand, keeping it on the stretch, and cutting with a pair of scissors through the mesentery close to its intestinal attachment. The cæcum, colon, and rectum should then be removed in a similar manner.

The intestines being placed in large absolutely clean dishes, which have previously been rinsed with distilled water, are opened; great care being taken that none of the intestinal contents are lost. The small intestines should be opened in one dish and the large intestine in another. A portion of the intestines where morbid appearances are most likely to be seen in cases of poisoning are the duodenum, the lower part of the ilium, and the rectum. The comparative intensity of the appearances of irritation should be especially noted. For example, if the stomach appears normal and the intestines are found inflamed the possibility of poison from an irritant may be denied.

The intestines are opened along their detached border by the enterotome. Care should be taken to distinguish the post-mortem discolorations which are usually seen along the intestines from those produced by disease. The former are most marked in the dependent portions. They are apt to occur in patches which can be readily recognized by stretching the wall of the gut. The darkish brown or purple discolorations which are sometimes seen as the result of decomposition are due to the imbibition from the vessels of decomposed hæmoglobin. Much care and experience are necessary to tell the amount of congestion which is within normal limits and to recognize changes of color produced by decomposition.

The pathological lesions ordinarily looked for in the examination of the intestines are ulcers, perforation, hemorrhages, strictures, tumors, and the evidences of various inflammations. To obtain an accurate idea of the various portions of the mucous membrane of the intestines, it is sometimes necessary to remove their contents. When very adherent this should be done by allowing as small a portion of distilled water as possible to flow over their surface. If any abnormalities are noticed along the intestinal tract, an accurate description should be given of their situation and extent; as also the amount of congestion seen in different portions of the intestinal tract.

If possible the different portions of the intestines, as well as the stomach, should be examined immediately after being exposed to view, as under the influence of the air those parts which are pale may become red, and slight redness may become very pronounced. In this way only can we estimate the degree of vascularity of the various parts after death. However, in cases of suspected poisoning, when it is impossible for the chemist to be present at the autopsy, the medical examiner should not open the stomach and intestines, but place them in sealed jars. As soon as possible afterward, the chemist being present, they should then be examined in the manner indicated. What may be lost by waiting, in changes of color which have taken place, will be more than counterbalanced by the data which the chemist will obtain from observing the contents and mucous membrane of the stomach and intestines when they are first exposed. The characteristic odors of certain poisons are so evanescent that they quickly disappear after opening of the stomach and intestines.

After a thorough examination of the intestines, they are to be put with their contents into wide-mouthed vessels, each part by itself, and the basins in which they were opened washed with distilled water and the washings put into the same bottle. As soon as the intestines are transferred to the jars they should be sealed.

=The Stomach.=—The stomach and duodenum are removed together. They are opened by passing the enterotome into the duodenum and dividing it along its convex border, the incision being continued along the greater curvature of the stomach as far as the œsophageal opening. They should be opened in a large glass dish which has been carefully washed with distilled water. The chemist and medical examiner will carefully note the quantity, odor, color, and reaction of the stomach contents; also whether luminous or not in the dark; the presence or absence of crystalline matter, foreign substances, undigested food or alcohol.

Portions of the contents should be placed in a small glass bottle and sealed, so that at a future time they may be examined microscopically. Only in this way can an absolute knowledge of the character of the stomach contents be obtained. In certain medico-legal cases the ability to decide the character of the stomach contents is of the utmost importance. The mucous membranes of the stomach and duodenum must be next carefully examined for evidences of hemorrhages, erosions, tumors, and of acute or chronic inflammations. The appearance of the rugæ and their interspaces, principally in the region of the greater curvature, should be noted; because here traces of poison and its effects are most frequently seen. If the stomach is inflamed, the seat of the inflammation should be exactly specified, as also that of any unusual coloration.

The condition of the blood-vessels are also noted. Vascularity or redness of the stomach after death should not be confounded with the effects of poison or the marks of disease. It may occur in every variety of degree or character and still be within normal limits. Vascularities which we might call normal are seen in the posterior part of the greater end and in the lesser curvature, and may cover spaces of various extent. Rigot and Trosseau have proven by experiment that various kinds of pseudo-morbid redness may be formed which cannot be distinguished from the varieties caused by inflammation; that these appearances are produced after death and often not until five or eight hours afterward, and that they may be made to shift their place and appear where the organ was previously healthy, merely by altering the position of the stomach. Ulcers, or perforations of the stomach as the results of disease, as also the digestion of the stomach after death, have been mistaken for the effects of irritant poisons.

When perforation of the stomach is the result of caustic poisons, the edges of the opening are very irregular, and are of the same thickness as the rest of the organ. The parts not perforated are more or less inflamed, and traces of the action of the caustic are found in the mouth, pharynx, and œsophagus. This is the opposite condition to that seen in spontaneous perforation.

In considering perforation of the stomach the following points given by Taylor are well to remember:

(1) A person may have died from perforation of the stomach and not from poisoning.

(2) A person laboring under disease may be the subject of poison.

(3) A person laboring under disease may have received blows or injuries on the abdomen, and it will be necessary to state whether the perforation did or did not result from the violence.

(4) The perforation of the stomach from post-mortem changes may be mistaken for perforations from poison.

Corrosives, if they do not produce perforation of stomach, will generally cause intense inflammation accompanied by softening of the inner coat, sometimes ending in gangrene. The inflammation varies as to its extent and intensity, sometimes affecting principally the mouth and œsophagus, but generally the changes are more pronounced in the stomach and duodenum, while in rare cases the inflammatory process may extend through the whole alimentary canal. The mucous membranes are sometimes bright red with longitudinal or transverse patches of a blackish color, formed by extravasated blood between the coats. Carbolic acid often produces in the stomach and œsophagus white patches—when these patches are carefully examined, an ulcerated surface beneath them is generally seen.

Narcotic Poisons.—It is a common but mistaken idea that these poisons produce some mark or characteristic effect upon the stomach walls; that they induce a rapid tendency to putrefaction; that the blood is in a fluid state; that hemorrhages are seen in various parts; that the stomach and intestines show sloughing without any inflammation. Some of these conditions may and probably do occur, but they are far from being invariable in their appearance. Experiments made by Orfila on animals with narcotic poisons prove the above statement. In conclusion, I would emphasize the fact that the narcotic poisons produce no characteristic changes in the stomach that can be detected.

=The Liver.=—The liver should be removed from the body and no attempt made to examine the organ in situ. After raising first one lobe and then the other, the diaphragm should be cut on either side and the suspensory and lateral ligaments divided, then the organ can easily be removed. The weight of the organ is ascertained, as also the measurements of its size recorded. The normal weight is from fifty to sixty ounces. The organ is normally about twelve inches in length by seven inches in depth by three and one-half inches in thickness.

The gall bladder is first examined to determine the character and amount of the bile and the presence or absence of gall stones, inflammatory lesions, and tumors.

At autopsies the surface of the liver, especially along the free border, is generally seen to be of a greenish or dark-brown color. This discoloration is due to the action of the gases developed by decomposition on the coloring matter of the blood, and has no pathological significance. The character of the surface of the liver is now noted, whether smooth or rough. The organ is opened by deep incisions in various directions, and the color, consistency, and blood supply of the liver tissue carefully recorded. The presence of new connective tissue, amyloid degeneration, abscesses, or tumors should not be overlooked. It should be remembered that, of all the poisons, phosphorus alone leaves characteristic appearances in the liver.

=The Pancreas.=—The pancreas is now easily removed, and its size and weight recorded. Normally it should weigh three ounces and measure eight inches in length by one and one-half inches in breadth by one inch in thickness. The organ should be opened by a longitudinal cut and examined for evidences of acute or chronic inflammation, fat-necrosis, tumors, calculi, and amyloid degeneration.

=Genito-Urinary Organs.=—It is very important in medico-legal cases that all the urine should be preserved and obtained uncontaminated; therefore before the bladder is opened a catheter should be introduced and the urine drawn off into a clean bottle which has previously been rinsed with distilled water. If more convenient the bladder itself can be punctured at its upper portion, a pipette introduced, and the urine drawn off in this manner.

The genito-urinary organs are removed together. This is done in the following manner. The body of the penis is pushed backward within the skin and cut off just behind the glans penis; the remaining portion of the rectum is raised. This with the prostate gland, bladder, and penis attached is removed by carrying the knife around the pelvis close to the bone and separating the pubic attachments. The organs are then laid on a clean board and the urethra is opened on a grooved director passed into the bladder, and the incision prolonged so that the internal surface of the bladder itself will be completely exposed. Examine the urethra for strictures, inflammatory lesions, and ulcers. Examine the bladder for congestion, hemorrhages, inflammation, and ulcers of its mucous surface, and note the thickness of its walls. Open the rectum and examine for ulcers, strictures, tumors, and the evidence of hemorrhage. The prostate gland is opened by a number of incisions into its substance. Examine for hypertrophies, tumors, and inflammatory lesions. Force the testicles through the inguinal canal, and cut them off. Weigh, open, and examine them for evidence of inflammation, tuberculosis, and tumors.

=Female Organs.=—Before removing these organs, any abnormalities such as adhesions, malpositions, and tumors should be noted. Dissect the organs away from the pelvic bones by carrying the point of the knife around the pelvis close to the bone. Cut through the vagina at its lower third, and the rectum just above the anus. The organs can now readily be removed. Examine the vulva for ulcers, hypertrophies, and tumors. Open and examine the bladder. Open the vagina along its anterior border and carefully examine its mucous surface for evidences of inflammation.

THE UTERUS.—Before opening the uterus, its size and shape should be recorded. The average normal weight of the organ is about one and one-quarter ounces; its length three inches, breadth two inches, and thickness one inch. Open the organ along its anterior surface by a blunt-pointed scissors passed through the cervix, and the incision carried as far as the fundus. Note the thickness of its walls and any abnormalities of its mucous membrane. During menstruation, the mucous membrane of the body is thickened, softened, and covered with blood and detritus. Retention cysts are found in the mucous membrane of the cervix and are not generally of pathological significance.

Remove, measure, and weigh the ovaries. Their normal weight is about one drachm each; their size, one and one-half, by three-quarters, by one-half inch. Open the organs by a single incision and examine for the evidences of acute and chronic inflammations, tumors, and cysts. The corpora lutea in various stages can be easily recognized in the substance of the organ. Open the Fallopian tubes and examine their contents and the condition of their membranes (see DISPUTED PREGNANCY AND DELIVERY, Vol. II.).

THE SPINAL CORD.

To remove the cord, the body should be placed on its face with a block beneath the thorax. An incision is made through the skin and muscles along the entire length of the vertebral column and the soft parts dissected away so as to expose the transverse process of the vertebræ. The lamina are divided with a saw through the articulate process (a double-bladed saw specially adapted for this work can be obtained). After the lamina have been completely severed, these together with the spinous process can now be readily torn away with a stout hook and the cord exposed. A long chisel with a wooden mallet will often greatly facilitate this work. Great care should be exercised not to injure the cord. The roots of the spinal nerves are now severed, and the cord removed within its membrane. It should be remembered that serous fluid within the membranes of the cord, as also intense congestion, especially along its posterior aspect, is often seen as the result of post-mortem change. The cord is laid on a clean board and the dura mater opened with a blunt-pointed scissors along its anterior aspect, and an examination made for the presence of hemorrhage, inflammatory lesions, and tumors. Softening of the cord can generally be detected by the finger passed along it. This, however, is not a perfectly accurate test, especially if the body has been dead some time. The cord is now cut by transverse incisions about half an inch apart throughout its entire length, and the cut surface examined for the evidences of disease such as hemorrhages, softening, and inflammatory lesions.

After the cord has been removed, examine the vertebral column for the evidences of fractures and displacements.

LATE AUTOPSIES.

Late autopsies are those performed after partial or complete destruction of the soft parts of the body, through the natural processes of decomposition, or the examination of bones exhumed long after interment. The term may be employed also to mean the inspection of an embalmed body, dead for some time.

The object of late autopsies is to determine identity, or to establish the guilt or innocence of suspected persons. An examination of the skeleton even many years after death may give important information as to the manner in which the deceased came to his end. This cannot better be illustrated than by the citation of one or two cases.

In the celebrated case of “Eugene Aram,” the bones of his victim were discovered thirteen years after the crime had been committed. A man who afterward proved to be Aram’s accomplice was arrested on suspicion. He confessed the crime, and the opinion formed by the medical witnesses was confirmed by his statements. The skull presented evidence of fracture and indentation of a temporal bone. Aram argued the case in his own behalf, but the testimony was too strong against him: he was convicted and executed.

Taylor records the case of a man, Guerin, who was convicted of the murder of his brother from evidence obtained from an examination of the skeleton three years after interment. Here, again, blows upon the head were the cause of death, and the fractures were plainly perceptible upon the exhumed skull.

An autopsy upon a body before the soft parts have been entirely destroyed, or upon an embalmed body, should be conducted in much the same manner as ordinary autopsies. In these cases the method of burial should be noted. If it be a case of murder, and the body has been hurriedly put into the ground, it is not likely that the custom of Christian nations has been observed—that of laying the body full length, with the head to the west.

In the case of partially destroyed bodies, the remaining soft parts will give little evidence of the mode of death unless the violence has been very extensive, and even then it may be impossible to determine whether a wound was inflicted prior to or after death. Recourse must be had to the skeleton, and the only evidence it can furnish is of fractures, unless, as happened in one case, a rope be found about the cervical vertebræ.

When the skeleton only is found, Taylor lays stress upon the following points:

(1) Whether the bones belong to a human being or one of the lower animals.

(2) If a human being, whether male or female.

(3) The length of time they have probably remained in the ground.

(4) The probable age of the individual to whom they belonged. If the maxillary bones be found, much information may be obtained from an examination of the teeth.

(5) The probable stature of the individual during life.

(6) The race to which he belonged. The conformation of the skull and thickness of the bones will give important information on this point.

(7) It should be determined whether solitary bones belong to the right or left side, and whether they form parts of one or more than one skeleton.

(8) Whether they have been fractured, and if so, whether it occurred during life, or by accident at the time of the exhumation. If it occurred during life, whether it be recent or of long standing.

(9) The presence or absence of personal deformities, of supernumerary fingers or toes, of curvature of the spine, of ankylosis of one or more joints.

(10) Whether they have been calcined, as murderers sometimes try to make away with the bodies of their victims by burning. Especially is this the case in infanticides (see IDENTITY, Vol. I., p. 408 et seq.; TIME OF DEATH, Vol. I., p. 452 et seq.).

AUTOPSIES OF FRAGMENTS.

These cases are usually cases of murder in the perpetration of which the criminal has mutilated the body with a view to destroying all traces of identity.

The importance which attaches to autopsies of fragments rests upon the fact that parts of a body may be found widely separated, and that one portion may be found before the others. In such cases it will be necessary to determine if they belong to one and the same body. The examination is conducted chiefly with a view to establishing this.

The examiner must note the manner in which the fragment has been separated; whether it is clean cut, as by one who understood something of anatomy, or, whether it has been separated roughly and by one ignorant of the body structure. The determination of this point will be one link in the chain of evidence which may lead to the detection of the criminal, or the acquittal of one accused. An anatomist or a butcher would be likely to cut through at a joint, and to do it neatly. The exact point at which the severance has taken place should be noted. The place of finding, the circumstances under which found, the condition and general appearance of the fragment should all be carefully recorded. The color of the skin will indicate with some accuracy the race to which the individual belonged. The probable sex may be determined by the presence or absence of hair, and the general conformation. This, however, will not apply in the case of children. The probable age may be fixed upon from the size and degree of development of the fragment. The cut surface should be carefully described, and if possible a drawing should be made of it.

There are special considerations which apply to certain parts of the body.

=The Head.=—The exact point of severance should be recorded. The number of vertebræ which remain attached to the head should be counted, and if the section pass through a vertebra, its number and the amount of it missing should be stated. The sex will be apparent in all instances; the race may be determined both by the color of the skin and by the shape of the head; the age may be approximated, though care must be had in expressing an opinion, for the manner of living is well known to affect the appearance of age. Evidence of violence prior to death should be noted, and the presence or absence of fractures ascertained; also observe the color of the hair and whether it be thin or abundant; the presence or absence of beard or mustache, and if present the color; and the color of the eyes.

=The Arm.=—The following points should be determined: the color of the skin as indication of race; the probable sex from its shape and general conformation; the probable age from its size and degree of development; marks of any kind, such as tattooing; and deformities, such as signs of old or recent fracture, or dislocation; and supernumerary fingers.

=The Leg.=—The examination of the leg should be conducted in much the same manner as that of the arm.

=The Trunk.=—An examination of the trunk will reveal the race, sex, and probable age, and may give evidence as regards the manner in which the deceased came to his or her death. Any marks or deformities should be recorded, and in all cases the viscera should be examined.

MEDICO-LEGAL REPORTS.[568]

After making a medico-legal autopsy, it will be necessary for the medical examiner to draw up a report of his findings, and the conclusions based thereon. The report should be clear and concise, and the language such as a coroner’s jury can understand. Technical terms should be avoided, and when their employment is necessary they should be explained in the margin or in parentheses.

The report should be drawn up in somewhat the following manner:

1. When and under what circumstances the body was first seen; stating hour of day, day of week and month.

2. When deceased was last seen living, or known to be alive.

3. Any circumstances that would lead to a suspicion of suicide or murder.

4. Time after death at which the examination was made, if it can be ascertained.

5. The external appearance of the body: whether the surface is livid or pallid.

6. State of countenance.

7. Any marks of violence on the person, disarrangement of the dress, blood-stains, etc.

8. Presence or absence of warmth in the legs, abdomen, arms, armpits, or mouth.

9. Presence or absence of rigor mortis.

To give any value to this point it is necessary for the witness to observe the nature of the substance upon which the body is lying; whether the body be clothed or naked, young or old, fat or emaciated. These conditions materially influence the rapidity of cooling and the onset of rigor mortis.

10. Upon first opening the body the color of the muscles should be noted. Carbon monoxide poisoning causes them to be of a cherry-red color.

11. The condition of the blood and its color.

12. The state of the abdominal viscera, describing each one in the order in which it is removed (see p. 370). If the stomach and intestines are inflamed the seat of the inflammation should be exactly specified; also all evidences of softening, ulceration, effusion of blood, corrosion, or perforation. The presence of hardened fæces in the rectum will bear evidence that no purging occurred immediately before death.

13. The state of the heart and lungs. (For special consideration of the lungs in cases of suspected infanticide, see Vol. II.; and of persons drowned, see Vol. I., p. 805 et seq.).

14. The state of the brain and spinal cord.

After a thorough consideration of the results of the examination, conclusions must be drawn from this examination; never from the statements of others. The conclusions commonly relate to whether death was due to natural or unnatural causes; if to unnatural causes, what are the facts which lead the examiner to this opinion. As the conclusions are intended to form a summary of the whole report, they must be brief and tersely stated.

PERSONAL IDENTITY,

INCLUDING

THE METHODS USED FOR ITS DETERMINATION IN THE DEAD AND LIVING.

BY

IRVING C. ROSSE, A.M., M.D., F.R.G.S. (ENG.),

Professor of Nervous Diseases, Georgetown University; Membre du Congrès International d’Anthropologie Criminelle, etc.

PERSONAL IDENTITY.

GENERAL CONSIDERATIONS.

Identity is the determination of the individuality of a person. In jurisprudence the term is applied to the recognition of a person who is the object of a judicial action. The establishment of the individuality of a person is known as absolute identity; while the relations of a person with some particular act is known as relative identity.

The great number and variety of facts concerned in the investigation of questions of identity are of considerable gravity and importance in their juridical bearing, and at the same time they are among the most interesting and most useful of the applications of modern medicine to the purposes of the law.[569]

Among the varied researches of legal medicine looking to an interpretation of facts, no other question occurs in which the solution depends more upon morphological and anatomical knowledge, and none is more dependent upon purely objective, visible, tangible facts.

Personal identity often constitutes the entire subject-matter of dispute in a civil case. Upon it may depend the question of absence or of marriage, of kinship or of filiation involving the possession of an estate, in which case the court often requires the most subtle of scientific evidence to assist in its decision. Many anthropological and medical facts, now appropriated by criminology and penal science, are useful in proving not only the present but in attesting future identity, thereby preventing in great measure the dissimulation of prisoners, deserters, false claimants to life insurance, fraudulent pensioners, and the like.

Such matters are of daily occurrence. The special agents of the U. S. Pension Office detect and cause the punishment of many fraudulent claimants. Stratagems and conspiracies to defraud life-insurance companies go much further than mere substitution. Instead of a “fraudulent” a positive death may come up for investigation, and in order to defraud an insurance company of a large amount, a body may even be procured by homicide to consummate the deception, as was done in the Goss-Udderzook tragedy near Baltimore in 1872.

A celebrated case now before the Supreme Court of the United States and involving the question of personal identity is that of the Mutual Life Insurance Company of New York, the New York Life Insurance Company, and the Connecticut Mutual Life Insurance Company of Hartford, Connecticut (Consolidated), plaintiffs in error, vs. Sallie E. Hillmon.

It is pre-eminently in criminal trials that the personal identity of the victim often constitutes an essential connecting link. Before it can move, the law requires, at the outset, proof of the individuality of both the author of a crime and of the victim. I shall, therefore, not touch upon such elusive individuals as Charlie Ross and Jack the Ripper, but limit my remarks to a synthetical exposition of the best-known facts regarding identification of the dead body and the interpretation of its organic remains.

The identity of a living person, or even our own identity, is often a difficult point to establish. It may also require medical evidence, oftentimes of a most involved character, to establish the fact of death. Hence the medico-legal process of connecting a dead body, or the remains or traces of the same, with a human being once known to have lived and moved on earth, is beset with difficulties that may give rise to still greater antagonisms of evidence. The question of personal identity is one of the hardest that could possibly come before a court. Celebrated cases and judicial errors have given it great notoriety. There are consequently few questions in forensic medicine that require more attention and sagacity, and none upon which the medical legist should pronounce with more reserve and circumspection. Medical men are absolutely the only persons qualified to assist in resolving the really delicate question of personal identity; yet the physician and the lawyer pursue the same line of logic and of inquiry. As the former must have a subject to dissect or to operate upon, so must the lawyer in pursuing a criminal investigation first prove a visible material substance known in legal phraseology as the corpus delicti, which he must connect with some personality, with some human being once known to have lived. In this important process the physician’s testimony being the indispensable guide of the court’s inference, he should limit himself to purely anatomical and material knowledge. The medical expert has absolutely nothing to do with guilt or innocence, as that is a question for the jury. He should, above all things, be absolutely free from prejudice, suspicion, or undue suggestion, and should remember that in thus sinking his personality his sole function as a skilled witness in cases of identity is to furnish testimony which, when taken in connection with other evidence in the case, may establish such a corpus delicti as would justify the inference of a crime.

A nice point may arise as to dispensing with the proof from the body itself, when the substantial general fact of a homicide is proved aliunde, as in the case of a criminal causing the disappearance of his victim’s body by means of its decomposition in lime or other chemical menstrua, or by submerging it in an unfathomable spot in the sea. Under circumstances such as the following: a person is seen to enter a building and is not seen to leave it, although all means of egress therefrom are watched; another person is seen to ignite the building, which thereupon burns down, and the charred remains of a human body are found in the ruins; the proof of identity from the body itself might be dispensed with in view of the substantial general fact of a homicide having been committed. In a delicate case where the man of art hesitates and finds no corpus delicti, the investigation of imprints and stains may give a clew of great value to the expert. Yet it is only upon absolute evidence, and in the strongest possible case, that the fundamental principle of the corpus delicti is disregarded.

In the case of Ruloff, the child’s body was not produced and no trace of it could be alleged to have been found; nevertheless the prisoner was found guilty of murder. This case was speedily overruled (18 N. Y., 179), on the ground that a dangerous precedent had been pronounced.

So indispensable is the showing of the corpus delicti in cases of recognition that lawyers have come to regard even the judicial confession of an accused as often the flimsiest and most unsatisfactory kind of evidence. Numerous cases of demonstrated fallibility of confessions are cited in the books, where the statement was utterly lacking in anything except motive or hallucination. In the Proceedings of the New York Medico-Legal Society, December 6th, 1876, Mr. James Appleton Morgan mentions the case of a German servant-girl who assured her mistress, whose little boy, a child of seven, had just died and been buried, that she (the servant) had poisoned the boy. The servant swore to her crime and was taken into custody, and it was only when no poison was discovered upon exhuming the child’s body and examining its stomach that against her own protest she was acquitted of the possibility of the crime. Another case of the kind that has had medico-legal notoriety was tried a few years ago before a court in Brittany. The accused declared that he had killed his servant and thrown the body in a pond. His guilt seemed certain, when the alleged victim put in an appearance, thus reducing the evidence to the strange hallucination that had prompted the confession.

But the most wonderful of these is the celebrated case of Boorn, in which medico-legal evidence took no part. In view of the seeming hopelessness of his case, the accused confessed to murder in expectation of mercy from the court, but was finally acquitted on the alleged victim walking into court and confronting the man who had sworn to having killed him.

Although wisdom and experience point to the necessity of showing something corporal and material in cases involving questions of life and death, yet very small traces or minute remains of a human body may, in certain circumstances, constitute a corpus delicti that may lead to trial if not to conviction. In 1868 the Lambert case, for murder on the high seas, was tried before Judge Benedict in the United States Court, the only corpus delicti alleged being a large pool of blood and brains found on the forecastle of a ship at sea, out of sight of land or other vessel. Circumstances, acts, and words pointed strongly to the murder of one of the crew, who was believed to have been brained with an axe and thrown overboard. Notwithstanding the fact that animosity was known to exist between the accused and the missing man, it further appeared that the accused, in a state of great excitement, had followed the missing man forward and returned alone with a hatchet in his hand, yet the jury in this instance were not satisfied as to the establishment of a corpus delicti beyond a reasonable doubt and accordingly failed to convict.

Two classical cases, that of Gardelle and of Dr. Webster, mentioned in many of the books, stand forth as instances of conviction where fragments of the human body were recognized after attempts to destroy them by intense heat. The conviction of Dr. Webster rested almost entirely upon medico-legal evidence; but it is probable that upon the same circumstantial evidence the increased industry of counsel would have so rung the changes in regard to its uncertain and unsafe nature, and would have so used the knowledge gained from advanced discoveries in the regions of the probabilities of science, as to have secured the acquittal of the prisoner had the trial taken place at the present time.

A similar affair of great medico-legal interest is the Goss-Udderzook tragedy, already referred to, an account of which is given by Drs. Lewis and Bombaugh among the “Remarkable Stratagems and Conspiracies for Defrauding Life Insurance Companies,” New York and London, 1878.

IDENTITY OF BURNT REMAINS.

The medical jurist will no doubt find cremation a formidable barrier in elucidating the question of identity, although the entire destruction of a dead body is a matter of extreme difficulty.

In the case of calcination chemical analysis of the ash would detect the phosphate of lime, but this would throw no light upon the subject, since the ash of human bones and that of the lower animals is identical. If the burnt bone is entire, the state of the epiphyses may enlighten the question of the determination of age. The following two cases, in which fragments or portions of bone had been submitted to the action of fire, show how medical training and some knowledge of comparative anatomy may contribute to the establishment of guilt or may attest innocence.

In the case of The Queen vs. John Henry Wilson, for murder, the accused burnt his step-father in a lime-kiln for over a week, and on strewing ashes from the kiln fine fragments of bone picked up were afterward identified as human. At the trial identity rested on the fact of finding two buttons and a buckle, which were recognized as part of the deceased’s wearing apparel when last seen.

In the second case, that of a young woman supposed to be in the family way who should not have been, it was thought that she had been confined and made away with the infant. Under this supposition the premises where she lived were searched by the chief constable, who found in the stove some bones and fragments of bones that had been burnt. On examination by a qualified medical man, the fragments turned out to be not human bones, but those of some other animal, presumably those of a pig and of a chicken, which the family, who lived in a tenement-house without a back yard, had put in the stove to get rid of the refuse.[570]

IDENTIFICATION OF HUMAN BONES.

In deciding whether certain bones are human or not, the medical jurist should exercise great caution in venturing an opinion as to the precise animal of which he may believe they formed a part. There is no great difficulty in detecting the smallest fragments of bone by means of the microscope, but we cannot say with safety whether the fragments belonged to a mouse, a man, or an elephant. A real difficulty occurs in recognizing the nature and origin of the bony remains when only a small fragment or a single bone is submitted for report. If a sufficient portion of the skeleton be submitted it can be easily recognized as human, as in the imbedded remains of the troglodyte found in the limestone deposit of Luray Cave, Virginia, and only in the exceptional case of the bones of one of the manlike apes could a difficulty of distinction arise. The characteristic signs that distinguish a gorilla skeleton, for instance, are the smaller thumb; notable length of tibia and of radius, although this relative length of extremities has been remarked in negroes; small facial angle, 30° to 40° in the monkey, 70° to 80° in man; very inferior cranial capacity, the maximum in a gorilla being 550 cubic centimetres, while the minimum in the human species is from 970 with a maximum of 1,500 to 1,900 centimetres; a low index of the foramen magnum; convexity of the squamo-parietal suture, and larger and more salient canines and incisors. The volume of the endocranium in the female gorilla, like that of the human species, is smaller than that of the male; this difference being almost 80 c.c. for the anthropoid female.

In studying the osseous system it should be remembered that certain modifying elements, as artificial compression, pathological deformities, posthumous distortions, and hygrometric conditions, may affect particularly the skull, and if due allowance be not made for these the study may lead to glaring absurdities. Not longer ago than 1725 there was found in a quarry at Œningen the skull of a fossil batrachian compressed into rude resemblance to the human cranium, which was announced to the world as Scheuchzer’s “Homo diluvii testis et theoscopos,” and as the remains of one of the sinful antediluvians who perished in the Noachic deluge.

ARE THE BONES OLD OR RECENT?

An important point may arise in questions of identification of bones as to the oldness: whether they are old or recent. The first indication is furnished by the presence or by the absence of the soft parts. The existence of the periosteum and of the spinal marrow is the most persistent proof of a recent state; but these alone with the soft parts are usually destroyed in two or three years. In ordinary circumstances a body becomes skeletonized in about ten years, although in exceptional cases the cadaver may resist decomposition after many years.[571]

This summer in transferring an old cemetery in Georgetown, D. C., the remains of the grandmother of one of the writer’s patients were found in such a state of preservation as to be easily recognized after fifty years of burial. More recently, in unearthing the remains of an old graveyard in East Washington, a striking peculiarity was noticed in the fact that many bodies of young people buried in recent years when taken up consisted of a few blackened bones and shreds of grave-clothes. while the remains of many older people buried long before the Civil War were found in an excellent state of preservation. One of these was a Mr. Fullin, who died from the effects of a sunstroke forty years ago and was buried in a metallic case. An old lady who attended his funeral was present when his remains were unearthed and said they looked as natural as when he was laid away in 1852. The features were well preserved and even the white linen of the shroud was unsoiled.

Alterations in the texture of the bone, such as that caused by dryness and by diminution in the proportion of organic matter, may be ascertained by histological examination, and one of the characters of age may be furnished by taking into consideration the specific weight. Placing the skull at an average density of 1,649, that of an infant would be 1,515, an adult 1,726, and that of old age 1,636.

Ascertaining the proportion of organic and inorganic matter, the phosphates and carbonates, by chemical means may furnish an additional help in the interpretation of the remains.

With all these diagnostic methods it may still be impossible to establish identity either absolute or relative, even where a whole skeleton is in question. The evidence may, however, be of great juridical use to the accused, as in the case of Van Solen, tried for the murder of Dr. Henry Harcourt, where the collective facts pointed to the identification of a body dead two years. The jury, however, after a second trial, were instructed to acquit unless they were certain that the remains were Harcourt’s. They acquitted, as no one decided and apparent feature was known to have existed by which the remains could be identified beyond a doubt.[572]

IDENTITY IN CASE OF ENTIRE SKELETON OR IN CASE OF ISOLATED BONES.

Where an entire human skeleton has been discovered, the objects of inquiry here, as in the case of fragments or remains, are to establish the identity of the victim and that of the author of the act, and to collect all available information relative to the nature of the death and to the diverse circumstances attending the commission of the deed.

In gathering evidence from the examination of the skeleton or of isolated bones, with a view to find out the probable cause of death of the person of whom they form a part, a great variety of questions will arise for consideration, such as those relating to race, stature, age, sex, and trade or occupation; the exterior signs furnished by dentition; the traces of congenital peculiarity or of injury, and the signs of disease either hereditary or acquired.

DETERMINATION OF RACE.

The question of race in connection with the subject of identification is of more than usual importance in the United States, owing to our motley population, composed as it is of aboriginal Americans, Chinamen, negroes, and of Europeans and their descendants. I well remember the first human bones that I saw exhumed. They were discovered in digging the foundation of a building near a kitchen-midden on one of the tributaries of the Chesapeake Bay. The apparent oldness of the bones and the finding of stone arrow-heads, tomahawks, and fragments of aboriginal pottery in the immediate vicinity were additional accessory facts that strengthened the presumption of the bones being those of a Choptank Indian.

Roughly speaking, there is not much trouble in recognizing the platycnemic tibiæ of the mound-builder, the skull of a Flathead Indian, an Inca skull, a negro skull, or even the skull peculiar to the lower order of Irish.

In many very old skulls a considerable portion of hair is often found attached. This of course may lend assistance in the matter of race identity. A few years since I undertook at the Smithsonian Institution a series of micro-photographs of the structure and arrangement of hair, with a view to race classification as suggested by Professor Huxley. Various specimens of hair from the yellow races were compared with that of fair and of blue-eyed persons, with the hair of negroes, with reindeer hair, and with the hair-like appendage found on the fringy extremity of the baleen plates in the mouth of a “bowhead” whale. The experiments, though far from satisfactory, were sufficiently conclusive to enable one to recognize approximately the horse-like hair of some of the yellow races, that of the negro, and that of a blond Caucasian.

Beyond the forementioned characteristics, the task of race recognition from observation of the skull is one of great difficulty and perplexity with illusory results. A considerable experience of several years with the large collection of skulls in the Army Medical Museum enables me to speak advisedly on this point.[573]

Although the technical procedures of craniometry require special measurements and employ an arsenal of special instruments, the results are far from conclusive as regards the determination of human types. Time and space do not permit the mention even in epitome of the various methods most relied upon by trained craniologists. Among the oldest operations of cephalometry, as well as the most incomplete, is the measurement of the so-called facial angle, which is employed to distinguish the skull of a lower order of animal from that of the negro and the white man. This angle, acute in the skulls of the lower animals, approaches a right angle as we ascend the zoological scale; being from 30° to 65° in the various apes; 75° in the Mongolian; about 70° in the negro, and between 80° and 90° for whites. The prognathous (projecting) jaws of the negro cranium are distinctive, as well as the shape of the nasal opening, which in the black is an equilateral triangle, while it is isosceles in the white. The books usually speak of the Eskimo skull as pyramidal, which in point of fact is not true. Inspection and examination of a large collection of Eskimo crania has changed and greatly modified some of the previous notions of the conventional Eskimo skull. From more than one hundred, collected in the vicinity of Bering Strait,[574] I find that the skulls present very considerable variations among themselves; some being brachycephalic, others dolichocephalic. In many the facial angle is 80°, and in one instance 84°, which exceeds that observed by me in many German skulls. Nor is the prominence of the zygomatic arches such a constant difference in the configuration as to justify one in speaking of the skull as pyramidal. On the contrary, in many of the specimens lines drawn from the most projecting part of the zygomatic arch and touching the sides of the frontal bone, instead of forming a triangle on being elongated, might, like the asymptotes of a parabola, be extended to infinity and never meet. The index of the foramen magnum in these skulls is about the same as that of European crania. The internal capacity shows marked difference, the cubic contents of the endocranium averaging that of the French or Germans.

As some modern writers lay great stress on the measurement of the cranial capacity, not only as an aid to race identification, but as an adjunct in the study of the criminal and insane classes, it may not be amiss to give the salient facts relative thereto.

It is admitted that the cranial capacity may vary with the intellectual state, hydrocephalic skulls, of course, being excluded. Microcephalic adults give a figure inferior to that of gorillas, some being as low as 419 c.c. Andaman Islanders and autochthonous Australians appear, in respect to cranial capacity, to be most badly off. The capacity of an Andaman has been found as low as 1,094 c.c.; while that of Australians (autochthonous) and of some American tribes show an average capacity of 1,224 c.c. in the normal as well as in their deformed crania. The cranial capacity increases in the yellow races and attains its maximum in the white races. In the middle European race 1,500 c.c. may be accepted as the average; 1,750 c.c. is the maximum, and anything above is macrocephalic; while the minimum is 1,206 c.c., which is rather too low than too high. According to Topinard’s nomenclature of the cranial capacity, macrocephalic in the adult European male are those having a capacity of 1,950 c.c. and above; a large skull is one of 1,950 to 1,650 c.c.; average or ordinary, 1,650 to 1,450 c.c.; small, 1,450 to 1,150 c.c.; microcephalic 1,150 c.c. and below. It would seem that the skulls of the insane are below the type, a measurement of sixteen male skulls giving an average of only 1,449 c.c. Scotchmen head the list with the most voluminous skulls, and according to a tabular statement made up from Welcker, Aitken, Broca, and Meigs, the English come next, with a capacity of 1,572 c.c. Then follow Eskimo, 1,483 c.c.; Germans, 1,448 c.c.; French, 1,403 to 1,461 c.c.; South African negroes, 1,372 c.c.; Ancient Peruvians, 1,361 c.c.; Malay, 1,328 c.c.; Mexican, 1,290 c.c.; Hottentot and Polynesian, each 1,230 c.c.; Australians, 1,364 c.c.; and Nubians, 1,313 c.c. The cranial capacity in man, like that of the anthropoid apes, varies according to sex, the difference being so great that it is necessary to measure separately.

In the troglodyte skulls of prehistoric times the variation is not more than 99.5 c.c.; but in the contemporaneous races the difference varies from 143 to 220 c.c. French craniologists usually speak of the Auvernats as possessing the highest cerebral capacity (1,523 c.c.), and mention the skull of a Parisian of 1,900 c.c. as the highest known. Some Eskimo skulls, however, measure from 1,650 to 1,715 c.c., and two eurycephalic Indian skulls in the anatomical section of the Army Medical Museum measure respectively 1,785 and 1,920 c.c.

Mr. Havelock Ellis, speaking of the psychic characteristics of criminals, says that the lower human races present a far larger proportion of anatomical abnormities than the ordinary European population; and Sir William Turner writes of the skulls collected during the Challenger expedition that although their number is certainly too limited to base any broad generalization on, as to the relative frequency of occurrence of particular variations in the different races, there is obviously a larger proportion of important variations than would occur in a corresponding number of skulls of the white races. Thus, for example, the squamo-frontal articulation is found in less than two per cent of European skulls, while it is found in twenty per cent of negroes, according to Ecker, and 16.9 in Australian skulls, according to Virchow. Again, the spheno-pterygoid foramen is found in 4.8 per cent of European skulls and in 20 per cent of American Indians; 30 per cent in Africans; 32 per cent in Asiatics, and 50 per cent in Australians. The wormian bones are also more common among the lower races; as a rule, the cranial sutures coalesce much earlier and the teeth are more precocious.

PHOTOGRAPHY, though of undoubted service in craniometry, has been applied as a crucial test in the matter of identity and found wanting. It is objected to on the ground that it has no character of precision, and that photographs of the skull have the common defect of being central, not orthogonal projections, such as anthropometry requires. Besides, the lenses of cameras are not uniformly perfect. Anatomists know, moreover, that salient differences in any collection of crania prevent methodical enumeration and constitute the stumbling-block of ethnic craniology. Cephalometry shows, further, that dolichocephalic, mesaticephalic, and brachycephalic skulls do not belong exclusively to the white, the yellow, or the black race, but exist among the three as a result of evolution.

On this subject Professor Lombroso, among the foremost contemporaneous medico-legal writers, cites the cranial asymmetry of Pericles, of Romagnosi, of Bichat, of Kant, of Chenevix, and of Dante, who presented an abnormal development of the left parietal bone and two osteomata on the frontal bone. Besides, there is the Neanderthaloid skull of Robert Bruce and the ultra-dolichocephaly noticeable in the skull of O’Connell, which contrasts with the mesocephaly of the Irish. The median occipital fossa is noticeable in the skull of Scarpa, while Volta’s skull shows several characteristics which anthropologists consider to belong to the lower races, such as prominence of the styloid apophyses, simplicity of the coronal suture, traces of the median frontal suture, obtuse facial angle (73°), and moreover the remarkable cranial sclerosis, which at places attains a thickness of 16 mm. (five-eighths of an inch). Further mention is made of the submicrocephaly in Descartes, Tissot, Hoffman, Schumann, and others.

De Quatrefages noted the greatest degree of macrocephaly in a lunatic, the next in a man of genius. Cranial capacity in men of genius is usually above the average, having been found as high as 1,660 c.c. in Thackeray, 1,830 c.c. in Cuvier, and 2,012 c.c. in Tourgueneff. The capacity is often found above the average in insanity, but numerous exceptions occur in which it drops below the ordinary average, as in the submicrocephalic skulls of Liebig, Döllinger, Hausmann, Gambetta, Dante, and Shelley.

From what has just been said, it follows that skull measurements for medico-legal purposes have no more significance than the fact that some men are taller and some shorter than others. The medical jurist should, therefore, not be too dogmatic in drawing conclusions as to race from the skull alone. To complete the diagnosis in the matter of skeletal race peculiarity, the splay foot of the negro with the unusual backward projection of the heel-bone, as well as the greater relative length of the tibia and of the radius, may be taken into consideration. There are other characteristics of the lower jaw and of the facial bones generally, the study of which leads up to the realm of transcendental anatomy; so their further consideration would hardly appeal to the “dispassionate, sympathetic, contemplative jury” of our enlightened countrymen.

DETERMINATION OF HEIGHT OR STATURE.

