Digitized by the Internet Archive in 2015 https://archive.org/details/studentshandbookOOhusb THE STUDENT'S HAND-BOOK OF FOKENSIC MEDICINE AND MEDICAL POLICE. Printed by Porteous and Dcnholm E. & S. LIVINGSTONE, EDINBURGH ( SIMPKIN, MARSHALL, AND CO. LONDON ] ( HARDWICKE AND BOGUE DUBLIN GLASGOW . ABERDEEN . FANNIN AND CO. A. AND W. STENHOUSE JAMES HADDEN JOHN ADAM THE STUDENT'S HAND-BOOK OF FORENSIC MEDICINE AND MEDICAL POLICE By H. AUBEEY ^WJSBAND, M.B. M.C., F.R.C.S.E., M.R.C.S., L.S.A. ,ECTURER ON MEDICAL JURISPRUDENCE AND PUBLIC HEALTH IN THE EXTRA-ACADEMICAL SCHOOL, EDINBURGH MEMBER OF THE GENERAL COUNCIL OF THE UNIVERSITY OF EDINBURGH EXTRAORDINARY MEMBER OF THE ROYAL MEDICAL SOCIETY, EDINBURGH FELLOW OF THE ROYAL PHYSICAL SOCIETY OF EDINBURGH MEMBER OF THE SANITARY INSTITUTE OF GREAT BRITAIN AND IRELAND AUTHOR OF THE ' STUDENT'S HAND-BOOK OF THE PRACTICE OF MEDICINE ' 'MEDICAL AND SURGICAL EXAMINATION QUESTIONS,' ETC., ETC. THIRD EDITION. EDINBUKGH E. & S. LIVINGSTONE, 57 SOUTH/BBIDGE / 1879 [All Rights Reserved} > i o CI .tiny. DOUGLAS MACLAGAN, M.D., F.R.S.E., ETC., ETC., PROFESSOR OF MEDICAL JURISPRUDENCE IN THE UNIVERSITY OF EDINBURGH, THIS LITTLE VOLUME IS INSCRIBED BY AN OLD PUPIL. N PREFACE. The demand for a Second Edition of this Hand-Book will sufficiently explain its raison d > etre two years ago. The present Edition has been considerably enlarged, and in many parts re- written, the author having tried to give the largest amount of information in the fewest words. The best authorities have in all cases been consulted, and to these the author would refer with grateful acknowledgment. Bentinck House Stroud Gkeen Road, London, K. April 1877 CONTENTS XI PAGE General Moral Mania - - 182 Partial Moral Mania - - 183 Dementia, or Fatuity - 185 Delirium Tremens - 187 Certificates of Lunacy - - - - 187 Toxicology - 197 Classification of Poisons - - 198 < General Evidence of Poisoning - - 200 Corrosive - 1 - 211 . Acids ----- - 211 1 Alkalies ----- - 226 , Caustic Salts - - 229 ^ULNERANT - - - - - 231 Irritant ----- - 231 1 Metalloid ... - - 231 Metallic ----- - 238 | Yegetable - - 278 Animal - - - ■ - - 285 Narcotic - - - .. . - - - 298 Somniferous - - 298 Deliriant - 305 Inebriant - - - - - 313 5EDATIVE ----- - 324 Cardiac - - - - - - 324 Cerebral ----- - 327 I Neural - - - - - 1 - 342 1 SXCITOMOTORY - - - - - 346 I Xll CONTENTS. PAGE Irrespirable Gases - 352 ToXICOHiEMIA - - - - - 355 Medical Police ------ 356 Man under Physical Influences - - - - 356 Individual Man - - - - - - 388 Vital Statistics *93 Life Assurance ------ 405 Air - - - - - - 407 Ventilation - - - - - - 417 Meteorology - - - - - - 432 Climate - - - - - - - 432 Drainage and Sewerage - - - - - 471 Water Supply, etc. - - - - - 497 Food - - 517 Clothing 524 Endemic Diseases - 527 Epidemic Diseases - - - - - 527 Schools, Churches, and Theatres - - - 547 Cemeteries - - - - - - 547 Quarantine Establishments » ... . 549 Duties of a Medical Officer - - - - 554 Duties of Inspector of Nuisances - - - 558 THE STUDENT'S HAND-BOOK OF FORENSIC MEDICINE AND MEDICAL POLICE. INTKODUCTIOK TO that branch of medical knowledge which is engaged in the solution of every question con- nected with the conservation of the species and the administration of justice, the terms Forensic or Legal Medicine has been applied. It also forms the Medical Jurisprudence of some writers. We find traces of this science in the Jewish law; among the Egyptians, according to Plutarch ; and even among the Romans, as early as the times of Numa Pompilius. Among German writers the term State Medicine includes both Medical Jurisprudence and Medical Police. In order to be as concise and as plain as possible, it will be necessary to discuss some matters of general application before considering others which have a more special interest. These will therefore be con- sidered under the following heads. 2 FORENSIC MEDICINE. MEDICAL EVIDENCE GENEKALLY. A. Documentary. B. Oral. 0. Experimental. A. Documentary. Under this head are included Medical Certificates, Written Opinions, and Medical Eeports. The Medical Certificate. — Certificates generally refer to illness, etc. There is no particular legal form pre- scribed in England for these documents. A statement signed by a registered medical practitioner, distinctly stating the nature of the illness of A or B, is all that is necessary as far as the law in England is concerned. In Scotland the law is somewhat different. ' A certificate of bad health by a physician or sur- geon must bear to be on soul and conscience/ . . . ' In cases of homicide, and other crimes against the person, medical certificates produced respecting the nature of the injuries must be verified on oath by the medical persons who granted them.' — Diet. Scot. Law. The omission of the words 6 on soul and conscience ' invalidates a certificate, and a juryman suffering from illness has been fined because the words were omitted in the medical certificate on which he claimed exemp- tion. Certificates of insanity can be procured already printed in the form prescribed by the law. Written Opinions. — These generally refer to civil questions. The Medical Report. — A report is a document given in obedience to a demand by the public authorities, and has reference chiefly to criminal cases. Medical reports are sworn to as true by those who draw them up. According to Alison, it is not a sufficient objection that a medical report was made up at an interval after the occurrence of the circumstances to which it refers. EXPERIMENTAL EVIDENCE. 15 when both cases are the same, the one to which he first received the subpoena. In Scotland witnesses are summoned by a writ, which must be delivered at the residence of the witness. Delivery to a member of the family, or a servant not within the house, will not do. If access cannot be gained, the copy is fastened to the most patent door of the house. If the witness do not appear, and it be clearly shown that he, was duly cited, a warrant for his apprehension may be issued, and he, becomes liable to be incarcerated till he find £ caution ' for his due attendance at the trial. His non-attendance may also, unless good excuse be forth- coming, render him liable to a fine, or unlaiv of a hun- dred merks Scots — about £5. C. Experimental. Under this head will be treated the examination of the living and the dead, identity, real and apparent death, cause of death, and experiments with the weapons alleged to have been used ; exhumations, and autopsies. Examination of the Living. With regard to the identification of the living, the opinion of a medical man is seldom sought. It is only in cases where questions have arisen as to the presence and character of certain marks on the body — of defor- mities, either congenital or produced subsequent to birth, or of doubtful sex, that a medical man may be consulted. The marks which most frequently give rise to differences of opinion are ncevi materni, scars, and tattoo marks. In cases of doubtful sex the male organs may resemble the female, the female the male, or they may be blended together in about equal proportions. The following questions may be put to the medical expert : — a. Do scars ever disappear ? b. Can the age of a scar be definitely stated ? 1G FORENSIC MEDICINE. c. Can tattooing, when once present, ever become thoroughly effaced by time ? In reply to the two first questions, I shall quote the words of the late Pofessor Casper : — 6 Conse- quently the scars occasioned by actual loss of sub- stance, or by a ivound healed by granulation, never disappear, and are always to be seen upon the body. But the scars of leech bites, or lancet wounds, or of cup- ping instruments, may disappear after a lapse of time that cannot be more distinctly specified, and may there- fore cease to be visible upon the body. It is extremely difficult, or impossible, to give any certain or positive opinion as to the age of a scar. 1 Devergie states, that where the brand of a galley-slave has vanished, it may be recalled by slapping its usual position with the palm of the hand. The scar remains white while the skin round it is reddened. A change of temperature to the part will sometimes cause the reappearance of a vanished scar. Washing may also help to reproduce scars. Cicatrices produced in childhood may grow in length, but not in breadth. The shape of cicatrices will depend upon the character of the wound which produced them, and also on the nature of the healing process. An incised wound healing by the * first intention' will most probably leave a white linear cicatrix ; on the other hand, a wound healing by suppuration will leave a more or less irregular scar. Dupuytren and Delpech state that the tissue formed in a cicatrix is never converted into true skin — the rete mucosum when once destroyed never being reformed. This may account for the white colour of ordinary cicatrices, but even to this rule exceptions may be taken, and dark-brown patches of pigment have been known to mark the situation of old lacerated wounds. With regard to the last question, the subject of the disappearance of tattoo marks has given rise to con- siderable discussion in the great Tichborne case. On EXPERIMENTAL EVIDENCE. 17 this subject the experiments of Hutin, Tardieu, and Casper appear to point to the fact ' that tattoo marks may become perfectly effaced during life/ but that after death the colouring matter with which the marks were made may be found in the lymphatic glands. Hutin found that in 506 men who had been formerly tattooed, the marks had disappeared from 47 of the number. But besides the spontaneous disappearance of tattoo marks from the lapse of time, these marks may be artificially removed, and in such a manner as to prevent the possibility of a definite opinion being given as to their primary character. The alternate appli- cation of strong acetic acid, potash, and dilute hydro- chloric acid appears to be the means adopted for their removal. On this subject see also Tardieu' s paper in the Annates d? Hygiene publique (Jan. 1855, p. 171 et seq.) The identity of the accused may be proved by the absence or malformation of the teeth correspond- ing with a bite on the party assaulted. Or it may be proved that the wound inflicted could only have been made by a left-handed person, or in a manner pecu- liar to those engaged in the slaughtering of animals, e.g., is the cut from within outwards, as employed by butchers 1 The correspondence in the size of the foot of the prisoner and the footprints found in the vicinity of the crime are important as evidence. The size of the footprint varies in running, walking, or standing, and this fact should always be borne in mind when an examination is required to be made of the footprints in the neighbourhood of the crime. Photographs may be used as a means of identification. As a means of disguise, the hair may be dyed, or the colour may be changed from dark to light. For darkening the hair, the acetate of lead or the nitrate of silver is most frequently employed, a wash containing the sulphide of potassium being used before the appli- cation of the lead solution. This removes the grease, and helps the rapid formation of the black sulphide of B IS FORENSIC MEDICINE. lead. To detect this fraud, some of the suspected hair should he steeped in dilute nitric acid, and then sul- phuretted hydrogen passed through the solution, the result being the formation of the black sulphide of lead. If silver be present, the addition of hydrochloric acid will throw down the insoluble chloride of silver. If careful examination be made of dyed hair, it will be found that the dye is irregularly taken by the hair, and I have not infrequently seen the hair close to the scalp white, or at least several shades lighter than the rest. The scalp may also be seen more or less dis- coloured, especially when the nitrate of silver is used and applied by the individual himself. For lightening the natural colour, solutions of chlo- rine, of varying strengths are used ; but it must be remembered that the action of chlorine is by no means uniform. Devergie states that he has not succeeded in producing a perfect whitening of the hair in less than from twelve to twenty hours. There is one more question bearing on this subject, viz. : — "What amount of light is necessary for the purpose of identification 1 In one well-authenticated case, a lady was enabled to identify the person of a thief by the light emitted by a momentary flash of lightning ; and it also appears probable that the flash of light from a gun or pistol may be of sufficient intensity for the purposes of iden- tification. Examination of a Person said to have been Assaulted. Carefully examine the bruises, wounds, etc., to see if they could have been inflicted as described. Ask no questions that may suggest an answer. Examine all weapons said to have been used, and hand them over EXAMINATION OF THE DEAD. 19 to the police. In all cases where danger to life is imminent, send to the authorities, and take dying- declarations, as these may become evidence of vast importance, and are as valid as if given on oath. Examination of Persons Found Dead. The Object of such Examination. 1. To answer the question, Who is it? a. Sex. b. Age. ! § Jft If only skeleton remain, examine pelvis, etc. Prior to puberty, the examination of the skeleton affords no evidence of sex. Eruption of teeth. Central incisors, 7 months. Lateral incisors, 7-10 ,, First molars, 12-14 ,, Canine teeth, 14-20 ,, Second molars, 18-36 ,, First molar, 6 years. 2 middle incisors, 7 , , 2 lateral „ 8 ,, First bicuspid 9 , , Second ,, 10 ., Canine 11-12 ,, Second molar, 12-13 ,, Wisdom teeth, 17-21 ,, Examine lower jaw. Ramus forms an obtuse angle in full-grown foetus, a right angle in adult life, obtuse in old age from loss of teeth. Ossification of bones. Ossification of the epiph} r sis of transverse, and spinous processes of the vertebrae, hardly commence before 16 years of age. From 20 to 30, two thin circular plates form on body of the vertebrae. Consolidation of the sacrum begins at 18th year, com- pleted at 30th. First and second bones of sternum united between FORENSIC MEDICINE. 25th and 30th, and second and third before 35th. Epiphysis of ribs begin to grow between the 16th and 20th years, completed by 25th. Epiphysis of clavicle begins to form between the 18th . and 20th years. c. Stature. Allow 1J to 2 inches for soft parts. d. Any peculiar!- J Colour of hair and whiskers. False ties. ( teeth. Malformations. As an aid to identification, it is important to remember that certain trades leave marks by which those engaged in them may be identi- fied. Thus, in shoemakers there may be more or less depression of the lower portion of sternum, due to the constant pressure of the last against the bone. In coachmen, corns may be formed between the thumb and index finger, and between the index and the second finger of the left hand, from the pressure of the reins. In stone-masons, from the constant action of picking up the bricks, flattening of the tip of the thumb and index finger of left hand is not uncommon. The finger-ends of turners and coppersmiths are also more or less flattened; in the latter a deposit of the metal may take place. An examination of the mouth, for the presence or absence of false teeth, or of any peculiar formation of the jaw, may lead to the identi- fication of the body. In the case of Dr Parkman, the recognition, by a dentist, of the false teeth worn by the deceased led to identification of the remains, and also to the discovery of his murderer. The presence of united fractures, as in the case of Living- stone, may lead to the identification of the EXAMINATION OF THE DEAD. 21 body. In one case, where a man was said to have died from a fracture of the ribs recently caused by a blow, it was found on examina- tion that the bones were united by a firm callus, clearly showing that the skeleton pro- duced could not be that of the man alleged to have been murdered. Nsevi materni and cicatrices, as in the case of the living, may also serve as means for identification. Sin- gular cases of mistaken identity have been recorded from the extraordinary occurrence of like marks on different individuals. 2. In the case of an infant found dead, it may be necessary to determine whether it was born alive, and also whether it had reached that period when it could maintain an existence apart from its mother. {See Infanticide.) 