When we have the entire skeleton to deal with, the height or stature may be determined with a reasonable degree of certainty by allowing from one to two inches for the soft parts. Most of the proportions given in works on artistic anatomy approach mathematical exactness. For instance, if both upper and lower extremities are extended after the manner of spokes in a wheel, and a point corresponding to the umbilicus be taken as a centre, the circumference of a circle described therefrom should touch the bottom of the feet and the tips of the middle fingers. When the arms are extended horizontally the line included in the middle-finger tips equals the height in the generality of men, although in exceptional cases it may vary. The negro giant, Nelson Pickett, is reported to have been eight feet four inches high, while his outstretched arms measured nine feet from tip to tip. Ordinarily the upper part of the symphysis pubis is the centre of the body. Some anatomists contend that this important point is really below the symphysis in the average man. The length of the foot about equals that of the head. According to Quetelet, its length is just one-ninth of the body in women, a little more than one-ninth in men. The conventional representation of the human foot with a second longer toe is, according to Professor Flower (see “Fashion in Deformity”), of negro origin and does not represent what is most usual in our race and time. Statistics of measurements made in England by several observers on hundreds of barefooted children fail to show one instance in which the second toe is the longer.[575]

Taken singly the bones may enable an approximate estimate of the height of the person when alive; but it should be remembered in connection with this subject that the height is not a fixed quantity, since it differs according to upright or recumbent position, also before and after a night’s rest. Moreover, the alleged height of the deceased may have been taken in boots and is probably incorrect.

Many tables of measurements have been constructed for the purpose of determining the height from the dimensions of the bones; but the relation that exists between the total height and the dimensions of different bones varies according to age, sex, asymmetry, and individual peculiarities, hence the tables will not bear the critical examination that warrants their use with assured correctness, even in a majority of cases. The femur is the bone that gives the best results in these measurements. Isolated fragments have been included in the enumeration; the nose and the middle finger multiplied by 32 and by 19 or 20 giving the approximate height. While the foregoing calculations will not bear scientific scrutiny, they are of sufficient importance to be taken in connection with other facts in determining the probable length of the skeleton. Among the most trustworthy of these tables are those of Dr. Dwight, of Harvard University.

DETERMINATION OF AGE.

The age is a still more difficult matter to state precisely. Even during life one may be as much as ten years out in guessing the age of an adult, while the error may be from fifteen to twenty years in the case of a corpse. Dr. Tourdes mentions a case where the age was guessed as sixty and sixty-five in a deceased person aged eighty-five.

The state of the osseous system and the condition and number of the teeth, which strictly speaking are not bone, are among the surest guides in the determination of age. The signs furnished thereby may vary according to the periods of increase, maturity, and decline.

During fœtal life and even at the epoch of birth the bone centres are few. The distal end of the femur, the proximal end of the tibia, and the astragalus are ossified at birth. Points of ossification appear in successive order of development. The exact period at which the bones begin to ossify and the progress of bony union being detailed in standard works on anatomy, it would be superfluous to repeat them here. These changes are, however, not absolutely certain as to time and order, as the tip of the acromion process of the scapula sometimes remains ununited throughout life; the ossification of the sternum and of the costal cartilages is very uncertain, while the teeth, like certain railway trains, are only due when they arrive.

From the character of the progress of consolidation of the skeleton the age may be estimated with a reasonable approach to accuracy up to twenty-five or thirty years, which is the stationary period as regards alteration in the osseous system. Above this period it is difficult to arrive at the age. About forty the cranial sutures[576] begin to disappear, although the time of the closure of the sutures varies within large limits; the coccyx becomes consolidated; ossification begins in the thyroid cartilage and in that of the first rib (although this state of the rib is regarded by many as pathological); the lower jaw, which in the fœtus and in infancy formed an obtuse angle, now assumes nearly a right angle. As senility progresses toward decrepitude, the bones become lighter and more brittle, owing to fatty atrophy, and their medullary canal larger; the jaw returns to its infantile shape from loss of teeth and atrophy of the alveolar processes; the bodies of the vertebræ (according to some authorities) bevel off in front; osteophytes are formed, and the neck of the femur approaches the horizontal. (See Abortion and Infanticide.)

DETERMINATION OF SEX.

In the matter of sex there should be no difficulty, after noting the proof furnished by the aggregate characteristics of both male and female skeletons. The points of contrast between the two skeletons are not so striking before the age of puberty. Generally speaking the cranial capacity of an adult woman is less, although it is contended that since the great majority of males of the human species are taller, heavier, and larger than the females, it follows that if due allowance be made for these variations, it will appear that the brain capacity of woman is relatively very little, if at all, inferior to that of man. The mastoid processes of the female skull are smaller; the lower jaw-bone is relatively smaller and lighter; the ribs are lighter and compressed; the spine is relatively longer; the collar and shoulder bones and the sternum[577] are smaller and lighter; there is a less pronounced angle in the femur, the neck of which approaches a right angle, while smallness of the patella in front and narrowness of the articulating surfaces of the tibia and femur, which in man form the lateral prominences, are said to make the knee-joint in women a sexual characteristic. But it is the striking contrast in the pelvis that furnishes a sexual significance that is of greater value than all the rest of the skeleton together. From a glance at the text-book account of the pelvis, it does not appear that much anatomical knowledge is necessary to identify the important points that give shape to the female pelvis. Its greater diameter (except the vertical), larger and more curved sacrum and coccyx, and great spread of the arch of the pubes are well-nigh incontestible signs. The differences as detailed in the books can be objected to only on the possibility of a so-called hermaphrodite pelvis in one of the other sex. We sometimes see a very large pelvis in a subject who by a teratological freak became a man. Masculine characteristics are, however, oftener found in women than feminine characteristics in men; hence the conclusion that the presence of feminine characteristics leaves but little doubt as to the sex, but that certain masculine indications, while giving a great probability for the male sex, are not absolutely decisive. (See Hermaphroditism.)

The finding of fœtal bones around or about the supposed female skeleton is suggestive. It could not be inferred from this fact alone that the woman was or was not pregnant at the time of death, since the absence of fœtal remains on the one hand might imply their entire decomposition in advance of those of the adult; on the other hand, the indiscriminate habit of undertakers, who often bury still-borns with adults, may account for their presence.

ACCIDENTAL SIGNS AND EVOLUTION OF THE TEETH.

The trade or occupation leaves but few marks on the bones that are useful in the matter of identification. It is in the recent and well-preserved cadaver, or, better still, in the living subject, that the professional signs are of importance. As a rule, the relatively larger scapulæ point to the fact of a day-laborer; necrosis of the lower jaw suggests a worker in phosphorus; worn and discolored teeth a user of tobacco, and aurification of the teeth might suggest the previous social condition. Gold crowns and fillings and dental prosthesis generally are among the most common and, at the same time, among the most useful signs of identification. By this means the bones of persons killed by Indians on the Western plains have been recognized years afterward. The traveller Powell, massacred in Abyssinia, was recognized in this way. From the presence of artificial teeth and the mechanical appliances for fixing them, dentists may recognize their own work beyond a doubt. One of the most common-hackneyed of these cases is that of Professor Webster.[578] Later cases, in which this kind of proof established convincing and conclusive identification, are those of Dr. Cronin, assassinated in Chicago in 1889, and of the bomb-thrower, Norcross. Every now and then accounts appear in the daily press of corpses having been recognized by inspection of the teeth. In Washington, only a short time since, the remains of an unknown man were exhumed from the Potter’s Field for judicial reasons. The unrecognized body had been found in the Potomac in an advanced stage of decomposition. From the signs furnished by the teeth the remains were identified as those of a person who had disappeared mysteriously and under circumstances that pointed to his having been murdered at a Virginian gambling den, and his body thrown into the river. In connection with this subject the Goss-Udderzook tragedy is of instructive interest.

In every important case a cast of the mouth should be taken, in order to set at rest any question that may subsequently arise as to the condition of the jaw, the absence of teeth, their irregularity or other dental peculiarities. A cast of the mouth of the deceased in the Hillmon case showed all the teeth to be regular and perfect, while it is alleged that Hillmon’s teeth were just the opposite. External signs furnished by dentition may assist greatly in fixing both age and identity. The evolution of the human dental system has been so well studied from intra-uterine life to old age that we may approximately tell the age, especially of children, from the teeth alone. This sign, so valuable in childhood, loses its value as the dentition progresses. Elaborate tables and dental formulæ to be found elsewhere deal with the two periods of dentition, the relative position and number of the teeth, and the like.

At birth the jaws show points of ossification only; but children are sometimes born with central incisors, as the writer has, in common with others, noted in several instances. The first dentition takes place from the seventh to the thirtieth month; the second between four and five years. In rachitic children these periods are later; but a syphilitic taint may hasten their development. The twenty-eight teeth characterize early youth. Wisdom teeth appear between eighteen and twenty-five, sometimes as late as thirty years. The presence of thirty-two teeth indicates maturity. This number is sometimes exceeded. Dr. Tidy, in his work on “Legal Medicine,” reports having seen several children between six and seven years with forty-eight teeth. Instances are recorded of cutting the teeth at advanced age, seventy and one hundred and eighteen years; of adults who have never had teeth; of supernumerary teeth, and of a third dentition. What purported to be a third dentition came under my notice some years ago, in the person of an old negro “voodoo doctor.” A more recent case, said to have occurred in an old man of seventy-four, at Seymour, Ind., is reported in the Weekly Medical Review, St. Louis, Mo., April 16th, 1892, p. 314.

The pathological signs furnished by the teeth should, of course, be looked upon as a personal characteristic that may lend additional light in the question of identity.

CONGENITAL PECULIARITIES, DEFORMITIES, AND INJURIES.

But congenital peculiarities or injuries of other parts of the skeleton are studied to greater advantage in determining proof or disproof of identity. We may recognize cranial asymmetry; the peculiar conformation of the idiot skull; the prognathous skull of the negro; the pyramidal skull of some of the yellow races, and the oval head of the white man; besides the ethnic artificial deformities already touched upon in considering the question of race. A metopic cranium, a cleft palate, a deformed spine or pelvis, a larger left scapula—indicative of left-handedness; a shortened extremity; bowed legs, club foot, the presence of extra fingers or toes, and the relative length of the fingers are each and all valuable facts in judiciary anthropology. In women of Spanish extraction the fifth finger is almost as long as the fourth—a fact so well known that glove-makers take advantage of it in sending gloves to Mexico, the Antilles, or to South America.

An estimate of the length of the hand seems to be a matter of difficulty, notwithstanding the extensive observation of high authority. In the majority of cases the ring-finger is longer than the index.

Important evidence is furnished from the existence of injuries such as fractures, whether old or recent; the marks of gunshot wounds, of trephining, amputation, excision, or other surgical operation on the bones. The remains of an old, ununited fracture in his left humerus enabled Sir William Fergusson to verify and settle all doubt as to the identity of the body of the great missionary and explorer, Dr. Livingston.[579] The existence of an injury may constitute evidence of great importance to the accused, as happened in the case of an English gentleman charged with murder, where the trial turned on the deposit of callus in a broken rib, the only bone produced in court. From the state of this callus there could be no doubt that the fracture must have been produced about eight or ten days before death, and could not have belonged to the deceased. There was, therefore, complete failure of the identity, and the accused was discharged.[580]

On the other hand, circumstances may arise in which the existence or not of an injury is a fact of great importance to the prosecution. Among other specimens in the Army Medical Museum at Washington, the bones of the forearm of Wirtz, executed for inhuman treatment of prisoners during the Civil War, show no remains or trace of fracture; yet it was claimed in defence at the trial that he could not have been guilty of the atrocities attributed to him, for the reason that this arm was disabled from a fracture.

Disease of the bones, whether hereditary or acquired, is an essential descriptive element in reconstituting individuality. Caries and necrosis, rickets, spinal disease, ankylosis, and other external manifestations of bone lesion may furnish pointers of such value as often to be incontestible. They are so evident as not to require detailed mention; but much care in such cases is necessary to distinguish between disease, decay, and violence, and artefacta. The last may have resulted from the axe or spade of the grave-digger or from post-mortem lesions made at the necropsy, as in the remains of the notorious Beau Hickman of Washington, whose body on being exhumed showed that sundry amputations and reamputations had been made on the principal limbs. Having died in a public hospital, the cadaver had been utilized in rehearsal of these operations previous to its burial in the Potter’s Field.

Injuries of the phalanges, known as “baseball fingers,” are valuable indications. This was one of the facts of identification in the celebrated Cronin case.

DURATION OF BURIAL.

The condition of the exhumed bones may throw some light on the question as to the probable length of time they have been under ground, as well as the probable cause of death. If the bones were entirely denuded of soft parts we should hardly expect them to be those of a corpse buried only three or four months previously. The noting of such an injury as a fracture inflicted by some sharp instrument on a skull found in a cesspool was sufficient, with other evidence of a general character, to convict a prisoner tried at the Derby Lent Assizes in 1847.

In all cases of the kind under consideration, special attention should be paid to the surroundings, every little detail of which should be noted with the utmost accuracy; for such articles as clothes, jewelry, buttons, and in fact anything that may furnish an inference,[581] may not only throw light on the identity of the person, but otherwise assist justice. Cases are recorded in which the identity has been established principally by the clothing found with the skeleton. In Taylor’s “Medical Jurisprudence” a case is mentioned where the skeleton, portions of clothes, buttons, and boots of a Cornish miner were identified after twenty-six years’ submersion in water. Somewhat similar circumstances, a few years ago, enabled the arctic explorer, Lieutenant Schwatka, and others to identify the remains of Lieutenant Irving, of the ill-fated Franklin party.

In exceptional circumstances, as that of great cold, for instance, organic remains may be preserved indefinitely. Visitors to the Junior United Service Club in London may remember the mammoth bones discovered in digging the foundation of the club-house. Accounts of remarkable preservation of bodies discovered a long time after the occurrence of Alpine accidents, and the finding of well-preserved mammoth remains in the Siberian ice, are matters of common knowledge. A few years since, in assisting to take the remains of a mammoth from an ice cliff in Escholtz Bay, Alaska, I came across the skull of a musk-ox and the rib of a reindeer which showed the deformity and callus of a united fracture, yet there are geological reasons for believing that thousands of years must have elapsed since these remains were entombed in the ice.

A precaution to be taken in judicial investigation of bones is to ascertain whether they belong to more than one body, as they may have been put together with a view to deceive. Each bone should be examined separately, to ascertain whether it is a right or left bone or belongs to the same skeleton. They should be put together with intelligence and care, and if incomplete parts of a skeleton they may be laid in sand or putty and photographed, or the medical man may go further and, Agassiz-like, reconstruct the skeleton from the fragments. In the case of a fracture the bones should be sawn longitudinally in order to study the callus.

THE HAIR AND NAILS.

Since the hair and nails resist decomposition an unusually long time, and are even believed to grow after somatic death, they may be considered as accessories of such value in the question that occupies us as to make it possible to verify certain characteristics regarding the remains of the cadaver even after years of inhumation. For instance, hypertrophy of the great toe-nail, the length and color of the hair, baldness, or a long beard might furnish evidence of the best kind. Both hair and nails may, however, change after death. A case is mentioned[582] in which the hair changed from a dark brown to red after twenty years of burial. Accredited cases of the growth of hair after death are also on record. Dr. Caldwell, of Iowa, states that he was present in 1862 at the exhumation of a body which had been buried for four years. He found that the coffin had given at the joints and that the hair protruded through the openings. He had evidence to show that the deceased was shaved before burial, nevertheless the hair of the head measured eighteen inches, the whiskers eight inches, and the hair of the breast four to six inches.[583] Quite recently in unearthing the remains of an old cemetery in Washington, D. C., a number of persons noticed that when the body of a young girl, supposed to be about twelve or thirteen years of age, was taken up it was found that her hair had grown until it extended from her crown to her feet. Many careful observations seem to prove the molecular life of the hair and nails after somatic death. It suffices to quote the well-known case mentioned in Ogston’s “Medical Jurisprudence,” of several medical students who were brought to trial for having in custody the dead body of an idiot boy. When found on the dissecting-table the body was so disfigured that there was only one means left of proving its identity. The boy had a whim during life of permitting his nails to grow, and had not allowed them to be cut for many years previous to his death. They had completely curled round the tips of his fingers and toes till they had thus come to extend along the palmar and plantar surfaces in a strange way. The counsel for the prosecution availed himself of the knowledge of this fact, and his proof seemed to be complete, when a medical man came forward and gave in evidence that it was not an unusual circumstance for the nails to grow for several inches after death. This astounding statement so nonplussed the judge that the case was allowed to drop as not proven.

In exceptional cases the hair may be green. I saw a case some years since, for which no cause could be assigned, and only a few days ago I saw another in a man who worked in a brass-foundry. At the Cronin trial a barber, who had counted the victim among his customers, recognized the shape of the head and texture of the hair. Subsequent evidence of medical experts was conclusive as to the identity of hair found clinging to a trunk, the hair cut from the head of the murdered man, and that of a single hair discovered on a cake of soap. This single strand, being lighter in color in some portions than in others, seemed to indicate that it could not have come from the head of the deceased, whose hair was brown. But it was shown that hair placed on soap or other alkaline substances becomes bleached in a manner similar to the color of a single thread. This evidence of vital importance linked the hair found in the trunk with that cut from Dr. Cronin’s head, and went far toward proving that one of the murderers had washed his hands with the soap after the deed had been done.

Reviewing the signs furnished by the osseous system, it will be seen that the study of the skeleton alone is beyond contradiction more satisfactory and more important in establishing identity than that of all the other organs. Consequently a correct interpretation of the facts observed and judicious application of the rules deducible therefrom may in the matter of a human skeleton put its identity beyond a reasonable doubt. But the expert should remember that as no two cases are just alike, unexpected questions and unforeseen features may present themselves, giving to each case merits of its own. At best the medical man’s conclusions will be probabilities, not certainties; therefore his expressions of opinion should be the more guarded, as upon it may hang the life of an innocent man.

IDENTIFICATION OF MUTILATED REMAINS.

Many of the foregoing remarks on the identity of the skeleton apply in cases where mutilated remains or a portion only of the body has been recovered. Circumstances often occur in which bodies may require identification after having been drowned and partly eaten by fishes or crabs, or after having been partly eaten by buzzards, or torn into fragments by animals, as has happened in the remains of a dead infant partly devoured by a dog, and in the case of a farmer who died in the woods and was subsequently eaten by his own hogs. After accidents and fires where many persons perish; after a railway disaster where bodies have been mangled, drowned, burnt, and frozen, all in the same accident; or after an explosion from steam or gas or in a mine, or from gunpowder, dynamite, or other substance, the human remains are generally in such a state as to defy all attempts at recognition.

To dispose of a dead body in order to avoid detection, criminals will mutilate, disfigure, and chop into fragments the remains, which they afterward place in a trunk, a wardrobe, or throw into a sewer or other hiding-place. Scarcely a year passes that judiciary medicine is not concerned with cases of the kind. The frequency of such crimes has been attributed by some to the so-called contagion of murder; others offer the simple law of the series in explanation; others still believe that imitation is the principal cause. While there is no doubt a grain of truth in each of these, less philosophic minds will look upon such a beastly proceeding as a mark of the complete satisfaction sought by the destructive instinct.

Why such things should be is of less concern than the fact that criminal mutilation of the dead body is not confined to any age or country. Though more frequent in the last fifteen years, it takes up quite a space in the history of human cruelty. The violent passion, wrath, and vengeance that caused the prophet Isaiah to be sawn in two at the age of one hundred years by order of Manasses and Agag cut into pieces by Samuel have not materially changed in the days of Jack the Ripper; and we find such crimes in antipodal parts of the world, among varied sociological conditions, no matter whether it be the North American Indian, who scalps and mutilates his enemy and places the severed penis in the mouth, or the civilized European, who cuts up the body of his victim and serves it in a curry at a feast of assembled friends.[584]

This new point of judiciary medicine has lately been elaborated by European writers under the title of Dépeçage Criminel, a term which applies to the operation resorted to by an assassin having for its end the getting rid of the body of the victim and to render more difficult the establishment of its identity.

The cleverness of experts scarcely keeps pace nowadays with the more complicated proceedings adopted by criminals. In fact, at a trial of this kind truth and science are often the under dogs in a fight, than which none in forensic medicine is longer and more embarrassing. To cause a rapid disappearance of the proofs of a homicide, with a view to escape the investigations of justice, murderers have been known literally to make hash of the victim which was subsequently eaten by themselves and others. Gruner relates the case of a man who, having killed and cut into pieces his victim, boiled and roasted the fragments and ate them with his wife. Such examples, however, suggest morbid rather than passional phenomena, which manifestly call for rigid scrutiny into the mental state of the culprit, who may be more of a lunatic than a malefactor.

In cases of infanticide new-born children are sometimes cut into pieces and the fragments burnt in order to facilitate the disappearance of the cadaver. There does not appear to be, however, any well-authenticated instance of the operation having been done on a living child. Generally the dismemberment is done in order to cause more ready disappearance of the remains.

The medico-legal problem to be solved in cases of criminal mutilation is to establish the identity of the victim and that of the author of the crime.

Many apparently trivial circumstances may assist in the formation of an opinion as to the identity of the culprit. If the victim be an adult, a man is the author of the deed; if an infant, a woman, the mother, is almost always the guilty one. The London Lancet (May 30th, 1863, p. 617) reports a case in which the body of a child, of apparently four to six months, was found in the sewage of a water-closet, minus an arm cut off below the shoulder, presumably that a vaccination-mark might not be adduced as evidence. A young woman was suspected. Several women deposed having seen a dusky-brown mother’s mark near the child’s navel. After steeping in pure water a portion of the skin said to include the mark, and after washing, the mark gradually reappeared at the end of three days, perfectly distinct. It was recognized by witnesses and produced at the trial as corroborative evidence. The accused was found guilty.

In a case of infanticide at Tarare, in 1884, the upper extremity of a fœtus was found to have been disarticulated after the manner of carving the wing of a fowl. This having suggested to Dr. Lacassagne a cook as the author of the crime, she was speedily discovered and convicted. A few years later an analogous case occurred in Florence and was reported by Dr. A. Montalti.

The instrument used for mutilating the body may furnish a suggestion of identity, to be dispelled or affirmed upon further investigation. The mode of section observed in various instances has led to the recognition of a butcher as the culprit. An expert would have but little trouble in distinguishing the hacking and mangling of a body from the careful cutting and preservation of muscles and blood-vessels in dissections made by medical students, whom the public, by the way, invariably suspect in cases of mutilation. If it can be ascertained that the instrument used was operated either by a left-handed person or by an ambidexter, such a fact may prove of importance. Sometimes the fragments are tied or sewn up in a package. The manner in which the knot is tied may indicate the occupation of the culprit. In one case the regularity of the sewing revealed that it was the work of a woman. Examination of the remains of clothing and of neighboring objects where the crime was committed may result in the identification of the victim or of the murderer. Indeed, it is the careful noting of trivial facts and their combination that is so valuable in all investigations of this class. A compound fact made up of minor facts, which considered severally would possess but little value, may sometimes solve the puzzle in a case where no single fact of conclusive value is obtainable.

Having collected as much of the mutilated remains as possible, the first step toward identification is to replace the pieces in anatomical order, to note carefully their correspondence or otherwise, and to ascertain whether the fragments belong to the same body or to two or several individuals. This is often a delicate and difficult matter, especially where decomposition is advanced or where the horror has been pushed to its utmost limits, as in the case of a fratricide committed in France by several persons, who fragmented the cadaver with a saw and hatchet; boiled the remains and fed them to hogs; and, after crushing the bones with a hammer, threw the fragments into a deep gorge. Again, the body may be divided into numerous pieces, a hundred or more, and disposed of in widely different localities, as in a pond, a manure-heap, a river, or a cesspool. The chopped-up remains of infants have been boiled in lye and afterward thrown into a privy or put in a barrel of vinegar. A mother has also been known to cook with cabbage the dismembered remains of her six-months’ child and serve it at a meal of which both she and her husband partook.

Numerous counterparts of such cases happening in late years could be cited where the object was to favor the disappearance of the cadaver, and in which the establishment of the identity turned on the examination of some small part of the organism; the uterus, the spermatic cord, the lobe of the ear, the hair, or the teeth furnishing a positive demonstration that led to judiciary results.

PUTREFACTION goes on very fast in a corpse that has been mutilated; but it is slower in parts which, on being separated just after death, have become bloodless in consequence of the hemorrhage. After submersion the outward signs of putrefaction put a notable obstacle in the way of identification, and after drowning the body becomes rapidly unrecognizable.

Supposing it impossible to reconstitute the cadaver in all its essential parts, it is always possible, by following the instructions already given for examining the skeleton, to infer from one or several parts of the cadaver the sex, age, height, and sometimes pathological peculiarities of the victim. Examination of the skeleton and teeth is of capital importance in an investigation of this class. The indications furnished thereby having already been touched upon, and being about all that we are justified in saying, it is only necessary to repeat that many of the details relative to these special indications are so confusing as to suggest caution in using the statistical tables of even high authority, as the observations they rest on are not of sufficient extent to deserve confidence.

A survey of the head, limbs, trunk, and genital parts will give the most useful indications. The HEAD, in fact, is the surest index for justice, and one that lends promptness in the discovery of the assassin. Typical illustrations of this occur in the Goss-Udderzook case and in the recent example of the bomb-thrower, Norcross. In the case of a woman murdered by her husband at Antwerp in 1877 and cut into one hundred and fifty-three pieces and her remains thrown into a privy, the color of the hair, the lobule of a torn ear, and the uterus of a woman having had children furnished special signs that led to identity and condemnation. Examination of the brain and its membranes, though furnishing no very notable characteristics in the matter of identification, may nevertheless be regarded as a natural corollary to that of the skull. Brain weight, which is greatest between thirty and forty years, 1,200 to 1,450 grams in man, 1,100 to 1,500 in woman, diminishes toward the sixtieth year. It is said that the diminution takes place a few years sooner in the opposite sex. The estimated loss of weight in a person of eighty years is admitted to be from 90 to 150 grams. Another sign of age is the tendency to degeneration found in the pineal gland, the cortical substance, the optic and striate thalami, and in the brain capillaries.

The state of the eyes, if not too decomposed, may still become a sign of identity. For instance, the color of the iris, an arcus senilis, a pterygium, a cataract or an operation for the same, an iridectomy, etc., are signs that occasion may utilize.

The TRUNK may show, as it has in several instances, incised wounds that caused death before the mutilation. Besides, the organs therein contained may by their weight, dimension, and tissue alteration indicate the progress of age and of degeneration. Modifications of the circulatory and respiratory apparatus are obviously characteristic. As age advances the only organ whose weight increases with the number of years, the heart, may become hypertrophied or dilated; its coronary arteries may undergo an alteration; the pericardium thickens, and in fact arterial atheroma and degeneration generally may begin between thirty-five and forty years. It should, however, be borne in mind that these signs of senility may come much later or even not at all. In a man of eighty-four years Tourdes found no notable tissue lesion; in another of one hundred and four Lobstein found no trace of ossification of the arteries of the trunk and upper extremities, and in Thomas Parr, aged one hundred and fifty-two years, Harvey found absolutely no lesion of this kind. Although toward eighty years the heart increases in weight in both sexes, the opposite has been observed in exceptional cases. Placing the average weight of this organ in the adult at 266 grams for men, 220 for women, it will be found that progress in weight gives toward the eightieth year an increase of 90 grams for men and 60 for women. Yet a case of cardiac atrophy is reported in a woman of eighty whose heart weighed but 170 grams.

Diminished weight of the lungs becomes accentuated with years. Especially is this the case after pseudo-melanosis and senile emphysema. The state of the lungs of stone-cutters and miners and various thoracic and abdominal diseases may likewise become signs of identity. A cirrhosed liver, an enlarged spleen, a senile kidney, and the like, are sufficiently obvious in their bearings on this question.

Like the trunk, the ARMS AND LEGS, in cases of the class under consideration, show but few traces of disfigurement other than the fact of their having been disjointed. The manner in which the sections were made and the proceedings employed for the disarticulation would equally affirm an experienced hand or the reverse. Such facts have of late years assisted in the discovery and condemnation both of a farmer and of a medical student, and also in the case of the cook already mentioned, who cut off her child’s arm after the manner of carving the wing of a fowl. The existence of deformity, injury, and disease in the limbs should, of course, claim attention, but their relativity in an investigation of the kind is too apparent to require further comment.

Mutilation of the GENITAL ORGANS is not so common. Persons familiar with border warfare have observed the savage custom of cutting off the victim’s penis and placing it in his mouth. In more civilized communities the culprits are generally women in whom hatred and ferocity prompt an act that marks the evident satisfaction sought by the destructive instinct. Sometimes, however, the genital organs have been cut from the cadaver of a woman, presumably for the purpose of concealing traces of rape that may have preceded the murder. The signs furnished by the female genital organs as to virginity, maternity, and the menopause are so easily demonstrated at the necropsy as to become positive proofs of identity. The uterus loses both in size and weight with age. This along with hard, atrophied, and germless ovaries attests the stoppage of menstruation. The question of identity may turn on the age at which menstruation ceases, as happened in an action of ejectment in the case of Doe on the demise of Clark vs. Tatom. The period known as change of life, when the uterus and ovaries lose their function, though placed at forty-five and fifty years, is quite uncertain. In spite of averages, menstruation is occasionally continued to seventy and upward.[585]

The signs furnished by the genital organs of the male are of less importance. Atrophy and diminished weight of the testicles and rarity or absence of the spermatozoids are indications of senility; although spermatozoids have been observed at ninety-four years. The structure of the spermatic cord at different periods of life from the last of intra-uterine to the first of extra-uterine life, in puberty, and in old age, is accompanied by characteristic modifications of development and regression, which are of interest on the question of medico-forensic diagnosis of identity, as shown by Dr. Pellacani.[586]

Congenital deformity of the genital parts, as epispadias or hypospadias; marks of circumcision, useful in India to identify Mussulmans above eleven years; traces of disease that may have left extensive cicatrices, as phagadenic chancre, suppurating buboes, etc., may also furnish characteristics of evidential value.

ENTIRE CADAVER DEAD BUT A SHORT TIME.

In the case of a body that has been dead a short time only, recognition from the features, even by the nearest relatives, is often a matter of the greatest difficulty. The change produced in the color and form of the body, especially after drowning, is a formidable obstacle to identification by likeness and general type of face. Pages could be filled with the mere mention of the multiplied instances of mistaken identity of the living, many of whom have been punished because they had the misfortune to resemble some one else. How much more careful, then, should be the medical examination of the remains in the progress of decay, with the distortion and discoloration of the features, and the consequent change or destruction of the peculiar expression of the countenance by which human features are usually distinguished and identified.

Among the innumerable instances of mistaken personal identity and cases of resemblance mentioned in history and fable, from the time of Ulysses down to the days of Rip Van Winkle’s dog Schneider, it appears that this animal is credited with more sagacity than man in the matter of recognizing his master even after years of absence. Indeed, recognition by animals may be considered a proof of identity. Many persons can recall instances of the kind, though perhaps not so dramatic as the one of the dog in the Odyssey, who recognized his master after twenty years of absence and died immediately thereafter.

As a matter of fact, time and circumstances will so alter resemblance as to account for some of these most striking proofs of the fallibility of human testimony that we see illustrated in chapters on mistaken identity. We easily forget the true image of persons and things, and time promptly modifies them. The evidence of the senses may be so little trusted in this regard that father, mother, husband, and nurse may attest a false identity in the case of their own children. A nurse has been known to testify to the identity of the severed head of a woman whom thirteen other persons were sure they recognized from characteristic signs, when the supposed victim put in an appearance and thus attested her own existence. The head of the unrecognized victim of this strange controversy is preserved in the museum of the Strassburg Faculty.

In another case of historical notoriety in France, forty witnesses on each side swore to the personality; while in the celebrated Tichbourne trial no less than eighty-five witnesses maintained positively, under the most rigid and scrutinizing cross-examination, that a certain person was Sir Roger Charles Doughty Tichbourne, a baronet; at the same time a corresponding number were equally unshaken in their conviction that he was a Wapping butcher, Arthur Orton.

Resemblances often bring about remarkable coincidences. A case is said to have occurred in Covington, Ky., where two men met, each the double of the other in form, stature, and feature, each having lost a right leg, amputated at the knee, and each being blind in the left eye from accident.

Puzzle and perplexity are not confined to remarkable cases and judicial errors; for so many people are unskilled in correct observation that it is a matter of common occurrence for two individuals to be mistaken the one for the other. The writer for some years has frequently been mistaken for a certain naval officer he is said to resemble, while the officer in question has become so accustomed to being called “Doctor” that he answers to the title without protest.

A case that has of late been much quoted in the journals is that of Tiggs. What was supposed to be his mangled body was identified by his wife, and further identification was forthcoming from one of his children and the employer of the deceased. The coroner had granted a certificate for burial, and as the hearse neared the door, to the surprise of all parties the real Tiggs entered the house and gave a satisfactory account of his absence.

Most mistakes of this kind are the result of existing imperfections in the average human mind or in its use. So few people are skilled in minute observation that Lord Mansfield’s dictum regarding the “likeness as an argument of a child being the son of a parent” should be received with a certain degree of reserve, especially in the question of identity from likeness after death. In Ogston’s “Medical Jurisprudence” a case is related of a father who could not recognize the body of his son drowned at sea ten days previously. The mother, however, identified her boy from the existence of two pimple-looking projections on the front of the chest, which proved to be supplementary mammæ.

As a rule, the changes in the face and countenance two weeks after death are such that it is well-nigh impossible to establish identity from the features alone. Yet in exceptional cases the external results of putrefactive decomposition have been so delayed or modified as to produce very small changes in the features even after many years of burial. Bodies have been known to retain a remarkable state of preservation for long periods in such circumstances as burial in a peat bog, in the sand of the desert, and in the frozen ground of cold countries.

Even photography in the matter of identity is not to be trusted. Though an important accessory to other evidence, it is often, and very properly, objected to by lawyers on the ground of being incompetent, irrelevant, and immaterial. The picture presented for comparison may not be an original one or it may have been taken years previously. The difficulty in recognizing one’s own most intimate friends from pictures taken only a few years back is a matter of common knowledge. Besides, the negative from which the picture was taken may have been retouched or altered, consequently it would not be the same as produced by the camera, and is, therefore, valueless as evidence. It is held to be incompetent to prove a photograph by merely asking a witness whether or not he recognizes the picture in question as that of a certain person.

In all cases where photographic pictures are required in a court of law the authorities are that the artist who took the picture must be produced and show that he took the picture, and that it is a correct representation of the original of which it claims to be a picture. If possible the negatives themselves should be called for and reproduced. Dr. Tidy states that he has known a volume of smoke appear in a print as issuing from a chimney, and used as evidence of the existence of a nuisance, when no smoke existed in the original negative. Only slight familiarity with the method of taking photographic pictures and the chemistry involved in the process suffices to show that many little details of sensitizing, exposing, developing, and printing greatly change the general appearance of the face. Some of the tricks that may be played with photography, illustrating its comparative incompetency as evidence in the matter of personal identification, I have seen in a series of pictures at the Department of Justice in Washington. All were photographs of the same person taken in such varying circumstances that no two are alike or recognizable as the same person, until scrutiny is brought to bear on the profile of the nose.[587] In considering photography in its bearing on this branch of medicine, it must also be borne in mind that a certain degree of imperfection arises from want of uniformity in the lenses of cameras. I have already mentioned the want of precision in photographing the skull, the common defect being central not orthogonal projection such as anthropometry requires.

SURFACE SIGNS OF IDENTITY.

Examination of the surface of the skin and of its appendages may in certain cases take decisive importance. Valuable medical proof is often furnished by scars, nævi, growths on the skin, pock-marks, traces of skin disease or of scrofula, and by the so-called professional stigmata which would suggest the trade, character of work, or occupation of the deceased. Thus cigarette-stains on the fingers of smokers, or silver-stains on the hands of photographers, the horny palm of the laborer, or the soft, delicate hand of one not accustomed to work, would be indicative. The alterations in the hand make it, so to speak, the seat of election; for in the majority of trades that may be mentioned it is the hand alone that bears the principal marks of daily work that indicate the calling. A case is recorded of a person who previously to his assassination was lame and walked with a crutch. Although the body was cut into fragments, an examination revealed in the palm of the hands characteristic callosities, showing prolonged use of support of this kind. In another instance of criminal mutilation a tattoo-mark found on the arm proved an overwhelming charge against the assassin and drew forth his confession. An accused was also convicted of murder after establishing the only missing link, the question of identity, which turned on the finding of cupping-marks and a tattoo on the body of the murdered man. Personal identity of the bodies of infants has, moreover, been proved by means of a small blister; by a patch of downy hair; by the similarity existing between two pieces of thread used to tie the umbilical cord; and by the severed end of that part of the funis attached to the infant fitting precisely to the corresponding portion attached to the after-birth. In addition to these a methodical examination may put in evidence other facts that may be derived from diverse influences that leave characteristic traces.

SIGNS FURNISHED BY MARKS, SCARS, STAINS, ETC., ON THE SKIN.

But of all the surface signs, whether congenital or acquired, that may throw light on the antecedents of the decedent, birth-marks, freckles, cicatrices, tattooes, and the professional signs furnish the best indications. Birth-marks (nævi materni), from their supposed indelibility, have given rise to discussion at many celebrated trials. As a rule, these marks are permanent and seldom lose their distinctness, though in exceptional cases they may undergo atrophy in the first years of life. Hence testimony as to the existence of birth-marks may often be uncertain when it has reference to a period a long way back. In a recorded case of supposed recognition of a person having a mark of this kind on her face, the alleged victim turned up and established her identity as well as the fact that she did not have the birth-mark attributed to her.

Before the introduction of the electrolytic method it was customary to resort to cauterization, excision, vaccination, and tattooing the pigmentary spot in order to modify or remove these congenital marks. Such proceedings usually left more or less of an indelible scar which occasion might utilize in the matter of medico-legal diagnosis. The traces of nævi may, however, be entirely removed by electrolysis. I have recently seen a nævus of large dimension on the face of a young woman so completely destroyed as to leave no trace of the operation.

The possibility of the disappearance of a scar in such circumstances depends here, as it does in other instances, on the depth of the wound. A cicatrix being the result of a solution of continuity in the derma, the question arises whether a wound that has divided the derma without loss of substance and healed by first intention leaves any perceptible scar. Some are of the opinion that a cicatricial line persists, but grows fainter with time. Histological examination in a question of this kind might prove conclusive by showing the structure of the fibrocellular tissue that constitutes the cicatrix. In the case of very superficial burns or wounds, the scar may completely disappear if the epidermis alone or the superficial part of the derma is attacked; on the other hand, if there has been long suppuration or loss of substance from ulcers, chancres, or buboes, especially on the neck, groins, legs, or genital parts, traces of their lesion will be found. It may, therefore, be asserted as a general rule that all scars resulting from wounds and from skin diseases which involve any loss of substance are indelible. A scar on the face is one of the points at issue in the celebrated Hillmon case already mentioned.

As the matter of cicatrices is treated in the section on WOUNDS, further mention here would be superfluous.

TATTOOING.

Of all the scars that speak, none in judiciary medicine affords better signs of identity by their permanency and durable character and the difficulty of causing their disappearance than those furnished by tattoo-marks.

The custom of tattooing having existed from the earliest historical epochs is of interest not only from an ethnological but from a medical and pathological point of view, while it is of great importance in its relation to medical jurisprudence in cases of contested personal identification which may be either established or refuted by this sign. So trustworthy is it in many instances as to become a veritable ideograph that may indicate the personal antecedents, vocation, social state, certain events of one’s life, and even their date.

Without going into the history of a subject mentioned by Hippocrates, Plato, Cæsar, and Cicero, it may be pertinent to say that tattooing is prohibited by the Bible (Leviticus xix., 28) and is condemned by the Fathers of the Church, Tertullian among others, who gives the following rather singular reason for interdicting its use among women: “Certum sumus Spiritum Sanctum magis masculis tale aliquid subscribere potuisse si feminis subscripsisset.” (De Virginibus velandis. Lutetiæ Parisorum, 1675, fº, p. 178.)

In addition to much that has been written by French, German,[588] and Italian authors, who have put tattooing in an important place in legal medicine, the matter of tattoo-marks a few years since claimed the attention of the law courts of England, the Chief Justice, Cockburn, in the Tichbourne case, having described this species of evidence as of “vital importance,” and in itself final and conclusive. This celebrated trial has brought to light about all the knowledge that can be used in the investigation of this sign as a mark of identity. Absence of the tattoo-marks in this case justified the jury in their finding that the defendant was not and could not be Roger Tichbourne, whereupon the alleged claimant was proved to be an impostor, found guilty of perjury, and sentenced to penal servitude.[589]

The practice of tattooing is found pretty much over the world, notably in the Polynesian Islands and in some parts of Japan. It is, however, not found in Russia, being contrary to the superstitions of the people, who regard a mark of this kind as an alliance or contract with evil spirits. Its use appears to be penal only, and is limited to Siberian convicts. The degrading habit, confined to a low order of development, exists at the present time as a survival of a superstitious practice of paganism, probably owing to perversion of the sexual instinct, and is still common among school-boys, sailors, soldiers, criminals, and the lowest order of prostitutes living in so-called civilized communities. Indeed, unanimity of opinion among medical and anthropological writers assigns erotic passion as the most frequent cause of tattooing, and shows the constant connection between tattoo-marks and crime. Penal statistics show the greater number of tattooed criminals among the lowest order, as those who have committed crimes against the person; while the fewest are found among swindlers and forgers, the most intelligent class of criminals. Even amid intellectual advancement and æsthetic sensibility far in advance of the primitive man, such as exists in London and New York, for instance, are to be found persons who make good incomes by catering to this depraved taste for savage ornamentation. Persons who have been to Jerusalem may remember the tattooers, who try to induce travellers to have a cross tattooed on the arm as a souvenir of the pilgrimage. If a writer in the Revue des Deux Mondes, 15th June, 1881, is to be believed, it appears that the Prince of Wales on his journey to the Holy Land had a Jerusalem Cross tattooed on his arm, April 2d, 1862. The “Cruise of the Bacchante” also tells how the Duke of York was tattooed while in Japan.

The process is now rapidly done, an Edison electric pen being utilized for the purpose, and some of the wretched martyrs have the hardihood to be tattooed from head to foot with grotesque designs in several colors. I know of several instances: one of a man in Providence, R. I.; another of a Portuguese barber, who has striped poles, razors, brushes, and other emblems of his calling over the entire body. Another man has likenesses of Abe Lincoln and of Kaiser Wilhelm of Germany on his respective shins. A Nova Scotian, tattooed from head to foot, has among other designs that of “St. George and the Dragon” on his back; while a Texas ranchman, six feet two inches tall, underwent the torture of eight weeks’ profanation of his body in order to appear in blue, brown, and red, with an irreverent image on his back of the Immaculate Conception and thirty-one angels.[590]

A singular mixture of erotic and religious emblems is often found among the varied and fantastic signs used in tattooing. I recall the case of a man who had represented on his back a fox-hunt, in which riders followed the hounds in full pursuit of a fox about to take cover in the anus. In another case of a man accused of criminal attempt on two little girls, examination of the sexual organs revealed a tattoo on the back of the penis representing the devil with horns and red cheeks and lips. When the little girls were asked if the accused had shown them his virile member, they answered, “This man unbuttoned himself and said to us: ‘I am going to make you see the devil.’” In the face of such affirmations, the accused confessed his crime and was condemned. Other tattoo signs of the grossest emblems of unnatural passion have been found among low prostitutes, pederasts, and tribades.

Statistics founded on numerous facts show many cases of tattooing of the penis and even of the labia majora in the lowest order of prostitutes, but these unclean images and revelations of lustful instinct do not occur in the same order of frequency as those noted on the forearm, the deltoid, or the inferior extremities. So valuable are these marks in their bearing on the class, vocation, character, and tastes of a person that the finding of anchors and ships would indicate a sailor; while flags, sabres, cannon, and other warlike signs would indicate a soldier, etc. It is also noticeable that in the tattooing practised by lunatics the image relates in some way to the nature of the peculiar form of mental disease from which they suffer, and it is chiefly among the more severe and incurable cases of mental degeneration that these signs are found. (See Dr. Riva’s article, “Il tatuaggio nel Manicomio d’Ancona,” Cronica del Manicomio d’Ancona, November, 1888.)

Almost always the motive that prompts these disfigurements of the skin is the result of impulse, of thoughtlessness, or of orgy, and almost all the tattooed come to repent of their folly. The subject of détatouage has of late taken a polemic turn in some of the Continental journals. There are besides many cases on record of severe accidents and complications following the operation, such as severe inflammation, erysipelas, abscess, and gangrene. Dr. Beuchon gives statistics of forty-seven cases, in which four were followed by mutilation and eight by death either directly or in consequence of an amputation. A certain proportion of what is known as syphilis insontium is to be found among the reported statistics of tattooing. Dr. Bispham, of Philadelphia, informs me that while at Blockley Hospital he saw thirty cases of syphilis that had been communicated by the same tattooer.

Tattooing may sometimes be accidental. I have seen a departmental clerk with an elongated tattoo on the back of his hand caused by accidental wounding with an inked pen. A bursting shell during a naval engagement has caused a characteristic tattoo on the face of a well-known officer to be seen any day in Washington. Two cases of the bluish-black discoloration of the skin from taking nitrate of silver have also come under my observation. Both occurred in medical men, one of whom lives in Florida, the other in the District of Columbia. Silver discolorations of this kind are indelible, but I learn from one of these gentlemen that large doses of iodide of potassium cause temporary fading of the discoloration, which returns on stopping the medicine.[591]

The indelibility of tattoo-marks is such that their traces may be easily recognized in the cadaver, though in a somewhat advanced stage of putrefaction. They have even been recognized on a gangrenous limb. Sometimes, however, it is impossible to recognize at first sight whether there has or has not been a tattoo. A strong light and a magnifying glass and a microscopic examination of the neighboring ganglia to detect the presence of coloring matter may assist in removing doubt. It has been found on the bodies of tattooed cadavers that the ganglia are filled with grains of coloring matter of the same nature as that employed in making the tattoo. Attempts to remove tattoo-marks generally leave a vicious scar that is equally indelible. An efficacious method is to tattoo the mark with a solution of tannin, which is followed by brushing over with nitrate of silver. A red cicatrix follows, and when the epidermis separates the tattoo disappears. A better method, however, is by means of the electric needle already mentioned in speaking of the electrolysis of nævi.

That a tattoo-mark may disappear by the effects of time and leave no trace is a matter that Cooper reports after examining the mutilated remains of a cadaver, and the statistics of Caspar, Tardieu, and Hutin place it as high as nine in the hundred. An officer of the United States Revenue Marine lately called my attention to several superficial tattooes on the back of his hand which had disappeared. The deeper ones, however, remained. The spontaneous disappearance of a tattoo seems to be possible when the operation has been done in such a superficial way as not to have passed the rete Malpighii, or when the tattooing has been done with some substance not very tenacious, as vermilion, which appears to be easily eliminated. But when the particles of coloring matter penetrate into the fibro-elastic tissue of the derma, the disappearance of the tattoo is rare.

In seventy-eight individuals tattooed with vermilion alone, Hutin found eleven upon whom the tattoo had disappeared. Out of one hundred and four tattooes made with a single color, India-ink, writing ink, blue or back, not a single one had completely disappeared. The results are identical if the tattooes are made with two colors. Thus in 153 tattooes with vermilion and India-ink, one instance showed a fading of the black, in another it had completely disappeared, the red being well marked; twenty times the red was partly effaced, the black being well marked; and in sixteen cases the red had completely disappeared, the black remaining visible.[592]

A tattoo-mark may sometimes be altered, in which case it proves deceptive as an index. A workman changing his trade seeks to transform the insignia of his first calling into those of the second, or a criminal in order to avoid identity will make a change. In the former instance the transformation is not difficult to detect, but in the latter so much care is required to recognize the change that penal science has relegated the sign to a secondary place.

As to the length of time since a tattoo-mark has been executed, authorities are that it is impossible to tell after two or three weeks. Whether a tattoo-mark is real or feigned is easily settled by simply washing the part. This question, as well as that of the judicial consequences of such marks, is hardly pertinent to the matter in hand.

VALUE OF PROFESSIONAL STIGMATA.

The so-called professional signs are of undoubted value in the surface examination for establishing identity, but it does not seem that their importance warrants the extreme prolixity given to them by some Continental writers, and even by one in the city of Mexico, Dr. Jose Ramos.[593] For instance, it is pretended that cataract is more common among jewellers because of the fineness of their work; yet out of 952 cataracts, of which a record has been kept, only two cases occurred in jewellers. Besides, there is not one special sign or physical trace left on the body by which a prostitute may be known, notwithstanding the fact that in life the collective appearance would seldom deceive an experienced man.

Only in the case of sodomy, where anal coitus has been frequent, would characteristic signs be found. On anal examination of 446 prostitutes, Dr. Coutagne[594] found the signs of post-perineal coitus in 180. He cites the case of a young prostitute presenting the astonishing contrast of a gaping anus surrounded by characteristic rhagades, with the genital parts of an extreme freshness, a very narrow vagina, and non-retracted hymen, constituting by their reunion a still firm ring. A fact yet more curious is shown by a specimen in the collection of the museum of the laboratory of legal medicine at Lyons. The genital organs of the cadaver of a woman of twenty-eight or thirty years showed a hymen intact and firm, but on examining the anal region it was surprising to find an infundibuliform deformity with all the signs of sodomitical habits, which of course rectified the opinion that had been made regarding the chastity of this woman.

Many of the signs enumerated as peculiar to different callings have no special anatomical characteristic that is easy to distinguish with precision, consequently they do not present a degree of certainty or constancy sufficient to be invoked as strong medico-legal proof of identity. Moreover, the effects of time or treatment may have caused alteration or disappearance of many of the signs in question, which would at best be of negative rather than of absolute value.

To arrive at an impartial appreciation of the relative value of the professional stigmata as signs of identity, a certain number of the signs should be thrown aside as illusory. Others, on the contrary, are durable, special, and constant, and assist in establishing the identity accordingly as the lesions or alterations are complete or evident; but it should be borne in mind that the physical alterations and chemical modifications resulting from the exercise of certain trades are not in our country so important from a medico-legal point of view as they are in Europe, where class distinctions are more defined.

VALUE OF STAINS AND DIFFERENT IMPRINTS.

In the same manner that a very small portion or fragment of the human body may suffice to establish the corpus delicti, so will minute remains or traces, as finger-marks, footprints, and other material surroundings, even smells or traces of perfume, be of great assistance to justice in determining the identity of both culprit and victim, and at the same time throw light on the attendant circumstances of the deed. The traces of a bloody hand or foot, smears of tar or paint, the various spots or stains found on fabrics, instruments, etc., may involve questions of great nicety the relativity of which is apparent, especially in criminal trials. Newspapers have familiarized the public with many cases of the kind, in which medical experts have demonstrated blood and other stains with sufficient accuracy and positiveness to satisfy a jury. The Cronin case is a notable instance.

IMPRINTS MADE BY FINGER-TIPS are known to be singularly persistent. In four specimens of inked digit marks of Sir William Herschel, made in the years 1860, 1874, 1885, and 1888 respectively, though there was a difference of twenty-eight years between the first and last, no difference could be perceived between the impressions. The forms of the spirals remained the same, not only in general character, but in minute and measurable details, as in the distances from the centre of the spiral and in the direction at which each new ridge took its rise. Sir William Herschel has made great use of digit-marks for the purposes of legal attestation among natives of India.[595] The extraordinary persistence of the papillary ridges on the inner surface of the hands throughout life has been a theme of discussion by the Royal Society,[596] and Mr. Galton has devised a method of indexing finger-marks.[597]

The IMPRESS OF A NAKED FOOT covered with blood may serve to direct the investigations of justice. In a criminal affair in France, where eight individuals were implicated, comparative experiments upon the identity of the foot, made with a view to determine to which of the individuals ought to be attributed the bloody footprints found near a wardrobe, it was shown that a degree of recognition could be established on reproducing the footprints with defibrinated blood. From the eight imprints of the left foot of each individual, impregnated with blood, measures and comparisons could be made, thus helping to establish the difference or the resemblance with those found near the wardrobe.

Imprints thus obtained may be looked upon as a kind of documentary evidence, but too much importance should not be attached to them as articles tending to prove criminality. The futility of such evidence is shown in the varying sizes of different impressions of the foot of the same person—first in rapid progression, secondly by standing, and third by slow advance. The results appear less sure in the case of footprints made in mud, sand, dust, or snow. Nevertheless many facts relating thereto may be noted with great certainty. The question has been mooted as to whether or not the impress left upon the soil gives always the exact dimensions of the foot that has made them. One side has contended that the footprints are a little smaller, while the other refutes this opinion and thinks that they are a little larger. The consistency of the soil, which does not seem to have entered into the discussion, doubtless accounts for the small differences that have given rise to this discrepancy of opinion. The outline of the sole of the foot and the relative position of the toes are more or less neatly designed as the ground is more or less wet or soft. The means employed for taking impressions of foot or other tracks in mud, etc., show considerable ingenuity on the part of those who have elaborated the subject. To discover foot-marks in mud, powdered stearic acid is spread over the imprint and a heat of at least 212° is applied from above. By this means a solid mould may be taken of the imprint. These researches have been extended to the exact reproduction of imprints left upon snow by pouring melted gelatine upon the imprint previously sprinkled with a little common table salt, which rapidly lowers the temperature of the snow about fifteen degrees and permits the mould to be taken without too much hurry. The study has been extended to the configuration of the plantar imprints in tabetics, but it does not appear so far to be of much medico-legal value.

The question may arise as to the length of time since the imprints were made. This would, of course, depend upon many circumstances, as weather, temperature, and the like. It is a fact that in Greenland footsteps in snow have been recognized many months after they were made. A few summers ago, on an arctic expedition, I climbed Cape Lisbourne, Alaska, in company with another person. The ground being thawed in many places, our feet left very decided imprints in the mud. A year afterward I visited the same spot, and on again making the ascent was astonished to recognize the footsteps made the year before.

Circumstances sometimes direct expert attention to vestiges of other animals. The tracks of a dog or of a horse may become the object of a medico-legal inquest. The books record a case in which it was necessary to ascertain whether a bite had been made by a large or a small dog. This question was settled by producing the dogs and comparing their teeth with the scars. Persons familiar with border life know the importance of trails and the minute observation that is brought to bear on them by the experienced frontiersman. In following cattle-thieves and murderers, while with the Fourth United States Cavalry on the Rio Grande frontier, I have known the peculiarity of a horse’s footprint in the prairie to tell a tale of great significance.

Observation in this respect may extend to such apparently trivial objects as the tracks of wheels, as those of a wagon, a wheelbarrow, or a bicycle, or to the singular imprints left by crutches or a walking-stick. The imprint left in the ground by a cane usually occurs in the remarkable order of every two and a half or every four and a half steps. Investigation of such circumstances may result in material facts that may be of great assistance in establishing the relation of one or several persons with some particular act.

DEFORMITIES AND PATHOLOGICAL PECULIARITIES.

The existence of deformities or injuries is so apparent in serving to establish identity that it seems almost superfluous to mention them, except for the purpose of deciding whether the wounds were made during life or after death. In the matter of gunshot wounds on persons who took part in the late Civil War, many of whom unfortunately belong to the vagrant class and are often found dead, their wounds sometimes afford excellent means of identification. In many instances the multiple character of these wounds is almost incredible. When on duty at the Army Medical Museum, in connection with the preparation of the “Medical and Surgical History of the War of the Rebellion,” I saw a man who was literally wounded from the crown of his head to the sole of his foot, the scars being fifty-two in number.

WOUNDS MADE DURING LIFE might show the suggillation peculiar to bruises or traces of inflammation. Besides, the gaping nature of the lips of the wound, the fact of hemorrhage having taken place and the coagulation of the blood, the infiltration of blood into the cellular tissue, etc., are surgical facts that would leave but little doubt as to the infliction of the wounds during life.

The cause of death is often a difficult matter to determine, as it may have been accidental, suicidal, or the result of homicide. The causes relating thereto are, moreover, so many and varied that space and time compel a reference to other headings of this work. In forming an opinion as to the probable date of death the extent of putrefaction is the chief guide. If death is quite recent, we may be guided by the post-mortem rigidity or the extent to which the body has cooled. The march of putrefactive decomposition would, of course, be regulated by circumstances. It takes place very rapidly in persons who have succumbed to excessive fatigue or to any disassimilative excesses or derangement resulting in ante-mortem change of the tissues, such as those occurring in virulent or infectious diseases. The body of an infant decays more rapidly that that of an adult. The course of putrefactive phenomena is also influenced by the seasons, the extent of the exposure to air, and to other mesological causes. There is a manifest difference in the special putrefactive change accordingly as a body is buried in the earth, submerged in a fluid, thrown into a cesspool, or buried in a dung-heap.

In certain cases, especially where the body has been much mutilated, it may be desirable to know whether there was one or several murderers. While no definite rule can be laid down on this point, we are justified in supposing that there were two or more assassins when the body of the victim shows both gunshot and knife wounds, or that two persons were concerned in the dismemberment and mutilation of a body which shows the simultaneous presence of parts skilfully cut, while others show evident awkwardness.

Where there is more than one mortal wound on the same dead body, a question of medico-legal significance may arise. This occurred in the Burton murder case at Newport, R. I., in 1885, which gave rise to discussion of the following abstract question: “Whether it is possible for an individual, with suicidal intent, and in quick succession, to inflict a perforating shot of the head and another of the chest implicating the heart. Or, reversing the proposition, is it incredible that a person bent on self-destruction can, with his own hand, shoot himself in the heart and in the head?”

After consideration of the case referred to and reversal of the previous decision of the coroner, the supposed suicide proved to be a homicide. Yet if the abstract question of possibilities is alone regarded, there is no doubt of the fact that a suicide could shoot himself in such manner, both in the head and the heart, or, changing the order, of shots in the heart and in the head. The number of cases recorded establishes beyond a doubt the feasibility of the self-infliction of two such wounds, and make it clear that the theory of suicide may be maintained in such circumstances.[598]

JUDICIAL ANTHROPOMETRY.

Of late years the subject of anthropometric identification has taken such a place before justice that it cannot be ignored by the medical legist. The facts of scientific anthropology have here been applied in such a way as to establish with great certainty both the present and future identity of individuals who attempt dissimulation of their name and antecedents. The method used principally in the identification of criminals and deserters from the army has been adopted in the public service[599] and by most municipalities, with the exception of New York, where the subsequent identification of persons connected with municipal affairs has been and may be a source of no little embarrassment.

The system is based on three recognitory elements: photography, anthropometric measurements, and personal markings, from which a descriptive list is made that gives absolute certainty as to individual identity.

Owing to the illusory nature of photography and the difficulty in finding the portrait of any given individual in the large and constantly increasing collection of a “rogues’ gallery,” the matter has been simplified and facilitated by grouping the photographic collection according to the six anthropological coefficients of sex, stature, age, and color of the eyes. Each of these primordial groups is again subdivided in such a way as to reduce the last group to a small number, when the portrait is easily found and verified on comparing the measurements of the head, of the extended arms, the length of the left foot, and that of the left middle finger.

The photographic proof for each individual consists of two portraits side by side, one of which is taken full face, the other in profile of the right side. On the back of the photographic card is recorded with rigorous precision all personal markings or peculiarities.

The measurements, which can be made by any person of average intelligence in three or four minutes, are extremely simple. The right ear is always measured, for the reason that this organ is always reproduced in the traditional photograph which represents the right face. Other special measurements are taken on the left side. The height sitting, dimensions and character of the nose, color of eyes, etc., are also noted.

It is contended that by these measurements alone the identity of an individual whose face is not even known may be established in another country by telegraph. The application of the system has proved of great service in the apprehension of deserters from the United States army (when the authorities have been able to find the card), while it is claimed to have caused the disappearance of numerous dissimulators of identity in the prisons of Paris. The police authorities of that city report that out of more than five hundred annual recognitions by the foregoing means, not one mistake has yet occurred.[600]

To avoid a possible source of error mensuration of the organs and the ascertainment of their form may be resorted to in the case of a cadaver that is much decayed, or in one that has been purposely mutilated or burned by the assassin in order to prevent recognition. A sufficient number of cases may be cited in which the measurement of a limb or a bone of a deceased person known to have been lame or deformed during life has resulted in the establishment of identity or the reverse.

A mistake may be prevented in the case of supposed mutilation of a drowned body, which may have been caused by the screw of a passing steamer. Other errors may result from carelessness, incorrect observation of signs, and neglect to follow the ordinary precautions that should obtain in all researches on identity of the dead body.

Certain circumstances indicative of the mental state of the culprit may throw light on the identity. A person of unsound mind would certainly be suggested as the perpetrator of such a deed as that of the woman already mentioned, who after killing and cutting up her infant, cooked portions of the remains with cabbage and served them at a meal of which she herself partook. Equally conclusive should be the inference in the case cited by Maudsley of a person who, for no ascertainable motive, kills a little girl, mutilates her remains, and carefully records the fact in his note-book, with the remark that the body was hot and good.

The handwriting left by the assassin might also furnish a strong presumption as to the existence of a mental lesion, since the writing of the insane is often characteristic, especially in the initial stage of dementia. I recall the case of a former patient, an aphasic, imprisoned for having stabbed a man in the abdomen and for having wounded his wife in such a way that her arm had to be amputated. Having lost the power to express himself phonetically, this man used a book and pencil, but his writing showed a degree of agraphia which alone would establish his identity beyond a doubt.

While it is quite possible that dishonest transactions, and even theft, may take place by telephone and the voices of the perpetrators may be unmistakable between distant cities, it is more likely that the phonographic registration of speech or other sound by means of a gramophone should become a matter of medico-legal investigation and a possible means that may lend great assistance in establishing personal identity. Although no precedent may be cited, it is not going into the domain of theoretical hypothesis to mention a discovery of such real scientific certainty that for years after death, and thousands of miles away, gives an indefinite number of reproductions that cannot possibly be mistaken by any one familiar with the voice before it had become “Edisonized.” Some gramophone disks lately shown me from Germany registered greetings and messages to relatives in Washington, who were delighted to recognize the exact reproduction of familiar tones and accents of the Fatherland.

So limitless is the field of research in this direction that there is scarcely an anthropological, biological, or medical discovery that may not sooner or later be applied with profit in the investigations of personal identity where the combined efforts of an attorney and an expert are required.

After the most rigid and scrutinizing anatomical and material examination is made and the closest inquisition entered on, it may often be impossible to give a reasonable explanation for the cause of the physical facts observed. The medical man should remember that his is the one great exception to the rule that rigidly excludes opinions, and that scientific men called as witnesses may not give their opinion as to the general merits of the case, but only as to the facts already proved. This qualifying rule being altogether reversed in investigations into personal identity, and the physician’s opinion as to identity being indispensable, it becomes a matter of most serious import that this opinion should be grounded upon absolute and well-attested facts.

MEDICO-LEGAL DETERMINATION

OF

THE TIME OF DEATH.

BY

H. P. LOOMIS, A.M., M.D.,

Professor of Pathology in the University of the City of New York; Visiting Physician and Curator to Bellevue Hospital, New York; Pathologist to the Board of Health, New York City; President New York Pathological Society, etc., etc.

MEDICO-LEGAL DETERMINATION OF THE TIME OF DEATH.

SIGNS OF DEATH.

THE cessation of respiration and the absence of audible heart-beats are signs generally regarded as sufficient in themselves to determine the reality of death. But persons have been resuscitated from a state of asphyxia or have recovered from a state of catalepsy or lethargy in whom, to all appearances, the respiratory and circulatory processes have been arrested.

So it is advisable that we should be acquainted with some absolute tests of death which are not connected with the heart-sounds or the respiration.

It is well known that these important functions, although apparently held in abeyance, must be speedily re-established so as to be recognized, or death will rapidly follow. This condition of apparently suspended animation is seen among hibernating animals; the bear, for instance, will remain for four or five months without food or drink in a state of lethargy—the heart-action and respiration hardly appreciable. Yet it will be sufficiently rapid to sustain life during the slow metabolic processes. A number of well-authenticated cases are reported in which persons could slacken their heart-action, so that no movement of the organ could be appreciated. The case of Colonel Townsend, reported by Cheyne, is an example. He possessed the power of apparently dying, by slowing his heart so that there was no pulse or heart-action discernible. The longest period he could remain in this inanimate state was half an hour.

Instances have occurred in the new-born child where without question there have been no heart-beats or respiratory movements for a number of minutes, the limit being set at five.

These are exceptional cases, and it is setting at defiance all physiological experience to suppose that the heart-action and respiration can be suspended entirely when once they are established, for a period as long. So, then, if no motion of the heart occurs during a period of five minutes—a period five times as great as observation warrants—death may be regarded as certain.

The respiratory movements of the chest are sometimes very difficult to observe. They can always be better appreciated if the abdomen and chest are observed together. There are two methods to determine whether respiration is absolutely suspended or not. First, by holding a mirror in front of the open mouth, observing whether any moisture collects on its surface. Second, by placing on the chest a looking-glass or basin of water, and reflecting from it an image by artificial or sun light. The slightest movement would be registered by a change in position of the image. While the writer considers the absence of heart-beats and of respiratory movement an absolute test of death, still some cases may occur in which the establishment of this test is very difficult, and the following additional tests may be employed:

1. Temperature of the body same as surrounding air.

2. Intermittent shocks of electricity at different tensions passed into various muscles, giving no indication whatever of irritability.

3. Careful movements of the joints of the extremities and of the lower jaw, showing that rigor mortis is found in several parts.

4. A bright needle plunged into the body of the biceps muscle (Cloquet’s needle test) and left there, showing on withdrawal no signs of oxidation.

5. The opening of a vein, showing that the blood has undergone coagulation.

6. The subcutaneous injection of ammonia (Monte Verde’s test), causing a dirty-brown stain indicative of dissolution.

7. A fillet applied to the veins of the arm (Richardson’s test), causing no filling of the veins on the distal side of the fillet.

8. “Diaphanous test:” after death there is an absence of the translucence seen in living people when the hand is held before a strong light with the fingers extended and in contact.

9. “Eye test:” after death there is a loss of sensibility of the eye to light, loss of corneal transparency, and the pupil is not responsive to mydriatics.

POST-MORTEM CHANGES.

The human body after death undergoes certain changes which will be discussed under the following heads:

1. Cooling of the body.

2. Flaccidity of the body.

3. Rigor mortis.

4. Changes in color due to

(a) Cadaveric ecchymoses. (b) Putrefaction.

COOLING OF THE BODY.

Immediately after death there is a slight rise of temperature, supposed to be due to the fact that the metabolic changes in the tissues still continue, while the blood is no longer cooled by passing through the peripheral capillaries and lungs.

The body gradually cools and reaches the temperature of the surrounding air in from fifteen to twenty hours; this is the ordinary course, but the time may be influenced by a variety of causes, such as the condition of the body at the time of death, manner of death, and circumstances under which the body has been placed.

In certain diseases, as yellow fever, rheumatism, chorea, and tetanus, the temperature of the body has been known to rise as high as 104° F. and remain so for a time. Again, it has been observed that when death has taken place suddenly, as from accident, apoplexy, or acute disease, the body retains its heat for a long time. The bodies of persons dying from hanging, electrocution, suffocation, or poisoning by carbon dioxide, do not generally cool for from twenty-four to forty-eight hours, and cases are recorded where three days have elapsed before the body was completely cold. On the other hand, bodies dead from chronic wasting diseases or severe hemorrhage cool very rapidly, even in four or five hours.

In determining the temperature of a dead body the hand is not a reliable guide: the thermometer should always be used.

FLACCIDITY.

The first effect of death from any cause is general relaxation of the entire muscular system. The lower jaw drops, the eyelids lose their tension, the limbs are flabby and soft, and the joints become flexible.

In from five to six hours after death, and generally while the body is in the act of cooling, the muscles of the limbs are observed to become hard and contracted, the joints stiff, and the body unyielding. Muscles which are contracted in the death-agony do not necessarily become relaxed at any time.

The muscular tissues in the dead body can be considered as passing through three stages: (1) flaccid but contractile, (2) rigid and incapable of contraction, (3) relaxed and incapable of further contractility.

RIGOR MORTIS.

This is sometimes called cadaveric rigidity and occurs generally within six hours after death and disappears within sixteen to twenty-four hours. Many theories have been advanced to account for it, but the most probable one is that the rigidity is due to the coagulation of the myosin in the muscles by the weak acids which are no longer removed from the system; the muscles always give an acid reaction and are opaque instead of transparent; after putrefaction has set in ammonia is developed, the myosin dissolved, and so flaccidity results.

Rigor mortis occurs first in the muscles of the eyelid, next the muscles of the lower jaw and neck are affected, then the chest and upper extremities; afterward it gradually progresses from above downward, affecting the muscles of the abdomen and lower limbs. The rigidity disappears in the same sequence. The period after death when rigor mortis manifests itself, together with its duration, is chiefly dependent upon the previous degree of muscular exhaustion. Brown-Séquard has demonstrated that the greater the degree of muscular irritability at the time of death, the later the cadaveric rigidity sets in and the longer it lasts. He has also shown that the later putrefaction sets in, the more slowly it progresses.

The more robust the individual and the shorter the disease, the more marked and persistent is this muscular rigidity. It has been noticed that the bodies of soldiers killed in the beginning of an engagement become rigid slowly, and those killed late quickly. This explains the reason why bodies are sometimes found on the battle-field in a kneeling or sitting posture with weapons in hand.

If the rigidity of rigor mortis after it is once complete is overcome, as in bending an arm, it never returns; but if incomplete it may return. This will serve at times to distinguish real death from catalepsy and its allied conditions. While the average duration of rigor mortis has been given as sixteen to twenty-four hours, it must be remembered that in some cases it has been known to last only a few hours, as in death by lightning or by electrocution. In other cases it has persisted for seven and fourteen days.

This long continuance of rigor mortis has been noted in death from strychnine and other spinal poisons, in suffocation, and in poisoning by veratrum viride.

Atmospheric conditions modify to a large extent the duration of rigor mortis. Dry, cold air causes it to last for a long time, while warm, moist air shortens its duration. Also immersion in cold water brings on rigor mortis quickly and lengthens its duration.

CADAVERIC ECCHYMOSIS—CADAVERIC LIVIDITY OR HYPOSTASIS.

Within a few hours after death the skin of the body, which is of a pale, ashy-gray color, becomes covered by extensive patches of a bluish or purple color, which are most pronounced and are first seen on the back part of the trunk, head extremities, ears, face, and neck, and are due to the blood, before coagulating, settling in the most dependent parts of the body, producing a mottling of the surface with irregular livid patches. There is also a stagnation of blood in the capillary vessels, especially in those in the upper layer of the true skin or in the space between the cuticle and cutis. The discoloration continues to increase until the body is cold, when it is entirely arrested. Later on, just before putrefaction begins, the color deepens, and the change appears to proceed from an infiltration of blood pigment into the dependent parts of the body.

At the same time the discolorations are appearing on the surface of the body, internal hypostasis is also taking place, most marked in the dependent portions of the brain, lungs, intestines, kidneys, and spinal cord.

This condition in the brain may be mistaken for so-called congestive apoplexy; in the lungs, for pulmonary apoplexy or the first stage of lobar pneumonia; in the intestines and spinal meninges, for the beginning of inflammatory changes.

The position of these hypostases will afford the best correction for this possible error. The appearances presented by cadaveric ecchymoses have often been mistaken for the effects of violence applied during life. Innocent persons have been accused and tried for murder or manslaughter on charges afterward proved to be groundless. Therefore it is of the utmost importance that the medical jurist should be able to distinguish between ante-mortem and post-mortem ecchymoses.

The following are the points of difference:

1. Situation. Post-mortem ecchymoses are seen on that portion of the body which has been most dependent, generally the posterior aspect, and they involve principally the superficial layers of the true skin; ante-mortem ecchymoses may occur anywhere, and generally the deeper tissues are discolored.

2. In cadaveric lividity there is no elevation of the skin and the discoloration terminates abruptly.

3. After cutting into the tissues where an ecchymosis has been produced by violence, the blood without the vessels is free in the tissue; this is not so in cadaveric ecchymosis.

4. Post-mortem ecchymoses are very extensive, ante-mortem generally limited in area.

A peculiar appearance of cadaveric lividity is observed in bodies which have been wrapped in a sheet and allowed to cool or that have cooled in their clothing. It occurs in the form of bands or stripes over the whole surface, and often gives an appearance as of a person flogged. The explanation of this appearance is that the congestion of the vessels takes place in the interstices of the folds, while the parts compressed remain whole. The unbroken condition of the cuticle, together with the other characteristics just mentioned, are sufficient to distinguish these ecchymoses from those produced by violence. While cadaveric lividity is seen in all bodies after death, it is especially pronounced in those persons who have died suddenly in full health or by violence, as from apoplexy, hanging, drowning, or suffocation. It is very slight in the bodies of those who have died from hemorrhage or anæmia.

The time at which cadaveric lividity appears varies greatly. Casper, who has investigated the subject thoroughly, sets the time at from twelve to fifteen hours after death.

PUTREFACTION.

At a period varying from a few hours to three days after death, certain changes are seen in the human body which show that putrefaction has commenced. A change of color appears first upon the middle of the abdomen and gradually spreads over the rest of the body; it is first pale green, which gradually deepens, and finally becomes purplish or brown. This change in color is due to the action on the hæmoglobin of the gases developed by decomposition. Similar discoloration makes its appearance on the chest, between the ribs, on the face, the neck, the legs, and lastly on the arms, where it is more marked along the large venous trunks, and has sometimes been mistaken for marks of violence. The eyeballs become flaccid, and if exposed to the air the conjunctiva and cornea become dry and brown. Gases are formed, not only in the hollow organs of the abdomen but also in the skin. Those developed in the cavities of the head and face force frothy, reddish fluid or mucus from the mouth and nostrils, and may cause swelling of the features and protrusion of the eyes and tongue. It must be remembered that the gases while producing distention of the abdomen may also cause changes in the position of the blood and slight displacement of the organs; they may also force undigested food into the mouth and into the larynx, and so lead to suspicion of death from suffocation.

As putrefaction advances, after a period of five or six days the entire surface of the body becomes green or brown, the cuticle becomes loose and easily detached; the tissues flaccid and often bathed in a reddish serum in such situations as the neck, the groin, and the back part of the scalp. The thorax and abdomen become enormously distended, the features distorted and scarcely recognizable, and the hair and nails loosened. Beyond this, it is impossible to follow the changes leading to disintegration with any degree of certainty. The changes which I have just described as produced by putrefaction are the ordinary ones seen in a body exposed to the air at a moderate temperature, but it must be remembered that the time and rapidity of the development of these changes may be influenced by a large number of factors, and that they are of very little importance in estimating the time of death. I have seen bodies buried two months that have shown fewer of the changes produced by putrefaction than others dead but a week.

The appearance of a body buried in a coffin will be as follows after a period varying from a few months to one or two years. The soft tissues will have become dry and brown and the face and limbs covered with a soft white fungus. Hard white crystalline deposits of calcium phosphate will be found on the surface of the soft organs, and when found on the surface of the stomach care should be taken not to confound them with the effects of poison. In time the viscera become so mixed together that it is difficult to distinguish them. For the most part the changes that take place in a body buried in a coffin are similar, but much slower, to those that occur if the body is exposed to the air or buried in soil. Even under apparently identical circumstances the most varied results have been observed, so it is not possible for a medical jurist to fix a definite period of death or the time of burial from the appearance of an exhumed body. For example, Taylor records a case where after thirty-four years’ interment an entire and perfect skeleton was discovered, surrounded by traces of shroud and coffin, while in an adjoining grave all that remained of a body that had been dead twenty-five years were the long bones and base of the skull, In one case a body was found well preserved after six years’ burial and in another after even thirty years’ interment.

This brings us next to a consideration of those factors that favor or retard decomposition.

CIRCUMSTANCES FAVORING PUTREFACTION.

1. =Temperature.=—Putrefaction advances most rapidly at a temperature between 70° and 100° F. It may commence at any temperature above 50° F., but it is wholly arrested at 32° F. So one day’s exposure of a body in summer may effect greater changes than one week in winter. After freezing, putrefaction takes place with unusual rapidity upon the thawing out of the body. A temperature of 212° F. stops all putrefactive changes.

2. =Moisture.=—Putrefaction takes place only in the presence of moisture. An excess of moisture, however, seems to retard the process, possibly by cutting off the excess of air. The viscera according to the amount of water they contain decompose at different times after death—for instance, the brain and eye rapidly, the bones and hair slowly.

3. =Air.=—Exposure to air favors decomposition by carrying to the body the micro-organisms which bring about putrefaction; absence of air soon arrests the changes: this is seen in bodies hermetically sealed in lead coffins, which remain unchanged for a long period of time. Moist rather than dry air favors putrefaction by lessening evaporation. Air in motion retards while still air favors the change.

It is to be remembered that a body decomposes more rapidly in air than in water or after burial. Given similar temperatures, the amount of putrefaction observed in a body dead one week and exposed to the air will about correspond to one submerged in water for two weeks or buried in a deep grave for eight weeks.

4. =Age.=—The bodies of children decompose much more rapidly than those of adults; fœtuses still more rapidly. Aged bodies decompose slowly, probably on account of a deficiency of moisture. Fat and flabby bodies decompose quickly for the same reason.

5. =Cause of Death.=—In cases of sudden death, as from accident or violence, the body decomposes more rapidly than when death results from disease. Putrefaction sets in early in death from the infectious fevers, such as typhus, pyæmia, and typhoid fever, also in death from suffocation by smoke or coal gas, by strangulation or after narcotic poisoning. Those parts of a body which are the seat of bruises, wounds, or fractures, decompose rapidly; this is especially seen in parts after a surgical operation.

6. =Manner of Burial.=—When a body is buried in low ground in a damp, swampy, clay soil, decomposition advances rapidly, as also when the grave is shallow so the body can be exposed to constant variations of temperature. A porous soil impregnated with animal and vegetable matter favors putrefaction, as also burying a body without clothes or coffin; this is especially seen where infants have been thrown into the ground and loosely covered with earth.

CIRCUMSTANCES RETARDING PUTREFACTION.

1. =The Temperature.=—Below 32° F. and above 212° F. putrefaction is entirely arrested. The rapidity of the change considerably lessens as the temperature advances above 100° F. A remarkable instance of the preservative power of cold is given by Adolph Erman, who states that the body of Prince Menschikoff, a favorite of Peter the Great, exhumed after ninety-two years’ burial in frozen soil, had undergone hardly any change. Buried in hot sand as is seen in the desert, a body putrefies very slowly and generally becomes mummified.

2. =Moisture.=—Absence of moisture retards decomposition. In the dry air of the desert bodies have been preserved for a long period of time.

3. =Air.=—If access of air to a body be prevented in any way by its inclosure in a coffin, by closely fitting clothes, or by complete immersion in water, putrefaction is retarded.

4. =Age.=—Adults and old people decompose more slowly than children. Males are said to change less rapidly than females, lean people than fleshy ones.

5. =Cause of Death.=—Putrefaction is delayed after death from chronic diseases unless they are associated with dropsy. Poisoning by alcohol, chloroform, strychnine, and arsenic retard putrefaction. In the latter case the putrefactive changes seem to stop after they have once commenced, and often a result very similar to mummification is seen. Death from the mineral acids, especially sulphuric, appears to delay putrefaction.

6. =Manner of Burial.=—Putrefaction is retarded by burial a short time after death; by interment on high ground, in dry, sandy, or gravelly soil; by having the grave deep, over six feet in depth if possible by the body being well wrapped and secured in a tight coffin, a lead one being the best in this respect. Lime or charcoal applied freely about a body will retard decomposition, as will also injection of the body through the arteries with such substances as arsenic, chloride of zinc, or antimony. The ultimate effect of putrefaction is to reduce all bodies to inorganic compounds, chiefly water, ammonia, and carbon dioxide. Three conditions are necessary for its establishment, (1) a given temperature, (2) moisture, (3) free access of air.

The order in which the various organs and tissues undergo decomposition, as given by Casper, who has investigated the subject carefully, is as follows: Trachea and larynx, brain of infants, stomach and intestines, spleen, omentum and mesentery, liver, brain of adults, heart and lungs, kidney, bladder and œsophagus, pancreas, large vessels, and last of all the uterus.

As the result of putrefaction, fluids, generally blood-stained, collect in the serous cavities of the body, and should not be confounded with serous effusions occurring during life. So also the softening of the organs and tissue resulting from decomposition should be carefully distinguished from those resulting from inflammation. These cadaveric softenings are most frequently found in the brain, spleen, and gastro-intestinal mucous membrane. Inflammatory softenings are differentiated by being rarely general but almost always limited, by the substance of the inflamed part being infiltrated with serum or pus and showing traces of vascular injection. In doubtful cases the pathologist should have recourse to the microscope.

As the result of putrefaction, various changes take place in the mucous membrane of the stomach and intestines which simulate the effects of poisons. The color of the stomach varies from red, which becomes brighter on exposure to the air, to a brown, slate, or livid purple. We can only presume that these color-changes are the result of irritant poisons when they are found in non-dependent parts and parts not in contact with organs engorged with blood, when they are seen soon after death, and when the membrane is covered with coagulated blood, mucus, or flakes of membrane.

EFFECTS ON PUTREFACTION OF SUBMERSION IN WATER.

There are certain modifications of the putrefactive changes when bodies have been submerged in water. In the first place, the changes are much less rapid; they often do not show themselves until about the twelfth day, and then as discolorations appearing generally first about the ears and temples, then on the face, from which they spread to the neck, shoulders, chest, abdomen, and finally to the legs. This is almost the inverse order of the putrefactive changes in bodies exposed to the air. As a result of the formation of gases, the body in a short time becomes buoyant; after floating on the surface of the water for a time, the gases escape and the body sinks, rising a second time when fresh gas has formed.

The rapidity of decomposition in water varies, being most rapid when the temperature is from 64° to 68° F. Stagnant as well as shallow water favors putrefaction. If a body becomes coated with mud the change is delayed. Submersion in a cesspool also retards it, and the conditions are such as to favor the formation of adipocere.

After a body has been removed from the water an exposure of a very few hours to the air causes rapid decomposition, so that in twenty-four hours more marked changes may occur than would have resulted from a fortnight’s longer submersion. The face soon becomes bloated and black, so that identification is well-nigh impossible. It is quite important in medico-legal cases to estimate the time which has elapsed since death in bodies found submersed in water. The following are the various changes ordinarily seen at different periods of time, as estimated by Devergie, who has especially investigated the subject:

=First Four or Five Days.=—Little change: rigor mortis may persist, particularly if the water is cold.

=Fourth or Fifth Day.=—Skin of the ball of the thumb and little finger, also the lateral surface of the fingers, begins to whiten. This whitening gradually extends to the palms of the hands and soles of the feet. The skin of the face will appear softened and of a more faded white than the rest of the body.

=Fifteenth Day.=—Face slightly swollen and red; a greenish spot begins to form on the neck and skin of the mid-sternum. The skin of the hands and feet is quite white and wrinkled. The subcutaneous cellular tissue of the thorax is reddish and the upper part of the cortical substance of the brain of a greenish tint.

=At One Month.=—The face is reddish-brown, the eyelids and lips green and swollen, and the neck slightly green. A greenish discoloration is also seen over the upper and middle part of the sternum. The skin is wrinkled. The hair and nails still remain intact. The scrotum and penis are distended by gas. The lungs become very emphysematous and overlap the heart.

SAPONIFICATION.

When the bodies were removed from the Cimetière des Innocents in Paris, in 1786, Fourcray observed that many of them had been converted into a substance which he termed ADIPOCERE. He gave it this name because it resembles both fat (adeps) and wax (cera). Under certain circumstances which will be considered later, it is known to be a late product of the putrefactive processes. Adipocere is a substance of a cheese-like consistency, yellow or yellowish-brown in color, and composed chiefly of a mixture of the fatty acids. Chevreul has shown by analysis that it is a true ammoniacal soap, but that when formed in water impregnated with lime a calcareous may be substituted for an ammoniacal base. This may take place either in a body exposed to river-water or buried in a grave wet by water containing calcium carbonate or sulphate. Saponification can only take place when animal fat is in contact with nitrogenous matter. Neither fat nor fibrin when kept separate will saponify. Skin deprived of all its fat will not be transformed into adipocere.