3. To ascertain the cause or causes of death. a. Position of the body. b. Attitude of the body. c. Relation to surrounding objects. Signs of a struggle. Direction of footsteps to or from the body. If in a room — What bottles and other articles of medicine are in the apart- ments? Examine the nature of the ex- crementitious matter in the night vessels. — Suicide % Homicide % d. Examine body externally. Are there any wounds on the body 1 Are there any signs of vital reaction in the wounds, pus, adhesive lymph, or blood clots 1 Possibility of apoplexy ; conformation of the neck, with respect to its shortness, fulness, and thickness. Marks upon the throat or under the ears. State of the linen and clothes of the deceased. Whether torn or in any way disordered. Whether stained with blood. WheUier they yield the odour of spirit, sourness, putridity, 22 FORENSIC MEDICINE. or that of tobacco. Leave the examination of back till examination of internal cavities, so that no fluids escape from mouth, etc. e. Eeport of witnesses. Can the body be identi- fied ? Is the body in the same situation and condition as when first discovered % Habits of the deceased. When last seen, and in whose society. What was his occupation or business] Had he experienced any dis- appointment or misfortune? Any insurance on his life. /. Examine cavities. In no case should a medical man ever hazard an opinion as to the cause of death. When the body is once placed in the hands of the authorities a medical man has nothing further to do till he receives the war- rant for inspection and examination, without which he should be careful not to touch the body for purposes of internal examination. 4. The time which may have elapsed since death. This can scarcely be determined with any precision, as so much depends upon the conditions under which the body may have been placed. The subject under con- sideration is, therefore, beset with difficulties, and its elucidation will require the greatest care on the part of the medical expert. Cooling of the Body. a. External circum- stances. Covered by bed-clothes, or otherwise unexposed, when cooling would be slower than in dry air quickly moving. h - Cation of body j sloW;iffat . a. Wasting diseases. Quick. b. Suffocation. Slow. c. Cholera and yel- ) Increase of heat low fever. ( after death. Kind of death. EXAMINATION OF THE DEAD. 23 The following circumstances must also be taken into consideration : — 1. Age. 2. Air. a. Moving, b. At rest. 3. Moisture. 4. Warmth. Temperature of the surrounding atmosphere. Bodies may be preserved for months if ex- posed to intense cold. 5. Nature of the supposed cause of death. 6. Presence or absence of the rigor mortis. The following table, suggested by Devergie, and adopted by Taylor, may be of use in aiding the expert in forming his opinion. It is divided into four stages or periods, the last being that in which putrefaction commences : — r From a few minutes to twenty hours after death. Animal heat more or less present, | but seldom continuing longer than ten or "| twelve hours. Muscles contract on the ap- plication of galvanic stimuli, and in the I earlier stage to blows. r From ten hours to three days. Body quite cold, and rigor mortis well marked ; muscles do not contract on the application of stimuli. The age, mode of death, and other collateral circumstances must, more or less, be taken into consideration before I an opinion can be given. f From three to eight days. The body is quite | cold, and cadaveric rigidity has passed off. j The muscles no longer respond to any gal- I vanic or mechanical stimulus. This stage | is modified and somewhat shortened in I summer. f From six to twelve days. Commencement of putrefaction. Putrefaction may, however, 1 take place on the first or second day after j death ; so that, as before stated, care must I be taken before any positive decision can I be given. First Period. Second Period. Third Period. Fourth Period. 24 FORENSIC MEDICINE. Modes of Sudden Death. Syncope. Asphyxia. Coma. Syncope, from o-vyKOTrrco, I strike down. Arrest of the action of the heart. This condition may "be brought about by — 1. Deficiency of blood due to haemorrhage. 2. Effect of certain diseases and poisons. Post-mortem Signs. — The cavities of the heart con- tain a normal quantity of blood. The blood is simply arrested in its course ; blood is therefore found in the large veins and in the arteries. The brain and the lungs are not engorged with blood. Asphyxia, from a priv. et cr^v^is, pidse. Apnoea is the better term — a priv. et Trvem, / respire. Asphyxia, or death from defect in the quality of the blood, is brought about when any impediment is placed on the healthy action of the lungs. Experiment has shown that for a short time after respiration has ceased, the heart still continues to act, and that if the impediment to the proper aeration of the air by the lungs be re- moved, life may be prolonged. Taking therefore the primary meaning of the terms asphyxia and apnoea into consideration, it may be remarked that the latter precedes the former in point of time, the one marking the period at which the action of the heart ceases, the other the cessation of the respiratory functions. Causes. — 1. Certain diseases affecting the lungs — pneumonia, bronchitis, etc., etc. 2. Mechanical obstruction to respiration — strangula- tion, drowning, hanging, or long -continued pressure exerted on the icalls of the chest. Post-mortem Signs. — Engorgement of the pulmonary artery, the right cavities of the heart, and vence cavce; SIGNS OF DEATH. 25 but on the left side of the heart the cavities, together with the aorta and pulmonary veins, are either empty or contain but little blood. It must be remembered, however, that cases of asphyxia do sometimes occur where the cavities on each side of the heart are empty, or nearly so. This is the case in the syncopal asphyxia of some writers. If also the obstruction to respiration be imperfect, the circulation may be continued for some time, congestion of one or more of the internal organs being the result. Coma. — Death in this case is due to some cerebral mischief. Cause. — Apoplexy, fracture of the cranial bones, compression or destruction of the brain substance. Post-mortem Signs. — Congestion of the membranes and substance of the brain, and of the lungs. The cavities of the heart, especially those of the right, con- tain more or less blood. Signs of Death. Real or apparent Death. It will be unnecessary here to discuss any of the theories put forth with regard to cases of apparent death or prolonged trance, but simply to note in the order of their occurrence the phenomena which attend real death. Real Death. 1. Entire cessation of respiration and circulation ; no murmur heard on auscultation. 2. The lustre of the eye is lost immediately after death. It has, however, been stated that the iris will respond to the action of atropine and calabar bean for as long as twenty-four hours after death, and that the action of the latter is always more marked than that of the former. 26 FORENSIC MEDICINE. 3. The most powerful stimulus applied to the body- does not cause any reaction. The muscles may, how- ever, be made to contract shortly after death by the stimulus of a slight blow, or by galvanism. 4. The surface of the body becomes of an ashy-white colour. Exceptions. a. Persons of florid complexions retain this for some time after death. b. The red or livid edges of ulcers. c. Blue, black, or red tattoo marks, if not effaced during life, do not disappear. Ecchymoses retain the hue they had at the time of death. d. An i icteric' coloration existing at death never becomes white. Death from Jaundice. e. A rosy tint of the skin described by Devergie, on those poisoned by carbonic acid. 5. The temperature of the body at the time of death is retained for some time. Cooling will depend on the medium in ivhich the body is placed. Average internal temperature of body during life, 98° to 100° F. a. Fat persons retain the heat longer than lean ones; adults longer than children or old persons. Bodies cooled by — 1. Radiation. 