Saponification commences in the fat of the female breast, of the cheeks and other parts of the body where large accumulations of fat are found, such as around the kidneys and in the omentum. As fat is distributed extensively throughout the body, nearly all parts may undergo this transformation. Taylor gives the following conditions as favorable to the change:

1. Bodies of young persons, because the fat is abundant and chiefly external.

2. Bodies of corpulent adults.

3. Exposure of bodies to the soil of water-closets.

4. The immersion of bodies in water, the change taking place more rapidly in running than in stagnant water.

5. Humid soil, especially when bodies are placed in it one upon the other. In this case the lowest of them is first changed.

When a body has been completely saponified it may remain in this state for years. In one instance, after seventeen years’ burial many of the organs could still be recognized.

The time required for saponification to take place is sometimes of medico-legal importance. Three years are usually necessary for bodies buried in the earth. The change occurs more rapidly in water. Cases are recorded where the body of a new-born child was completely saponified in six weeks, and again, the change had commenced in a body which had been in the water about four months; but these are unusual cases.

DATA UPON WHICH OPINION AS TO TIME OF DEATH IS FORMED.

The changes which take place in a body before putrefaction sets in may enable a medical jurist to form an opinion as to the probable time which has elapsed since death; yet it must be remembered, to pronounce the time which has elapsed can only be done approximately, for very many conditions will have to be considered, which will vary in each individual case. The importance of considering the minutest detail is well illustrated by the death of Prince de Condé, Duke of Bourbon, who was found dead in his bedroom in the chateau of St. Cyr. When discovered at 8 o’clock in the morning, the deceased was found partly undressed, hanging by his cravat to one of the window shutters. The body was cold and the lower extremities rigid. As in asphyxia from hanging the warmth of the body is usually preserved longer than under common circumstances, viz., from twelve to fifteen hours, before which period rigidity is seldom complete, the medical examiner inferred that the deceased must have died very soon after he retired to his bedroom on the previous night. As this was proven to have been 10 P.M., it followed that only ten hours had elapsed—a short time for cooling and rigidity to have taken place. It was thus rendered probable that the hanging took place soon after deceased reached his bedroom. It was alleged that the duke had been murdered, and that his body had been afterward suspended to create a suspicion of suicide. The condition of the body was, among other things, adverse to this opinion. From 10 to 12 o’clock it was proved there were numerous attendants moving about near the duke’s apartments. They would have heard any unusual noise the duke must have made in resisting his assailant. But no noise was heard in the room at that or any other time, and the presumption of this being a homicide was thus strongly rebutted.

=Cadaveric rigidity=, while often it will aid to, is not a reliable guide. When once it is established it may remain two, three, or four days, according to the season of the year and other circumstances, and when it exists there is no rule by which it can be determined whether a body has been in this state three hours or three days.

=Putrefaction=, while appearing on an average, under a mean temperature, in from three to six days, is yet influenced by many circumstances. The heat and moisture of the surroundings, the age, sex, amount of flesh on the body, mode of death, position and coverings of body, all must be considered.

=The temperature= of the body aids us, yet the retention of warmth by the abdominal viscera may be met with in a marked degree twenty hours after death; in one case, personally known to me, the thermometer registered 76° F. seventeen hours after death.

The temperature of the body, its rigidity, and the evidences of putrefaction all furnish data from which we can estimate the probable time which has elapsed since death. It must be remembered that no one of them furnishes any positive proof.

Some medical jurists have attempted to give a more definite character to these changes in the recently dead body by dividing the interval between the stopping of the heart’s action and the beginning of putrefaction into three periods. In the first, the warmth, pliability, and muscular irritability remain. In the second, these conditions are lost and the body is cold and rigid. In the third, the body is cold and pliant, the muscles are relaxed, and the joints are flexible, the cadaveric rigidity having entirely ceased.

There can be no doubt about the existence of these stages, but when we come to define the precise time at which one begins and the other ends, we find it impossible. For example, the first stage embraces a period which cannot be more closely defined than by stating that the person may have been dead from a few minutes to twenty hours—a statement too vague to be upheld by a counsel who defends a prisoner.

The changes which take place in these periods and the average time they last have been given as follows by Devergie:

FIRST PERIOD, Few Minutes to Twenty Hours.—Characterized by warmth of the body and general or partial relaxation of the voluntary muscles. To what portion of this period the special case belongs must be estimated according to the degree of heat in the trunk and extremities and the degree of rigidity in the muscles, the neck and the jaws commonly showing this condition first, the legs last. Warmth of the body rarely remains as long as twenty hours; in general it is sensibly cold in from ten to twelve hours. During this period the muscles are susceptible of contraction under the galvanic current, and in the early stage under the stimulus of blows.

SECOND PERIOD, Ten Hours to Three Days.—The body is perfectly cold throughout and rigidity is well marked. The muscles no longer respond to stimuli. The duration of this period seems long, yet in one instance the body will be found cold and rigid nine hours after death. Again, cooling and rigidity may not come on for three or four days.

THIRD PERIOD, Three to Eight Days.—The body is perfectly cold. The limbs and trunk pliant and free from cadaveric rigidity. The muscles are not capable of contracting. In summer this period is much shorter; often it will come on before three days.

Putrefaction commences when a body is kept under the most favorable conditions, in from six to twelve days, as a slight greenish discoloration of the abdomen which gradually spreads throughout the body. The time at which putrefaction shows itself and the rapidity with which it advances is dependent upon so many factors, many of which it is impossible often for the medical examiner to ascertain, that too much reliance must not be placed upon it. Casper estimates the following to be the average changes generally found in the periods of time given:

TWENTY-FOUR TO SEVENTY-TWO HOURS after death a slight green color is visible over the centre of the abdomen. The eyeballs are soft and yield to external pressure.

THREE TO FIVE DAYS after death the green color of the abdomen becomes intensified and general, spreading if the body be exposed to the air or buried in the ground in the following order: genitals, breast, face, neck, upper and lastly lower extremities.

EIGHT TO TEN DAYS after death the discoloration becomes more intense, the face and neck presenting a shade of reddish-green. The ramifications of the superficial veins on the neck, breast, and limbs become very apparent. Finally the patches congregate. Gases begin to be developed and distend the abdomen and hollow organs and to form under the skin in the subcutaneous and intermuscular tissue. The cornea falls in and becomes concave. The sphincter ani relaxes.

FOURTEEN TO TWENTY-ONE DAYS after death the discoloration over the whole body becomes intensely green, with brownish-red or brownish-black patches. The body is bloated and appears greatly increased in size from the development of gases within the abdomen, thorax, and scrotum, and also in the cellular tissue of the body generally. The swollen condition of the eyelids, lips, nose, and cheeks is usually of such extent as to obliterate the features and to destroy the identity of the body. The epidermis peels off in patches, while in certain parts, more particularly the feet, it will be raised in blisters filled with red or greenish liquid, the cuticle underneath frequently appearing blanched. The color of the iris is lost. The nails easily separate and the hair becomes loosened.

FOURTH TO SIXTH MONTH after death the thorax and abdomen burst and the sutures of the skull give way from the development of gases within the head. The viscera appear pulpy, or perhaps disappear, leaving the bones exposed. The bones of the extremities separate at the joints. At an advanced stage the soft parts gradually disappear.

In giving an opinion as to how long a time has elapsed since death when a body has undergone marked putrefactive changes, we must consider carefully not only the conditions of the organs, but the mode of death and the “surroundings.” By these I mean the quantity of clothing worn, the depth of the grave in which the body has been interred, the season of the year, the heat and moisture of the atmosphere. The question sometimes presents itself to the medical examiner, Of two persons found dead, which died first? The importance of this point was well illustrated in the “Lizzie Borden case.” By a careful consideration of all the conditions presented by each body in the ways I have indicated, the question will not ordinarily be a difficult one to decide.

THE

MEDICO-LEGAL CONSIDERATION

OF

WOUNDS,

INCLUDING

PUNCTURED AND INCISED WOUNDS, AND WOUNDS MADE BY BLUNT INSTRUMENTS OTHER THAN GUNSHOT WOUNDS.

BY

GEORGE WOOLSEY, A.B., M.D.,

Professor of Anatomy and Clinical Surgery in the Medical Department of the University of the City of New York; Surgeon to Bellevue Hospital; Member Medical Society of the County of New York, New York Academy of Medicine, New York Surgical Society, etc., etc.

WOUNDS.

GENERAL CONSIDERATIONS. THE DIFFERENT KINDS OF WOUNDS.

THE surgical and medico-legal ideas of wounds are quite different, the latter including the former as well as other varieties of injuries.

=Definitions.=—Surgically a wound means a solution of continuity and refers to every such lesion produced by external violence or developing spontaneously. The medico-legal acceptation of the term is much broader and includes any injury or lesion caused by mechanical or chemical means. Vibert[601] quotes Foderé as defining a wound medico-legally as, “Every lesion of the human body by a violent cause of which the results are, singly or combined, concussion, contusion, puncture, incision, tear, burn, twist, fracture, luxation, etc.; whether the cause is directed against the body or the body against the cause.” The same author quotes another definition of a wound as, “Every lesion however slight, resulting in concerning or affecting the body or health of an individual.” Taylor[602] defines a wound in a medico-legal sense as “a breach of continuity in the structures of the body whether external or internal, suddenly occasioned by mechanical violence.” Thus, the term wound in its medico-legal acceptation includes not only surgical wounds but contusions, fractures, burns, concussion, etc. In France at least the voluntary inoculation of syphilis has been considered as coming under the category of wounds.[603]

Medico-legally, the severity of a wound is much more important than the kind of wound. Thus we may consider wounds according to their comparative gravity, as mortal, severe, or slight.

A mortal wound is one which is directly fatal to life in a comparatively short time, usually from hemorrhage, shock, or the injury of a vital part. A wound may result fatally without being a mortal wound, as when a slight wound causes death on account of some wound infection.

Severe wounds, or “wounds causing grievous bodily harm,” as they have long been called, do not put life in imminent danger, though they may be inconvenient or detrimental to health. Pollock, C. B., says that a wound causing grievous bodily harm is “any wound requiring treatment.”

A medical opinion or certificate may be required as to the danger of a given wound, and on this opinion may depend the question of bail for the prisoner. By the danger of a wound in such a case is usually meant imminent danger, as any wound may be remotely dangerous to life.

Slight wounds, as already stated, may result fatally under certain conditions. Under the French practice a slight wound is one which does not incapacitate one from work for more than twenty days. Looked at in another way, slight or severe wounds may be classified according as they are completely curable, leaving no infirmity or disturbance of function, or not completely curable. The latter are such as are necessarily followed by permanent or temporary infirmity.

The question as to the severity of any given wound may sometimes be left to the jury to decide from the description of the wound, or a medical opinion may be required.

Although the intent of the assailant is often of equal or greater importance than the severity or kind of wound, yet this can only occasionally be inferred from the surgical aspects of the wound.

The classes of wounds to be treated in the following pages are incised and punctured wounds and wounds with blunt instruments, some of the characteristics of which we will now consider.

=Incised wounds= are such as are produced by a cutting instrument, and they are distinguished by the following characteristics: They measure more in length than in the other dimensions. They are usually straight in direction, though not infrequently curved, and they may even be zig-zag, especially where the skin lies in folds. The edges of an incised wound are linear, and show no signs of contusion. They are either inverted or everted and the edges and sides of the wound are retracted. The eversion of the skin is due to its elasticity, but in some regions of the body, e.g., in the scrotum, etc., the skin is inverted owing to the contraction of the muscle fibres immediately beneath. The gaping of the wound is due to the retraction of the divided muscles and fibrous structures. It varies according as the muscles are cut directly across or more lengthwise, and in proportion to the distance of the wound from the points of attachment of the muscles.

The fibrous tissues, fasciæ, and aponeuroses retract less, and so give a somewhat irregular surface to a large wound.

Ogston[604] divides incised wounds into three parts, the commencement, centre, and end, of which the end often has two or more serrations differing from the commencement, which has but a single point. There are often one or more slight, superficial, tentative incisions situated almost always, though not invariably, near the commencement.[605] The deepest part of the wound is more often near the commencement. If there are angular flaps on the edges their free angles point to the commencement of the wound.

Coagula and clots of blood are to be found in the wound, more or less filling it up if it has not been interfered with. On examination the ends of the divided vessels are found plugged with clots which may protrude somewhat from their openings.

If the wound is seen very shortly after its infliction, hemorrhage is in progress, and the divided arteries show their position by their individual, intermittent jets of blood. The severity of incised wounds depends upon the amount of hemorrhage, which is greater the deeper and larger the wound, and the more vascular the tissues in which it occurs, especially if large and important vessels are concerned. In the latter case an incised wound may be very rapidly fatal.

Incised wounds present the least favorable conditions for the spontaneous arrest of hemorrhage of any form of wounds. The edges of an incised wound may be quite rough and even dentated or lacerated if the edge of the weapon be rough and irregular.

The kind and condition of a weapon which has produced a given incised wound may often be learned by an examination of the characteristics of the wound.

Weapons cutting by their weight as well as by the sharpness of their edges, such as axes, etc., may cause a certain amount of contusion about a wound; they crush the soft parts to a certain extent, and the bones may be indented or even fractured.

Wounds caused by fragments of bottles, pieces of china, earthenware, or glass, though strictly speaking incised wounds, are often curved, angular, and irregular, and their edges jagged and contused.

Wounds caused by scissors may sometimes be of the nature of incised wounds. When they present a double wound of triangular shape, with the apex of the triangle blunt, they are more of the nature of punctured wounds. In general a “tail” or long angle in the skin at one end of an incised wound indicates the end of the wound last inflicted, and some light may thus be thrown upon the inflicter of the wound.

Incised wounds present very favorable conditions for healing by primary union, but often fail in this and heal by secondary union. When an incised wound fails to unite by primary union, bleeding continues for several hours or even as long as a day, the blood being mixed more or less with a serous discharge. The latter continues until the third day or so. By the fourth or fifth day the surface has begun to granulate, and there may be a more or less profuse purulent discharge from the surface. The granulating surfaces do not necessarily discharge pus, however. For some days, therefore, after the infliction of an incised wound, or until the surface is covered with granulations, the characteristics of the wound permit of a diagnosis as to the nature of the wound.

The diagnosis of an incised wound is generally without difficulty. Some wounds by blunt instruments, however, in certain regions of the body, resemble incised wounds very closely. Such instances are found where a firm, thin layer of skin and subjacent tissue lies directly over a bony surface or a sharp ridge of bone. These are seen most often in the scalp or in wounds of the eyebrow where the sharp supra-orbital ridge cuts through the skin from beneath. The diagnosis of an incised wound can often be made with great probability from the cicatrix. This is especially the case if the wound has healed by primary union and the cicatrix is linear.

The prognosis in incised wounds is good as to life unless a large vessel has been divided or unless an important viscus has been penetrated. The prognosis as to function varies with the position and extent of the wound, and the circumstance of the healing of the wound.

=Punctured Wounds, Stabs, etc.=—These are characterized by narrowness as compared to depth, though the depth is not necessarily great. They are more varied in character than incised wounds owing to the great variety of form of the weapons by which they may be made. From the form, etc., of a particular wound we may often infer the variety of weapon by which it was produced. According to the weapon used, punctured wounds have been divided into several classes, of which M. Tourdes distinguishes four: 1st. Punctured wounds by cylindrical or conical instruments like a needle. If the instrument be very fine like a fine needle, it penetrates by separating the anatomical elements of the skin, etc., without leaving a bloody tract. Such wounds are generally inoffensive, even when penetrating, if the needle is aseptic, and they are difficult to appreciate. On the cadaver it is almost impossible to find the tract of such a wound. If the instrument be a little larger it leaves a bloody tract, but it is difficult to follow this in soft tissues, more easy in more resistant structures, such as tendon, aponeurosis, cartilage, or serous membrane.

If the instrument be of any size this variety of punctured wounds presents a form quite different from that of the weapon. Instead of a round wound it is generally a longitudinal wound with two very acute angles and two elongated borders of equal length, showing but little retraction. This is the shape of the wound even when the instrument producing it is so large that the resulting wound resembles that made by a knife (see Fig. 2). The direction of the long axis of these wounds varies in different parts of the body and is uniform in the same part. Their shape and direction are explained by the tension of the skin or still more clearly by the direction of the fibres of the skin, just as with the same round instrument in a piece of wood a longitudinal opening or split would be made parallel to the grain (see Fig. 1). In some regions, as near the vertebræ, the fibres may run in different directions, and the resulting wound is stellate or triangular in shape as if a many-sided instrument had caused it. As the direction of the fibres of the various tissue layers, such as aponeuroses, serous and mucous membranes, etc., may be different, a deep wound involving several such layers would have a different direction for each layer. In illustration of this, examine the figure of a wound through the wall of the stomach (see Fig. 3).

The wounds above described when large are smaller than the weapon, as the splitting of the skin has certain limits and also owing to the elasticity of the skin, which is put on the stretch by the weapon and relaxed on its withdrawal. When such wounds are small they are larger as a rule than the instrument causing them.

2d. Punctured wounds by instruments both sharp pointed and cutting, like a knife or dagger. If these wounds are perpendicular to the surface, they have more or less the form of the weapon used. The angles may show whether the knife, etc., had one or two cutting edges, but even though the back of the knife is broad the wound may resemble one caused by a double-edged weapon. Thus stab-wounds from a common pocket-knife show only exceptionally a wedge-shape, but regularly a slit, the edges of which are slightly curved to one another and end in two acute angles. The reason of this lies in the fact that the wound is only caused by the cutting edge of the knife, so that we cannot tell as a rule which angle was occupied by the back of such a knife (Figs. 4 and 5). The depth of these wounds may equal the length of the weapon or be almost any degree less, but the depth may even be greater than the length of the weapon by reason of a depression of the parts at the time of the blow. The wound is often shorter and broader than the weapon causing it, though more often it is larger than the weapon from the obliquity of the wound and the movement of the weapon on being withdrawn. The wound is smaller than the instrument where the parts are on the stretch at the time the wound is inflicted.

This variety of punctured wounds may resemble the former class in the direction of its long axis, if the cutting edge of the instrument is blunt. The regularity and smoothness of the edges distinguish them from certain contused wounds.

3d. Wounds made by instruments with ridges or edges, files, foils, etc. If the edges are cutting the wound presents more or less the shape of the weapon (Fig. 6). But this is not always so, probably from the instrument puncturing obliquely or from the tissues being unequally stretched (Fig.7). If the edges are not cutting the wound resembles those of the first class, though the edge often presents little tears, and the wound may thus be more or less elliptical with two unequal angles. The wound of entrance and exit may be different.

4th. Irregular perforating instruments, the wounds from which resemble contused wounds.

=Contusions and Contused Wounds.=—A contusion is a wound of living tissues by a blow of a hard body, not sharp-edged or pointed, or by a fall, crushing, or compression, and without solution of continuity of the skin. A contusion usually involves a moderately large surface in comparison to the two other classes of wounds. Contusions are of all degrees of severity. If the blow or injury is slight, there is only slight redness and swelling of the skin with pain, disappearing in a few hours, and leaving no traces. If the blow be harder it produces more or less crushing of the tissues, accompanied by ecchymosis with or without a wound or excoriations of the skin, etc. The contusion may have the shape of the contusing body, such as a whip, the fingers, etc.

=Ecchymosis.=—This is characteristic, as a rule, of contused wounds. It consists in the infiltration of blood into the tissues, especially the cellular tissues. The source of the blood is from the rupture of blood-vessels, and the size of the ecchymosis varies partly with the number and size of the blood-vessels, or with the vascularity of the part. The size of the ecchymosis also varies with the looseness of the tissues into which it is infiltrated. This looseness of the tissues may be natural as in the scrotum and eyelids, or it may be due to the attrition of the tissues caused by the blow. An ecchymosis is larger when the contused parts cover a bony or resisting surface, and there may be no ecchymosis whatever, even from a severe blow, where the underlying parts are soft and yielding, as is the case with the abdominal parietes. Here we may have rupture of the viscera without any signs of ecchymosis superficially. An ecchymosis may be infiltrative or it may mostly occupy a cavity usually formed by a traumatic separation of the tissues; this is especially the case in the scalp and extremities when the injury is severe. These tumors, which are called hematomata, may be rapidly absorbed or they may remain a long time and occasionally suppurate. Sometimes the anatomical conditions, especially of the connective-tissue spaces, allow the extension or migration of the ecchymosis under the action of gravity, even to a considerable distance. When it meets an obstacle it accumulates above it, as in the inguinal region for abdominal ecchymosis and at the knee for those of the thigh. The course along which the ecchymosis travels is indicated externally by a yellowish stain, soon disappearing, so that soon no sign persists at the site of injury, but only below where the blood is arrested.

An ecchymosis becomes visible at varying times after the injury according to the depth of the ecchymosis and the thinness of the skin, for the ecchymosis is mostly beneath, not in the skin. If the ecchymosis is superficial it shows in one or two hours or even in less time where the skin is very thin, as in the eyelids and scrotum. In such cases it increases for thirty or forty hours and disappears in a week, but may last longer, i.e., as long as fifteen to twenty-five days.

An ecchymosis may not show at the point struck, at least not until several days have elapsed, or it may only show on the under surface of the subcutaneous fat until it has imbibed its way, as it were, to the surface. This may explain the discrepancy in the description of an injury examined by two medical experts at different times.

If an ecchymosis is extensive and deep, especially if it occupies a cavity, there may be nothing to see in the skin for four or five days, and then often only a yellowish discoloration instead of a dark blue color. In such cases, too, the appearance in the skin may be more or less remote from the injury, having followed the course of the least anatomical resistance. Between these two extremes, an ecchymosis may become visible at almost any time. Rarely an ecchymosis occurs only deeply between muscles (pectorals, etc.) and not superficially at all.

The extravasation of blood which forms an ecchymosis has sometimes been given different names, according to its extent or position, for instance, parenchymatous or interstitial hemorrhages or apoplexies, suffusions, ecchymoses, petechiæ or vibices. All such may, however, be called ecchymoses or hematomata. When blood is effused into the serous cavities of the body, special names are sometimes applied according to the position, such as hemothorax, hematocele, etc.

The color of an ecchymosis is at first a blue-black, brown, or livid red. This color changes first on the edges, later in the darker centre, and becomes in time violet, greenish, yellow, and then fades entirely. This change in color is owing to a gradual decomposition of the hæmoglobin of the blood. We can tell the age of an ecchymosis from its coloration only within rather wide limits, for the rapidity of change of color varies widely according to a large number of circumstances, especially according to whether the ecchymosis is superficial or deep. We can only say that the first change, i.e., that to violet, in a superficial ecchymosis, occurs in two or three days.

As an exception to the above color change, we may mention subconjunctival ecchymosis, which always remains a bright red, as the conjunctiva is so thin and superficial that the coloring matter of the blood is constantly oxidized.

The form of an ecchymosis often reproduces well enough that of the instrument, except if the latter be large it cannot all be equally applied to the surface, and its form is not distinctly shown by that of the ecchymosis. After its first appearance an ecchymosis spreads radially, the edges becoming less clear. This change occurs more rapidly the looser the surrounding tissues, and at the end of a few days the first form of an ecchymosis may be changed, so that an examination to determine the nature of the weapon should be made as early as possible.

Ecchymoses are more easily produced in the young, the aged, and in females, also in the case of such general diseases as scurvy, purpura, hemophilia, etc. In fact, in the last three classes they may occur spontaneously. This fact should never be lost sight of, as the attempt may be made to explain a traumatic ecchymosis in this way. The diagnosis between the traumatic variety and such cases of spontaneous ecchymoses is, in general, easy, for in the latter case their number, form, size, and occurrence on parts little exposed to injury and on the mucous membranes, as well as the general symptoms of the disease, leave little or no room for doubt.

From an oblique or glancing blow a considerable area of skin may be stripped up from its deep attachments forming a cavity which may be filled by a clear serous fluid alone, or with some admixture of blood. These cases have been studied especially by Morel Lavallée and Leser, and the fluid has been thought to be lymphatic in origin, hence the name “lymphorrhagia.” Carriage accidents, especially where the wheels do not pass directly but obliquely across or merely graze the body, are especially liable to show this form of extravasation, which is thought to be more common than is generally supposed, being often obscured by a small quantity of blood.

=Contused Wounds.=—If with the contusion we have a solution of continuity of the skin, then we have a contused wound. This may sometimes resemble an incised wound if the weapon has marked angles or edges, as a hammer, or, as we have already seen, in wounds of the scalp or eyebrow (Fig. 8). Careful examination, however, by a small lens if necessary, is sufficient to distinguish them if they are fresh. If they are four or five days old and have begun to granulate, it may be impossible to distinguish them. Contused wounds present on examination small tears on the edges which are widely separated and more or less extensively ecchymosed. Contused wounds are often irregular, and have thickened or swollen and ragged borders. They may, like simple contusions, show by their shape the form of the instrument which caused them. In contused wounds, unless they be perfectly aseptic, we usually find sloughing of the contused, necrotic tissues. This leaves a cavity to be filled up by granulation like wounds with loss of substance. They therefore often present large cicatrices which may be mistaken for those of ulcers. In contused wounds the bone may sometimes show the impression of the instrument causing the wound.

A variety of contused wounds is that where the wound of the skin consists merely of an erosion or excoriation with an ecchymosis beneath. The wound may reproduce the shape of the weapon, i.e., finger-nails, etc. After death the skin becomes brownish-yellow, hard, and dry, and then they are called by the French “plaques parcheminées.” They are distinguished, as a rule, from those produced after death, by the ecchymosis beneath.

=Lacerated wounds= resemble contused wounds very closely, but are not ecchymosed to any considerable extent. The solution of continuity is sometimes very extensive and irregular, and may present several flaps. The bone or bones are often fractured at the same time. They seldom bleed much. The course of repair resembles that of contused wounds as a rule. The prognosis is variable, for there may be slow and extensive cicatrization and impairment of function, etc. These wounds usually result from machinery accidents and accidental tears, etc. They are therefore seldom the occasion of criminal proceedings but more often of a civil suit, and thus require medical examination.

The injury which causes a contusion or contused wound may not infrequently produce effects far more serious and more or less remote from the contusion. Some of these effects it may be well to particularize. Blows on the abdomen are sometimes quickly followed by death without visible lesion to account for it. That authentic examples of this exist has been denied by Lutaud, except for cases of rapid death following contusions of the abdomen which had caused extensive rupture of the viscera and abundant hemorrhage. But Vibert gives two cases from his own experience, which are as follows:

A young man, twenty years old, received a kick in the stomach at a public ball. Numerous witnesses of the scene testified that he only received this one blow. The man collapsed immediately and died in a few minutes. On autopsy nothing was found but two small ecchymotic spots in the peritoneum covering the intestine, the largest not the size of a bean.

In the second case, the injury was also a kick in the stomach and the man died almost immediately. Absolutely no lesion was found on autopsy. Both were in full digestion.

König[606] says: “A number of severe contusions of the belly run a rapidly fatal course without the autopsy showing any definite anatomical lesion of the viscera.” He also adds that the less severe cases at first often show very profound shock, which is out of proportion to the force of the injury. The cause of death has been explained, like that of sudden death from a blow on the larynx, by the theory of inhibition. These cases are often illustrated experimentally on frogs, where the same result is obtained under similar conditions. Such cases are the more remarkable from the fact that the fatal blow may cause no ecchymosis or other mark of injury to appear on the abdominal walls.

Blows on the head may produce a variety of results besides that of the contusion itself. In fact, death itself may result though the marks of contusion are very slight or even imperceptible. Intracranial hemorrhage, laceration with ecchymosis of the brain, on the same or opposite side to the injury, and concussion of the brain may result. Of these only concussion will be considered now.

=Concussion= has been defined as a shock communicated to an organ by a blow or fall on another part of the body, which may or may not be remote, and without producing a material or appreciable lesion. According to Lutaud,[607] English pathologists understand by it a temporary or permanent nervous exhaustion resulting from a sudden or excessive expense of nervous energy. Its effect is observed in the function of an organ and especially in the brain. Concussion of the brain causes stupidity, loss of consciousness, amnesia, coma. The intracranial lesion most often associated with concussion is ecchymosis and laceration on the surface of the brain, but there may be no lesion visible even if the case is a fatal one. Fatal concussion has been observed where the marks of external violence were very slight or even failed entirely, as illustrated by the two following cases cited by Vibert:[608]

Vibert made an autopsy on a man who had been struck by a pitchfork, one of the teeth of which struck behind the ear, the other two in the face, only producing slight skin wounds. The man immediately lost consciousness and died in two days in coma. No lesion whatever was found within the skull, and only three slight ones externally.

He observed another case where the man fell three or four metres into an excavation, landing on his feet, and died in a short time. On autopsy only slight erosions and no intracranial or extracranial lesions were found.

This case belongs to a rare class where the blow is transmitted through the spinal column without sign of injury externally or internally to the head.

The following case cited by Vibert is even more remarkable in the production of the severe though not fatal concussion: An officer was riding at full speed on horseback, when his horse suddenly stopped short. By great exertion the officer clung to the horse, but immediately lost consciousness. His fall from the horse was broken by those about him, and the concussion he received was not due to the fall, but to the shock of stopping suddenly when his momentum was great.

As a rule, however, the diagnosis of concussion, especially if it is severe enough to be fatal, is easily made by the marks of external violence with or without intracranial lesions. The effects of concussion may be transient and leave no trace, but, on the other hand, they may be prolonged and severe, i.e., paralysis, aphasia, loss of memory, imbecility, etc. The medical examiner should be on his guard against simulation in respect to these prolonged effects of concussions. One of the most frequent consequences of concussion is temporary amnesia, which ordinarily succeeds immediately after the injury, but sometimes develops more slowly. The following curious case is quoted from Lutaud as cited by Brouardel:

A woman in getting out of a train at Versailles, where she had gone to attend the funeral of a relative, was struck by the door of the compartment. She fell, but did not lose consciousness, and picked herself up, but forgot what she had come for.

Another result of an injury which has caused a contusion or contused wound may be a fracture or dislocation. Fractures and dislocations of special parts will be referred to later, in considering injuries of the several regions of the body, but it seems appropriate here to refer to some of those general considerations relating to these injuries which may especially demand the attention of the medical expert.

=Fractures= may be produced by blows or falls, or from muscular action. The medical witness may be questioned as to the cause of the fracture or, if it was produced by a blow, whether a weapon was used or not, as the defence is likely to assert that it was caused by an accidental fall. The nature of the associated wounds and contusions, if any exist, may, as we have seen, indicate the weapon used. If anything exists to indicate that a fall which caused the fracture was not accidental, this should be noted, as the assailant is responsible for the effects of the fall.

A number of conditions influence the ease with which a fracture is produced and account for a fracture being due to a slight injury, and so are mitigatory circumstances in the case.

Fractures are more easily produced in the old and young, especially the former, than in the adult from the same force. This is due to brittleness of the bones in the old and their small size in the young. Certain diseases like syphilis, arthritis, scurvy, carcinoma, and rickets make the bones more frangible, and there is a peculiar brittle condition of the bones known as fragilitas ossium, more or less hereditary, in which the bones become fractured from very slight violence. Mercer is quoted by Taylor as stating, but on how good authority it does not appear, that in general paralysis of the insane the bones are particularly liable to fracture. Certain it is that not uncommonly insane patients are found dead with single or multiple fractures, but the attendants are generally convicted.

In some parts, like the orbital plate of the frontal bone, the bone is very thin and brittle, but brittleness from any cause only mitigates, it does not excuse.

Taylor[609] reports a case in point where it was proved that the bones of the skull were thin and brittle, and the fractured skull proved fatal from inflammation of the brain. The punishment was mitigated owing to the circumstance of the brittleness of the bones.

SPONTANEOUS FRACTURES may occur from only a moderate degree of muscular action, and even where there is no disease of the bones, but the above-mentioned condition of fragilitas ossium, rendering the bones more brittle, aids in the production of such fractures. The olecranon, patella, and os calcis are particularly liable to such fractures, but the long bones of the ribs and extremities are sometimes so fractured, as instanced in the following cases cited by Taylor:[610]

The humerus of a healthy man has been broken by muscular exertion simply by throwing a cricket ball.[611] In 1858 a gentleman forty years old, during the act of bowling at cricket, heard a distinct crack like the breaking of a piece of wood. He fell immediately to the ground, and it was found that his femur was fractured.

Again, in 1846, a healthy man, æt. 33, was brought to Gray’s Hospital with the following history: He was in the act of crossing one leg over the other to look at the sole of his foot, when something was heard to give way; his right leg hung down and he was found to have received a transverse fracture of the femur at the junction of the middle and lower thirds.

The writer had a case in Bellevue Hospital during the past winter (1892-93) of a man who stated that he had been well and active until some weeks previously, when, from muscular force alone, he sustained a fracture of the neck of the femur. Something abnormal in the bone may be present in such cases.

In cases of spontaneous fractures there are no marks of external violence which, if present, would remove the idea of spontaneity.

Fractures of the extremities are not dangerous per se, unless they are compound or occur in old, debilitated, or diseased persons, and they are more severe the nearer they are to a joint. The healing of fractures is more rapid in the young than in the old and in the upper than in the lower extremity. It is not proven that adiposity of itself impedes union.

The question may be asked, how long before examination a given bone was fractured. As a rule, we can only say as to whether the injured person has lived a long or short period since the injury, as the process of repair varies according to age and constitution. No changes occur until eighteen to twenty-four hours, when lymph is exuded. According to Villermé the callus is cartilaginous anywhere between the sixteenth and twenty-fifth days, it becomes ossified between three weeks and three months, and it takes six to eight months to become like normal bone.

The question may also be asked: Has a bone ever been fractured? The existence and situation of a fracture can often be recognized long after the accident, by the callus or slight unevenness due to projection of the edges or ends of the fragments. Where the bone lies deeply covered by soft parts, it is difficult and often impossible to tell, long after union has taken place, whether or where a fracture has occurred.

The answering of this question may sometimes be of importance in identifying the dead, especially in the case of skeletons. In the latter instance by sawing the bone longitudinally we can tell by the thickness, irregularity, or structure of the bone tissue whether a fracture existed, and if it were recent or old at the time of death.

=Dislocations= call for a medico-legal investigation less often than fractures. They are less common in the old and where the bones are brittle, when fracture occurs more readily. They are seldom fatal per se, unless between the vertebræ or when compound. They may occur from disease in the affected joint or even spontaneously. The diagnosis of a dislocation is easy until it has been reduced, and then it may leave no trace except pain in and limitation of the motion of a joint besides swelling and ecchymosis. These effects are transient, and after they have disappeared it may be impossible to say whether a dislocation has existed on a living body, unless, as sometimes occurs, especially in the shoulder joint, there may be a temporary or permanent paralysis of a nerve and muscular atrophy. After death, the existence of an old dislocation may often be recognized on dissection by scar tissue in and about the capsule.

EXAMINATION AND DESCRIPTION.

The examination of wounds or injuries in a case which is or may become the subject of a medico-legal investigation should be made with particular care and exactness.

As the examination of the wounded person is to give most, and in some cases all, the information to the medical expert on which he is to base his testimony, it should be made with reference to all the possibilities of the case.

The particular variety of wound as described in the foregoing section should be noted, and any peculiarities as to its situation, shape, extent, length, breadth, depth, direction, and the parts involved. Besides these points, the condition of the edges of the wound, whether swollen and ecchymotic, smooth and straight or dentated and irregular, and whether inverted or everted and gaping, are matters of importance. The presence or absence of coagula and clots, the staining of the tissues with blood, the presence of ecchymosis and its comparative age, as shown by its color, should also be noted.

Many of the above points help us in solving another problem, namely, the form of the instrument used. This question will be discussed in a subsequent section, but the basis for our opinion is founded, of course, on an examination of the particulars of the wound. The solution of still another question which often arises and which will be discussed in the next section, namely, whether a wound was produced before or after death, is based upon particular features of the wound such as the fluid or clotted condition of the blood on the surface, or ecchymosed in the tissues, also the amount of the hemorrhage as compared to the vascularity of the part as well as the greater or less staining of the tissues with blood, and the conditions of the edges, whether inverted or everted and whether or not retracted. The question as to whether a wound was directly, secondary or necessarily the cause of death, is determined, in part at least, by examination of the wound. In this connection we take note as to whether a wound has opened or divided a large vein or artery or is situated in such a vascular part as to be fatal from hemorrhage. We also note whether death could have been due to shock from the situation of the wound, or whether an inflammation which was directly responsible for death was necessarily due to the wound, as in case of a penetrating wound of the viscera, etc. Further, we note whether one of the many forms of wound diseases from infection of the wound has complicated the case and caused death in the case of a wound not otherwise necessarily fatal. It may be added that often the necropsy aids us in the solution of the question as to whether the wound was the necessary and direct cause of death, by showing a healthy or diseased condition of the viscera.

The question as to which of a number of injuries was first inflicted, also as to the relative position of the victim and assailant, can be answered, if at all, only by an accurate and close examination of the wounds.

Finally, the most important question of all, from a medico-legal standpoint, namely, the distinction between homicidal, suicidal, and accidental wounds, is decided or inferred from the characteristics of the wound after careful examination.

All the foregoing questions contribute to the solution of this the most important one. The various questions referred to above will be considered at greater length in the subsequent sections. They have been merely referred to in brief above, to show the various lines of thought a medical examiner must have in mind in making an examination.

As to the act of examination itself, the physician should conduct it in such a way as not to harm the wounded person. Often simple inspection is the most that can be done, or the examination may have to be deferred altogether until the physician in charge informs the court that an examination may be safely made. It is often necessary for the expert to get information as to the original lesion from the physician in charge. If the wound has been a fatal one and if we are called in after death, we may examine the wound on the dead body with much more freedom. Here we may examine the depth, direction, etc., of a punctured wound by cutting down on a probe or director. After careful inspection of the wound we may examine it by palpation, and go on to the dissection of the wound and the surrounding parts, tracing and noting the various vessels, muscles, etc., involved in the wound, and looking for the presence of any foreign body in the wound.

Furthermore, if the cause of death be at all obscure, we should examine not only the wound itself and the parts about the wound, but also, by an autopsy, all the cavities and organs of the body. For death may have been due to natural causes in an organ not examined, if the examination has not included all, and the physician has to disprove it.

In examining at an autopsy the depth of a wound in reference to the instrument which caused it, it should be borne in mind that the wound may be deeper than the weapon owing to a depression of the surface by the handle of the weapon. This may appear especially marked in the case of the movable viscera, as at the time of the accident the viscus may have been as near as possible to the surface, and at the examination as far as possible from the surface, as in the case of a given coil of the intestines. Also the thorax when opened at autopsy enlarges or expands a little, so that the measured depth of a wound may be greater than the weapon which caused it. Vibert[612] mentions a case of a penetrating wound of the thorax involving the heart, where the measured depth of the wound was 0ᵐ.035 greater than the length of the instrument. This may also be accounted for by a depression or flattening of the thorax by the blow, as in the case of soft parts. It is often difficult in an examination to measure accurately the depth of a wound, for one may find it hard to determine the precise end of a wound. Also, for exact measurement it is necessary to have the parts in the same position as at the time of the accident, and these parts are more or less displaced by the necessary dissection.

Besides the examination of the wound there are other points the examination of which may aid us in solving the problems presented by a case. Among these, the examination of the clothing or dress is perhaps the most important. This may indicate the weapon used in an incised or punctured wound. Contused and lacerated wounds or fractures, etc., may be produced without injuring the clothing. Blood, dirt, or grease on the clothing may throw light on the case. In self-inflicted wounds the wound in the clothing and that on the body may not and often do not correspond, as an intending suicide often (a murderer rarely) opens the clothing to select the spot for the wound. The wound in the dress is then added by a second blow not corresponding to the first. In this way we may sometimes distinguish between a homicidal and suicidal wound, and thus remove a false suspicion of murder or show that a wound was self-inflicted to conceal other crimes or to falsely impute it to another. The suspicion of homicide in accidental wounds may be cleared up by an examination of the dress, as in the following instance related by Taylor:[613]

A woman was found dead in bed with two indentations about the middle of the right parietal bone, a large superficial clot here and three ounces of clotted blood between the dura mater and skull, which latter was fractured over an area of four inches. No other cause of death was found. The evidence brought out the facts that she had been knocked down the evening before, about 7:30 o’clock, by a man accidentally running into her. She fell on the back of the head, was stunned, raised up, and stimulated; she then walked home, ate her supper, and was last seen at 9 o’clock by a fellow-lodger who let her in and noticed nothing unusual. The next morning she had evidently been dead some time. Suspicion fell upon the lodger, who had often quarrelled with her, and the two claws of a hammer found in his room corresponded more or less closely with the two indentations found in the skull. At the adjourned inquest, however, the bonnet worn by the deceased at the time of the accident was found to have two indentations on the back of it corresponding to those on the woman’s skull and containing dust and dirt, and rendering probable what from the history seemed unlikely, that the fall in the road caused the fatal injury. The examination of the dress thus avoided an unjust accusation of murder.

Contused and lacerated wounds and fractures or dislocations may be produced without injury to the dress, especially if the latter be elastic or yielding. The comparison of the wound in the clothes with that on the body may indicate the position of the body at the time of the blow. The examination of the clothes of the injured person may indicate a struggle which would support the idea of homicide. A blunt instrument may indirectly cause an injury by striking something in or on a person’s clothes. Instances have been reported where a wound has been caused by an article in the pocket, or worn outside the clothing, without any trace of an injury to the clothes or pocket lining.[614]

The examination of the dress may further show which of several cuts or stabs was first inflicted. This is shown by the staining of the edges of the cuts in the clothing, the edges of the first cut or stab showing no blood-stain or only on the inner surface, as the knife is clean of blood on entering and all that is removed by the clothing on its withdrawal is found on the inner edges. If the edges of the cuts in the outer layers of clothing are bloody, it is evident that the knife was already bloody when used, and the corresponding wound was not the first inflicted.

The imprint of the bloody hand of the assailant may sometimes be found on the clothing of the one injured, and is especially important as evidence, when the hands of the assaulted are not bloody. In the case of a severe wound, especially if it is likely to become the object of a criminal investigation, the physician should always require to see the dress of the wounded. The examination of the clothing which the accused wore at the time the assault took place may give important evidence by showing evidences of a struggle or blood-stains. Absence of the latter would not prove the innocence of the accused, as the clothes actually worn may be destroyed and others substituted, or the marks and stains may be removed. In the latter case, the eye of a medical man may detect traces of blood which otherwise would go unnoticed, and a microscopical and chemical examination would reveal the real character of the stain.

Besides the examination of the clothing of the accused, the examination of his person may furnish evidence of his being engaged in a more or less desperate struggle by the scratches, marks of nails, contusions, bites, etc., on the face, neck, front of chest, forearms, and hands. If the accused should attempt to explain these wounds and spots, the latter may or may not verify the explanation, and thus additional evidence may be obtained as to the guilt or innocence of the accused.

It is well for the medical expert, as well as for others, to collect the statements of the wounded person relative to the circumstances of the injury. Also, if the accused will vouchsafe any such statements we may compare these with one another and with the facts indicated by the wound, etc.

Other points to examine, especially in cases of suspected suicide, may be briefly mentioned. The presence of the weapon in the hand of the victim and firmly grasped in general indicates suicide, if it corresponds to the weapon causing the wounds, for otherwise it may have been used for defence. If not in the hand, note the spot where the weapon was found. In the case of a suicide, the hand as well as the weapon held by it is likely to be bloody, also in case of murder the generally empty hand is apt to be bloody, as the hand is naturally carried to the wound.

We cannot further describe the many points which the medical examiner should bear in mind in making an examination in a medico-legal case, without repeating too fully what will be given at greater length in subsequent sections, reference to which should be made for further particulars. Tardieu proposed as a basis for examining and studying wounds, (1) to visit the wounded person and see what state he is in, and to determine (2) the nature, (3) the cause, (4) the consequences of the wound. Also if the wounded person is dead (5) to examine the body for the cause of death in order to see if the latter is due to the wound. Also (6) to determine the circumstances of the affray.

=The description= of a wound should be given in plain language, avoiding the use of scientific terms or expressions, so as to be readily understood by judge and jurors. Otherwise the usefulness of the medical expert is very much decreased. The description should also be precise and sufficient to justify the conclusions arrived at as to the cause of a wound, its gravity and results, and the weapon used. With a view to exact statement in description, it is well to take notes as to the result of the examination and not depend merely on memory. The object of the witness should be to be understood and not to be thought thoroughly scientific.

WAS THE INJURY INFLICTED BEFORE OR AFTER DEATH?

This is a question which may often be asked in cases of fatal injuries, and it is one which must be answered as definitely as we are able, for the defence may rest on the assertion that the wound or injury was post mortem and not ante mortem. What are the means we have to enable us to answer the above question? The most important factor is the condition of the blood and the changes that it undergoes after death. For some hours after death the body retains its animal heat. As long as this is retained rigor mortis does not set in and the blood is more or less fluid. This period varies, but on the average it does not last longer than eight or ten hours. Before this time, however, the blood has begun to undergo certain changes. These changes result in the inability of the blood from a post-mortem wound to coagulate completely. At first the greater part may coagulate, but after a time coagulation is less and less complete, and the coagula are not as firm as those from the blood of a living person. The period at which these changes occur also varies, but they may generally be clearly noticed in from three to four hours after death, or even sooner. In the first two to four hours after death, therefore, as far as the condition of the blood is concerned, it may be difficult or impossible to say whether a wound was made before or soon after death. In other words, this difficulty exists as long as the tissues of the body live after the body as a whole is dead.

There are certain general pathological or occasional conditions of the body in which the blood during life does not coagulate at all or only imperfectly, as in scurvy and in the case of the menstrual blood. Also blood in a serous cavity, especially if it be abundant or there exists inflammation, is found not to coagulate or only imperfectly. Post mortem the blood remains liquid long after death in cases of death by drowning, asphyxia, etc., and in such cases hemorrhage may be free in a wound made some time after death. Furthermore, after putrefaction has set in the blood again becomes more or less liquid, and may flow away from a wound like a hemorrhage, but it no longer coagulates.

The principal signs of a wound inflicted during life are (1) hemorrhage, (2) coagulation of the blood, (3) eversion of the lips of the wound, and (4) retraction of its sides.

1. HEMORRHAGE varies in amount with the size of the wound, the vascularity of the part, and the number and size of the large vessels involved. In incised or punctured wounds the amount, as a rule, is quite considerable. If there is a free exit most of the blood runs off; the rest stays in the wound, where it soon coagulates with the exceptions mentioned above. But besides partly filling the wound in the form of a clot, the edges of the wound are deeply stained with the coloring matter of the blood, and this stain cannot be removed by washing. This staining involves especially the muscular and cellular tissues.

Further, a hemorrhage during life is an active and not a passive one; the blood is forced into the interspaces of the tissues in the vicinity of the wound, and is found infiltrated in the cellular tissue, the muscles, the sheaths of the vessels, etc. It is here incorporated, as it were, with the tissues so that it cannot be washed away. In an ante-mortem wound the arterial nature of the hemorrhage may show by the marks of the jets of blood about the wound or on the clothes or surrounding objects. When a large vessel has been divided and the exit for the blood is free, this may run off without infiltrating the tissues or even staining the edges to any considerable extent, and there may remain but little in the wound. In the case of lacerated and contused wounds the amount of hemorrhage is less, but rarely fails entirely, and if the wound is in a vascular part it is liable to cause death from hemorrhage, though a whole limb may possibly be torn off without much hemorrhage. In the latter case, however, there are usually found clots of blood adhering to the edges of the lacerated wound and the ends of the vessels. In contusions where there is no wound of the skin the blood is prevented from flowing externally, and its accumulation and distribution form an ecchymosis. Here again we see the active power of the hemorrhage which infiltrates between the tissues, stains them deeply, and appears either as a mere stain or in fine clots incorporated, as it were, with the tissues or partly occupying a cavity formed by an extensive displacement of the surrounding parts. The amount of blood varies under the same conditions as in incised wounds, and also according to the greater or less disintegration of the tissues by the blow, allowing a larger or smaller central cavity to be formed. In “bleeders” the amount of the hemorrhage does not vary under the normal conditions, but a fatal hemorrhage may occur from a very insignificant wound. After hemorrhage from a wound made during life the veins are empty about the wound, especially those situated centripetally, while normally after death the blood is mostly aggregated in the veins. They are the source of post-mortem hemorrhage, but do not empty themselves to any great extent.

The hemorrhage from a wound made after death may be extensive if the blood remains fluid as in the cases mentioned above, i.e., after death from drowning or asphyxia or after the commencement of putrefaction. Otherwise the amount of hemorrhage decreases with the length of time after death, until the blood loses its fluidity and hemorrhage no longer occurs. In general, it is slight unless a large vein is opened, for the veins are the source of the hemorrhage. There is usually scarcely any hemorrhage after the first two to four hours. This applies also to subcutaneous hemorrhages or ecchymoses. These post-mortem hemorrhages are passive and not active, consequently there is less infiltration of blood into the surrounding tissues, which merely imbibe it, and the stain is less deep and may be washed off the edges of the wound, in contrast to the stain of ante-mortem wounds. After putrefaction has set in the hemorrhage may be more abundant, as the blood is driven to the surface by the formation of gas in the abdomen and thorax. At the same time, the coloring matter of the blood transudes through the walls of the veins and is imbibed by and stains the tissues, so that it may be impossible to distinguish it from a true ecchymosis. Fortunately these conditions are of small moment, as an examination is seldom deferred so long.

CADAVERIC ECCHYMOSES show almost invariably while the body is still warm and the blood more or less liquid, i.e., during the first eight or ten hours after death. They are not due to injury or violence before or after death, but they may closely resemble ecchymoses produced on the living body and be mistaken for them. This is the more important as they are quite constant on the cadaver.

In this connection, it may be said that an ecchymosis due to a blow before death may not show till after death, as it requires some time for a deep ecchymosis or even an ecchymosis covered by a thick layer of skin to show superficially. Thus a man kicked in the abdomen died thirty-five hours after the injury from peritonitis, due to a rupture of the bladder. No ecchymosis appeared at the site of the injuries until after death. It is not uncommon in cases of hanging to observe an ecchymosis along the course of the cord appearing only after death. Huize met with a case of this description. Devergie remarked that on the bodies of those drowned ecchymoses are often hidden for a time on account of the sodden state of the skin, and they appear only after the water has evaporated, which may require some days. Furthermore, it is not necessary to survive long after an injury in order that an ecchymosis may show post mortem. If the blood is fluid at the time of the blow and any capillaries or larger blood-vessels are torn, then we may have an ecchymosis though death be almost instant. Casper thought that it required some time before death for an ecchymosis to develop, and that if the person injured by a contusion died soon after the injury, an ecchymosis would not appear after death. There are many well-authenticated cases to prove that Casper’s opinion is wrong. Among the most famous of these is that of the Duchesse de Praslin.[615] She was attacked and killed by her husband while she was asleep in bed. The thirty or so wounds showed a mortal conflict, and she could not have survived more than one-half hour, and yet after death there were numerous ecchymoses from the contusions.

Another case is also mentioned by Taylor.[616] A young man died suddenly after a blow from a companion, having been struck in the side a fortnight before by a heavy box, which knocked him senseless and nearly killed him. The post mortem revealed an ecchymosis on the side which on the authority of Casper’s opinion was attributed to the old injury. The color of the ecchymosis would be sufficient to settle all such doubts, as the changes of color would have fully developed or the color even disappeared in part in fourteen days’ time.

An ecchymosis made post mortem does not undergo the color changes seen in ecchymoses during life, unless the tissues are œdematous in which the ecchymosis occurs. These changes in color have already been described, the deep blue changing to violet in eighteen to twenty-four hours at the earliest. In support of the foregoing and disproving Casper’s views, Christison found that within two hours after death severe blows on a dead body are followed by a livid discoloration, similar to those produced by a blow shortly before death. This livid discoloration is due to the effusion of a very thin layer of blood external or superficial to the true skin, sometimes in a stratum of the true skin or more rarely into the cellular tissue, staining deeply the partition walls of the fat-cells. Of course, a more or less recent contusion or ecchymosis on a dead body was not necessarily produced at the same time as the cause of death. It should be borne in mind in this connection that ecchymosis is not a necessary result of a blow or contusion.

According to Devergie, ecchymosis does not appear when a blow inflicted post mortem is received by skin directly covering a bony surface beneath, and rarely appears where there is a large amount of fat and no solid point of resistance beneath the site of the blow.

We have already referred to the fact which Portal long ago remarked, namely, that the spleen has been ruptured without ecchymosis or abrasion of the skin. The same absence of ecchymosis has been noticed in cases where the liver, stomach, intestines, bladder, etc., have been ruptured as the result of contusing blows.

The following case cited by Taylor[617] illustrates this point. Henke reported the case of a man who died of peritonitis a few hours after fighting with another man. There was no mark on the skin or ecchymosis, though there existed peritonitis from rupture of the small intestine. The blow was proven by direct evidence, and though some medical witnesses on account of the absence of external signs thought that no blow could have been struck, others of more experience admitted that it could have been the cause of the rupture.

Watson[618] reports a similar case of a girl nine years old who received a blow from a shoe on the abdomen. This was followed by great pain, collapse and death in twenty-one hours. No marks of injury were visible externally, but peritonitis existed from rupture of the ileum.

A similar case is reported by Williamson,[619] where peritonitis resulted from complete rupture of the ileum without any trace of injury externally, though the blow was struck by the hoof of a horse.

Another case was brought into Guy’s Hospital[620] who had been run over by an omnibus. No injury was discoverable, though the wheel had passed over the chest and abdomen. He died of peritonitis, however, which set in on the second day, and on post-mortem examination the liver and small intestines were found ruptured.

Christison thought as the result of his experiments and experience that the most reliable signs of an ecchymosis made during life, and distinguishing it from one caused by a blow after death, were as follows: The skin of the ecchymosed area is generally much darkened and discolored from blood infiltrated through its entire thickness; the skin is also much firmer and more elastic from swelling of the part if the contusion is received some hours before death. But we may have an effusion beneath and not in the substance of the skin, and the above signs might possibly be due to an injury inflicted only a few minutes after death. The above signs may therefore be absent, and when present are not absolutely indicative of an injury received during life. In general, the effects of severe contusions inflicted soon after death may closely resemble those of slight contusions received during life.

There is little danger of contusion if the blow be inflicted on a dead body after the loss of body heat and the beginning of rigor mortis.

2. COAGULATION OF BLOOD.—As stated at the beginning of this section, blood from a wound inflicted during life coagulates with the exception of that from those suffering from certain pathological or occasional conditions or in certain locations, already mentioned. This coagulation is not immediate, but is complete in about five minutes. The entire amount of blood lost is thus coagulated and the coagula are firm. These coagula (if the wound is not interfered with) occur in the opening of a wound and on its edges, especially at the mouths of the blood-vessels, which are thus plugged. The blood which infiltrates the interspaces of the tissues is coagulated in the form of these interspaces. The same is true of the blood of an ecchymosis whether there be a hematoma or only an infiltration between the tissues, or both. These clots represent more or less the form of the space occupied by the blood. In the case of the scalp a subcutaneous clot may be mistaken for a depressed fracture of the skull from the fact that the edges of the clot become very hard while the centre is still quite soft. A wound in which a large artery has been divided may present very little clotting in the wound if the opening is free and the blood has mostly escaped in a jet.

In a wound produced soon after death there may be some clotting, but less in amount, firstly, because there is less hemorrhage, and, secondly, because not all the blood clots. These conditions increase with the length of time after death, so that after a time a wound made on a cadaver would show very little if any clotting owing to very slight hemorrhage, and little or no clotting of the blood extravasated. When the body has lost its animal heat and rigor mortis has begun to set in, then there is no more coagulation of the blood and no more hemorrhage, under normal conditions, for the blood has mostly become clotted in the vessels of the body. Consequently, with the exception of wounds inflicted very soon after death, we can distinguish an ante-mortem from a post-mortem wound by the condition in which the blood is clotted. If there is any hemorrhage, the wound being inflicted before the loss of animal heat and the blood remains entirely fluid on the surface or in an ecchymosis, we know that the wound was produced after death and some hours after death unless any of those conditions exist in which the blood does not normally coagulate. If the hemorrhage is slight or quite moderate in amount and venous in character, if the blood is only clotted in part and the clots are rather soft and do not form a plug at the mouth of each artery, and especially if the staining of the walls of the wound can be washed off, then the wound was probably produced post mortem, but not so long after death as in the first case supposed. If the characters of the hemorrhage and the clotting are still more like those normal to a wound inflicted during life, then, as a rule, it is impossible to say from these two features of the wound, hemorrhage and clotting, whether the wound was inflicted during life or a very short time after death.

3. EVERSION OF THE LIPS OF THE WOUND.—The edges or lips of a wound inflicted during life may be inverted, instead of everted, if a thin layer of muscular fibres is attached directly to the deep surface of the skin, as is the case in the scrotum. The eversion of the edges of the skin is due to their elasticity, and ceases to occur as soon as the skin loses its vitality. Consequently eversion ceases to occur soon after death, within a very few hours. A wound in which the edges are neither inverted or everted was therefore inflicted after death. If this sign is present and marked, the wound was inflicted during life or within two or three hours or less after death. If this sign is present but very slightly marked, the wound may have been made even somewhat longer after death.

4. RETRACTION OF THE SIDES OF THE WOUND is also dependent on their vitality and ceases to occur when this is lost a few hours after death. In the retraction of the edges of the wound we have all the parts involved, but unequally. The muscles, arteries, skin, and layers of connective tissue all retract, varying in the degree of retraction according to the order in which they are named. In different parts of the body this comparative order of retraction is liable to more or less variation. Every surgeon is familiar with this retraction of the tissues, which necessitates certain rules in the technique of operations, especially of amputations. Muscles retract the more the longer they are and the farther the incision is made from their attachment. Without specifying a definite time, we may say that, as a rule, this retraction lasts no longer than about two hours after death, consequently when it is absent we may infer that the wound was inflicted two hours or more after death. The amount of retraction grows less and less after death for about two hours, after which it is very slight if it occurs at all, owing to the loss of elasticity of the tissues. This sign is especially useful in the case of a mutilated body where, by examining the degree of retraction of the muscles, we may infer whether the mutilation was done before or after death. The sides of a cut made on the cadaver are comparatively smooth and even, owing to the absence of the unequal retraction of the various elements, which makes the surfaces of a gaping ante-mortem wound uneven and irregular. Relying on these circumstances in the “affaire Ramus,” cited by Vibert,[621] one was able to recognize the order in which the body had been mutilated.

OTHER MINOR SIGNS of a wound inflicted during life may be briefly mentioned. If the edges of the wound are swollen, or show signs of inflammation or gangrene, or if pus or adhesive material is present on the edges of the wound, we may infer that the wound was inflicted some little time before death. Of course, if cicatrization has commenced, some days must have elapsed before death after the wound was received. If the blow causing a contusion was inflicted some time before death, there will be more or less of a general swelling of the region, partly due to the blood effused, but also partly due to œdema.

It is not always easy to say whether a fracture was produced while the body was living or dead. If the body was still warm when a post-mortem fracture was produced there is little difference from an ante-mortem fracture, except that there may be a little less blood effused. In a fracture produced after rigor mortis has set in there is little or no blood effused. In the case of fractures the presence of callus, indicating the process of repair, shows that the accident occurred during life, and, as we have already seen, we may form some idea of the length of time elapsed between the injury and the time of death. On the cadaver it is said to be harder to cause fractures and lesions of the skin than on the living body. Casper says that fractures of the hyoid bone and the larynx are impossible after death, and he also was not able to rupture the liver or spleen.

In distinction to the characteristic signs of a wound inflicted during life, we may mention briefly some of the signs of post-mortem wounds when the wound has been inflicted from two to ten or twelve hours or more after death:

(1) The hemorrhage is slight in amount and may fail altogether.

(2) The character of the hemorrhage is venous, corresponding to the source of the hemorrhage from the veins, the arteries being nearly empty after death.

(3) The edges of the wound are not deeply stained, and this staining may be removed by washing. The spaces between the tissues are not infiltrated with blood.

(4) The blood remains either entirely fluid or, if there are clots, these are softer than those in an ante-mortem wound, and only a portion of the blood is thus clotted. There are no clots plugging the open mouths of the arteries on the surface of the wound; the veins may or may not be closed by an imperfect clot.

(5) The skin of the edges is not everted or inverted.

(6) The sides of the wound do not gape and their surfaces are smooth and even, as the tissues are not unevenly retracted.

RÉSUMÉ.—It is very easy from the foregoing to distinguish between a wound inflicted before death and one ten or twelve hours after death.

If the hemorrhage has been abundant and arterial, if it has infiltrated between and deeply stained the tissues and the stain cannot readily be washed off; if the blood coagulates completely and the coagula are firm and are found lying in the wound, plugging the vessels, and incorporated with the tissues between which they lie; if the edges of the skin are everted and the sides of the wound are retracted and uneven—under these circumstances, we may be sure that the wound was inflicted during life or a very short time after death. If, on the contrary, the hemorrhage is slight in amount or almost fails altogether; if it is venous in character; if the edges of the wound are only stained by imbibition of the blood, which is not infiltrated between the tissues, and the stain may be washed off; if the blood is not at all or only slightly clotted and the clots are soft; if the skin is not everted and the sides of the wound are smooth and lie nearly in contact; if there are no clots plugging the divided arteries on the surface—then we need have little hesitancy in saying that the wound was produced after death, but probably not later than ten or twelve hours after death. If the wound was inflicted still longer after death and before putrefaction, then we would have a lack of the signs due to hemorrhage, clots, staining, etc. If we find the conditions more or less midway between the first two, we may be left in some doubt as to the date of the injury. Thus if the hemorrhage is moderate, the blood mostly but not altogether clotted and the clots moderately firm, the skin slightly everted, and the sides slightly separated and not altogether smooth on their surface; if the surfaces are fairly deeply stained and the stain cannot be easily washed off—then we can only say that the wound was inflicted during life or within two hours or so after death, and this fact is often enough for the purposes of the medico-legal inquiry.

The same is the case with contusions where there is no bleeding externally. If we have a bluish, violet, green, or yellow tumor with or without more or less superficial œdema; if this tumor fluctuates or is hard, but in either case is elastic; if on incision the skin and the tissue spaces are infiltrated with blood which is coagulated, or if there is a cavity filled with clotted blood, the coagulum being firm and the entire amount of blood coagulated—then the wound was inflicted during life. If, however, the surface shows a bluish or violet color, little or no swelling of the skin, which is of natural thickness, and the ecchymosed area is not tense and elastic to the touch; if further the blood is found on incision to be fluid or if coagulated only partly so, and the blood is not infiltrated into the tissue spaces, but merely imbibed by the tissues—then the blow was inflicted after death, and probably more than two or three hours after.

In contusions especially we may have difficulty, as the sign of fluidity of the blood may fail and putrefaction may modify the conditions of the wound unless parts deep beneath the surface be examined.

We see, then, that in some cases it is very easy to say that a wound was inflicted post mortem. If a wound was not inflicted until ten or twelve hours after death or even sooner, we cannot easily mistake it. But in many cases it may be hard or impossible to say whether a wound was inflicted during life or within an hour or two after death. Here we must be cautious in expressing an opinion which should be guarded. But we should remember that it is important to be able to state that a wound was inflicted before or immediately after death, as no one but a murderer would think of inflicting a fatal injury on a body immediately after death. In such cases a well-guarded medical opinion may often meet all the requirements of the case.

Granted that a given wound was produced before death. There are, then, one or two questions which may arise, and which depend for their answer on the length of time the wounded person could have lived and the physiological or muscular acts which he could have performed after receiving the injury and before death. The first of these questions may be expressed as follows:

COULD THE VICTIM HAVE PERFORMED CERTAIN ACTS AFTER HAVING RECEIVED HIS FATAL INJURY? The term “certain acts” here refers to almost any thing or things which would require time and strength—in other words, the continuance of life with bodily and mental powers for a certain time after receiving a mortal injury.

This question may be raised in relation to an attempted alibi of the accused, who may have been proved to be in the presence of the victim a moment before death. If after this moment the victim has moved from the spot or performed certain acts before death, the attempted alibi may depend upon the answer to the question as to whether the given acts of the victim were compatible with the fatal character of the wound. An alibi can aid in the acquittal of the accused only when the nature of the injury was such that death would be supposed to be immediate or nearly so. Great care should be taken on the part of the medical witness in answering this question, for after very grave wounds, proving speedily fatal, the victim sometimes can do certain acts requiring more or less prolonged effort, as shown by numerous examples. Wounds of the brain are especially noticeable in allowing a survival of several hours, days, or even weeks, during which time the injured person may pursue his occupations. Where the survival has lasted days or weeks, the alibi has no importance, but not if the survival is of shorter duration. The following case is cited by Vibert[1] and may be mentioned in this connection, though the wound was caused by a bullet which traversed from behind forward the entire left lobe of the brain. After the injury the victim was seen by several witnesses to climb a ladder, though with difficulty, for he had right-sided hemiplegia. He was found insensible more than half a mile away, and did not die until six or eight hours after the injury. Severe injury of important organs is sometimes not incompatible with an unexpectedly long survival. Devergie cites two illustrations of this which are quoted by Vibert.[622] A man received several extensive fractures of the skull, with abundant subdural hemorrhage, and rupture of the diaphragm with hernia of the stomach. The stomach was ruptured, and nearly a litre of its contents was contained in the left pleural cavity. Notwithstanding all this, he was able to walk about for an hour or so and answer several questions. He died only after several hours. Another man, crushed by a carriage, received a large rupture of the diaphragm, complete rupture of the jejunum, and rupture and crushing of one kidney. Yet he walked nearly five miles, and did not die until the next day.

More rarely wounds of the great vessels are not immediately fatal. M. Tourdes is quoted by Vibert[623] as citing the case of a man who descended a flight of stairs and took several steps after division of the carotid artery; also of one who lived ten minutes after a bullet-wound of the inferior vena-cava.

Even wounds of the heart are not as speedily fatal as is commonly supposed, and often permit of a comparatively long survival.

Fischer[624] found only 104 cases of immediate death among 452 cases of wounds of the heart, and healing occurred in 50 cases among 401. Vibert[625] mentions two striking cases of long survival after wounds of the heart. A woman received a stab-wound which perforated the right ventricle, causing a wound one centimetre long. She did not die until twelve days later, when on autopsy there was found an enormous extravasation of blood in the left pleural cavity and pericardium. The second case, though one of bullet-wound, is equally applicable and instructive in this connection. A man received a bullet-wound which perforated the left ventricle, the bullet being found later in the pericardium. After being wounded he threw a lamp at his assassin which set fire to the room. He then went into the court-yard, drew some water, carried it back in a bucket, extinguished the fire, and then lay down on his bed and died.

In studying the wounds of different regions of the body, we may find many other mortal wounds which, though speedily fatal, leave the possibility of more or less activity before death. We see, therefore, that even in those wounds which are commonly supposed to be immediately fatal, even by many medical men where attention has not been called to the exceptions, such exceptional cases are not uncommon in which death is not immediate. Time and even strength may thus be allowed for more or less complicated activity. An alibi cannot, therefore, be allowed without question on the part of the medical expert, who must exercise great caution in expressing an opinion. The second question which may sometimes arise in connection with the last, but having little to do with the subject of this section, is the following:

HOW LONG BEFORE DEATH HAD THE DECEASED ACCOMPLISHED CERTAIN PHYSIOLOGICAL ACTS? For instance, how long after a meal did he die? This is hard to answer with precision, as digestion varies with the individual, and digestion begun during life may go on to a certain extent after death. We may be able to say if digestion has just commenced, is well advanced, or has terminated. What was eaten at the last meal may be learned by the naked eye, the microscope, the color of stomach contents and their odor. The state of the bladder and rectum is sometimes called in question. All the above facts have less bearing on the case than those in relation to the former question.

THE CAUSE OF DEATH FROM WOUNDS.

The cause of death should be certain and definite. In reality, there is only one real cause, though one or many circumstances may be accessory causes. In most cases of death from the class of wounds which we have been considering, there is no difficulty in determining the cause of death so as to be able to state it definitely. But if the deceased had recovered from the first effects of the wound and then died, or if death seems as much due to disease as to injury, then the real cause of death may be obscure. If the medical witness is in doubt as to which of two causes was the primary cause of death the doubt should be stated at once, as it may weaken the testimony if brought out later.

Wounds may be directly or indirectly fatal. They are directly fatal if the victim dies at once or very soon after the wound, with no other cause internally in his body or externally from his environment. Wounds are indirectly or secondarily fatal if the injured person dies from a wound disease or complication, the direct consequence of the wound, or from a surgical operation necessary in the treatment of the case. Wounds may also be necessarily fatal either directly or secondarily, or not necessarily fatal. In the latter case death may be due as much, if not more, to other causes than the wound, and sometimes not at all to the wound itself. Thus death may be due to natural causes, latent disease, an unhealthy state of the body, imprudence or neglect of treatment, or improper treatment, etc. These various degrees of responsibility of a wound as the cause of death we will now consider more at length.

I. WAS THE WOUND THE CAUSE OF DEATH DIRECTLY?

If so, it must have caused death in one of the following ways:

1. =Hemorrhage.=—This may act by producing syncope. But the amount of the hemorrhage may not be sufficient for this result, and still cause death by disturbing the function of the organ into which it is effused, as in the brain or in the pleural or pericardial cavities. The blood here acts mechanically. Blood in the trachea may also kill mechanically by causing asphyxia.

The amount of hemorrhage required to produce syncope varies under a variety of circumstances. Less is required in the very young, the aged, and the diseased, also less in women than in men. Young infants may die from hemorrhage from very slight wounds, even from the application of a leech or the lancing of the gums. A sudden loss of blood is much more serious than an equal amount lost slowly. This is the reason that the wound of an artery is more serious and more rapidly fatal than a similar loss of blood from other sources. It is hard to specify the absolute quantity which must be lost in order to cause death by syncope. The total blood in the body is about one-thirteenth of the weight of the body, making the total amount of blood weigh about twelve pounds. Of this, about one-fourth is in the heart, lungs, and large blood-vessels. According to Watson, the loss of an amount varying from five to eight pounds is enough to be fatal to an adult. But less is enough to prove fatal in many cases, as the rapidity of the loss of blood and the age, sex, and bodily condition of the wounded person affect the amount necessary. Though death from a small artery is slower than that from a large one, yet it may occur in time, as shown in the instance quoted by Taylor,[626] where a man bled to death in thirty-eight hours from the wound of an intercostal artery. Thus, too, a wound of the branches of the external carotid artery is often enough to cause death, and a wound in a vascular part may cause death from hemorrhage, though no vessel of any size be divided.

INTERNAL HEMORRHAGE may be fatal from mechanical interference with the function of an organ, as well as from syncope. Thus we may have death from syncope due to hemorrhage into the peritoneal cavity or, after contusions, into the intercellular spaces and the cavity due to the blow, into which several pounds of blood may be extravasated. Internal hemorrhage is most fatal when due to the rupture of a viscus such as the heart, lungs, liver, kidney. Taylor[627] cites a case of a man run over and brought to Guy’s Hospital in November, 1864. He had pain in the back, but there were no symptoms or marks of severe injury. He left the hospital and walked home, where he was found dead in bed a few hours later. His abdomen contained a large amount of blood from the rupture of a kidney. After severe flagellation blood may be effused in large quantity beneath the skin and between the muscles, which is just as fatal as if it had flowed externally from a wound. In fact, if the injuries are numerous the loss of much less blood is enough to prove fatal, the element of shock here assisting that of hemorrhage.

How are we to ascertain whether a person has died from hemorrhage? This may be more difficult in the case of an open wound, for the body may have been moved from the spot where it lay after the wound was received, and the blood on the body, clothes, and surrounding objects may have been removed. Then the case may be presumptive only, but we may arrive at a definite conclusion by attention to the following points: If the wound was in a very vascular part and of some size, or if a large vessel or many moderately large vessels were divided and the vessels, especially the veins in the neighborhood, are empty, then we may be quite sure of death from hemorrhage. If there is no disease found which could be rapidly fatal the case is still stronger. The body should be pallid after fatal hemorrhage, but the same may be the case from death from other causes. In case the body and surrounding objects have not been disturbed, then the amount of clotted blood in the wound, on the body and clothes, and about the body, taken in connection with the foregoing points, can leave no doubt. We should remember, however, that not all the blood about the body was necessarily effused during life, but a little hemorrhage may have occurred after death while the body was still warm and the blood fluid, i.e., during the first four, eight, or ten hours. But the amount thus lost is small. In cases of death from internal hemorrhage we do not have so much difficulty in pronouncing an opinion, as by post-mortem examination we can determine the amount of the hemorrhage. We can judge, too, from its position, whether it has acted mechanically to interfere with a vital function, and has thus caused death, or whether the latter was due to syncope from the quantity lost.

=2. Severe mechanical injury of a vital organ=, such as crushing of the heart, lungs, brain, etc. This crushing may be accompanied by hemorrhage, but death may be more immediate than the hemorrhage would account for. The mechanical injury done to the vital centres in the medulla by the act of pithing is the direct cause of the sudden death which follows it. Exceptionally slight violence to a vital organ is fatal, but this may be better explained by attributing it to shock.

=3. Shock.=—An injury is often apparently not enough to account for the fatal result so speedily. The marks of external injury may fail entirely or be very trifling. Thus more than once persons have died in railway collisions with no external marks of violence. So, too, a blow on the upper abdomen, on the “pit of the stomach,” has been rapidly fatal without any visible injury to the viscera. Death is attributed to the effect on the cardiac plexus, and there may be no marks externally or only very superficial ones. In Reg. v. Slane and Others (Durham Wint. Ass., 1872), quoted by Taylor,[628] the deceased was proved to have sustained severe injuries to the abdomen by kicks, etc., but there were no marks of bruises. All organs were found healthy on post-mortem examination, but the injured man died in twenty minutes. Death was attributed to shock and the prisoners were convicted of murder.

Death from concussion of the brain is another example of death from shock. This may occur with only a bruise on the scalp and with no intracranial hemorrhage or laceration of the brain. The medical witness should be cautious in the above classes of cases in giving evidence, as the defence may rely upon the absence of any visible signs of mortal injury to prove that no injury was done, a principle fundamentally wrong.

Also a number of injuries, no one of which alone could be the direct cause of death, may cause death on the spot or very soon afterward. Death in such cases, where there is no large effusion under the skin, is referred to exhaustion, which, however, is merely another term for shock. Such cases are exemplified by prize-fighters who, during or after the fight, become collapsed and die of exhaustion. Having sustained numerous blows on the body during the many rounds, the body presents the marks of various bruises, but there may be nothing else to explain the sudden death. No one injury or bruise is mortal, and yet, when the deceased was previously sound and in good health, death must be referred directly to the multiple injuries received in the fight. We have already stated above that if the injuries are numerous, the loss of a smaller amount of blood may be fatal. We see, therefore, that there is not always a specific and visible “mortal” injury to account for death. This is a well-known medical fact, but it does not accord with the erroneous popular prejudice that no one can die from violence without some one visible wound which is mortal. In other words, the non-professional mind leaves out of account the idea of shock, only regarding material injury and not functional disturbance. If the circumstances accompanying death are unknown, it is well to be cautious. But if the deceased was in ordinary health and vigor and there was no morbid cause to account for the sudden death, we need not hesitate to refer death to the multiple injuries.

II. WAS THE WOUND THE CAUSE OF DEATH NECESSARILY?

This brings up a number of interesting questions to be considered. In medical jurisprudence there is probably no condition so common as that the injury is admitted, but death is attributed to some other cause. Thus if there are several wounds it may be hard to decide on the relative degree of mortality of any particular one, so as to be able to say that death was directly or necessarily due to this or that one. The defence may plead that death was not necessarily due to the particular wound attributed to the prisoner. This brings up the question—

=Which of two or more Wounds was the Cause of Death?= No general rule can be laid down for all cases, but each case must be judged by itself. Another way of putting the question is: “Which of two or more wounds was mortal?” The questions are not quite synonymous, for two or more of the wounds might be “mortal” but not equally the cause of death. In fact, as we have already seen, no one of the wounds if they are multiple may be of itself mortal, but taken together they are so. Consequently we will suppose that there are but two wounds, and not multiple ones, and the question remains which of these wounds was the cause of death. A wound may be said to be of itself mortal when it is the cause of death directly or indirectly in spite of the best medical assistance. In some continental states mortal wounds are divided into two classes, those absolutely and those conditionally mortal, the former including those in which the best medical assistance is at hand, sent for or timely rendered without everting the result. The mortal result in the second class is conditional on want of treatment, improper treatment, or accidental circumstances. As Taylor says, it is better to look at the effect of the wound and the intent of the assailant, as is done in English law, rather than at accidental relations of the wound.

To return to the question, we can readily imagine that a man may receive two wounds at different times or from different persons, and die after the second wound. Taylor[629] mentions the following case in which the question arose as to which of two injuries caused death: In Reg. v. Foreman (C.C.C. February, 1873) the prisoner had struck the deceased some severe blows on the head. A fortnight later, having partially recovered, another man gave him some severe blows on the head. A fortnight later still he had left hemiplegia, and died a few days later of a large abscess in the brain. The question arose which set of blows had been the cause of the abscess. The prisoner, the first assailant, was acquitted, as the deceased had had no serious symptoms until the second assault, and there was no satisfactory medical evidence as to the relation of the two assaults to the abscess formation. The same author also supposes the following case: A man having received a gunshot wound of the shoulder is doing well, when in another quarrel he receives a penetrating stab-wound of the thorax and abdomen. He dies after lingering for a time, under the effects of these wounds. If the wound of the shoulder could be proven to be the cause of death, the second assailant could not be convicted of manslaughter, and so too with the first assailant if it could be shown that the victim died of the stab-wound. It might be possible for a surgeon to decide the question definitely at once if death occurred soon after the stab, which was found to have penetrated the heart, a large blood-vessel, or one of the viscera; or, on the other hand, if the stab-wound was found to be superficial and not penetrating, and the wound in the shoulder had suppurated and caused septicæmia.

In either or any case, everything would depend upon the evidence furnished by the medical witness. His knowledge and judgment are required to distinguish the guilty from the innocent.

Again, sometimes death may appear to be equally the result of either or both wounds, in which case, as far as the medical evidence goes, both assailants would be liable to the charge of manslaughter. Or the second wound may be accidental or suicidal, and again the question would arise as to the cause of death. A case illustrating this is told by Taylor[630] substantially as follows: A grocer’s assistant pursued a thief, who had stolen from a cart, into a coal-shed, where he was stabbed twice in the abdomen. The larger wound suppurated, the smaller wound healed up, and the man died of peritonitis. On post-mortem examination the suppurating wound was found not to involve a vital part, while the small healed wound had wounded the liver and gall bladder and had set up the fatal peritonitis. The large suppurating wound had apparently been inflicted purposely; the fatal wound, directed upward and backward, might have been accidental by the deceased rushing upon the knife held more or less in self-defence. The case never came to trial, as the assailant was never found, but it can be readily imagined what complications might have arisen.

Furthermore, the wounded person may have taken poison or been subsequently ill-treated, and he may have died from these causes rather than the injury. But the question arises as to whether the wound was necessarily the cause of death. Here, in order to exculpate the assailant, the supervening disease or maltreatment must be such as to account for sudden or rapid death under the symptoms which actually preceded death.

=Was Death Due to Natural Causes?= Again, the injury may be admitted, but it may be claimed that death is due to natural causes. It is not unusual for wounded persons to die from natural causes, though the case may appear otherwise to laymen. This is often seen with suicidal wounds, especially those inflicted during the delirium of a disease, or the disease may supervene later and cause death without relation to the wound. Where the wound was inflicted by another, accurate discrimination is especially important in order to save the accused from imprisonment under false accusation and consequent loss of character. A careful examination is the only way to determine such cases, which depend therefore on the medical testimony.

Again, the question may arise as between DEATH FROM WOUNDS OR LATENT DISEASE, the wound perhaps being admitted, but death being attributed to latent disease. Here a close attention to symptoms and a careful post-mortem examination can alone decide. A man may die from the rupture of an aneurism, from an apoplexy or some other morbid condition after receiving a severe wound. Or a man with a hernia may receive a blow upon it causing a rupture of the contained intestine followed by peritonitis and death, or the recipient of a blow may have a calculus in the kidney which may perforate a blood-vessel or the kidney tissue and set up a fatal hemorrhage as the result of a blow.

Thus, medically speaking, the result of the injury is unusual and unexpected, and due to an abnormal or unhealthy state of body of the wounded person.

If it can be clearly shown by the medical testimony that death was due to the above or any other latent diseases, the responsibility of the assailant may be lessened or removed. The law looks to this point and is lenient in its punishment in the absence of malice on the part of the assailant. The crime is still manslaughter and may even be murder if the assailant was actuated by malice and the abnormal or unhealthy state of the body of the victim was taken advantage of. Generally there is no intention of murder, but the nature of the wound and the means of infliction will help to show this, which is for the jury rather than the medical witness to decide. There is less ground for mitigation of the punishment if the assailant was aware of the peculiar condition of the wounded person, especially in the case of those notoriously ill or of pregnant women.

Closely allied with this subject are those rare cases where ABNORMAL ANATOMICAL CONDITIONS, such as a thin skull or brittle bones, cause a slight injury to be followed by unexpected and untoward results, not to be looked for in the average individual. In such cases the evidence of the abnormal condition furnished by the medical witness may diminish the responsibility and mitigate the punishment.

Furthermore, the responsibility of the assailant may not be altogether removed, for the question naturally arises, Was death accelerated by the wound? This depends upon the circumstances in each case upon which the medical witness must base his opinion. Maliciously accelerating the death of another is regarded as criminal on the principle that that which accelerates causes. The following cases are quoted from Taylor[631] to illustrate the above distinctions. In Reg. v. Timms (Oxford Lent Ass., 1870) the deceased had been struck on the head by the accused with a hatchet, from which injury he had partly recovered under treatment in twelve days. But six weeks later he was seized with inflammation of the brain, with convulsions, and died. At the autopsy disease of the kidneys was found, and death was referred to this and the inflammation of the brain due to the blows. The prisoner was convicted after the judge had charged the jury that it was manslaughter if they believed that the blows conduced in part to the death of the deceased.

In the following cases there was no connection between the violence and the cause of death. A man struck his father on the head with a hammer and was sentenced to two months’ imprisonment, as the injury did not appear serious. The father thought the punishment too little, became much excited, and was hemiplegic six days after the wound was inflicted and died three days later. No injury of the brain was found under a fracture of the inner table at the site of the blow, but a large clot was found in the lateral ventricle which, in the opinion of the medical witnesses, was not dependent on the blow, and the prisoner was acquitted (see Reg. v. Saxon, Lancashire Sum. Ass., 1884). Also in Reg. v. Hodgson (Leeds Sum. Ass., 1876) the prisoner had struck his wife with a belt, a short time after which she fell back and died suddenly. The cause of death was found to be heart disease, and the blow not being causative in producing the fatal result, the prisoner was acquitted. Or again in Reg. v. Thompson (Liverpool Sum. Ass., 1876): The prisoner had stabbed his wife in the cheek. The wound was severe but not mortal. Two days later she was delivered of a child in the infirmary to which she was taken. She died nine days later of puerperal fever. The prisoner was acquitted on the charge of murder, as there was no necessary connection between the wound and the puerperal fever. Acquittals have taken place in cases of death occasioned by terror or dread of impending danger produced by acts of violence, as in the case of Reg. v. Heany (Gloucester Lent Ass., 1875). Here the prisoner in an altercation with his wife, who was suffering from cancer, held up a knife in a threatening manner, but did not touch her. This gave her a shock; she died two days later from fright. As there was no distinct proof that death was accelerated by this act, the prisoner was acquitted of the charge of murder. Taylor[632] found among a large number of cases occurring in England during twenty years that the latent causes of death, as registered in wounded persons, were chiefly inflammation of the thoracic or abdominal viscera, apoplexy, diseases of the heart and large blood-vessels, phthisis, ruptures of the stomach and bowels from disease, internal strangulation, and the rupture of deep-seated abscesses. Sometimes the person was in good health up to the time of injury, while in other cases there was merely a slight indisposition. It was only by carefulness on the part of the medical experts that the true cause of death was ascertained.