2. Conduction. 3. Convection. b. Bodies immersed in ivater cool more rapidly than in air. 9 This fact may be of importance in determining survivorship in a case of drowning. c. Bodies in bed and covered by the clothes, or in cesspools and in dung-heaps, cool less rapidly than when exposed. SIGNS OF DEATH. 27 d. Persons killed by lightning keep longer warm than others (?). e. Death by suffocation retards the process of cooling. f The body may be cold externally, but possess a considerable amount of heat when the internal organs are exposed. Persons ivho have died of cholera, yelloiu fever, or suddenly of some acute disease — rheumatism — may retain for some hours a considerable amount of heat. It has even been asserted that in some diseases — cholera — there is an increase of temperature soon after death. g. Most bodies, under ordinary circumstances, are, as a ride, quite cold in from eight to twelve hours after death. 6. Eelaxation more or less general of trie muscular system takes place. If the above signs are alone present, death must have taken place in from ten to tioelve hours cd the longest (Casper). 7. Want of elasticity in the eyeball. This condition invariably occurs in from twelve to eighteen hours after death. 8. Flattening of the muscles of those parts on which the body rests, due probably to loss of vital turgidity. 9. Hypostasis or Suggillation, due to the gravitation of the blood to the most dependent parts of the body. The marks begin to form in from eight to twelve hours, and increase in size till putrefaction sets in. They may be mistaken for ecchymoses or bruises. Hypos- tasis of the lungs may be mistaken for congestion, inflammation, etc. Errors may also occur with regard to this condition in the brain, kidneys, and abdominal organs. The heart is an exception to the rule, but it may contain clots varying in size and colour, and known as polypi. They are post-mortem forma- 23 FORENSIC MEDICINE. tions. The use of the word suggillation is objection- able, as it has been used in opposite senses by Conti- nental and British authors. 10. Cadaveric rigidity. Cadaveric rigidity, or rigor mortis, in every case pre- cedes putrefaction, and consists in a shortening and thickening of certain muscles, chiefly the flexor and adductor muscles of the extremities, and also the elevators of the lower jaw. This condition commences in the muscles of the back of the neck and lower jaw, and then passes into the muscles of the face, front of the neck, chest, and upper extremities, and then, last of all, into those of the lower extremities. It in most cases passes off in the same order, the body becoming quite flaccid, the rigor mortis never returning. These phenomena occur whilst the body is cooling. The cause of the rigor mortis is by no means evident. Ey some it is held to be due to the coagulation of the albuminous transverse bands seen in all voluntary muscles. By others to the coagula- tion of the fibro-albuminous fluid found between the fibres of muscle. Cadaveric rigidity generally supervenes in from eight to twenty hours after death ; but in some cases it comes on earlier, and may continue from four to nine days. After narcotic poisoning, the rigor mortis is said either not to occur at all, or to pass off so rapidly as to be entirely absent before the body is inspected. In poisoning by carbonic acid the rigor mortis is slight, whilst in cases of strychnia poisoning it soon supervenes, but lasts a long time. In infants and young children cadaveric rigidity is feeble, and soon disappears. A low temperature at the time of death favours the duration oi post-mortem rigidity; and this is still more remarked if, with the low temperature, the person be in a state of intoxication at the time of death. Putrefactive dis- coloration of the body may co-exist with a prolongation of the rigor mortis. CADAVERIC RIGIDITY. Prom the moment of death till the time when putre- faction sets in, the muscular structures of the body may • be said to pass through three stages. 1. Muscular Irritability. The muscles flaccid, but still possessing the power of contractility on the application of certain stimuli. Parts contracted during the act of dying, as the muscles of the hand grasping a knife or other weapon, may con- tinue so for some time after death. 2. Cadaveric Rigidity. A state of rigidity, the power of contractility absent. 3. Commencement of putrefaction and chemical \ change. Eelaxation again present; all power of contraction lost, not to be gained. Cadaveric rigidity is purely muscular, and is not dependent on the nervous system. This state — cadaveric rigidity of the muscles — must be distinguished from muscular spasm occurring at the moment of death. They may be thus distinguished : — In the former case, if any object be placed in the hand prior to the commencement of the rigor mortis, the article can be readily removed, even if the precaution be taken of binding it in the hand prior to the occasion of the rigor mollis. In the case of muscular spasm, the object is found grasped in the hand, and can only with difficulty be removed. The difficulty experienced in removing a pistol or other weapon from the hand may point to suicide, its easy removal to homicide, the weapon having been placed there after death. Cadaveric Eigidity. Table showing the principal points to be noted in the period of accession of this condition, and the causes 30 FORENSIC MEDICINE. which retard or hasten its appearance, or modify its duration : — f In a shortening and thickening of J the muscles, particularly the In ivliat does it consist ? flexors and adductors of the ex- tremities, and elevators of the lower jaw. r Generally in from eight to twenty hours after death. It has been known, however, to supervene within three minutes of death, or it may be delayed for sixteen or seventeen hours. 1 Period of invasion. i From one to nine days. Three weeks (Taylor). * Back of neck and lower jaw, ( muscles of the face, front of the | neck, chest, upper extremities, and then the lower extremities. i Back of neck, lower jaw, etc., fol- \ lowing the course of its accession. { Prolonged by dry cold air, and by ( cold water. Effects of enfeebling dis- { Rapid in its invasion, and passing ease prior to death. \ off rapidly. ' The accession may be prolonged ; I but, other things being equal, it | is more strongly manifested, and continues longer. Period of duration. Order in which the muscles are affected. Order in which it dis- appears. Effects of exposure to cold. Effect of a robust frame at period of death. Effects of violent prior to death. Effects of poison. exercise J Rapidly supervenes, and rapidly \ disappears. Poisons which cause violent con- tractions for some time prior to death — strychnia, etc. — influ- ence the rapid invasion of the rigor mortis, its short duration, rapidly followed by putrefaction. Where death in poisoning by strychnia is almost instantaneous, with a short convulsive stage, the rigor mortis comes on rapidly, and re- mains a long time. PUTREFACTION. 31 Cutaneous Hypostasis. 1. Meaning of the expression. The gravitation of the blood in the capillaries after death, in obedience to the laws of inert matter. 2. On ivhat parts of the body usually seen ? On the most dependent parts of the body ; on the whole of the back of the body, if the body be snpine. 3. At what period after death first observed ? In from eight to twelve hours, gradually extending in size till putrefaction sets in. 4. Whether or not affected by death from hemorrhage ? Formed after every kind of death, even after death due to haemorrhage. 5. With ivhat result of external violence sometimes confounded ? Liable to be confounded with ecchymosis, the result of injury. 6. How distinguished from this ? Effused or coagulated blood is found when an incision is made in a true ecchymosis, however small. Only a few bloody points seen on a slight or deep incision into a post-mortem stain or true hypostasis, and it is never raised above the surface, as eccyhmoses sometimes are. In describing these two conditions, 6 ecchymosis ' and 6 hypostasis,' it is preferable to describe the former as 6 discoloration from extravasated blood/ and the latter as ' lividity after death. 