Again, it may be claimed that DEATH was not necessarily the result of the wound and was AVOIDABLE BY GOOD MEDICAL TREATMENT. There are many cases of wounds not mortal with proper and skilled treatment which might become so by improper treatment. They may thus become directly mortal by interfering with a source of hemorrhage which had been arrested, or secondarily mortal by infection of the wound by meddlesome treatment. It would depend on the medical witnesses to determine whether and how far the treatment had been responsible for the fatal result. If the wound is not of itself mortal and it has only become so from improper treatment, this should be a mitigating circumstance in favor of the accused. Medically speaking, we can seldom make the sharp distinction which Lord Hale did legally between a wound becoming mortal from improper treatment and one in which improper treatment causes death irrespective of the wound. In case of a slight wound this distinction might be possible, but not so in case of severe wounds. Also there would probably be no conviction, as far as the medical evidence is concerned, if the wound was only mortal in consequence of improper treatment and not mortal as its usual and probable result. This may naturally introduce the question of the COMPARATIVE SKILL IN TREATMENT. If death is entirely or partly due to a wound the responsibility of an assailant is not altered by unskilful treatment. The entire question of the relation of the wound to the fatal result and the effect on this result of the treatment employed is left to be determined by the medical experts, and in its solution great care and judgment must be used. Although a given fatal wound might not have caused death under the best possible treatment and surroundings, yet, according to the above rule, the assailant is held responsible as long as the fatal result is due partly, at least, to the wound. Therefore we see the responsibility of the surgeon not only for the life of his patient, but also for that of the prisoner. He should, therefore, not deviate from the ordinary and most accepted practice in such cases, as any such deviation is taken hold of by the counsel for the defence. In fact, every point of the treatment is subjected to criticism.

In a lacerated wound of the foot, if death occurs from tetanus, it may be claimed that death would not have occurred if the foot had been amputated, or, if the foot were amputated and death followed, it may be claimed that amputation was unnecessary and was the cause of death. The surgeon should, therefore, be able to give the best reasons for every step of treatment.

Again, it may be claimed that DEATH was not a necessary result of the wound and WAS AVOIDABLE BUT FOR IMPRUDENCE OR NEGLECT on the part of the wounded person. A man after being wounded may refuse to receive medical assistance, or, after receiving it, may disobey instructions or refuse to submit to an operation proposed. Thus with a compound depressed fracture of the skull the patient may either refuse to see a surgeon, or he may refuse to submit to an operation proposed, or he may with or without operation disobey the instructions as to diet and quiet, and eat or drink heavily and refuse to go to bed. Such a case we can readily imagine might die of meningitis, etc.

If the symptoms of a wound are unfavorable from the start, or if the wound of itself is likely to prove mortal, the responsibility of the assailant is unmitigated by imprudence or neglect of medical assistance by the wounded person. This is not allowed as mitigatory, as a sane man is a free agent and is not obliged to call in or submit to medical treatment. Moreover, a medical witness in many cases could not swear that an operation or other plan of treatment would certainly save life. Thus an amputation of the leg for wound of the foot causing tetanus is by no means a certain means of cure. But we can readily imagine a case where the refusal to submit to the treatment proposed might be an important element in causing death. Thus in a compound depressed fracture of the skull with compression, the medical witnesses would agree that the operation would in all probability save life. This fact would probably be only mitigatory in diminishing the penalty, and, as stated above, would not secure acquittal. But it is none the less important for the medical witness to bear these facts in mind and bring out the facts and conclusions clearly in his testimony.

DEATH FOLLOWING SLIGHT PERSONAL INJURIES.—Here again the claim might apparently be justified that death was not necessarily due to the trifling injury. And in reality there is commonly some unhealthy state of the body to explain such an unexpected result. When the disease accounting for this unhealthy state of the body is in some other part than the injury, an examination with ordinary care will explain the case. But if the disease and injury are located in the same part, especially in the head, the case is more perplexing, but may be cleared up by careful and thorough examination. Also the usual results of such an injury should be considered, and whether the disease would be a usual result of the injury, or whether the sum total of the pathological conditions found would be accounted for by the violence. It should be remembered that the presence of chronic disease is no excuse. Thus Taylor[633] cites the case of Reg. v. Hapley (Lewes Aut. Ass., 1860), where a boy with chronic disease of the brain suffered from no unusual symptom until he received a severe flogging, which was followed by death in less than three hours. The same author mentions also the following case to show that fatal results may follow very slight and trivial blows. Annan[634] tells of a healthy four-year-old girl who received a slight blow from the shaft of a wheelbarrow on the skin about three inches below the knee. There was even no external mark of violence, and the injury was thought to be so slight as not to require treatment. There was pain, however, which increased on the following day, marked constitutional symptoms appeared, and the child died on the fourth day. Even to the punishment inflicted by schoolmasters death has been imputed.

When DEATH occurs FROM WOUNDS AFTER LONG PERIODS the injury may be admitted, but it may be claimed that death was not necessarily due to the wound. Medically speaking, death is just as much the result of the injury as if it occurred on the spot. Of course, death must be clearly traceable to the usual and probable results of the injury, and not be dependent on any other cause. An examination of the wounded part and of the whole body will enable the medical witness to determine the cause of death and whether it is clearly traceable to the injury. A doubt on this point may lead to acquittal. Certain forms of wounds or wounds in certain localities are especially liable to end fatally after a long delay, but as the direct result of the wound. These are wounds of the head and of the spine. As to the first class, the injured person may apparently recover and be doing well, when he may suddenly die from a cerebral abscess, for instance. This is the result of the injury, but remains a longer or shorter time latent. In wounds of the spine the patient is generally paralyzed below the point of fracture, but is apparently in good health. In a longer or shorter time he may die of a pneumonia, cystitis, or bedsores, which are the known and regular consequences of the injury or injured condition. Astley Cooper cites the case of a man who was injured on the head and died two years later from the effects of the injury, as was clearly made out by the continuance of brain symptoms during the entire period. An interval of eleven years occurred in another head injury between the injury and the fatal result. The first result of the injury was concussion of the brain, and the case is mentioned by Hoffbauer.[635] This long interval is unusual. There is a rule in English law by which the assailant cannot be indicted for murder if the victim of the assault lives a year and a day. Practically this makes little difference, as nearly all cases would die within that time; but the principle is wrong as looked at from the medical standpoint. The protracted cases concern, as above stated, mostly injuries of the head, spine, and chest, among which there are some cases, like the examples cited, where, according to English law, justice would fail to be done.

III. WAS A WOUND THE CAUSE OF DEATH SECONDARILY?

A wound is secondarily the cause of death when the victim, having recovered from the first ill effects, dies from some wound disease or accident or from a surgical operation rendered necessary in the proper treatment of the wound. There may be much difficulty in establishing the proof of death from a wound by means of secondary causes, for, 1st, the secondary cause must be in the natural course of things; and, 2d, there must be no other accidental circumstances to occasion the secondary cause.

The secondary cause may be partly due to the constitution of the deceased from habits of dissipation, which fact would serve as an expiatory circumstance in the case. Among the secondary causes of death may be mentioned septicæmia, pyæmia, erysipelas, tetanus, gangrene, that is, wound diseases, also the wound accident—as we may call delirium tremens, and surgical operations rendered necessary to the treatment of the case. We may add, besides the regular wound diseases, inflammation in and about the wound, septic in character, perhaps not justifying the title of septicæmia, but which, with its accompanying fever, may be the “last straw” in a case which might otherwise recover. Some of these secondary causes will now be considered more at length.

SEPTICÆMIA is a general febrile disease due to the absorption into the system from a wound of the products of bacteria or due to the introduction into the blood and tissues of the bacteria themselves. Depending on the two sources of origin, we have two forms of septicæmia: 1. Septic intoxication or sapremia, due to the absorption of a chemical poison, ptomaïnes, and often readily influenced and cured by the removal of the source of these ptomaïnes in decomposing blood-clots, secretions, etc. 2. Septic infection comes on less rapidly but is more serious than the former is, if properly and quickly treated, because the source of the trouble cannot be removed, but is in the blood and the tissues. The latter form is the more common one in wounds, though the former may occur in abdominal wounds, especially when a blood-clot is present. The first form begins acutely, the second form more gradually. The infection in septicæmia takes place through a wound and may be due to the weapon which caused the wound, the unclean condition of the parts wounded, or to the subsequent treatment or want of treatment. It may even take place through the intestinal mucous membrane as in cases of tyrotoxicon poisoning. It is most likely to occur during the first four or five days before the surfaces of the wound granulate, and it consists in the introduction of bacteria, especially staphylococci and streptococci. The disease is characterized by severe constitutional symptoms, acute continuous fever, inflammation of certain viscera and of the wound, and nervous disorders. A pronounced chill ushering in the fever is generally absent. Prostration is especially marked, the patient finally passing into a typhoid condition indifferent to surroundings. Anorexia and headache are usually present; diarrhœa is common, vomiting is not. The skin is pale and dusky, but not commonly icteric; at first it is hot and dry, later moist and finally cold and clammy. The spleen is often enlarged. The pulse becomes weak and rapid and delirium is followed by coma. The prognosis is grave. Antiseptic treatment generally prevents and often cures the disease, as is the case with many other of the wound diseases; hence the failure to employ it may be alleged by the defence in mitigation of the responsibility of the assailant for the fatal result.

PYÆMIA is closely allied to septicæmia. It is due to the setting free of bacterial emboli or septic emboli from a broken-down, septic thrombus in the neighborhood of the wound, and the circulation of these emboli in the blood until they are arrested and form the characteristic metastatic abscesses, especially in the lungs, joints, abdominal viscera, and parotid gland. Almost always the source of infection is an infected wound. Granulation does not prevent the occurrence of pyæmia, which, as a rule, commences at a later stage than septicæmia. It is most important, however, for our purpose to remember that there is such a thing as spontaneous pyæmia. An injury not causing a wound may here be the exciting cause, but the resulting pyæmia is an unexpected consequence. A bruise of a bone, for instance, by allowing bacteria, which in certain conditions may be circulating in the blood, to find an exit from the vessels into the bruised part, may develop an acute osteo-myelitis, which may be a starting-point of a pyæmia. It is but proper to state, however, that spontaneous pyæmia is a rare occurrence. In fact, it is so rare that if pyæmia occurs and we find ever so trifling an infected wound, we can safely attribute the pyæmia to the wound and not to a spontaneous origin.

Pyæmia begins, as a rule, in the second week of the healing process or even later. It usually begins with a chill, which may be frequently repeated. The fever is very irregular and exacerbations occur with each metastatic abscess. The skin is icteric, the icterus being hematogenous. The pulse is rapid and becomes weaker. Infective endocarditis may develop, which increases the danger of metastatic abscesses, which may then occur in the brain. Otherwise the mind is clear and unaffected until the final delirium and coma. The disease may become chronic, but usually lasts a week or ten days. The prognosis is very grave.

ERYSIPELAS is a still more frequent complication of medico-legal wounds, and though not so fatal as the two preceding, it is probably more often the secondary cause of death on account of its far greater frequence. It too is an acute infective inflammation due to the presence of a micro-organism, streptococcus erysipelatis. This occurs mostly in the lymphatics of the skin, and effects an entrance through some wound or abrasion of the skin or mucous membrane, which may be almost microscopic in size. Probably there is no such thing as true spontaneous erysipelas, though the wound may be often overlooked and only visible on the closest examination. If a wound has been inflicted, the size and severity of it cannot be alleged as a reason why it was not the starting-point of an erysipelas. The erysipelas must be clearly traced to the injury. That is, it must occur before recovery from the wound or not later than a week after it has healed, for the incubation is probably not longer than this. It is difficult to connect an erysipelas with a wound if it occurs some time after it has healed or if it occurs at a different place and not about the wound. Wounds of certain regions, as, for instance, scalp wounds, are especially liable to develop erysipelas, but this is probably owing to the imperfect antiseptic treatment or delay in applying it. Certain individuals are more prone to it than others; thus it has been stated that blondes and those suffering from Bright’s disease are more susceptible, though how true this is it is hard to say. It is also probably more prevalent at certain times of the year, particularly in the spring. A wound after it has scabbed over or has begun to granulate, that is, after the first four or five days, is very much less apt to serve as the avenue for infection. Erysipelas usually begins with a chill, or a convulsion in children. Nausea and vomiting are the rule. The fever is remittent and ranges from 102° to 104° F., and the temperature may be subnormal when the inflammation is subsiding. Prostration is marked and the pulse more or less weak. There may be delirium while the fever is high. Locally there is rarely anything characteristic until twenty-four hours or so after the chill. Then we have a reddish blush with some tension, burning and itching of the skin. At first the redness is most marked about the wound, later at the edge of the advancing, serpentine margin. It spreads widely and rapidly, and after three or four days the part first attacked begins to improve. Desquamation follows. The duration may be a week or ten days or as long as a month. The inflammation may be much more severe, involving the subcutaneous connective tissue in phlegmonous erysipelas.

FACIAL ERYSIPELAS is a common variety and was once regarded as idiopathic, but a wound on the skin or mucous membrane is probably always present. The prognosis of erysipelas is usually favorable. Since the use of antiseptics it is far less common than formerly, though still the most common of the infective wound diseases.

If a man wounded in an assault is taken to a hospital where erysipelas prevails, the question of responsibility arises, for, medically speaking, he is subjected to great and avoidable risks.

TETANUS is an infective bacterial disease affecting chiefly the central nervous system and almost always, if not always, originating from a wound. Tetanus, like erysipelas, is probably always traumatic and never strictly idiopathic. The wound may be so slight as to escape notice. When it follows such injuries as simple fracture internal infection probably occurs, though such cases are extremely rare. It is said that the weather influences the development of tetanus, and that it is more common in the tropics. There are also certain sections where tetanus is much more common than elsewhere and where it may be said to be almost endemic. Punctured wounds are most likely to be followed by tetanus, for they offer the best opportunity for the development of the bacteria, which are anaërobic. Wounds in dirty parts of the body, like the hands and feet, are more apt to be followed by tetanus than those elsewhere. Tetanus usually appears about the end of the first week after a wound has been received, but it may not appear for a longer period, even three or four weeks, so that the wound may have been some time healed. To connect tetanus with a particular wound, note (1) if there were any symptoms of it before the wound or injury, (2) whether any other cause intervened after the wound or injury which would be likely to produce it, and (3) whether the deceased ever rallied from the effects of the injury. Tetanus comes on suddenly without warning. The injured person first notices that he cannot fully open the mouth, he has lock-jaw, and the back of the neck is stiff. The muscles of the abdomen and back are next involved so that the back is arched in the position known as opisthotonos, and the abdomen presents a board-like hardness. The muscles of the fauces, pharynx, and diaphragm may next become involved, causing difficulty in swallowing and breathing. The thighs may or may not be involved, but the arms and legs almost never. Owing to the spasm of the abdominal muscles, micturition and defecation are difficult and respiration is hindered. The muscles are in the condition of tonic spasm which permits the patient no rest, the face bears the “risus sardonicus,” and the suffering is extreme. If the patient lives more than two or three days the tonic spasm partly gives way to increased reflex irritability, in which a noise, jar, or draught of air may give rise to clonic and tonic spasms in the muscles affected. The patient may die at such times from tonic spasm of the respiratory muscles, or he may die of prostration from want of food and sleep, worn out by the suffering and muscular spasm. The mind is usually clear to the last. Fever is not characteristic of the disease. Tetanus may be rapidly fatal; in two or three days, or it may be or become more chronic. The prognosis of acute tetanus is almost invariably fatal; that of chronic tetanus is grave, but a certain proportion of cases recover.

Diagnosis.—This is easy. It differs from a true neuritis in the peripheral nerves in that no matter where the wound is situated the first symptom is in the muscles of the jaw and the back of the neck, and not at the site of the injury and distally from this point. Trismus is applied to a milder form of the disease in which only the face and neck muscles are involved and “lock-jaw” is a prominent symptom. Some cases of tetany may be mistaken for so-called spontaneous tetanus. Tetany may follow child-bed, fevers, mental shocks, exposure to cold and wet, extirpation of goitre, intestinal irritation, etc. It consists of painful tonic spasms of the muscles of the arms and feet. The attacks last one-half to two hours or more, and may be preceded by a dragging pain. They may be brought on by pressure on the nerve leading to the muscles affected. Striking the facial nerve often causes contraction of the face muscles. There is no trismus but there may be opisthotonos. The patient seems well between the attacks and most cases recover without treatment.

DELIRIUM TREMENS may occur as a secondary consequence of injuries, or necessary surgical operations in the case of those who are habitually intemperate. Those who habitually use opium, tobacco, cannabis indica, or even tea or coffee to excess are said to be subject to it. It may, therefore, be justly alleged that death is avoidable in very many cases, but for an abnormal and unhealthy state of the body. The disease is characterized by delirium, a peculiar tremor of the muscles, insomnia, and anorexia. Pneumonia may complicate the case. The patients die in fatal cases from exhaustion due to insomnia, lack of nourishment, and their constant activity of body and mind. The prognosis is usually favorable, taking all cases together, but in delirium tremens secondary to surgical injuries or operations the prognosis is serious.

DEATH FROM SURGICAL OPERATIONS performed for the treatment of wounds. The operation is a part of the treatment, and if it is done with ordinary care and skill the accused is responsible for the result. The necessity and mode of operation must be left to the operator’s judgment. As the defence may turn on the necessity for and the skilful performance of the operation, it is well to wait for the advice and assistance of others if practicable, for death is not unusual from severe operations. The patient may die on the operating-table after losing little blood, from fear, pain, or shock. Or he may die from secondary hemorrhage or any of the secondary causes of death from wounds enumerated above. The evidence of the necessity of the operation must, therefore, be presented by the operator. If an operation is necessary and not performed, the defence might allege that death was due to the neglect of the surgeon. Another question for the medical witnesses to determine is whether the operation was rendered necessary because of improper previous treatment, for if it was the responsibility of the assailant may be influenced. The meaning of the term “necessity” is here a matter of importance. Unless an operation is necessary to the preservation of life, if death occurs there is some doubt whether the assailant is responsible. But, medically speaking, we would not hesitate to urge an operation on a wounded man in order to preserve function, or even to save deformity as well as to save life. In the case of operations done under a mistaken opinion, neither necessary to save life nor, as the result proves, to save function or guard against deformity, if death follows the assailant may be relieved from responsibility. Thus an aneurism following an injury might be mistaken for an abscess and opened with skill but with a fatal result. It is also for the medical experts to determine whether an operation was unnecessary or unskilfully performed, for if it were and death resulted from it, the responsibility of the prisoner is affected unless the original wound would be likely to be fatal without operation. According to Lord Hale, if death results from an unskilful operation and not from the wound, the prisoner is not responsible. But yet death may occur as the result of the most skilful operation necessary to the treatment of a wound, and not be dependent at all on the wound itself. If the operation is skilfully performed, and yet the patient dies from secondary causes, such as those above enumerated or any others, the prisoner is still responsible, and the medical testimony is concerned with the performance of the operation and the secondary causes of death. The relative skill of the operator or surgeon is probably not a question for the jury in criminal cases, on the ground that the man who inflicts the injury must take all the consequences, good or bad. In a civil suit, for instance an action for malpractice, the case is otherwise, and all the medical facts and opinions are submitted to the jury. The law regards three circumstances in death after surgical operations: (1) The necessity of the operation, (2) the competence of the operator, and (3) whether the wound would be fatal without operation.

Death may occur from anæsthetics used in an operation without any recognizable contributing disease of the patient, or carelessness or lack of skill in the administration of the anæsthetic. Of course, the question of absence of contributing disease on the part of the patient and of its proper administration must be satisfactorily answered in cases of death from the anæsthetic in an operation rendered necessary in the treatment of a wound. Death from an anæsthetic may occur before, during, or after an operation itself. Medically speaking, the necessity of the use of an anæsthetic in operations cannot be questioned, and in emergencies where an operation becomes necessary, and not a matter of choice, its use, with special care, is justifiable even with existing organic disease, which usually contraindicates it. As death may be alleged to be due to the use of a particular anæsthetic, it is always best in operating on account of an injury which may require a medico-legal investigation, to use that anæsthetic which is most generally used and indorsed in the particular section of country in question. Of course, it is not lawful to operate against the will of a person who preserves consciousness and will. It may be added in this connection that if a medical man be guilty of misconduct, arising either from gross ignorance or criminal inattention, whereby the patient dies, he is guilty of manslaughter, according to Lord Ellenborough. Omissions or errors in judgment, to which all are liable, are not criminal.

IV. WAS THE WOUND MADE BY THE INSTRUMENT DESCRIBED?

It is not often necessary to prove that a weapon was used, though it may affect the punishment. For the use of a weapon implies malice and intention and a greater desire to do injury. The prisoner may swear that no weapon was used when the nature of the wound clearly proves that one was used. The explanation of the prisoner of the origin of the wound may thus be discredited. We cannot often swear that a particular weapon was used, but only that the wound was made by one similar to it in shape and size. Thus Schwörer tells of the case of a man stabbed in the face by another. The medical witness testified that the wound was caused by a knife shown at the trial which had a whole blade, but a year later the point of the knife which had really caused the wound was discharged from an abscess in the cheek at the site of the wound. The surgeon thus made a too definite statement in regard to the knife shown.

It is often very difficult to answer the above question. We base our opinion chiefly on two sources: 1st, and most important, by an examination of the wound, and, 2d, by an examination of the instrument said to have been used. Certain particulars of the wound may furnish indications as to the weight, form, and sharpness of the instrument used. There are certain wounds which must have been made by an instrument, namely, incised and punctured wounds. The above question is determined more or less by what has been said in a former section on wounds, but we will now consider what special features of these and other classes of wounds indicate the nature, shape, size, etc., of the weapon used.

=Incised wounds= must be made by a cutting instrument. We would here exclude those contused wounds of the scalp and eyebrows which closely resemble incised wounds, but we have already seen that we can diagnose between these wounds and incised wounds by careful inspection. But the locality should put us on our guard, so that in case of wounds of these two regions we should be especially careful in making the examination.

In the case of incised wounds we cannot often tell the shape or size of the weapon, but we are able to tell certain characteristics about it. The sharpness of the instrument may be inferred from the clean and regular edges. The depth of the wound may also indicate the sharpness of the weapon. A long “tail” in the wound indicates that the weapon was sharp as well as that this was the part of the wound last made. If the edges of the wound are rough, we may infer that the edges of the weapon were rough and irregular. Wounds caused by bits of china or glass or fragments of bottles, besides having rough and lacerated edges, are characterized by an irregular or angular course in the skin.

Some cutting weapons, like an axe, act as much by means of their weight as by their cutting edges. Wounds caused by such weapons we can often distinguish by the following signs: The edges are not as smooth as is the case with a cutting instrument, and they may be more or less lacerated and show signs of contusion. The wound is often deep in comparison with its length, and the ends of the wound abrupt instead of slanting up from the bottom to the surface. The section of resisting organs and the impression of the edge of the weapon on the bone are further signs of the use of such a weapon.

The form and direction of a wound may possibly give some indication of the form of the instrument—for instance, whether it be straight or curved like a pruning-knife, as in the case cited by Vibert[636] of a wound of the neck which suddenly became deeper toward its extremity and changed its direction; the whole being explained on the supposition that it was made by a pruning-knife.

But it is in =punctured wounds= especially that we are enabled most often and most accurately to determine the kind of a weapon used. Here from the form of the wound we may judge of the form and size of the weapon. In speaking of punctured wounds in a former section we divided them into four groups, reference to which may here be made. In the first group, or those caused by cylindrical or conical weapons, when the weapon is very fine it may leave no track at all; if a little larger, we may infer from a linear bloody track that the weapon was needle-like in shape. The length of the instrument or the depth to which it penetrated may be found, as a rule, only by dissection. If the weapon were larger and conical, we have seen that the wounds would be linear with two angles, the length of the wound being parallel to the direction of the fibres in the skin.

Here we may judge of the form of the weapon from the following circumstances: From a comparison of the depth with the size of the opening, we know that it was a punctured wound. The edges and angles are not smooth and even enough for a stab-wound with a knife, for the edges are torn and not cut, and a stab-wound would be the only form of wound with which we would be likely to confuse it. Furthermore, the direction of the long axis of the wound parallel to that of the skin fibres in the region in which it occurs and the very slight retraction of the edges distinguish it from a stab-wound. By these signs we can almost always distinguish such wounds from stab-wounds, and thus tell the form of the weapon used. As to the size of weapon used, these wounds if of any size are generally smaller than the weapon, for the skin is put on the stretch by the weapon and yields to a certain extent. The actual wound, therefore, is smaller in circumference than the weapon. The size of the wound is smaller than that part of the weapon occupying the wound when the weapon was arrested; it may be very much smaller than the weapon at its largest point. Small wounds of this kind are generally larger than the instrument producing them.

The second group of punctured wounds, or stab-wounds, are by far the most common and, therefore, the most important variety of punctured wounds. If the stab-wound is perpendicular to the surface the form of the wound may represent pretty closely that of the weapon at the point where the latter was arrested, whether it has a single or double cutting edge. But even here there are exceptions. Frequently a weapon with a broad back and only one cutting edge may produce a wound resembling that of an instrument with two cutting edges, the second angle tearing as in the former class. Here on close examination we can sometimes distinguish the difference between the two angles, and judge correctly of the shape of the weapon. In fact, wounds made by common pocket-knives are regularly slit-like and not wedge-shaped, as the wound is caused only by the cutting edge of the knife. Again, if the single cutting edge is blunt, in rare cases the wound is produced in the same manner as those of the first group, or conical and cylindrical instruments. We would be led to suppose that the wound was produced by such an instrument, as both angles are torn, unless the direction of the wound might not follow that of the fibres of the skin, in which case we would be left in doubt. Stab-wounds are sometimes angular from the knife being withdrawn in a slightly different direction from that in which it was introduced or from an unequal retraction of the skin (see Fig. 9). If the stab-wound is obliquely directed, we can still judge of the general shape of the weapon, with exception of the cases above mentioned. The dimensions and size of the weapon are here much harder to determine. The dimensions of a stab-wound in the skin may be the same as those of the weapon, or of that part of the weapon which is arrested in the wound, but often they are not so. To measure the size of a wound exactly so as to get at the exact size of the instrument, we should place the region of the wound in the same position, etc., that it was when the wound was inflicted, and this we cannot often do. As the skin was tense or relaxed at the time the wound was inflicted, so the wound in the skin appears smaller or larger, just as with a sheet of rubber under similar conditions. If the instrument is very blunt, the wound in the skin may be smaller than the weapon whether the skin near the wound is tense or not. Thus Hofmann saw the wound from a blunt bayonet one centimetre shorter than the weapon.

The wound of the skin may be shorter and broader than the weapon used on account of retraction of the edges of the wound, and this is especially marked when the wound lies transversely to the direction of the skin fibres. On the other hand, the length of the external wound is more often greater than that of the weapon, because the wound is elongated by making pressure toward the cutting edge on withdrawal of the weapon, and an oblique wound measures longer than the weapon. If the blow is from above downward and the cutting edge of the weapon is uppermost, the length of the wound is not so likely to be increased much beyond the measurement of the weapon as when the cutting edge is directed downward. There is but one condition in which a stab-wound is at all likely to correspond in dimensions with that of the weapon, and that is when the wound is perpendicular to the surface. Even here the wound may be lengthened on withdrawal of the weapon, and we have to allow for retraction of the edges and try to put the parts in the same condition of tension or laxity as at the time of wounding. Even in the most favorable case, therefore, we cannot with certainty tell the exact size of the weapon. If a stab-wound be directed obliquely to the surface, then the length of the wound is greater than that of the weapon, unless this increase be exactly counterbalanced by the lateral retraction of the wound. The size of the weapon in such oblique wounds is further obscured by the changes of size due to withdrawal of the weapon, retraction of the edges, and the condition of the tension of the skin at the time the wound was inflicted.

Dupuytren remarks that stab-wounds are smaller than the weapon owing to the elasticity of the skin, but a lateral motion of the weapon may cause considerable enlargement of the wound. If a stab-wound has traversed a part of the body, the wound of exit is smaller than that of entrance.

The depth of a punctured wound may be any part of the length of the weapon, or it may even be deeper than the length of the weapon owing to a depression of the surface by the force of the blow, or the pressure of the handle of the weapon or the hand holding it. We have already seen that this may occur in a marked degree in penetrating wounds of the abdomen involving one of the movable viscera, also in wounds of the thorax, partly from depression of the surface and partly from an expansion of the thorax when opened at the autopsy, thus increasing the measured depth of the wound. Punctured wounds of the third class made by instruments with ridges or edges, like foils, files, etc., present more or less the shape of the weapon if the edges are cutting, but not always so if the direction of the wound be oblique or the parts unevenly stretched. If the edges are not cutting they cause wounds more or less like the first class of punctured wounds, but we can often distinguish them from the latter by little tears in the edges. The entrance and exit wounds may not be alike.

Wounds made by bits of glass and earthenware have irregular and uneven edges. Taylor[637] relates a case, Reg. v. Ankers (Warwick Lent Ass., 1845), where the wound was attributed to a fall on some broken crockery, but the wound was cleanly incised and the prisoner was convicted. As it may be alleged in defence that a given wound was caused by a fall on broken crockery or other substances capable of producing a punctured wound, it is important to notice whether the edges are lacerated and irregular or smooth and clean. The author quoted above cites another case which occurred to Watson, where the prisoner alleged that a deep, clean-cut wound of the genitals of a woman which had caused her death was due to a fall on some broken glass. The character of the wound disproved this defence. Another feature of such wounds, especially if they be deep in comparison to their length, is that they are very apt to contain small particles of the glass or earthenware which caused them. In fact, in all wounds it is well to search for any small fragments which will throw light upon the weapon used.

Wounds caused by scissors are often of characteristic shape. If the scissors were open we find two symmetrical, punctured diverging wounds, presenting more or less clearly the form of the blades of the scissors. If the blades have been approximated there is a triangular interval between the punctures, the apex of which is truncated if any skin remains between the punctures.

Lacerated wounds may not indicate the weapon used as clearly as punctured wounds, but the agent which produced them is often indicated by the appearance of the wound. They are generally accidental. But where they occur, as they not infrequently do, on the bodies of new-born children, they may give rise to the charge of infanticide. In some cases the weapon which caused the wound fits the wound produced, and thus important evidence may be furnished the prosecution. Taylor[638] cites the case of Montgomery (Omagh Sum. Ass., 1873), where a bill-hook which fitted the injuries on the skull of the deceased was found buried in a spot to which the prisoner was seen to go. These facts connected the prisoner with the weapon and the weapon with the murder. In other cases the wounds may be so lacerated or contused that the indications of the weapon are obscured.

=Contusions and Contused Wounds.=—The shape of a contusing body is sometimes reproduced by the contusion and the ecchymosis. Thus we are enabled to distinguish the marks of a whip, the fingers, the fist, etc. This is best seen when the ecchymosis is fresh, for soon the edges extend and the outline is less clearly marked. Plaques parcheminées, which we have already described as the marks of contused erosions, may show the form of finger-nails, etc. Contused wounds like simple contusions may show the shape of the weapon.

If the contusing body has a large area, the whole of this area cannot often strike the body at once, so that the outline of the contusion does not represent that of the weapon. But in general, severe contusions present greater difficulties than the preceding classes of wounds. We must generally be content if we can determine whether the wound was caused by a weapon, including the fist, or by a fall, and we are often unable to say even this. A fall is often alleged by the defence as the cause of the injury, but of course if the prisoner was responsible for the fall he is responsible for the results of the fall. If there are contusions or contused wounds on several parts of the head, or if the wounds are on the vertex of the head, it is presumptive of the use of weapons. We cannot often swear that each and every wound on the head was due to the use of a weapon. On the other hand, the presence of grass, sand, gravel, etc., in a wound is presumptive of a fall and of the origin of the wound in this manner. In case of a fall from a height the wound or wounds might be in almost any part of the body, on the vertex or elsewhere. Such a fall may be the result of accident, suicide, or murder. It is not unusual for female complainants to ascribe their wounds to a fall to exculpate the prisoner, especially if this happens to be her husband. We should remember that in the scalp or over the eyebrows a contused wound caused by a blunt instrument may resemble an incised wound. As already stated, however, if the wound is fresh careful examination will lead to a correct opinion, and the use of a sharp instrument may be disproved. If the wound is not recent there is great difficulty in judging of the cause. It is well to caution against accepting the interested statements of others in regard to the use of a weapon, unless the character of the wound bears them out very strongly. There may be a bad motive for imputing the use of a certain weapon to the assailant. It is far better to rely solely upon the evidence furnished by the wound in such cases.

It would be useful if we could lay down some general rules to discriminate between wounds caused by the blow of a weapon and those caused by falls, but this we are unable to do so as to cover all cases. Each case must be judged by itself.

If the question is asked which of two weapons caused certain contusions or contused wounds, we are still less likely to be able to answer it. In such a case we must make an accurate examination of the form of the wound and compare it closely with that of the weapon. In such cases also the second source of information on which we base our opinion as to the relation of a weapon to the wound may be of use, namely, the examination of the weapon. The presence of blood, hair, cotton or woollen fibres on one of two weapons indicates that this was the weapon used. The presence of blood is particularly to be looked for, and in those parts of the weapon from which it could be washed off least easily. We should further note the condition of the point and edge of the weapon, and if the edge is broken or nicked at all, whether this condition is old or recent. The sharpness of the edge should further be noted, and if the edge is sharp note whether it has recently been sharpened. All these points have a certain bearing on the case. Also the location, shape, depth, etc., of the wound should be carefully noted to see if an accidental fall would be likely to account for it. For these features of the wound may be such that no fall could cause it.

We see, therefore, that in incised and punctured wounds the use of a weapon may not be hard to make out, but that in general the question whether a particular instrument caused the wound is often difficult or impossible to answer. Often the best we can do is to say that the wound could have been produced by the weapon.

V. WAS A WOUND SELF-INFLICTED OR WAS IT INFLICTED BY ANOTHER?

In other words, was it suicidal or homicidal? Speaking of suicide in general, its most common cause is alcoholism. It is not infrequent in youth. Lutaud[639] states that in fifteen years, presumably in France, there were 1,065 cases of suicide between the ages of ten and fifteen years. This seems to be only explicable on the ground of heredity or of cerebral affections. Among 27,737 cases of suicide, observed in France, the same author gives the following commonest causes in the order of greatest frequence: Drowning, strangulation, pistol-wounds, incised and punctured wounds, poison. The age, sex, and social conditions influence the choice of means. Thus among males drowning is preferred by the young, pistol-wounds by the adult, and hanging by the aged, while among females asphyxia is the favorite method, as there is no pain and no disfigurement.

While many pathologists consider suicide an act of mental alienation, and though such may be the case in a large number or even in a majority of cases, yet in a considerable number it is a voluntary and rationally planned act. The question, Is it suicide or homicide? may be put in all cases of death by cutting instruments, and in many from other kinds of wounds. It is often, if not generally, impossible to answer it with absolute certainty. It is hardly suitable for the medical witness to try to reconstruct the scene of the crime from the medical facts, for he should abstain from everything not medical and should distinguish that which is positively proven from that which is merely probable.

Suicides often leave a letter or some such indication to show that the wound was self-inflicted. If such is not the case, the question as to the cause of the wound may or may not be medical. If the question is a medical one, there are certain points to notice as to the wound, such as its nature, situation, direction, and the number and extent of the wounds, from which we are to form an opinion. There are also other circumstances which furnish evidence and thus assist us in answering the question. This evidence is furnished by the weapon, the signs of struggle, the examination of the clothes and body of the deceased and the accused, the position and attitude of the body, and any organic lesions, etc., predisposing to suicide.

The =nature= of the wound bears upon the question of the homicidal or suicidal origin in the following way: Most suicidal wounds are incised or punctured wounds. Incised wounds of the throat are generally presumptive of suicide, but a homicidal wound may be inflicted here to conceal the source of infliction of the wound. Such a wound if homicidal would imply malice, on account of the attempt at deception and concealment, and would convict the assailant of murder. Unless the deceased was asleep or drunk or was otherwise incapable of resistance, such a homicidal wound can often be distinguished from a similar suicidal wound by the form and direction of the wound, by its irregularity, and by other wounds on the hands or person of the deceased. Taylor[640] mentions a case in which the peculiar form of the wound, like that made by butchers in killing sheep, led to the suspicion that homicide had been committed by a butcher, who was subsequently arrested, tried, and convicted of murder. The regularity of the wound has been taken to indicate suicide rather than homicide. That it does so is not questioned, but it is more or less fallacious if resistance is impossible, in which case a murderer may easily make a regular, clean, incised wound here. Contused wounds are seldom suicidal, for they are not sufficiently speedily or certainly fatal. They are also more painful and disfiguring. Contused wounds usually indicate murder or accident, though there are not wanting cases of suicide by such weapons as a hatchet or a hammer. There is more difficulty in the case of a contused wound from a fall instead of from a weapon; for here we have to decide whether the fall was accidental, suicidal, or homicidal. The nature of the wound is of little assistance in the case of insane or delirious patients, who may commit suicide in the most unusual and curious manner.

Taylor[641] relates the case of a delirious patient in Guy’s Hospital, in 1850, who tore away the whole of the abdominal muscles from the lower part of the anterior abdominal wall. If the case had not occurred in the hospital or where there were witnesses of the deed, the nature of the wound would have indicated homicide except for the delirium. The following case, quoted by the same author, illustrates a wound of very unusual nature and situation, which might have been taken for a homicidal wound with intent to conceal as far as the situation of the wound was concerned. The wound was accidental and occurred in the following way. A girl fifteen years old jumped on to her uncle’s knee while he was holding a stick between his legs which she did not notice. The Stick passed up her anus, but she withdrew it and went on playing, though she complained of pain. On the following night acute symptoms of peritonitis set in, and she died of it in forty-eight hours. On post-mortem examination a rent was found in the anterior part of the rectum penetrating the peritoneal cavity.

=The Situation or Position of the Wound.=—A suicidal wound must be in such a position that the deceased could have inflicted it himself. Such wounds are, therefore, generally anteriorly or laterally situated. The “site of election” for suicidal wounds is the neck for incised wounds and the chest, especially in the region of the heart, for punctured wounds. The situation of suicidal wounds, of lunatics, etc., shows all kinds of fantasies. The mere situation does not suffice to distinguish suicidal wounds, as a murderer may simulate a suicidal wound for purposes of concealment. Some regard a wound in the back as proof against suicidal origin, but it is not so much the situation of a wound as the situation taken in connection with the direction which furnishes the proof against suicide in such wounds.

As a rule, a suicidal wound, besides being in an accessible part of the body, is also in a part commonly known to be rapidly mortal, as the neck and heart. But suicidal wounds are not always in the situation which is anatomically best for being rapidly fatal. Concealed wounds or wounds in inaccessible parts presumptive of murder may be suicidal and so placed to impute them to another and give rise to the suspicion of murder. The blood-vessels of the arms and legs may be selected as the site of a suicidal wound. This situation is often regarded as uncommon, though the writer has met with it in one or more cases of attempted suicide. It is illustrated in the famous case of Abdul Aziz, the Sultan of Turkey. He was found dead under suspicious circumstances with two oblique, ragged wounds at the bend of each elbow, directed from above downward and from within outward. The joint on the left side was penetrated, while only the skin and veins were involved on the right side. Death was due to bleeding from the ulnar artery and the veins. The clothing was soaked with blood and scissors stained with blood were found on the sofa. These wounds were consistent with suicide, though not what would be expected. Nineteen physicians who examined the body agreed in reporting it as suicidal, though one reason given for this opinion, namely, “that the direction and nature of the wounds, as well as the instrument which might have effected them, lead to the conclusion of suicide,” was hardly a valid one, for the wounds were not typical of suicide in nature, direction, or position. Such wounds are rarely homicidal, though at least one such case is mentioned.

Suicidal incised wounds, as has been said, are usually in the neck, where they may sometimes be arrested by the larynx, especially if it be ossified, though the incision often divides the larynx. The situation of the wounds is often between the larynx and the hyoid bone, and then meeting no bony resistance, they may divide the great vessels and even nick the vertebræ. But it is rare to be so deep, at least on both sides at once. As a rule, it is deepest on the side on which it is begun and ends more superficially. As far as the situation of a wound is concerned, there is no wound which a suicide can inflict but what may also be inflicted by a murderer. The reverse, however, is not true. We cannot always certainly distinguish between suicidal and homicidal wounds from their situation.

=The direction of the wound= is one of the most important points to notice. It is considered by some to furnish presumptive evidence for the medical jurist, and taken in connection with the nature and situation of the wound may often lead us to a positive opinion as to the question of the suicidal or homicidal nature of a wound. The evidence from the direction of wounds is only furnished by incised and punctured wounds, rarely by contused wounds. Suicidal incised wounds of the throat are almost always directed from above downward and from left to right if the suicide be right-handed, and in the same direction from right to left if the person be left-handed. Transverse wounds in this situation without obliquity are also compatible with suicide, though perhaps more common in homicide, while obliquely transverse wounds from above downward and from right to left in a right-handed individual are indicative of their infliction by another. Homicidal incised wounds of the neck inflicted from behind or the right side, if the victim and assailant are right-handed, or from the left side if they are left-handed, may have the same direction as similar suicidal wounds. Such a wound may be inflicted by a murderer to deceive as to the cause of the wound by raising the suspicion of suicide. If an incised wound of the throat be inflicted by another from in front, then its direction is usually the reverse of a similar self-inflicted wound.

Homicidal incisions, especially in the throat, may extend at one or the other end beyond the skin wound. In similar suicidal wounds at both angles of the wound the skin is the first and the last part injured, and in such wounds the spine is seldom reached. It should be borne in mind in this connection that a given suicide may be ambidextrous and this fact may be unknown to the friends of the deceased. This is especially the case in the use of the razor from practice in shaving, and the razor is the usual weapon used in such incised wounds of the throat. Neglect of this point may lead to an unwarranted suspicion of murder. The two following cases cited by Taylor[642] well illustrate this fact:

In the case of Sellis,[643] the man was generally supposed to be right-handed, though he was found dead in bed with his throat cut and the razor on the left side of the bed. In point of fact, he was ambidextrous in the use of the razor. The second case, which occurred in London in 1865, was still more remarkable.