7 Putrefaction. Internal conditions which modify putrefaction : — 1. Age. 2. Sex. 3. Condition of the Body. a. Constitutional peculiarity, b. State of the body. 32 FORENSIC MEDICINE. 4. Kind of Death. a. The result of disease. b. The result of poison. External conditions which modify putrefaction : — 1. Air. 2. Moisture. 3. Warmth. Internal Conditions ivhich modify Putrefaction. 1. Age. — The "bodies of young children, other things being equal, are said to putrefy rapidly. It should he remembered, however, that clothing possesses consider- able power in retarding putrefaction, and that, in the hurry and anxiety to get rid of the infants, they are oftener exposed naked than clothed, which may, in some measure, account for their more rapid decomposition. 2. Sex. — Sex, it would appear, has little or no influ- ence either to retard or hasten putrefaction ; but it has been remarked that females dying during, or soon after, child-birth, irrespectively of the cause of death, do putrefy most rapidly. 3. Condition of the Body. a. Constitutional Peculiarity. — It is generally ad- mitted that persons of the same age and sex, dying similar deaths, and subjected to like conditions as to exposure to the air and interment in the same soil, exhibit marked differences as regards the accession and rapidity of putrefaction. The explanation may be diffi- cult, but the fact still remains. b. State of the Body. — Fat and flabby corpses putrefy more rapidly than the lean and emaciated. Hence old people, who are generally thin, keep fresh for a com- paratively long time. Bodies also which are much mutilated rapidly decompose, decomposition setting in first at the part injured. In examining wounds and bruises said to have been inflicted during life, it is well to remember that the tendency of putrefaction is to make them appear more severe. PUTREFACTION. 38 4. Kind of Death. — a. Effect of Disease, b. Effect of Po isons. a, Effect of Disease. — Healthy persons dying sud- denly, other things being equal, are said to decompose more slowly than those who have died from exhausting diseases, as in the case of typhoid, phthisis, dropsy following organic disease, or of those diseases attended with more or less putridity of the fluids. b. Effect of Poisons. — Putrefaction rapidly supervenes in those who have died suffocated by smoke, by car- bonic oxide, and by sulphuretted hydrogen. Narcotic poisoning is stated to accelerate this condition \ but poisoning by phosphorus, alcoholic blood-poisoning, and in cases of death from sulphuric acid, the putrefactive changes are greatly retarded. The manner in which death takes place from the action of the poison greatly advances or retards putrefaction. Thus, in the case of poisoning by strychnia, it is found that when death has occurred rapidly, without much muscular exhaustion,^ putrefaction sets in slowly; but that when the mus- cular irritability has been by successive fits greatly exhausted, the contrary is the result. Arsenic, chlo- ride of zinc, and antimony are reputed to possess anti- septic properties. External Conditions which modify Putrefaction. 1. Air. — Exposure in the open air has a marked effect in promoting putrefaction ; but garments fitting close to the body, and thus excluding air, have a con- trary effect. Dry air, or air in motion, by assisting evaporation from the corpse, acts as a preservative. The composition of the soil in which the body is placed has also a more or less modifying effect. In light, porous soil, allowing of the free ingress of air, decom- position is more rapid than in close, compact soil, as clay ; but in this we have to contend with another 1 agent, moisture, which more or less counteracts the pro- tective virtue of the closer earth. c 34 FORENSIC MEDICINE, 2. Moisture. — Putrefaction cannot proceed without moisture. The body, however, contains sufficient water to enable this process to commence spontaneously. Organic substances artificially deprived of water do not putrefy. Cold and heat possess marked antiseptic pro- perties — the former by freezing the i fluids in the body, the latter by drying them up. 3. Warmth. — A temperature between 70° and 100° P. is found most favourable to decomposition. The effect of cold is shown by the fact that a body immersed in water during winter, at a temperature between 36° and 45° P., may be so well preserved as to present, ten or twelve days after death, well-marked signs of violence, . which would in summer have been utterly obliterated in five or seven days. The preservative influence of cold water will, however, depend greatly on the depth at which the body has been submerged. Bodies so submerged, and then exposed to the air, putrefy with such rapidity that exposure for one day is said to work a greater change than three or four days' longer retention of the body in the water. As an instance of the preservative power of cold, may be men- tioned the mammoth found in Siberia embedded in. a block of ice. The Phenomena of Putrescence in their Chronological Order. /. — External, One to Three Days. — Greenish coloration of the abdominal walls. Odour of putrescence is gradually developed, and concurrently with this the eyeball be- comes soft, and yielding to pressure. Three to Five Days. — The green colour, of a deeper shade, has now passed over the abdomen, extending also to the genital organs. Patches of this green coloration also make their appearance somewhat irregu- ■ PUTKEFACTION. 35 larly on other parts of the body, such as the neck, * hack, chest, and lower extremities. A dark-reddish \ frothy fluid about this time wells up from the mouth. Eight to Ten Days, — The patches of green colour I have now coalesced, so that the whole body is dis- \ coloured. On some- parts of the body the colour is of a reddish green, due to the presence of decomposed *■ blood in the cellular tissue. The abdomen is now dis- tended with gases, the products of decomposition. The colour of the eyes has not disappeared, but the cornea • has fallen in. Eelaxation of the sphincter am takes i place, and the superficial veins appear like reddish- : brown cords. The nails still remain firm. Fourteen to Twenty Days. — The colour of the sur- face is now bright green, with here and there patches of a blood and brown colour. The epidermal layer of the skin is raised in bullae of varying size, in some places the skin being more or less stripped off. The nails are detached, and can be easily removed. The hair can be pulled from the scalp with ease. The body is now greatly distended with gases, and the features cannot be recognised, owing to the swollen condition of the face. The body is generally covered with vermin. In determining the time at which death occurred, it will be necessary to take into consideration the season of the year, as it is found that an advanced stage of decomposition may be present in from eight to ten days, with the thermometer ranging between 68° and 77° F., which in winter, with a temperature of from 32° to 50°, would require twenty to thirty days. ' Bodies green from putridity, blown up and excori- ated, at the expiry of one month, or from three to five months after death (coet. par.), cannot with any cer- tainty he distinguished from one another 1 (Casper). Three to Six Months. — During the above period the stage of colliquative putrefaction has set in. The thoracic and abdominal cavities, due to the increased formation of gas, have burst. The bones of the cranium 36 FORENSIC MEDICINE. have more or less separated, allowing the brain to escape. The soft parts are more or less absorbed, and no recognition of the features is possible. The sex can only be positively made out by the presence of a uterus, or by the peculiar growth of hair on the pubes, which in woman only covers the pubes, but in man extends upwards to the navel. Saponification. — Bodies exposed to the action of water, or buried in damp, moist soil, are apt to undergo certain changes, in the course of which they become saponified, and the formation of a substance known as adipocere is the result. Adipocere — adeps, lard, and cera, wax — is chiefly composed of margarate of ammonia, together with lime, oxide of iron, potash, certain fatty acids, and a yellow- coloured odorous matter. The melting point is 126 -5° F. Adipocere has a fatty, unctuous feel, is either pure white or of a pale-yellowish colour, and with the odour of decayed cheese. The formation of this substance ' to any considerable extent is not likely to occur in less than three to four months in water, or six months in moist earth, though its commencement may take place at a much earlier period.' To explain the formation of adipocere, it has been supposed to be due to the decomposition of the mus- cular structures of the body, by which hydrogen and nitrogen are evolved, these combining to form ammonia, which, coming in contact with the fatty acids of the fat, a soap is formed. The process of saponification takes place most rapidly in young fat persons ; next, in those adults who abound in fat, and in those whose bodies have been exposed to the soil of water-closets, or immersed in water; and lastly, in those who have been buried in moist, damp soil. The muscular tissue appears to be the first to undergo this change. In water the process is said to be completed in about five months, but in soil a period of two to three years appears necessary. Mummifica- PUTREFACTION. 37 tion is of no medico-legal interest, as the causes which produce it are unknown, and no reliable data can be obtained as to the period of its accession, or the time required for its production. Table showing the Order in tohich the Internal Organs undergo Putrefaction. 1. The trachea: 2. The brain of infantsr 3. The stomach.- 4. The intestines.-— 5. The spleen. 6. The omentum and mesen- tery. 7. The liver. 8. The adult brain. 9. The heart. 10. The lungs. 11. The kidneys. 12. The bladder. 13. The gullet. 14. The pancreas. 15. The diaphragm. 16. The blood-vessels. 17. The uterus. II. — Internal. A. Organs which putrefy early. 1. The Trachea, including the Larynx. — This rapid change in the trachea must be borne in mind, in order to avoid the error of attributing death to suffocation or drowning. An examination of the trachea should never be omitted. (See Casper, vol. i., p. 45, Syd. Trans.) 2. The Brain of Infants up to the First Tear. 3. The Stomach. — The first traces of putrefaction are seen in from four to six days after death. All the coats of the stomach are softened, but there is no exco- riation, as is the case when corrosive poisons are taken. Emphysematous separation of the mucous coat may be present, but must not be confounded with the excoria- tion just mentioned. 4. The Intestines. — Casper declares that he does not remember any case in the course of his experience where the intestines were c found earlier putrefied than the stomach.' In the course of putrefaction they become 38 FORENSIC MEDICINE. of a dark-brown colour, bursting, and allowing an escape of their contents ; and they ultimately become changed into a dark pultaceous mass. 5. The Spleen. — This organ in some cases putrefies before the stomach and intestines ; but, as a rule, it resists decomposition longer. 6. The Omentum and Mesentery. 7. The Liver. — This organ is not infrequently found firm and dense some weeks after death. It putrefies earlier in new-born children than in adults. The con- vex surface first shows signs of putrefaction. The gall bladder also remains for some time recognisable. 8. The Adult Brain. — The brain of newly-born chil- dren, as mentioned before, soon putrefies. This is not the case in the adult brain. Putrefaction sets in not on the surface, but at the base of the brain. A wound of the brain causes it to putrefy more rapidly than if no injury be present. B. Organs ivhich putrefy late. 9. The Heart 10. TJie Lungs. — Contemporaneously with the appear- ance of decomposition in the heart the lungs also begin to show signs of putrefaction, though this condition may take place earlier. 1 1 . The Kidneys. — These organs are long in yielding to the putrefactive process. 12. The Bladder. — Nearly all the other organs of the body are in a state of decomposition before this viscus becomes materially affected. 13. The Gullet. — This long remains firm, even after the stomach and intestines fail to be recognised. 14. The Pancreas. — The body must be far advanced in putrefaction before this gland becomes affected. • 15. The Diaphragm. — This may be distinguished after the lapse of four to six months. 16. The Blood-vessels. — The aorta may be recognised after the body has been interred for fourteen months. PUTREFACTION. 39 17. The Uterus. — Of all organs of the body, the uterus resists the putrefactive changes longer than any- other organ. — Casper. ( Table showing some important facts to be noticed with regard to Putrefaction. 1. Earliest external indication of it. a. In a body exposed to air. — Greenish colora- tion of the abdominal coverings. b. In a body immersed in water. — Face, head, and ears, gradually extending from above downwards. 2. Earliest internal indication. — Found in the trachea, including the larynx. 3. Advanced putrefactive appearances to be expected in a body exposed to air, say from fourteen to twenty days at mean temperature, as regards — a. Epidermis. — Eaisedhere and there in blisters about the size of a walnut, in some places the size of a dinner plate, and quite stripped off. b. True Skin. — Maggots cover the body, chiefly in the folds of the skin. c. Cellular Tissue. — Elown up with gas. 4. Comparative time required to produce equal extent of putrefaction in a body. a. In air. — One week. One month. b. In ivater. — Two weeks. Two months. c. In earth. — Eight weeks. Eight months. Does lime hasten putrefaction ? — It is a very general opinion that it does. Careful experiment has, however, proved that lime neither retards nor hastens putrefaction, but that it prevents, by absorbing them, the escape of the gases produced during the process ; it is, therefore, a good and safe deodoriser, and in this property its true value lies. 40 FORENSIC MEDICINE. Table showing the points to be noticed in determining the Sex, Age, and Stature, from an Inspection of the Skeleton. 1. Determination of the Sex. a. From the Bones Generally. — The bones of the female are smaller and more slender than in the male ; they are also smoother, less curved, and not so strongly marked by the attachments of the muscles. The joints are also smaller than in the male. b. From the Thorax. — The thorax in the female is deeper than in the male, the sternum shorter and more convex, the ensiform cartilage thinner, and ossified later in life. The cartilages of the ribs are longer, and the ribs smaller, than in the male. c. From the Pelvis. — In the female pelvis the ilia are more expanded and horizontal ; the sacrum more concave ; and the os coccygis more slender, movable, and turned more backwards ; the tuberosities of the ischia are wider apart, and flatter; the pubis is more shallow ; the cartilages of the symphysis broader ; the angle formed by the descending rami of the ossa pubis more rounded, and the pubic arch wider. The whole pelvis is shallower, and the outlets larger, than in the male. The antero-posterior diameter of the well-formed female pelvis at the brim is about 4^ inches, the lateral diameter about 5 inches, the oblique about 5 \ inches. At the outlet, the lateral and antero- posterior diameters are about 4| inches respectively. Before the age of puberty, the differences in the male and female skeleton are not well marked, and an examination of the pelvis prior to that period of life will afford no evidence of sex. 2. Determination of Age. a. From the Ribs. — More or less complete ossification of the cartilages as age advances. In the very aged, the cartilages may be completely ossified. b. From the Skull. — The imperfect ossification of the PUTREFACTION. 