A publican was found dead in bed with his throat cut in a left-handed manner. He was supposed to be right-handed and there was bloody water in a basin in the room. His wife, who gave the alarm, had marks of bruises on her, and though she said she had found her husband dead in bed after having left it for a short time, suspicion fell upon her, especially as they were in the habit of quarrelling. The suspicions were removed, however, by the explanation that he had been brought up as a wood-carver, which required him to use both hands equally, and that he had frequently threatened to kill himself, and further that the bloody water in the basin was due to a daughter washing her hands after having touched her father. It is even conceivable that an ambidextrous person, to avoid suspicion of suicide or to impute murder to another, might inflict a suicidal wound from right to left. Notwithstanding all this, the above cases are very rare exceptions, and the rules stated above as to incised wounds in the throat hold in almost every case.

In the case of stab-wounds of the chest, especially in the cardiac region, the same rule as to the direction holds good, and in these wounds we can often define the direction more accurately than in the case of incised wounds. If the suicide is right-handed the wound is regularly on the front or side of the body and directed obliquely from above downward and from right to left, while it is from left to right in case of a left-handed suicide. A murderer from behind, or from that side the hand of which the victim would use, may inflict a wound in the same situation and direction as a suicidal one. Here again this may be done with the motive of concealment of the nature of the crime. Homicidal stab-wounds inflicted from in front, as they generally are, are usually directed from left to right, and they may be directed from above downward or in the opposite direction. Oblique wounds from above downward may be either suicidal or homicidal; those directed from below upward are almost always homicidal.

When a wound is caused by an instrument both cutting and puncturing, suicide cannot be admitted unless the direction of the wound is compatible with that which the weapon which inflicted the wound, held in the hand of the deceased, might cause. Taylor recommends to place the weapon in the hand of the deceased to see if the direction of the wound could possibly correspond with that which could be taken by the weapon in the hand of the deceased with any position possible for the arm and hand. Therefore certain wounds by position and direction exclude suicide, but if a wound is possibly suicidal it is also possibly homicidal.

Though suicidal wounds vary, the above points are sometimes of real assistance in distinguishing between suicide and homicide, especially if the body has not been moved.

=Evidence Furnished by the Number and Extent of Wounds.=—Multiplicity of wounds, as a rule, indicates homicide, and indeed the reverse is true in a majority of cases that a single wound points to suicide. There are many exceptions, however, to both statements. Multiple wounds are possible in suicide, and that, too, with different weapons; even drowning or hanging may be resorted to after self-inflicted wounds have failed. If several wounds are found, each one of which or more than one of which may be considered grave, it is usual to conclude that the wounds were not self-inflicted, but the medical expert should not judge too hastily from this fact alone, for most wounds do not kill instantly. With the presence of several wounds in a case of suicide only one of these, as a rule, is “mortal” in character. This being so, some have asserted that if two mortal wounds are present, especially if one of them is stupefying, such as a wound about the head, such wounds are incompatible with suicide. A definite statement of this kind cannot go unchallenged unless the two wounds are in different parts of the body, and both of such a nature as to be immediately or very rapidly fatal. For all cases of suicide or homicide do not die immediately from wounds commonly called mortal; in fact, this may be said to be the exception rather than the rule. We may safely say, however, that if there are several distinct wounds on the throat, each involving the large vessels, the inference is plainly murder.

Several wounds by the same or different weapons cannot, therefore, be proof of homicide. The case of a lunatic suicide is reported who inflicted thirty wounds upon his head. In a case of homicide with multiple wounds the situation or direction of some one or more of them may give evidence as to the origin of the wounds. Ogston, Sr.,[644] states that especially in the case of incised wounds of the throat a suicide may make a number of small or superficial tentative cuts besides the principal one, but these incisions are all usually parallel (see Fig. 10). In the case or multiple homicidal incised wounds of the throat, on the other hand, the wounds are not parallel, owing probably to the resistance of the victim in this case and his remaining passive in the former. The extent of the wound refers to the number and importance of the parts injured. In regard to incised wounds of the neck, this point has been thought by some to furnish presumptive evidence of suicide or homicide—of homicide if the wounds are deep, of suicide if they are not. While it is true that suicidal wounds of the neck are, as a rule, not very deep, and that they seldom reach the vertebræ and generally do not divide the vessels on more than one side, yet sometimes such wounds are as deep and extensive as homicidal ones. This may imply a determined purpose not to be foiled in the attempt at suicide. Thus Marc reports a case of suicide by an incised wound of the neck, where the wound was so deep as to reach the vertebræ or their anterior ligaments and to divide the trachea and œsophagus, both carotids and jugular veins. The extent of this wound was greater than in most suicides, but still we can hardly lay down a hard-and-fast rule of much practical value according to which extensive wounds are evidence of murder. Such wounds are, however, presumptive of murder taken in connection with other signs pointing that way.

The question may arise in regard to a wound, whether the victim wounded himself by precipitating himself on the weapon. This may be alleged by the defence, but it is difficult to believe if the wound is deep, for the body would naturally repulse the weapon. If the wound is deep the weapon must at least have been strongly held, which may or may not be consistent with the theory of self-defence. If the direction of the wound is oblique from above downward, or if there is one external wound and two separate tracts internally, from a second use of the weapon on the part of the person holding it, then the above allegation is doubtful, if not impossible.

By comparing the relative positions of the deceased and accused, as indicated by the witnesses and accused, with the position and direction of the wound, we may often judge whether the allegation is possible or probable.

Besides the above points derived from the wound itself, there are several other factors which belong to the category of circumstantial evidence, but which come within the province of the medical expert. These latter points of evidence are sometimes almost as important as the former, while taken in connection with them they help to make the evidence far more conclusive.

=Evidence furnished by the weapon= as to the origin of wounds.

We have already seen in a former section that we can often tell, by various signs of the wound, with what kind of a weapon it was made. We may thus be able to say that a wound was made by a weapon similar to one exhibited. Also by examination of the weapon itself and from the circumstantial evidence of where and how it was found, we may sometimes say that the wound was inflicted almost certainly with a particular weapon. All this evidence may sometimes be made use of in judging between the suicidal and homicidal origin of a wound.

The POSITION of the weapon or the place where it is found is a matter of considerable importance. If it has not been touched, its position should be carefully examined, or inquired about if it has been moved. The presence of a weapon which might have caused the wounds in the hand of the victim is in general proof of suicide. The weapon must not merely lie in the hand, it must be gripped by the hand. One might suppose that the weapon placed and held in the hand until rigor mortis sets in would still be firmly held. Casper says that this is not so, but that the weapon falls from the grasp as soon as the hand is unbound. Also Hofmann’s[645] experiments proved the same point. By the use of ligatures and several artificial means he tried to confine a weapon in the hand of a recently dead body so that it would be as firmly held as by a contraction of the muscles during life. These experiments were entirely unsuccessful, for though the fingers remained closed, the object was simply held and not grasped, and fell from the hand on the release of pressure.

In suicide the weapon is sometimes held so firmly that force is required to dislodge it. It seems as if the muscular spasm or grip persists after death, as cadaveric spasm, until rigor mortis occurs and sets it, as it were. The murderer, therefore, cannot imitate this grip, and an unsuccessful attempt to do so would indicate murder. It should be borne in mind that the weapon in the hand of the deceased may have been for the purposes of defence; therefore it is necessary to note whether the wounds on the body correspond to those which could be made by the weapon. Indeed, this fact is most important to note in all cases of suspected suicide where the weapon is found. If the weapon is not in the hand of the deceased, note carefully where it lies. If death is due to a suicidal or accidental wound which is immediately or very rapidly fatal, the weapon is generally found near the body. If so, it is well to note on which side it lies, and if it lies near, whether it has apparently fallen or been thrown or placed there. If the relation of the body and the weapon has been disturbed by moving either, the position of the weapon as found by the medical witness is of little value. In cases of suicide the weapon may possibly be found at some distance or even concealed, though this is exceptional. Thus Taylor[646] states that the razor in one instance was found shut at the side of the deceased, who had committed suicide by cutting his throat. In another instance the razor was found in the pocket of the deceased, bloody and closed. As a rule, the weapon is found lying at the side of a suicide if it is not grasped in the hand. If the weapon is far from the body and the wound was quickly fatal, especially if the weapon is hid or cannot be found, it is strongly presumptive of murder. If the weapon is found near the body it is well to note whether the edge is sharp or blunt, straight or bent, or notched, as these points may assist us in forming a judgment as to suicide or murder.

A weapon belonging to the victim may be substituted by the murderer for the one really used, and the former may be placed by the side of the body. Therefore the weapon found should correspond to the wounds as to length, depth, sharpness, etc., to be compatible with suicide.

Generally a suicide foiled in the attempt to take his life uses the same weapon over again if he persists in the attempt. But he may not do so; on the contrary, if the first attempt was made with a knife, the second may be made with a pistol, etc. Several wounds by the same or different weapons cannot therefore be an absolute proof of homicide.

=The presence of blood, hair, and other substances on the weapon= used, or probably used, is a matter of some importance. Blood is not necessarily found on the weapon used to inflict a mortal wound, especially in the case of blunt instruments. In stab-wounds, too, the vessels may be compressed by the blow or the weapon may be wiped as it were on withdrawal by the elasticity of the skin and by the clothing, except for a thin yellowish film. Thus it is that the first stab-wound shows no blood on the outside of the clothes but only on the inside, but the outside of the second is usually bloody but may be but little so. To make sure whether or not there is blood on a knife or other weapon it is necessary to examine all the depressions on the instrument, as the blade itself may have been washed, and only those traces of blood remain which are less accessible to cleaning by washing. Blood coagulated on a blade indicates, as a rule, blood from a living animal, but it may not do so. Furthermore, it may be hard to distinguish between a thin layer or spots of dried blood not coagulated or coagulated and dried blood in a similar form.

If blood is not found on a weapon, hair and other substances which can be identified may be. This is especially the case with blunt weapons, on which, as we have seen, blood usually fails. A fragment of the weapon may break off in the wound, as in stab-wounds, and may be identified as belonging to one in the murderer’s possession.

=The signs of a struggle= furnish important evidence, as they are not likely to be found in the case of suicide. If the wounds were inflicted by a cutting instrument, the existence of a struggle may be indicated by incisions on the palm of the hand or fingers or on the dorsum (see Fig 12). Such wounds would not be self-inflicted and would indicate a struggle with the murderer. Or if contusions or ecchymoses indicating the form of the foot, fist, fingers, or finger-nails are found on the face, neck, chest, forearm, or hand of the deceased, this again indicates a struggle with the assailant, and goes far to prove murder. The same is true of the imprint of a bloody or dirty hand on the clothes of the victim when the victim’s hands were not bloody. Also such an imprint in a position where the deceased could not have reached with the particular hand indicated, as is the case if the impression of a right hand be found on the victim’s right arm; this indicates a struggle with a murderer, etc. In one case of murder, on the back of the left hand of the deceased there was found the bloody mark of a left hand evidently not that of the victim himself. The presence of marks of violence about the mouth of the deceased, done to close it to prevent the victim from giving an alarm, especially if surprised during sleep, is presumptive of murder. Sometimes hair or fragments of clothing belonging to the accused are found in the grasp of the deceased, indicating a desperate struggle, and they are very suspicious of murder. Thus Taylor[647] cites the case of a murder trial in Ireland, in 1877, where hairs found firmly grasped in the hands of the deceased were found to correspond to the hair of the accused. The clothes of the deceased, as well as those of the accused, often indicate a struggle unless the accused can satisfactorily account for the condition of his own clothes in some other way.

=The examination of the clothes and body= of the deceased and the accused may furnish important evidence.

If suicide is accomplished by a weapon like a knife, it is rare for the hand not to be bloody. If it is not bloody we may well suspect a case of supposed suicide. The presence of blood on the hand does not prove suicide, though its absence may disprove it, as the hand is generally bloody in case of murder by being carried to the wound.

The examination of the clothing of the deceased is of great importance. As we have noticed before, a suicide generally opens them, a murderer rarely. A suicide is often partly or even wholly undressed when he inflicts the wound, while murder is usually committed on those entirely dressed. The wound of the clothes should correspond to that of the body in case of murder. In suicide the wounds of the body and of the clothes may not correspond, especially if there exists a motive to falsely impute the crime. The clothes of the deceased as well as those of the accused may indicate a struggle, as we have already noticed. Of course, in regard to the clothes examined, it is necessary to clearly prove that they were worn at the time by the deceased or accused, otherwise serious mistakes may be and sometimes are made. In examining the blood-spots on the clothing, note whether the blood occurs in large patches or sprinkled as by a spurting vessel or by continued violence.

The body of the accused may present scratches, marks of nails, contusions, bites, or other wounds indicative of a struggle. It would be well to ask the accused how he received the wounds or scars, to see if his explanations tally with the injuries. It is hard to tell when wounds which have cicatrized were inflicted; we can only distinguish between old and recent ones, and thus control the statements of the accused. An examination of the finger-nails of the prisoner soon after the crime may reveal blood underneath when the rest of the hands and person are free from it. Note also the site and shape of the blood-spots, if they exist, and whether or not they came from an arterial jet. These spots may be on the body or clothes of the accused. The account of the accused as to these spots may or may not correspond to the facts as indicated by them. The above leads us to the more or less important question:

COULD THE ASSAILANT HAVE ESCAPED WITHOUT STAINS?

It is possible for the murderer to escape without being spotted with blood, but the probability of this occurrence depends on the nature of the wound and the relative positions of the deceased and the assailant at the time the wounds were inflicted. This latter fact is very largely, if not altogether, a matter of speculation as far as the medical evidence goes. It is a popular, though false, idea that a murderer’s clothes must be bloody, and the police may be misled in expecting to find them so in every instance. Taylor[1] cites several cases in which either no blood was found on the murderer’s clothes, or only small spots wholly out of proportion to the amount of blood which must have spurted or flowed from the wound. Absence of blood on the prisoner’s clothes is often made use of by the defence to prove the prisoner’s innocence, whereas, besides the possibilities of having had no spots in the first place, the clothes may have been changed or washed before the examination was made. This has occurred in more than one murder trial. Taylor[648] mentions the following cases in illustration:

It was alleged that the absence of blood-stains on the prisoner’s clothing was a strong proof of his innocence in the trial of Sub-Inspector Montgomery for the murder of Mr. Glasse (Omagh Ass., July, 1873). In this case the weapon was a bill-hook which had produced contused wounds on the head. There was blood on the floor about the body, but the wounds were not likely to have been accompanied by much spurting. Yet it was assumed that the assailant in this case must have been covered with blood. Much stress was laid upon the absence of blood-stains. On the first two trials the jury could not agree, owing chiefly to the absence of blood-stains, but on the third trial he was convicted and afterward admitted that he had removed the blood-stains from the clothes with cold water. Also in the case of Reg. v. Courvoisier (C.C.C., 1840) the accused, who was tried for the murder of Lord William Russel, had no blood-stains on his clothes. All the vessels of the throat of the deceased had been cut to the vertebræ while he was asleep. It was contended most strongly that the accused could not possibly have committed the crime, as he had no blood-stains. But after conviction he confessed that he wore no clothes when he committed the murder, and he only had to wash his hands and the carving-knife he used. Again, in the case of Reg. v. Thompson (Durham Wint. Ass., 1863) the defence mainly relied on the absence of blood on the prisoner’s clothing. The wound in the throat of the wife of the accused was five inches long, directed from left to right, dividing all the vessels and nerves of the neck. The medical witness stated justly that no such wound could be self-inflicted. It was rapidly fatal. No weapon was found near the body. The prisoner was convicted.

The same author cites the case of a prisoner on whose trousers worn soon after the murder no blood-marks were found, but the trousers actually worn by him were found with blood upon them. Juries have even acquitted the prisoner apparently only because no marks of blood were found, though the other circumstances were explicable only on the theory of murder.

It should be remembered in this connection that blood-stains may be found on the clothing of many, especially on the coarse clothing of working-people. This may be accounted for by the occupation, flea-bites, accidental circumstances, or it may occur without definite explanation. Such persons may be accused of murder and yet the blood-stains be consistent with innocence. Too much importance should not, therefore, be attached to them, even if the accused cannot satisfactorily explain them and if he does not attempt to do so in a suspicious way. That blood on the clothing even under suspicious circumstances may be consistent with innocence is illustrated by the case of a suicide by cutting the throat, in 1872, cited by Taylor.[649] In this case the son first found his father dead, and thought that he had broken a blood-vessel. He raised the body, staining his hands and clothes, then went for help. At the inquest he was closely questioned as to the presence of the blood-stains, but there could be no doubt that the case was one of suicide.

In general, we may say that a murderer is much more likely to escape without blood-stains in contused wounds, and more likely in the case of punctured wounds than in incised wounds, for in punctured wounds the bleeding is much less free and is less likely to spurt from the wound. In the case of incised wounds he is most apt to escape without stains if he is behind or to the side of the victim when he inflicts the wound—in other words, when a part of the body of the deceased was between the assailant and the wound inflicted. Furthermore, the assailant is more likely to escape without blood-stains if there is a single wound than if there are several, and each additional wound makes it more likely that he will be spotted with blood.

The examination of the ground or floor and the furniture, etc., may furnish some evidence as to the nature of the crime, and also help the witness to answer the questions which may sometimes be asked, i.e., AT WHAT SPOT WAS THE VICTIM WOUNDED? and WHERE DID HE DIE? This question is sometimes settled by examination of the spot where the deceased lay and the furniture, etc., about. Sometimes the floor or ground and the furniture or surrounding objects at a distance give the requisite evidence. The examination of the cracks and corners of the floor and furniture should not be neglected, and Taylor instances a case where the hair of a dog helped to clear up the case. If the body has not been disturbed the most blood is usually found where the deceased died. If the victim succumbs at the spot where he was wounded, blood is found only in the immediate neighborhood, except for arterial jets, which may be as far distant as two metres. The separate blood-spots of an arterial jet are circular if the jet strikes the object perpendicularly, oval or wedge-shaped with the larger end away from the body if it strikes the object obliquely.

If the blood-stains are more diffused and are found in other places, careful notice should be taken as to whether the different places communicate with one another by traces of blood. If they do not communicate, it goes to show that the body was moved after active bleeding had ceased, that is, after death, but this indication is not absolutely positive. If traces of blood do connect the larger blood-spots, it is of interest and importance to know where the deceased was wounded and where he died, also whether he moved or if he was moved before or after death. This question is not always capable of solution. Some injuries exclude the possibility of active motion. Stupefying contused injuries of the head or an incised wound opening a great artery are both inflicted where there is the greatest hemorrhage, and the spot where the deceased was wounded and died should be identical. In such cases a second large spot of blood, connecting or not with the first wound, indicates that the body has been moved. But if the wound does not bleed much or rapidly, the wounded person may fall at a distance from the spot where he was injured, and death occurs, as a rule, where there is the greatest amount of blood; for a certain amount of bleeding occurs for a short time after the victim falls or even after death. One can find in many places the signs of arterial jets marking the movement of the deceased from one blood-spot to another. This is quite different from the tracks caused by dragging a bleeding body. All this it is important to notice, for the dragging or passive moving of the body strongly indicates murder. Blood at a distance may indicate the occurrence of a struggle, or that the body was moved, or it may show the tracks of a murderer. As to the latter point, the imprints of the hands and feet, whether bloody or not, may indicate murder and establish the identity of the murderer. We have already seen how they may occur on the deceased and indicate a struggle, and thus be presumptive of murder. When the marks are made by the naked foot, it is well to examine it by lining it off in squares, and so to compare it with the imprint of the foot of the accused. Simple inspection can sometimes give the required evidence. We may even get an impression of such imprints in the snow. Imprints of the boots or shoes worn by the accused compared with those imprints found at and near the scene of the crime may sometimes help to clear up the case, but this may perhaps be considered outside of the sphere of the medical witness. Such and other signs of a struggle about one of the blood-spots would indicate that the wound was received there, though death may have occurred at another spot. In such a case it would be well to examine to see if there was much blood where the body was found, for if there was not it would indicate that the body had been moved there after death, and thus be strongly presumptive of murder.

As furnishing some evidence which may help to distinguish between suicide and homicide in the origin of wounds, the question may be asked, WHAT WAS THE POSITION OF THE VICTIM WHEN INJURED OR DYING? and also, WHAT WERE THE RELATIVE POSITIONS OF THE VICTIM AND ASSAILANT?

The position of the victim at the moment of the injury is sometimes indicated by the position of the wound, the direction of its tract, and the direction from the wound of the blood on the body and clothes. On the neck or extremities the course and form of the wound may indicate the position of these parts when the wound was inflicted, for sometimes in flexions of these parts the skin lies in folds, and a wound inflicted when these parts were so flexed would be irregular, wavy, or zig-zag. Further, the position and movement of these parts necessary to restore directness to the wound may indicate the position of the parts when the wound was inflicted. The examination of the relative positions of the wound in the clothes and the body may help to indicate the position of the body when wounded. The position of the blood on the body and the direction of the blood from the wound, whether below or at the sides, etc., tends to show the position of the body when bleeding. Thus if the body was at any time in the erect position, some of the blood-stains will be vertically below the wound, or if the victim was lying on the back then the stain would be at the sides only and not below the wound, except such stains as indicate that they were produced by arterial jets. Few suicides cut the throat in the recumbent position; therefore it may be considered in the light of an indication of homicide if the blood-stains show that the victim was not erect after the wound was inflicted. It is well also to note the form, direction, and obliquity of the blood-spot. This would indicate, by comparison with the wound, the relative position of the wounded person and the blood-spot, and thus show whether the body had been moved or not, as, for instance, by the murderer for the purpose of robbery. The force of the bleeding is also indicated by the form of the spot, and this would indicate how rapidly death probably ensued. This fact might thus help us to judge whether the victim probably died where he was wounded, and whether other and remote blood-spots would not be presumptive of murder. If the victim is found in night-clothes, this fact would help to show that he was lying down when wounded. The medical evidence as to the position of the victim when injured is, therefore, circumstantial and not very positive; that in regard to the relative position of the victim and assailant is even less positive. We presuppose in this question that the case is one of murder. We are not to prove murder or refute suicide. We can rarely be positive as to the relative position of the assailed and the assailant. A wound in the back may be caused by some one in front with an arm behind. The direction of the wound would indicate this, for if the assailant is right-handed and inflicts a wound on the back from in front, a stab-wound would almost always be directed from left to right, an incised wound from right to left, both from above downward. With a left-handed murderer the direction would most likely be from right to left and from above downward for a stab-wound, and from left to right and from above downward for an incised wound. If the assailant were at the back of the victim and wounded him in front, the direction of these wounds would be the opposite of the above, i.e., from right to left for a stab-wound and from left to right and from above downward for an incised wound with a right-handed assailant and vice versa with a left-handed assailant. These wounds occur more commonly than those of the back, and are especially noticeable in incised wounds of the throat. In the case of these incised wounds of the throat inflicted from behind, the direction from left to right and from above downward resembles that of self-inflicted wounds in the same situation. As a general rule, wounds are on the same side of the victim that the assailant was; the facts given above help to show us the exceptions. Thus a wound on one side is presumptive that the murderer was on that side, or possibly at the front or back and only exceptionally on the opposite side. The presence of wounds on one side only may help to confirm the testimony of a witness that the victim was against a wall or some other obstacle which protected the other side. The question of the relative position of the combatants in duels and the nature of the weapons used as shown by the wounds has sometimes come up, especially in other countries, to determine whether the combat was regular and fair.

In all cases of suspected suicide, but where a doubt exists between suicide and murder, or even accident, hereditary disposition and organic affections of the body, such as alcoholism, incurable or painful diseases, chronic inflammation of the brain and meninges or of the genito-urinary organs—all such and hereditary predisposition may support the idea of suicide.

IMPUTED OR SELF-INFLICTED WOUNDS.

Closely allied with the question of the suicidal or homicidal origin of wounds is the question whether a wound imputed to another is self-inflicted or inflicted by another. These wounds are seldom fatal. In discussing the question whether a wound is self-inflicted or inflicted by another, we have referred occasionally to suicidal wounds where the circumstances were such as apparently purposely to imply murder and impute the cause of death to some one else. This happens more often in cases of unsuccessful suicide. Here we have recourse to the same evidence that we have gone over in the present section which helps to distinguish between a suicidal and a homicidal wound. The case may be somewhat more difficult, as the unsuccessful suicide may manufacture evidence against the accused and hide to some extent the evidence of suicide. These cases can usually be decided, however, in connection with the circumstantial and other evidence. The majority of cases of imputed but self-inflicted wounds are very superficial, often not below the true skin. Being self-inflicted they have many of the characters of suicidal wounds. Thus they are usually situated in front and on the left or right according as the wounded person is right or left handed, and the direction is usually similar to that in suicidal wounds. Such wounds are generally incised or punctured wounds, seldom contused wounds, and in this respect they resemble suicidal wounds. As exceptions to this rule, Bergeret[650] mentions some cases where females in attacks of hysteria have inflicted severe contusions on themselves, and have preferred charges of attempted murder against innocent persons. Like suicides also the hands are seldom injured, though they may be much so in resisting homicide.

In other respects, however, these wounds differ from suicidal wounds. Thus they are not usually situated over a “mortal” spot, and they are often numerous and scattered, sometimes parallel and sometimes not. The wounds in the dress do not correspond even as often as in suicide. In comparing cuts in clothing with those on the body, it is important to find what articles were worn at the time the assault was alleged to have taken place, and to make sure that the clothes examined were those worn or alleged to have been worn. It may not be necessary that the clothes examined should have been really worn, for if they were alleged to have been worn and were not, the examination of them will almost always show the deception or the self-inflicted nature of the wounds. Then take careful note of the position, direction, form, and size of the cut and the apparent sharpness of the weapon in the several layers, and see if they correspond with one another and with the wounds on the body in those various particulars. In imputed wounds the clothes are generally cut when off the body and can seldom be done so as to deceive a careful examiner. Several wounds cannot exist in the same region of the body without some being bloody and showing the marks of it on the clothes. Even a single wound of the clothes generally shows blood on the inner surface if there is a corresponding wound of the body underneath. In simulated and imputed injuries the blood-stain may be on the outside of the clothing instead of on the inside, showing that it was artificial and not natural. An impostor may either do too much or too little, and the medical witness should be on guard against both alternatives. Taylor[651] mentions a case which occurred in London some time ago, in which there were two cuts in the shirt near together exactly alike in size, form, and direction, making it evident that the weapon had gone through a fold of the shirt. This proved that the shirt could not have been worn at the time it was cut, for if the shirt was folded while on the body the weapon must have gone through the fold and then through another layer of shirt, making three cuts instead of two, or five instead of four, before it could have reached the body. This and other facts made self-infliction of the slight wound on the chest probable. The same author cites another case showing the imperfect manner in which the cuts in the clothes are made in imputed wounds, the clothes being off the body at the time. The case occurred in Nottingham in 1872, the accused being charged with wounding the plaintiff on the highway by stabbing him in the arm, though there was no robbery or other motive for the act. The coat and shirt sleeve were found cut, but there was no corresponding cut in the lining of the coat sleeve. The charge was clearly false, and was trumped up by the youth who was the plaintiff because he wished to leave the place where he had been sent for private study.

In examining a case where the self-inflicted nature of imputed wounds is in question, the following are some of the many points to keep in mind in the examination and to be ascertained by the examination: (1) The relative position of the plaintiff and the assailant at the time of the alleged attack. This can be compared with the position as stated by the plaintiff or other witnesses. (2) The situation, direction, depth, nature, and number of the wounds. (3) The situation and direction of blood-marks or wounds on the dress or person of either or both. (4) The marks of blood and the quantity of it at the spot of the alleged struggle. (5) The signs of a struggle and the various other points of circumstantial evidence gone over in considering suicidal and homicidal wounds.

Though a severe blow may cause a slight mark, it does not follow that a slight mark implies a severe injury, else the exception is made the rule. The inconsistency of the story of the plaintiff is generally so palpable that imposture is evident, but prejudice and unjust suspicion are often excited against those accused. Thus Taylor[652] states that “a strong suspicion was raised against the then Duke of Cumberland, in 1810, in reference to the death of Sellis, when a skilful examination of the wounds on the deceased would have shown that they might have been self-inflicted.” The same author also cites the case of M. Armand, a merchant of Montpelier, who at Aix in March, 1864, was tried for an alleged murderous assault on, or imputed murderous strangulation of, his servant. The excoriation on the back of the neck was so slight as to escape the observation of some medical men, and it was evidently self-inflicted, either accidentally or purposely, as the facts showed. The assertions of a number of medical men were taken by the court to support the servant’s story to the effect that his master had struck him a severe blow on the back of his neck, rendering him insensible for many hours from concussion of the brain. The evidence given chiefly by Tardieu for the defence showed the story of the complainant to be a fabrication, and the accused was justly acquitted.

WAS A WOUND ACCIDENTAL?

In answering this question we must distinguish accidental wounds from those self-inflicted and those inflicted by another. These three classes comprise all wounds. In case of a trial for murder it may be alleged by the defence that the wound was caused by accident or that it was due to suicide from a fall, falls being a common class of accidental wounds. So we have to judge between accident on the one hand and homicide and suicide on the other hand. The question arises especially in cases where the injury causing death is one commonly due to accident.

As to the QUESTION BETWEEN ACCIDENTAL AND SUICIDAL WOUNDS, they are often easily distinguished, especially if the body has not been disturbed. In suicide there is clear evidence of design, and the circumstantial evidence helps to make the case clear. It may not always be possible to decide, however, as an accidental wound may sometimes resemble a suicidal or homicidal one. Accident is often shown by the nature of the wound. Thus it is rare for an accidental mortal wound to be caused by a knife or similar weapon held in the hand and forced into the body by a fall, the blow of an opening door, etc. But such exceptional cases have been reported. Incised and punctured wounds are, therefore, very rarely accidental, and most accidental wounds are contused wounds or contusions.

Again, accident is often shown by the situation of the wound, which should be on an exposed part of the body unless the accident is due to a fall from a height, when the wound may be almost anywhere. But such injuries are easily shown to be due to falls. The fall, of course, may be accidental, suicidal, or homicidal. Some wounds in exposed parts forbid accident on account of their nature, i.e., deep incised wounds of the throat. If the deceased has a life insurance, suicide is less probable, as the insurance is not paid in case of suicide. In fine, accidental wounds are distinguished from suicidal by—(1) Their nature; accidental wounds are almost always contused, suicidal very rarely so, only in cases of lunatics and delirious persons and where suicide is accomplished by a fall. (2) The situation of the wound or wounds indicates their origin. We have already studied the situation of suicidal wounds and have also seen that accidental wounds are only on exposed parts, except when the injury clearly indicates a fall from a height. The evidence from the direction of wounds rarely applies, as this is valuable only in incised and punctured wounds, which are seldom accidental. Both kinds of wounds are usually few in number except in case of a fall from a height or a crush, though sometimes suicidal wounds are multiple.

The evidence from weapons, if there be any, points strongly to suicide. The signs of a struggle are hardly consistent with either suicide or accident. The only case in which they might occur would be where a struggle occurred to prevent a suicide from throwing himself off a height or before a vehicle or railway train. In such a case accident would be excluded by the signs of a struggle, and the question would lie between homicide and suicide. The examination of the clothes of the deceased would furnish no evidence unless some letter or paper were found stating the purpose of committing suicide. Little or no evidence would be furnished by the position of the body when found in cases which might otherwise be doubtful. Organic lesions or other facts predisposing to suicide would furnish presumptive evidence against the wounds being accidental. Of all these various points the first, as to the nature of the wounds, is by itself the most valuable and conclusive. But this gives us no assistance in clearing up a case where it is doubtful whether a fall from a height or a crush by a vehicle or railway train was accidental or suicidal. Some of the other points mentioned may aid us in such a case, and also the fact that such injuries are far more often accidental than suicidal. But in these cases, also, certain circumstances may show that the fall was not the result of accident.

Accidental wounds are generally caused by a fall or a crush, and the fact of their accidental character is generally established by the circumstances of the event. Certain accidental wounds present characteristics which allow the true nature of the wounds to be determined. But in some cases a suspicion may arise and the question may be asked as to WHETHER THE WOUND WAS ACCIDENTAL OR HOMICIDAL. For instance, if a person receives fatal homicidal injuries, and just before or after death the body is thrown from a height or is run over and crushed, it may be hard to determine the murderous element among the many wounds. This is the case if the homicidal wounds were contusions or were caused by blunt instruments, but rarely, if ever so, if they are incised or punctured wounds or both. But even in the former instance, a close examination of the lesions and of the locality of the injury can often clear up the case. Thus in a case mentioned by Vibert,[653] as cited by Hofmann after Taylor, a woman was found dead at the foot of some stairs in a cave. She had died of a fracture of the skull and of the spine, produced by the fall. But about four or five feet above the level of the top step there was found on the wall the fresh marks of an arterial jet of blood. Examination showed a wound in the right temporal region which had opened the temporal artery, and it was therefore thought that the woman was wounded at the top of the stairway and then thrown down, which was afterward proved to be true. In another case, reported by M. Tourdes, a man knocked down and killed by an axe, which crushed his skull and caused the brain to exude, was placed in a road frequented at night by heavy wagons. The head was placed in the rut, but the coagulated blood and brain formed a puddle which did not appear on the wheels or their track, and no bloody furrow was caused by their passage. The same author mentions the case of a woman plainly strangulated by the hands and then thrown into the ditch of the fortifications of Paris.

It is especially with regard to fractures of the skull that the question often comes up as to the accidental or homicidal nature of the injury, as to whether it is due to a fall or a wound. Sometimes a depressed fracture may show the form of the instrument. An extensive comminuted fracture of the skull may indicate greater violence than would be received from a fall from the little height which the circumstances may allow. As to the slighter degrees of fracture, the disposition of the fracture itself often shows less than the form and site of the ecchymosis, the lesion of the scalp, and the place and position of the body when found. In such cases the traces of a struggle, the existence of other wounds, etc., may be of great importance. In distinguishing between homicide and accident, as in distinguishing between the latter and suicide, the most obscure and difficult cases are those where the injury has been caused by a fall from a height or by a crush.

This is illustrated by the case of Madame de Tourville, which is quoted by Taylor.[654] She was killed in July, 1876, by a fall from a precipice. Her husband, a lawyer, was accused of murder committed by pushing her over a precipice in the Stelvio Pass. The place where her dead body was found was at a considerable depth below, and the injury was chiefly in the head, which had been crushed by the fall. The body showed no evidence of intentional violence. The prisoner’s guilt was established on the following points: (1) The false and inconsistent statements made as to the occurrence; (2) the marks of the body having been dragged some distance so that a part of the dress was found, in a bloody condition, some way from the body; (3) there were marks of blood on the prisoner’s hands and clothing. After a long trial he was convicted, though the sentence was afterward commuted to imprisonment for life. Of course, as we have already stated, if a person is responsible for a fall he is also responsible for the results of the fall. This applies to many of the contused injuries and deaths from falls in prize-fights and drunken brawls.

We may sum up the points of evidence which help us to distinguish between an accidental and a homicidal injury much as we did when the question lay between accident and suicide. (1) The evidence from the nature of the wound is not quite so conclusive as when the question lies between suicide and accident. For contusions and contused wounds are far more often homicidal than suicidal, and accidental wounds are almost always of this class. If, however, the wounds are incised or punctured, this fact points almost certainly to homicide. (2) As to situation, a homicidal wound may be situated almost anywhere; an accidental wound, except in falls from a height, only on an exposed place. (3) The direction of the wound can seldom help us in the case of contused wounds which, practically, are the only ones in question, though it may possibly be incompatible with accident. (4) As to the number of wounds, homicidal wounds are far more apt to be multiple either in a small area or scattered in such a way that an accident could hardly account for them all. (5) A weapon may give evidence more often here than when suicide is in question, for a weapon may be used to inflict contused wounds which may resemble those received in a fall. The evidence furnished by a weapon or blood, hair, etc., on the weapon, etc., is strongly in favor of murder. (6) The evidence from a struggle is also more important because it is more often found. A struggle may occur in homicide, and only in homicide, as a rule, so that signs of a struggle are strong evidence of murder and against the idea of accident. (7) The examination of the clothes and body of the deceased may give valuable evidence, showing, as it may, signs of a struggle or other marks of an assailant and indicating murder. (8) Examination of the position and attitude of the body and of the spot where it lay and the ground around may furnish more or less proof of murder, as in the case quoted above. Thus the track of the murderer may be discovered or the body may have been interfered with and moved or robbed, all indicating homicide.

In any case, whether it is desired to distinguish accidental from suicidal or homicidal wounds, those cases present the most difficulty which result from falls from a height or crushes. But, as the case of Madame de Tourville shows, the above given and other circumstances may often show even then that the fall or the crush was not the result of accident.

FALLS FROM A HEIGHT may, therefore, be the result of suicide, homicide, or accident. The injuries are similar in all three cases. A fall of six to eight metres causes, as a rule, numerous lesions, and shows such a traumatism that the case usually excludes the possibility or, at least, the probability that the wounds resulted from blows. Sometimes, however, the gravity of the lesion is not proportional to the height of the fall. Thus Vibert[655] relates the case of a man, afterward employed for several years in the École de Médicine, who jumped from the top of the column of the Bastile, a height of fifty metres. He rebounded on to some canvas stretched at the foot of the monument, then fell to the ground, and was able to get up and walk away. Curiously enough, he killed himself later by jumping from the top of an omnibus in motion. In the case of falls from a height, it is especially true that with grave lesions internally the skin may be intact or only slightly ecchymosed or eroded, or the ecchymosis may be only deeply seated so as not to appear superficially. In the latter case, if life had continued the ecchymosis might have shown itself at some spot on the surface in a few days, but these falls from a height are fatal as a rule. In falls from a height, besides ecchymoses, which may occur where there are no other injuries or may fail where there are many injuries, the lesions consist of fractures of bones and ruptures of internal organs, with or without surface wounds. The fractures may be of a number of bones, and especially of those which first touched the ground, though the skull may be fractured at some part whether or not it was struck in the fall. These fractures are often comminuted, especially fractures of the skull and pelvis, and when the fall is from a great height. Ruptures of muscles may occur with the fractures.

Ruptures of internal organs are not rare in such cases. According to Vibert,[656] the order of frequency of rupture of the various organs is as follows: liver, spleen, kidneys, lungs, heart, stomach, intestines, bladder, brain. Rupture of the liver occurs especially on the anterior and inferior surfaces and the bleeding is rather abundant. The healthy spleen does not rupture readily, except from a severe traumatism, but if it is hypertrophied it may rupture spontaneously from muscular violence. The lung may be ruptured internally without showing the rupture on the surface and with the ribs intact. Two such cases are mentioned by Vibert,[657] and he refers to others mentioned by Nelaton and Holmes. Rupture of the brain without fracture of the skull is very rare, though cases have been observed and reported, among others by Casper-Liman. In falls from a height the rupture of the aorta, mesentery, diaphragm, and larynx have been noted. It should be remembered in this connection that rupture of the liver, intestine, bladder, etc., may be caused by contusions without sign of violence externally, and such cases cannot, therefore, be attributed to falls unless there are other signs of the latter.

In crushes caused by a heavy vehicle, the lesions resemble in many respects those due to a fall from a height. Thus we find fractures and internal ruptures, but we more often and regularly find subcutaneous ecchymoses and ecchymoses between the muscles. The skin is often stripped up extensively and the injuries are generally limited to the region injured. It is rare to find that the cause of the injury leaves no trace on the skin, for it usually gives the form to the erosions or ecchymoses. Sometimes, for instance, the marks of a horseshoe are clearly visible. Ruptures of internal organs may occur here too when there are slight external marks of violence or even none at all. Thus Vibert[658] relates the case of a man with the head crushed, but with no signs of injury to the trunk save a few erosions at the level of the sternum, who had not only rupture of the kidneys, the liver, and the spleen, but also of the lungs and of the heart. In the heart the apex was completely detached and floating in the pericardium, which was intact. There was no fracture of the ribs nor subcutaneous or sub-muscular ecchymoses. The age of the subject was thirty-two, so that the costal cartilages were not probably ossified, which may have accounted for the absence of fracture of the ribs.

Crushes by the fall of heavy weights resemble the latter class of crushes, and differ from falls from a height in the fact that the wounds are usually limited to one region. The lesions themselves are more or less similar. Similar internal lesions may be caused by the compression of the chest and body by the knee of a murderer, which may occasion rupture of the internal organs, fractures of ribs, etc. Thus, too, from the pressure of a crowd the ribs may be fractured and the lungs injured. It is particularly in these cases of injury from crushes or falls from a height that we may have most difficulty, as far as the medical evidence goes, of distinguishing between accident, suicide, and murder. But the various points and considerations mentioned above will sometimes enable the medical witness to clear up the case. In some cases the non-medical evidence, circumstantial and otherwise, may be sufficient of itself, or at least in conjunction with the medical evidence.

In falls from a less high place the difficulty is somewhat different, for here there may arise the question between a fall and a contusion or contused wound, and the question generally lies between accident and murder, or, very rarely, between accident and suicide. We have referred to both of these questions above, and from the facts mentioned the case can often be solved.

OF MORE THAN ONE INJURY WHICH WAS THE FIRST INFLICTED?