41 bones of tlie head points to early childhood. Later in life the bones are solidly united, but become thin from the absorption of their diplde. c. From the Jaws. — The toothless narrow lower jaw of the aged is very characteristic, the narrowing being due to the loss of the teeth, and subsequent absorption of the alveolar process of the jaw. 3. Determination of Stature. a. When the complete Skeleton is found. — The body must be laid out in position, and an estimate made, it being usual to allow an inch and a-half to two inches for the thickness of the soft parts. b. When only portions are found. — As there does not appear to be any uniform relation between the length of any of the long bones and the stature of the entire skeleton, no reliable data can be arrived at by the measurement of a bone alone. Taylor remarks, that [ the best that can be said of this mode of measurement is that it can never be proved wrong ; for, in general, there can be no witness to speak to the stature of the" person while living.' The following are some of the instructions issued to medical inspectors by the Crown Office in Scot- land, slightly modified : — I. Part of General Directions. 13. When any portions of the body, or any substances found in or near it, are to be preserved for further examination, they ought never to be put out of the custody of the inspectors, or of a special law-officer. They must be locked up in the absence of the person who keeps them. When they are to be trans- mitted to a distance, they should he labelled, and the labels signed by the inspectors ; and after being properly secured and sealed, they should be delivered by the inspectors themselves, or the special law-officer whose duty it is to see them delivered, into the hands of the parties for whom they are intended. . 42 FORENSIC MEDICINE. II. Necessary Implements. 14. Besides the ordinary instruments used in common dis- sections, the inspectors should be provided with a foot-rule for measuring distances, and a glass measure graduated to drachms, for measuring the quantities of fluids, two or three stoneware jars of medium size, or when these cannot be had, a few clean bladders, for carrying away any parts of the body which it may be necessary to preserve for future examination, and in cases of possible poisoning, three or four bottles of eight, twelve, and sixteen ounces, with glass stoppers or clean corks, for preserving fluids to be analysed. The common square green glass pickle bottles are very suitable, and can generally be obtained. No bottle or jar should be used until it has been thoroughly washed under the supervision of one of the inspectors. 15. All distances, lengths, surfaces, and the like, whose extent may require to be described, ought to be accurately measured ; and the same rule ought to be followed in ascertain- ing the volume of fluids. When large quantities of fluids are to be measured, any convenient vessel may be used, whose capacity is previously ascertained by the inspectors. Conjectural estimates and comparisons, however common, even in medico- legal inspections, are quite inadmissible. III. External aspect, and Examination of the Body. 16. The importance of the external examination, and the particulars to be chiefly attended to in performing it, will vary in different cases with the probable cause of death. It compre- hends an examination — 1. Of the position of the body when found, as well as of all external injuries or marks presented by it. 2. Of the vicinity of the body, with a view to discover the objects on which it rested, or from or upon which it may have fallen, marks of a struggle, signs of the presence of a second party about the time of death or after it, weapons or other objects the property or not the property of the deceased, the remains of poisons, marks of vomiting ; and where marks of blood are of importance, and doubts may arise as to their really being blood, the articles presenting them must be preserved for further examination. 3. Of the dress, its nature and condition, stains on it of mud, sand, or the like, of blood, of vomiting, of acids, or other corrosive substances, marks of injuries, such as rents or incisions; where injuries have been inflicted on the body, care should be taken to compare the relative position of those on the body and those on the clothes; and where stains, apparently from poison, are seen, the stained parts are to be preserved for analysis. 4. Ligatures, their material and kind, INSTRUCTIONS TO MEDICAL INSPECTORS. 43 as throwing light on the trade of the person who applied them ; the possibility, or impossibility, of the deceased having applied them himself ; their sufficiency for accomplishing their apparent purpose, etc. 17. The inspectors will commence the examination of the body itself by surveying the external surface and openings. Before cleaning it they will examine it on all sides, not neglect- ing the back, as is often done, and look for marks of mud, blood, ligatures, injuries, stains from acids, and the like ; foreign bodies, or injuries within the natural openings of the body, viz., the mouth, nostrils, ears, anus, vagina, and urethra. If there are impressions of finger-marks, they will consider which hand pro- duced them. If there be any doubt about stains being blood, the skin presenting them must be preserved for analysis. If there be acid stains, or other probable remains of poison, or any foreign matter, the nature of which may require to be determined by analysis, these must also be preserved. The ordinary places for the impressions of ligatures are the neck, the wrists, the ankles, and the waist. The degree of warmth of the trunk and ex- tremities, the presence or absence of cadaveric rigidity, and whether it exists equally in the upper or the lower extremities, should be noted in this stage of the proceedings ; in other cases the progress of putrefaction, as indicated by the odour of the body, the looseness of the cuticle, the colour of the skin, and formation of dark vesicles on it, the evolution of air in the cellular tissue, the alteration of the features, the softness of the muscles, the shrivelling of the eyes, the looseness of the hair and nails. 18. In this part of the examination it will sometimes be necessary to observe the particulars by which the body may be identified. These are numerous. But the most important are the stature, the degree of plumpness, the size and form of the nose and mouth, the colour of the eyes and hair, the state of the teeth, warts, nasvi, deformities, scars of old abscesses, ulcers, and wounds. 19. The body is next to be washed, if necessary, and the hair of the head shaved, or at least closely cut ; and a thorough examination of the whole integuments is to be made. At this stage the inspectors will look particularly for the appearance of lividity, noting its chief seat and its relation to the posture in which the body was found — for impressions on the skin of objects on which it had rested — for marks of injuries, more especially contusions, taking care to ascertain their real nature by making incisions through the skin — for marks of disease, such as erup- tions, ulcers, and the like— for marks of burning — for marks of concealed punctures in the nostrils, mouth, external openings of the ears, the eyes, the nape of the neck, the arm-pits, the 44 FORENSIC MEDICINE. anus, the vagina, and beneath the mammre or scrotum ; in infants, also in the fontanelles and the whole course of the spine. At this stage, wounds and other injuries should be carefully examined according to the directions given in Division V. (infra). Where the injury may have caused loss of blood, the presence or absence of pallor of the skin, lining membrane of the mouth and the gums ought to be noted. IV. Dissection, or Internal Examination of the Body. 20. In commencing the dissection of the body, it must be laid down as an invariable rule that all the great cavities should be examined, and also every important organ in each, however distinctly the cause of death may seem to be indicated in one of them. It is right to examine the cavity of the spine, and at all events its upper portion, in any case where an unequivocal cause of death has not been discovered elsewhere. 21. In examining the organs situated in the several cavities of the body the inspectors must be guided in a great measure by their ordinary anatomical and pathological knowledge. 