We can sometimes tell the order in which wounds were received, but the question is rarely answerable with certainty. If one wound is mortal and one or more are not, whether the wounds are suicidal or homicidal, it has sometimes been considered that the former must have been inflicted last. But we cannot admit that as a general rule the most grave wound was the last inflicted. For the murderer or suicide, especially the former, may go on wounding after the infliction of a mortal wound, especially as it is the exception, and not the rule, to die instantly after a mortal wound. Several assailants may have inflicted wounds at the same time, which would still further increase the difficulty. The question might then arise, Which assailant had inflicted the mortal wound or which had first inflicted a mortal wound? Under such circumstances, it would not be easy to give a specific answer. There are several signs which may indicate which wound was first inflicted in certain cases. An instrument may become duller or even bent or twisted after and on account of the first wound, and the subsequent wounds would vary accordingly. The wound of the clothes corresponding to the first stab-wound may be and often is only bloody internally, while the second and following wounds are bloody on both sides. The following case quoted by Taylor[659] from the Annales d’Hygiene, 1847, p. 461, illustrates this point. A man received three stabs from an assailant, one in the back at the level of the eighth rib, traversing the lung and heart and causing rapid death, and two on the left elbow, cutting the coat and shirt but only grazing the skin. The first one was evidently the first inflicted, for both the wounds in the clothing on the arm were bloody externally at the edges, although there was no blood effused here. The correctness of this opinion was confirmed at the trial.

The point of a knife arrested and broken off in a bone may show that this was the last wound. The amount of bleeding may show which was the first wound. Thus if several severe wounds have been inflicted, all or several of which would naturally cause profuse hemorrhage, and one showed signs of such hemorrhage while another did not, the former would be likely to be the first wound inflicted. Or if one showed slight hemorrhage where much would be expected, this fact would indicate that it was one of the last inflicted. The absence of the signs of spurting blood may tell which of two or more fatal wounds were first inflicted, for this would indicate that this wound was inflicted when the heart action was weakened by loss of blood or even after death, and the other wound or wounds which did not present this sign would have been the first received. In fact, if any of the signs are present about a wound which we have seen to indicate that a wound was inflicted at any time after death, this would show that this wound was not the first received, and that the other or others were inflicted earlier.

Questions as to the CONSEQUENCES of WOUNDS NOT FATAL may often be brought up in civil actions for damages. In certain countries the question of the consequences as to incapacity may determine whether an injury shall be the ground of a criminal as well as of a civil action. Thus in France an injury which involves an incapacity of twenty days or more subjects the assailant to a criminal action. The term “incapacity” in this instance refers to general incapacity and not to incapacity for fine and professional work. The latter, however, comes in under the civil action which may be instituted against the assailant or those directly or indirectly responsible for the injury. The amount of the incapacity, its causes, whether due wholly or partly or not at all to the given injury, the probable duration of the incapacity, the treatment which it has and will necessitate, and many other such questions form part of the medical testimony required in such cases. Sometimes with slight wounds the results, accompaniments, and complications may prolong the incapacity very greatly, as also the state of health and the habits of the wounded person, the neglect of treatment, improper treatment, etc.

Any bodily or mental infirmity or ill-health which may result from an injury and its necessary treatment in the past and future, all these questions and many more unnecessary to mention may be required of the medical witness. No general rules can be laid down for all such cases. In giving his testimony the medical man must depend in any particular case upon his knowledge, judgment, and experience.

We can seldom give a precise solution of the question of survival to determine the succession or inheritance if several of a family die together in an accident. In case of death from inanition, cold or heat, or in drowning especially, if some have wounds more or less grave in themselves, we can sometimes form an opinion. With wounds we cannot often do so, although in case of murder, the nature of the wounds, the position of the bodies, the examination of the spot of the accident or tragedy, may sometimes help us to form an opinion.

INCISED AND PUNCTURED WOUNDS AND WOUNDS OF BLUNT INSTRUMENTS REGIONALLY CONSIDERED.

The several varieties of wounds which we have been considering vary considerably in their nature, their effects, their danger, and in many other ways according to the region of the body in which they are situated. Some of these varieties are common in one situation and almost never occur in others. Although the nature of wounds found in the several regions of the body is not as important for a medical jurist as their danger and their influence in causing death, we will now consider the differences they exhibit on account of the region in which they occur.

WOUNDS OF THE HEAD.

These are often characterized by their apparent harmlessness and their real gravity sooner or later. We might almost make the opposite statement and say that those apparently grave are often virtually harmless, though this would be true only in a limited sense and in certain cases.

As to their nature, we find punctured wounds extremely rarely, incised and lacerated wounds often, while contusions and contused wounds are still more common. Incised and lacerated wounds of the head involve the scalp almost exclusively. These wounds heal remarkably well, even when the attachment is merely by a narrow pedicle, owing to the abundant blood-supply. Hemorrhage from the incised wounds is often free, for the vessels cannot retract, but it is seldom dangerous unless the wounds are very extensive. The only way in which they differ materially from similar wounds elsewhere is in the greater frequency of complicating erysipelas here than elsewhere. This is probably owing to the presence of septic conditions, as the head is generally dirtier than other parts of the body, and slight wounds especially are neglected. If the scalp is shaved over a wide margin and cleaned like other parts of the body, erysipelas is found little or no oftener than with similar wounds elsewhere. The density of the scalp is so great that the redness and swelling accompanying inflammations is comparatively slight. If erysipelas follows slight wounds of the head, there is some reason to suspect constitutional predisposition or careless treatment. From infection of such wounds of the scalp abscess or diffuse cellulitis of the scalp may develop as well as erysipelas. The constitutional symptoms in such a case may be marked or even severe, but the prognosis is favorable. In very rare cases necrosis of the skull may result or the inflammation may even extend to the brain. These incised and lacerated wounds of the scalp are usually accidental or inflicted by another; they are rarely self-inflicted. Contusions and contused wounds are the most common forms of injury to the head. These two kinds of injuries are almost invariably inflicted by another or are accidental. We have already seen that contused wounds of the scalp or over the eyebrow may closely resemble incised wounds in these localities. This fact should be borne in mind, as careful examination can usually distinguish them if they are fresh and until they begin to granulate. These wounds are liable to the same complications as incised wounds, in fact more liable, as the contusion makes the wound more susceptible to inflammation and the edges are more apt to be infected at the time of the injury.

One of the results of contusions of the head is the extravasation of blood, most often between the aponeurosis of the occipito-frontalis muscle and the pericranium. These extravasations are usually in the form of a hematoma. Such hematomata often present a hard circular or oval rim with a softer centre, and may readily be mistaken for fracture of the skull with depression. The diagnosis between hematoma and depressed fracture is not usually difficult, however, for with hematoma the ridge is elevated above the level of the skull and is movable on the surface of the skull; also the wounded edges often pit on pressure. With depressed fracture, on the other hand, the edge is at or about the level of the rest of the skull; it is sharper, more irregular, and less evenly circular. Contusions and the resulting hematoma may occasionally end by suppurating, but this event is rare. Contusions and contused wounds may occasionally show the marks of a weapon, indicating that they were inflicted by another. Also the position of the injury will indicate its origin, whether it is accidental or inflicted by another, for the former would not naturally occur on the vertex unless the fall was from a considerable height.

Another result of injuries to the head, especially of contusions and contused wounds, is FRACTURE OF THE SKULL. This may be simple or compound, depressed or not, etc. Fractures are serious inasmuch as they imply a degree of violence which may do damage to the brain. The fracture itself, especially if properly treated, affords a good prognosis, irrespective of any brain lesion. One variety of fracture of the skull offers an exception to this favorable prognosis, and that is fractures of the base of the skull. These may be fatal directly from injury of the vital centres at the base of the brain or soon fatal from hemorrhage in these parts. Or the fatal result may be secondary to an inflammation or meningitis which good treatment is often unable to prevent. It should not be considered that these fractures are uniformly fatal, for quite a considerable proportion recover. Fracture of the base usually occurs as the result of a fall. The injured person may land on the feet or buttocks, and yet receive a fracture of the base of the skull, the force of the fall being transmitted through the spine to the base of the skull. Fracture of the base of the skull usually occurs from an injury to the vault, not by contre coup, but by extension of a fissure found higher up in the skull. This extension takes place in the same meridian line of the skull with that of the force which produced the fracture, and in this way the base of the skull is fractured in different parts according to the point and direction of the application of the force. Thus in case the force compresses the skull antero-posteriorly the fracture will pass antero-posteriorly toward the base from the front or the back, whichever received the blow (see Fig. 13). Fractures of the vault of the skull occasionally occur opposite to the point struck; this may occur by contre coup, but not always so, as not infrequently in such rare cases a close examination may reveal an extension of a fissure from the point injured to the opposite pole of the skull. The shape and rarely the size of a fracture of the skull, especially if punctured in character, may show the shape and more rarely the size of the instrument or object which produced it. Apart from fracture of the base, the prognosis in fracture of the skull is serious, mainly on account of the danger of inflammation, which is greater in compound fractures, and also on account of the more remote danger of irritation from depressed fragments causing epilepsy, insanity, etc., at a later period.

A circumstance that Taylor[660] says is connected with fracture of the skull with depression—namely, that the person, sensible as long as the object producing the fracture remained wedged in, became insensible and began to manifest other fatal symptoms as soon as it was removed—must be extremely exceptional. It may be explained, if it occurs, by the occurrence of hemorrhage after the object which occluded an open vessel by its presence or its pressure was removed. For it should be remembered that the symptoms of compression in a depressed fracture of the skull are very rarely due to the compressing effect of the depressed bone, but rather to an injury of the brain, intracranial hemorrhage, or a local and temporary interference with the circulation.

We may truly say that wounds of the head are dangerous in proportion as they affect the brain. The existence of affection of the brain may be hard to tell from the appearances, for an injured person may recover from the first effects of a comparatively slight wound and yet die suddenly later.

=Concussion= is the name applied to one of the effects on the brain of a more or less violent blow directly on the head or transmitted indirectly to the head. Though the term “concussion” implies a functional rather than an organic lesion, yet in the majority of cases it is equivalent to laceration of the brain. With laceration of the brain there is usually more or less effusion of blood which may be limited to a very thin layer. Concussion may exist without laceration of the brain. Even death has been known to occur from concussion of the brain without any visible signs of injury to the brain, so that the concussion must have been functional and the fatal result due to shock of the nervous system. Fatal concussion does not, therefore, necessitate the existence of compression or visible injury of the brain. Concussion may sometimes be due to a violent fall upon the feet, in which case the shock is transmitted through the spinal column to the head with or without fracture of the base of the skull. It was in this way that the Duke of Orleans, the son of Louis Philippe, died.

The symptoms of concussion show all degrees of severity. Thus the injured person may become confused and giddy with or without falling, he may become pallid and nauseated and may vomit, but after a short period he recovers gradually.

With a more severe injury, with which there is generally some laceration of the brain, the injured person falls and lies quiet and relaxed, apparently unconscious, though often he can be partly roused. Paralysis and anæsthesia are absent. The heart is feeble and fluttering, the skin cold and clammy. The pupils, as a rule, react to light, but otherwise vary considerably. Urine and fæces may be passed involuntarily. As he begins to regain consciousness, vomiting usually occurs. Consciousness usually returns within twenty-four or forty-eight hours, when headache and indisposition to exertion are complained of, and this may last for a long time. Occasionally the symptoms instead of abating increase, and coma supervenes, often indicating meningitis, encephalitis, or intracranial hemorrhage. In other cases the person may die almost immediately on the spot where he fell, while in still others apparent recovery takes place and death occurs later either suddenly or after a reappearance of symptoms. In such cases, abscess of the brain may occur and be the cause of the fatal result. These abscesses are the result of the injury, which may be almost anything from a compound fracture to a slight contusion not leaving any scar. The abscess may occur within a week[661] or not until after months or years. This interval of apparent recovery may lead to the false supposition that death was not due to the injury, but to some intervening cause. It is well to bear in mind that about half of the cases of abscess of the brain are not traumatic. A large majority of these are due to suppuration in the middle ear, a few to septic diseases or tuberculosis. The situation of the abscess often distinguishes between the traumatic and non-traumatic varieties. The traumatic variety is usually found beneath the injury or sometimes directly opposite, where the brain is injured by a kind of focussing of the radiated effects of the blow. The cases of abscess of the brain due to ear disease are usually found in the temporal lobe of the brain lying over the position of the ear or in the cerebellum behind it. The uncertainty of the nature and the extent of the cerebral injury in so-called contusion of the brain renders it necessary to be very careful in giving a prognosis. Any injury should be considered serious which has produced unconsciousness, for such an injury may produce enough laceration of the brain to render serious danger possible or even probable. We have seen that as a rule the symptoms of concussion come on immediately, but it is possible that symptoms at first so slight as to escape notice may become serious in a few hours or days. A gradual hemorrhage may sometimes account for this. The knowledge of certain acts performed or a conversation held at the last moment before the injury may be retained after recovery from concussion of the brain. This is not necessarily the case, for instead of remembering up to the moment of the injury, the injured person may remember only up to a certain time shortly before, or a part and not everything may be remembered.

The diagnosis of concussion of the brain from alcoholism is sometimes a matter of medico-legal interest or importance. Concussion may be so slight as to simulate intoxication. The history often clears the case up. The history of a blow or a fall or the presence of marks of violence on the head indicates concussion, though the blow or fall may not have caused the symptoms, which may be due to alcoholism. The odor of the breath may indicate alcoholism, but here too we may have both present and the concussion may be responsible for the symptoms. Or again the alcohol may have been given as a heart stimulant after the accident. This combination often occurs. If there is no odor in the breath, the presumption is in favor of concussion. As mistakes are still not infrequently made in diagnosis, those cases in which there is any ground for doubt should be carefully watched for developments. In general, the existence of concussion is more often overlooked than the coexisting alcoholism, so that if there is any doubt in a given case it should be treated as one of cerebral injury. The injury which causes the concussion in such cases is often due to the alcoholism. We may be able to verify this supposition if the injury is such as would be likely to be caused by a fall. There may be nothing found in the brain after death to distinguish between concussion and alcoholism. A bruise on the head only indicates a probability of concussion, for the bruise and alcoholism may both be present, the former perhaps due to the latter. The presence of alcohol in the stomach would indicate the existence of alcoholism.

Another effect of an injury which has caused concussion of the brain is an extravasation or effusion of blood. Extravasation of blood in or on the brain is one of the commonest causes of death from injury to the head. It may occur with or without marks of external injury. A person suffering from such an extravasation of blood may recover from the first effects of the injury, and at a varying time afterward the symptoms may return and increase so as to result fatally. In such a case the opening of the bleeding vessel may have become plugged until some exertion, emotion, or excitement on the part of the injured person has loosened the plug. A hemorrhage may have ceased from partial syncope and return with a stronger heart action due perhaps to the administration of alcohol. This effusion may occur on the surface of the brain in connection with a superficial laceration of the brain or just beneath or outside the dura mater and not involving the brain directly. The latter cases are almost always due to the effects of violence, though there is at least one case of apparently spontaneous rupture of the middle meningeal artery. The violence which causes a rupture of the branches of this artery may be so slight as to leave no bruise or so severe as to cause fracture of the skull. The most important symptom of such extradural hemorrhage is a period of consciousness after recovery from the first effects of the injury, then stupor may appear and deepen into coma. A subdural hemorrhage may cause almost the same symptoms, though the injury is usually such as has produced a depressed fracture. This hemorrhage is most often due to the rupture of a number of small vessels under the fracture, though if one larger vessel is ruptured it is most often the middle cerebral. A thin layer of hemorrhage in connection with a superficial laceration of the brain is of frequent occurrence with or without the other two forms of intracranial hemorrhage. If the brain is lacerated we may have convulsions in addition to other symptoms. Death occurring during or soon after a prize-fight may occur from some of the above classes of intracranial extravasations. It may be questioned whether the blows or a fall caused the hemorrhage. It is generally due to a fall in such cases, but may be due to blows, but the guilt is the same unless the fall was accidental. As the result of severe traumatism the vessels of the interior of the cerebrum may be ruptured or hemorrhage may occur into the ventricles of the brain. In such cases the symptoms will resemble those of ordinary apoplexy, only the cause is different from the latter and the injury is usually so severe as to leave no doubt as to the existence of a traumatism. The following question may arise in cases of intracranial hemorrhage and especially in the latter class of such cases, i.e., in cerebral hemorrhage:

WAS THE EXTRAVASATION OF BLOOD DUE TO DISEASE OR VIOLENCE?—It may be alleged in defence that the hemorrhage was the natural result of disease. Where the hemorrhage is extradural or subdural or in connection with a superficial laceration of the brain, the cause is almost always traumatic. We have referred to one case of extradural hemorrhage from spontaneous rupture of the middle meningeal artery.[662] Subdural hemorrhage may occur from Pachymeningitis hæmorrhagica interna, but this condition is readily diagnosed on post-mortem examination and often with considerable certainty during life. A history of alcoholism, headache, impaired intellect, unsteady gait, occasional losses of consciousness, stupor increasing to coma, etc., indicates such a condition.

It is in cases of cerebral hemorrhage that there is the most difficulty in discriminating between that due to disease and that due to injury. It may be alleged that the hemorrhage was from diseased vessels, or that the effects of a blow, which cannot be denied, were aggravated by disease of the cerebral vessels or by excitement due to intoxication or passion. Cerebral hemorrhage from disease is rare before 40 years of age, except in alcoholics. When the hemorrhage is due to disease the blood-vessels are diseased. The most frequent site of such hemorrhages is the course of the lenticulo-striate artery in the ganglia of the base or the white substance of the centrum ovale.

When injury is the cause of the hemorrhage it is usually found beneath the point injured or directly opposite to this. External signs of the blow are generally visible if it be severe enough to cause a cerebral hemorrhage. The vessels may be perfectly healthy and the victim quite young if the hemorrhage is due to an injury, also the ruptured vessels may be plainly torn. The most difficult cases are those where there is the history of an injury and at the same time such a condition of disease of the cerebral vessels, etc., as would account for spontaneous hemorrhage. Where the injury was slight in the case of alcoholics or aged people the medical witness should be especially careful in stating that a cerebral hemorrhage was due to the injury. Then, too, in the act of falling from the occurrence of a cerebral hemorrhage due to disease the head may be injured and show marks of violence. It should be borne in mind that an injury to the head may be inflicted when disease of the brain, vessels, or membranes already exists. In such a case a slight blow might cause extensive hemorrhage, but as that which accelerates causes, death, even though it might sooner or later have occurred in the same manner without injury, is due to the injury inflicted.

From the above considerations we see that spontaneous cerebral hemorrhage and that due to disease are not always easily distinguished from that due to violence. In severe injuries the structure of the brain is plainly bruised, etc., but the greatest difficulty exists in cases of slight violence where arteritis of the cerebral blood-vessels coexists. The spontaneous extravasation of blood in or upon the brain from excitement does not usually occur except with diseased vessels, old age, or alcoholism. It is rare, therefore, in the young and healthy. If there is any doubt as to the origin of the hemorrhage, the medical witness should state the cause most probable in his judgment. Taylor[663] supposes the case of a man excited by passion, alcohol, or both, who becomes insensible and dies after being struck a blow so slight that it would not have affected a healthy person. If examination reveals a quantity of blood effused into the substance of the brain, there can be little doubt in the mind of the medical man that the excitement was the principal cause of the effusion. On the other hand, if a severe blow or a violent fall on the head had been received in a personal conflict with another and it is found that death was due to an effusion of blood upon the surface, there can be little doubt in the mind of the medical examiner that death was due to the blow, which would satisfactorily account for the conditions found without reference to coexisting excitement, etc. In fact, in all cases where a question is raised as to the cause of the hemorrhage, it is most important to consider whether the violence was not sufficient to account for the hemorrhage without the coexistence of disease or excitement. It is also most important to bear in mind that after severe injuries, as after a fall, causing extensive fracture of the skull, followed or not with extravasation of blood, the injured person may walk about and die some distance from the place of the accident and where no chance for a similar accident exists. In this way the suspicion of murder may be occasioned, as illustrated in the following case cited by Taylor:[664] A man was accused of the murder of his companion, who was found dead in a stable with fracture of the temporal bone which had caused rupture of the middle meningeal artery. The accused stated that the deceased had been injured by falling from his horse the day before. After the fall, however, the deceased had gone into a public-house, where he remained some time drinking before returning to the stable. The extravasation had here taken place gradually, as is characteristic of hemorrhage from the middle meningeal artery, and perhaps the excitement due to the drinking had influenced it.

THE DATE OF AN EFFUSION OF BLOOD may sometimes be a matter of importance in determining whether a given extravasation of blood in or on the brain was caused by a recent blow or had existed previously. The color and consistence of these effusions indicate whether they are old or recent; the precise date we cannot state, but the information we can give is often all that is required. The color of recent effusions is red, which changes after some days to a chocolate or brown, which generally turns to an ochre color (see Plate I.). This latter color may be met with from twelve to twenty-five days after the injury. The consistence of the coagula also becomes firmer with age, and as the coagula become firmer they are more or less laminated and the expressed lymph may lie between the laminæ or around the coagula.

On account of the many layers of the brain coverings, a rough diagram of the coverings as given by Taylor[1] may be of much use to the medical expert in illustrating his evidence so as to make it clear to the court (see Fig. 19).

=Wounds of the brain= vary very widely in their immediate results according to the part of the brain injured. Thus sometimes a slight wound of the brain may be instantly fatal and often a severe wound in another part is not so. Extensive wounds may occur especially in the frontal lobes with remarkably slight disturbance. If a person with a wound of the brain survives the first effects of the injury the danger of inflammation remains. This danger may not be removed for a long time, for the inflammation may develop very slowly, not showing itself for from three to ten weeks or even later. Thus Taylor[665] cites the case of a child who was accidentally shot through the brain. The symptoms of inflammation did not appear until the twenty-sixth day and death occurred on the twenty-ninth day.

=Wounds of the face= heal remarkably well on account of its great vascularity. If severe they may leave great deformity or disfigurement, which may be the ground of a civil suit and thus require the testimony of a medical expert. If the wound involves the orbit or its contents it may be more serious, either from a fracture of the thin upper or inner wall of the orbit, separating it from the brain, or from extension of a secondary inflammation of the contents of the orbit to the brain. Wounds of the eyebrow may cause supra-orbital neuralgia or amaurosis from paralysis of the upper lid. Some fractures of the nose, especially those due to severe injury near the root of the nose, may be more serious than they appear. For in such cases, of which the writer has seen several, the fracture is not confined to the nose, but involves also the ethmoid bone and its cribriform plate forming part of the base of the skull. In such a case a fatal meningitis is a common result.

=Wounds of the neck= are very rarely accidental, more often homicidal, but most often suicidal. In nature they are most often incised wounds. As we have already seen, the kind and condition of the weapon used is often indicated by the character of the wound. We have also seen that in many cases a suicidal wound of the neck can be distinguished from a homicidal one with more or less probability or even certainty. Wounds of the neck are often dangerous, and they may be rapidly fatal if they divide the main vessels, especially the carotid arteries. Wounds of the larynx, trachea, and œsophagus are grave and often fatal from entrance of blood into the air-passages or from subsequent œdema or inflammation occluding the air-passages. Wounds of the sympathetic and pneumogastric nerves may be fatal, and those of the recurrent laryngeal nerves cause aphonia. The situation of the average suicidal or homicidal cut-throat wound is in front, generally across the thyro-hyoid membrane, sometimes dividing the cricoid-thyroid membrane, and not at the side of the neck where the great vessels lie and would be more easily divided. The force is expended, as a rule, before the great vessels are reached. The epiglottis may be cut or detached and the incision may even reach the posterior wall of the pharynx, but the majority of the suicidal cases recover with proper treatment. The homicidal cases are more often fatal from division of the great vessels, though, as already stated, in either class of cases a fatal result may occur if the air-passages are opened from the entrance of blood into them and the consequent asphyxia.

CONTUSIONS of the neck may be so severe as to cause unconsciousness or even death. The latter may be due to a reflex inhibitory action, as in cases of death from a blow upon the pit of the stomach. As a result of such contusions we may have a fracture of the larynx usually confined to the thyroid and cricoid cartilages (see Fig. 20). This may be followed by hemorrhage from the larynx, some of which may pass down into the trachea and threaten death from asphyxia. Later emphysema often develops throughout the tissues of the neck, and there is great danger of œdema of the larynx. The prognosis is serious unless tracheotomy is performed early or the case is closely watched. It is most serious where the cricoid cartilage had been fractured, as this requires a greater degree of violence. Whereas incised wounds of the throat are most often suicidal, contusions are most often accidental or inflicted by another. Among the latter class of injuries may be included the so-called garroting, by which a person is seized violently around the throat, usually from behind, and generally with a view to strangle and rob. In such cases the larynx or trachea may be injured in the same way as by a contusing blow.

WOUNDS AND INJURIES OF THE SPINE AND SPINAL CORD.

Injuries of the spine resemble more or less closely those of the head. FRACTURES OF THE SPINE generally occur in combination with dislocation, as fracture-dislocation. Thus displacement is generally present and causes a fatal compression or crushing of the cord. When the cord has once been crushed at the site of the displacement of the fracture-dislocation there is no hope of its ever healing. Therefore the lower end of the cord is never again in functional connection with the brain. These injuries are more rapidly fatal the higher up they are. If the injury is above the fourth cervical vertebra death is nearly immediate, for then even diaphragmatic breathing is impossible, and the injured person dies of asphyxia. Fracture of the odontoid process of the axis, which regularly occurs in hanging, may occur from falls on the head, etc., and is not always immediately fatal. Thus in one case[666] the person lived fifteen months and in another case sixteen months. In the latter case the fracture was due to the patient turning in bed while his head was pressed on the pillow. In some cases it may be questioned how far this injury may result from disease of the bones or ligaments. Therefore a careful examination of these parts should be made after death, which will usually enable us to answer this question, which may be brought up by the defence. It is hardly necessary for our purpose to enumerate the symptoms of fracture-dislocation of the spine. Of course the patients are almost always unable to walk and so are bed-ridden. A marked feature of fracture-dislocation of the spine is the length of time intervening between the injury and the fatal termination, and yet the injury is wholly responsible for the death of the injured person. This delay may last for months or even for years with careful treatment. But sooner or later the case generally ends fatally, though not necessarily so. Where the cord has been entirely crushed the result is almost always fatal; where the cord is not so injured recovery may and often does occur. According to Lutaud, fractures of the spine are sometimes followed by secondary paralysis coming on after healing of the fracture. At the outset we can seldom give a definite prognosis, which can only be given after watching the developments of the case. The prognosis is more favorable in fracture of the arches alone or when the injury is in the lower part of the spine and not very severe. The commonest cause of fracture-dislocation of the spine is forced flexion of the spinal column. Injuries to the spine are generally the result of falls or blows on the spine, especially in its lower part. Lutaud[667] states that after forced flexion of the spine without fracture paraplegia may sometimes occur, which is attributed to forced elongation of the cord. This paraplegia, which may seem to be grave, is completely recovered from as a rule.

Incised or punctured wounds of the spinal cord are rare, as it is so well protected except in the very highest part behind. Here between the occiput and the atlas and between the latter and the axis, and to a less extent between the axis and the third cervical vertebra, the cord is more exposed, owing to the narrowness of the laminæ. It is here that pithing is done, which is almost instantly fatal, as the medulla oblongata and upper part of the spinal cord are the parts injured, and they contain the respiratory and other vital centres. Pithing may be done with such a small needle-like instrument as to leave scarcely any trace. Only a slightly bloody streak may persist, which may appear superficial if the instrument is introduced obliquely. Such a mark in this location with no other apparent cause of death should always lead to an examination of the upper part of the cord, which will always reveal the cause of death in such cases. Pithing is practised especially in infanticide.

As with the brain, so with the spinal cord, we may have CONCUSSION due to the shock of a contusing blow. Concussion of the spinal cord, as of the brain, may be fatal without showing scarcely a mark of violence externally or internally. As the cord is so well protected from injury, it must be extremely rare to have concussion of the cord without some actual lesion of its substance. As concussion of the cord is not often the result of the injuries of which we are treating, but rather of railroad injuries and the like, it will not be considered at length in this connection. As a result of a blow or fall on the spine or communicated to it, hemorrhage may occur in the substance of the cord or around it between or outside its membranes. In very rare cases such a hemorrhage may occur spontaneously as the result of disease, of which the writer has seen one case. It may be associated with concussion or laceration of the cord. It may destroy life directly by extension or indirectly by leading to a spreading inflammation. Hemorrhage in or about the cord causes a gradual compression of the cord, and in cases of fracture of the spine often adds to the compression due to the displacement of the bones. In hemorrhage into the substance of the cord paralysis comes on early or immediately and may be complete while symptoms of irritation fail. The latter symptoms are most marked in meningeal hemorrhage in which paralysis is delayed in appearance and generally incomplete. The products of an inflammation due to an injury may compress the spinal cord in the same way that hemorrhage does.

Wounds and injuries of the varieties we are considering, affecting the spine and spinal cord, are generally accidental, less often homicidal, and almost never suicidal.

WOUNDS OF THE THORAX AND THORACIC ORGANS.

=Wounds of the thorax caused by incising, puncturing, or blunt instruments.= These wounds are most often punctured wounds; contused wounds are common and incised wounds are not rare. They are perhaps most often homicidal in origin or at least inflicted by another, and the accidental origin of these wounds is probably the least common.

Incised or punctured non-penetrating wounds of the thoracic wall are rarely grave. Bleeding, as a rule, is not serious, though it may be quite free. Such wounds may be accompanied by emphysema, though not penetrating, owing to the movements of the chest and a valve-like action of the edges of the wound. Contused wounds of the thorax are more dangerous, especially if the violence was great, owing to the complicating fracture of the ribs, rupture of the thoracic viscera, etc.

FRACTURE OF THE RIBS is a common result of contusions of the chest. It is more dangerous when due to a direct blow or injury, as then the splintering occurs internally and may wound the lungs, heart, or large vessels, while with fracture from indirect violence, from compression of the chest, the splintering of the ribs occurs externally. Fracture of the upper ribs requires more force than that required to fracture the lower ones, and consequently the former is the more dangerous. The diagnosis of fracture of the ribs is generally quite easy by means of crepitus felt or heard, false motion, local tenderness, etc. FRACTURE OF THE STERNUM may be serious if depressed on account of the wounding of the viscera behind it. Devergie[668] cites such a case where the depressed portion of the sternum produced a transverse non-penetrating wound of the heart about an inch in length, which had caused death in thirteen days. Simple fracture of the sternum without displacement of the fragments is rarely serious unless injury of the thoracic viscera is produced by the same violence. Wounds or injuries of the thorax are grave or not according as they penetrate or injure the thoracic viscera or do not do so. A wound may just penetrate the thoracic wall without wounding the thoracic viscera, and is then serious as a rule only when followed by inflammation. In fact, many of the penetrating wounds of the thorax wounding the viscera are only grave on account of consecutive inflammation. We have already seen that various characteristics of wounds of the thorax, especially of stab-wounds, enable us to determine the kind of weapon used, its size, sharpness, etc., and sometimes to identify the weapon itself. In much the same way we can often determine whether the wound was suicidally or homicidally inflicted. The cause of death in wounds of the thorax may be directly due to the wounding of one or more of the thoracic viscera, or it may be due to the inflammation occasioned by it. Wounds of the lower part of the thorax may involve at the same time the thoracic cavity proper and its contained viscera, the diaphragm and the abdomen and its viscera. This is the order in which the different parts would be met with in a wound from behind forward; the order might be the reverse of this in a wound from before backward. Penetrating wounds of the thorax may involve the lungs, heart, or great blood-vessels. Of these, the lungs are most often injured, which is easily accounted for by the greater size of the lungs. In =wounds of the lungs= the immediate danger is from hemorrhage. The hemorrhage appears externally through the wound and from the mouth, being coughed up. Where the lungs are injured by a blow, fall, or crush without external injury, blood appears in the mouth only. The blood coughed up from the lungs is bright red and frothy, and it may also be frothy at the external wound. Hemorrhage from the external wound may be slight, especially if the wound is oblique and acts as a valve. In wounds of the lungs most of the blood may collect in the pleura or in the lungs, and thus, by compression from without or by displacement by the blood within it, prevents air from entering the lungs and produces asphyxia, which may be fatal. More or less dyspnœa usually occurs at first. Emphysema is generally present in the cellular tissues, but this latter symptom may also occur at times with non-penetrating wounds of the chest. If death does not occur speedily from hemorrhage by compression of the lungs or heart, there are good hopes of saving the patient, but the prognosis should be reserved. For even when the first effects of the wound of the lung are survived, the patient may die from the effects of inflammation, recurring hemorrhage, or a too sudden relaxation of regimen. Thus, for instance, if too much food, talking, or exertion are indulged in the case may on this account terminate fatally, and such aggravating causes of death may mitigate the sentence.

=Wounds of the heart= are among the most fatal. Although it was once considered, and is usually thought now by laymen, that wounds of the heart must be necessarily and instantly fatal, the facts are otherwise. If the wound is small and oblique life may be prolonged, and cases are recorded[669] in which wounds of the heart were not directly fatal, and in some of which recovery would have probably resulted if not for other diseases. Cases in which the heart wall was wounded but not penetrated, and in which healing took place, are not very rare.[670] Thus Callender removed a needle from the substance of the heart. But there is perhaps only one case[671] on record in which a wound penetrating the cavities of the heart was recovered from. It is the rule rather than the exception that wounds of the heart, penetrating or not, are not immediately fatal. Thus in a series of twenty-nine cases of penetrating wounds mentioned by Devergie,[672] as collected by Ollivier and Sanson, only two ended fatally within forty-eight hours, the rest in periods ranging from four to twenty-eight days. This delay in the fatal result has been attributed to the arrangement of the muscle fibres crossing one another and tending to close the wound, or at least to make it smaller. As to the various parts of the heart wounded, the right side, especially the ventricle, is most often wounded. Thus out of fifty-four cases of wounds of the heart, Taylor[673] states that the right ventricle was wounded in twenty-nine cases, both ventricles in nine, the right auricle in three, and the left auricle in one case. This greater frequency of wounds of the right side of the heart is easily accounted for by its more exposed position anteriorly, just beneath the chest wall in a part of its extent. The rapidity of death depends largely upon the site and extent of the wound. Lutaud[674] states that out of twenty-four cases of wounds of the right ventricle only two were fatal within forty-eight hours, and out of twelve cases of wounds of the left ventricle three were not immediately fatal. Wounds of the auricles are generally fatal immediately, especially if the cavity is extensively laid open. It is the general opinion that wounds of the auricles are most rapidly fatal, next those of the right ventricle, and lastly those of the left ventricle. This difference is probably due to the comparative thickness of the walls of these parts. Thus the wall of the left ventricle is so thick as to tend to close a wound unless it be extensive. In wounds of the heart death rarely occurs from external hemorrhage, which may be quite slight or even altogether wanting where the wound is due to a crush or fracture of the ribs. Death is usually due to the compression of the heart by the blood in the pericardium. This usually causes syncope, or a slighter pressure may be fatal by causing cerebral or pulmonary anæmia or shock. Death may occur suddenly in this manner or not until after some time. Thus in penetrating stab-wounds little or no blood probably escapes at first, in most cases, but it may ooze or, later on, suddenly burst out into the pericardium. Therefore after a wound of the heart the patient does not, as a rule, die immediately, as formerly and often at the present time erroneously supposed. This fact is of little importance as a rule in surgery, for the patients generally die sooner or later, but it is of importance in medical jurisprudence, for upon it may hang the solution of questions of murder, suicide, or justifiable homicide. It also accounts for the fact that the injured person can exercise voluntary power after the injury. Thus Watson[675] met with a case where a man ran eighteen yards and died six hours after a stab-wound of the right ventricle. The coronary artery was divided and the pericardium was filled with blood. Also Boileau met with an accidental penetrating stab-wound through both ventricles in a soldier who ran two hundred yards, then fell and died in five minutes. A boy admitted to Guy’s Hospital in 1879 lived forty-two hours with a bayonet-wound transfixing the right auricle, the septum, the left ventricle, the mitral valve, and entering the left auricle.

Minute wounds of the chest are sometimes made by needles, etc., in the region of the heart with the intention of killing infants or children. Taylor[676] also mentions the case of a fatal wound of the heart from a needle, the result of accident. We have already cited the case of a needle lodged in the heart wall and removed by Callender by operation. That the puncture of the heart by a small instrument is not necessarily serious is proved by the experiments of Senn,[677] by which he found that “the heart can be punctured with a perfectly aseptic, medium-sized aspirator needle without any great immediate or remote danger.”

In cases of RUPTURE OF THE HEART the question may come up as to whether it was the result of disease or violence. We have already seen that rupture of the heart may occur from falls or crushes without marks of violence to the chest. In general, we may say that in rupture of the heart from violence the right side and base are most often involved, while in rupture from disease the left ventricle is generally ruptured, especially near the apex. The exciting causes of rupture of a diseased heart are often violent emotions or exertion, which may both be present in a quarrel with another and cause rupture without direct violence. The cause need be but slight if the heart is diseased, whether the cause is a natural one or outward violence. Rupture from disease may therefore excite suspicions of murder, but those cases can usually be satisfactorily solved by examination of the organ post mortem. A slight degree of violence may cause rupture of a diseased heart about ready for rupture from natural causes. When a diseased heart ruptures during a quarrel, the symptoms of rupture of the heart may be observed to come on suddenly before and without the infliction of any violence.

=Wounds of Arteries and Veins=, especially within the thorax.—Wounds of large trunks are generally speedily mortal. In the chest we may occasionally meet with wounds of the intercostal or internal mammary vessels or the vena azygos veins. These wounds are often serious and may be fatal. We have already seen that blood in the large cavities of the body, like the chest, is commonly not coagulated, or at least the greater part of it. We have already seen, too, that after wounds of the carotid artery the victim may preserve the power of locomotion for a short time, but not the power of struggling. This fact may be important to help distinguish between murder and suicide. In such wounds of the carotid the voice may be lost, as the trachea is often divided. Death from wounds of large vessels may be due to loss of blood, and if this danger is passed the case may still terminate fatally, as in a case where the brachial was tied for injury and death occurred in three days from gangrene. The wounds of comparatively small vessels may prove fatal from hemorrhage, etc.

In wounds of blood-vessels death may occur from the entrance of air into them. In some cases where this is supposed to have occurred it is quite probable that death was really due to hemorrhage. A considerable quantity of air may enter the circulation, especially the arterial circulation, without a fatal result. When death does occur it is owing (1) to “mechanical over-distention of the right ventricle of the heart and paralysis in the diastole,” or (2) to “asphyxia from obstruction to the pulmonary circulation consequent upon embolism of the pulmonary artery.”[678] Senn found that fatal air embolism could hardly occur spontaneously in a healthy jugular vein, as the walls collapse readily from atmospheric pressure.

=Wounds and Ruptures of the Diaphragm.=—These may be due to weapons, fracture of the ribs, falls or crushes, and disease. They also occur as the result of congenital malformation, though these cases seldom survive long. These injuries are generally homicidal or accidental in origin. As a rule, the viscera are wounded at the same time, or, if not wounded, at least herniated, and may thus become strangulated. It is therefore hard to estimate the danger in such cases, but the prognosis is at all times serious. The most serious cases of such injury to the diaphragm are due to violent contusions or falls when the stomach and intestines are full. The hemorrhage is usually slight, but hernia of one or more of the abdominal viscera usually occurs in such cases, and is said to be more readily produced during inspiration when the fibres are on the stretch. According to Devergie, rupture of the diaphragm with hernia is more common on the left side in the central tendon in front of the crura and at the junction of the left muscular leaflet. Also on either side of the ensiform cartilage and especially on the left side there occurs an area of the diaphragm which may be congenitally weak or even absent, and here too rupture and hernia are likely to occur. Phrenic or diaphragmatic hernia occurs especially after lacerated wounds, even after the wounds have apparently healed. If hernia occurs long after the injury was inflicted, it may be asked whether the wound was the cause of the hernia, and so of death. This can only be determined by examination. Almost any or all of the movable abdominal viscera may be found in a diaphragmatic hernia. It was once supposed that this accident would be immediately fatal, but this is far from the truth. Devergie relates the case where a person lived nine months with the stomach and colon in the chest and died from another cause. Thus a person may have a phrenic hernia and die from another cause, or having had a rupture or wound of the diaphragm he may suddenly acquire a diaphragmatic hernia by reason of a blow or sudden exertion, or the latter may strangulate an existing hernia. A person with a diaphragmatic hernia may have the power of moving or walking, but is more or less incapacitated owing to the compression of the lungs which exists and the consequent dyspnœa, etc.

WOUNDS AND CONTUSED INJURIES OF THE ABDOMINAL WALL AND VISCERA.

Such wounds and injuries of the abdominal wall may be incised, punctured, or due to blunt instruments, etc. They are usually homicidal or accidental, seldom suicidal except in delirious patients or lunatics. The cause of death in such cases may be due to hemorrhage, shock, etc., or to secondary inflammation, which is especially likely to occur in penetrating wounds. The kind of weapon used may often be judged from the nature of the wound. Incised and non-penetrating punctured wounds are usually simple and not grave, but may be otherwise from hemorrhage from the deep epigastric artery, or from inflammation in or between the muscles, or in the subperitoneal connective tissue. In the latter case peritonitis may occur, but is rare. A ventral hernia may, however, result later on, as also from a cicatrix, especially if it is transverse. In such cases the question arises whether the natural results of the wound were aggravated by unskilful or improper treatment or even wilful neglect on the part of the patient or practitioner.

CONTUSIONS of the abdomen are more serious often than those of the chest, for there is less power of resistance. We have already seen that death may occur from a contusion of the abdomen too slight to show a mark of ecchymosis or a serious injury internally. This has been attributed by some to an effect on the solar plexus or reflexly on the cardiac plexus causing a fatal inhibition. Lutaud and others have expressed the doubt whether the cases reported by Travers, Allison, Watson, Cooper, Vibert, and others were carefully examined, and have inferred that some visible organic change must have been present. Some such cases, however, have been examined with especial reference to this point, and no physical injuries and no other cause of death elsewhere has been found. There is no ground, therefore, for a jury to doubt that a contusion of the abdomen was the cause of death because there are no visible marks of injury.

Again, it is a well-known fact that the blows severe enough to cause rupture of the abdominal viscera may sometimes leave no trace of violence in or on the abdominal wall. On the other hand, it must be remembered that effusions of blood may be found post mortem in the sheaths of muscles without indicating violence, so that blood may be found effused in considerable quantity in and around the abdominal muscles without violence having been done. In such cases, therefore, we should note whether abrasions or ecchymoses of the skin are absent or not. If they are absent and there is no other evidence of a blow, the medical witness should hesitate to attribute such an effusion of blood between the muscles to an act of violence.

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