22. The inspectors should begin with that cavity over which there is a wound or other mark of injury. Or, if there be an injury on the extremities, the dissection ought to commence there. In the absence of any such guide, that cavity should be taken first where the circumstances of death, so far as they are ascertained, may lead the inspectors to expect unusual appear- ances. In other cases the abdomen should be first opened but not dissected, and a general survey made of the parts exposed, without disturbing them materially ; the position of the diaphragm being determined by examining it with the hand, then the thorax is immediately to be examined, unless there is good reason for doing otherwise. The reasons for this method of procedure are as follow : — If the abdominal organs are removed, and the veins cut, the blood in the heart may drain away through the vense cavse, and error result. If, on the other hand, the thorax be first opened, the relation of the abdominal organs to each other cannot be clearly made, owing to the relaxation of the diaphragm, due to the severing of its thoracic connections. Again, if the thorax be first opened, the position of the diaphragm cannot be determined. The inspectors may begin with the head, which may be examined thoroughly in the first instance, afterwards the chest and belly, as above described ; the spine being reserved till the conclusion. Wherever unusual appearances are discovered in the first cursory survey, the anatomical examination ought in general to be begun there. 23. In examining the several regions of the body it is to be observed, that wherever a wound, or other obvious injury of the INSTRUCTIONS TO MEDICAL INSPECTORS. 45 external parts, lies in the way of the ordinary incisions, that part must be avoided, so as to leave the external injury unaltered. 24. The most approved mode of opening the head in medico- legal cases is, after dividing the integuments from ear to ear, and reflecting the scalp over the forehead and occiput, to make the usual circular incision through the skull, about an inch above the orbits in front, and over the occipital protuberance behind, using the saw lightly and carefully after the outer table of the skull has been divided, so as to avoid injuring the mem- branes of the brain ; and to raise the skull-cap from before backwards, taking care to detach the dura mater from the skull with the handle of the scalpel or a spatula where it adheres firmly. Should the dura mater be firmly adherent to the skull- cap, the better practice is to divide it carefully, so as to remove both at the same time. Tearing the membrane and crushing the brain substance are thus avoided. In infants and young children this mode of procedure is most necessary, as in them the dura mater is, as a rule, adherent. 25. The ordinary mode of examining the membranes of the brain, and the brain itself, answers well in medico-legal dis- sections. Effusions of fluid within the skull should always be measured. After the brain is removed, the dura mater ought to be stripped from the base of the skull to facilitate the search for, fractures there, which will, of course, indicate external violence. After the removal of the brain, the upper part of the spinal canal should be examined through the foramen magnum before any part of its course be laid open; and search should be particularly made for dislocation or other injury in the region of the atlas and dentata. In cases of fatal fractures of the head, the strength of the bones should be attended to. In cases of extravasation within the head, the state of the coats of the cerebral arteries should be examined. 26. The best mode of opening the spine is, after having finished the examination of the brain, to cut through the integuments from the occiput to the coccyx, — to lay the vertebrae thoroughly bare on each side by cutting away the muscles, — to make an incision with the saw on each side of the skull, from the postero-inferior angle of the parietal bones into the lateral edge of the occipital hole, — to remove the triangular portion of the occipital bone thus detached, and then to cut the rings of the vertebrae on each side with the bone nippers or spine-knife, beginning with the atlas. The only exception to this course occurs where there is reason to think that the bones are injured ; in which case, the laying open of the canal should stop at the distance of two or three vertebrae from the injury, and the injured bones, with two or three adjacent vertebrae on 46 FORENSIC MEDICINE. each side, should be removed entire before the examination is extended further down the spine. 27. The organs of the throat may be examined, either by dividing the lower jaw-bone at the chin, cutting the soft parts close to the inner surface of each half of the bone backwards, and then turning the two segments outwards ; or by freely reflecting the skin of the throat, separating the soft parts from the inside of the lower jaw, the knife being carried parallel with and close to the bone, drawing the tongue out below the chin, and then continuing the dissection backwards. 28. The best mode of examining the organs situated in the throat is, after detaching the soft parts from the lower jaw, as advised in Sect. 27, to dissect the soft palate from the bone, and, proceeding backwards, to detach the whole soft parts from the base of the skull and vertebrae down to the sternum, leaving them connected with the organs in the chest. Besides the ordinary points to be attended to in this part of the examina- tion, the presence of venereal or other ulcerations is a matter requiring attention in some cases. 29. It is necessary to examine the pharynx and gullet, the larynx, trachea, and its greater ramifications ; the lungs, the heart, and the great vessels with particular care, because here are most frequently found the causes of sudden natural death. In examining the heart, each auricle and each ventricle ought to be laid open by an independent incision of its parietes ; and this should not intersect either any of the valvular openings or the septum cordis. 30. For laying open the chest and abdomen, the most con- venient method is to make an incision down the fore part of the neck, chest, and abdomen to the pubes ; then cutting from the peritoneum upwards, to dissect back the integuments and muscles of the chest, and examine the abdomen, as in 22 ; next, divide the cartilages of the ribs, and, cutting upwards close under them, to raise the cartilages along with the sternum. In separating the sternum from the clavicles, care must be taken not to wound the subjacent vessels ; and this may be avoided by the dissector moving each shoulder so as to show the exact position of the sterno- clavicular joints, and then dividing both joints cautiously. In dividing the cartilages of the ribs, the saw is sometimes necessary. The cartilages should be cut as far from the sternum as possible, to give free space for the sub- sequent examination. 31. In inspecting the organs in the chest, a cursory examina- tion should be first made by turning them over, ascertaining the nature and measuring the quantity of effused fluids, feeling for tumours or other diseases, and opening the pericardium to obtain a view of the heart. The most convenient course to INSTRUCTIONS TO MEDICAL INSPECTORS. 47 pursue next is, without moving the heart from its place, to lay open its several cavities, in order to judge of the quantity and state of the blood in both sides of that organ. For this purpose the following incisions should be made : — The first, beginning close to the base, is carried along the right border of the heart directly into the right ventricle towards the apex, care being taken not to cut the septum. This lays open the right ventricle. The second incision, opening up the right auricle, begins midway between the entrances of the vena; cavse, ending just in front of the base. The third, for exposing the left auricle, commences at the left superior pulmonary vein, and ends just in front of the base, close to the coronary vein, care being taken not to wound it. The fourth, displaying the left ventricle, commences behind the base, and ends close to the apex. The whole of the organs in the chest — namely, the lungs, heart, and gullet — together with the parts dissected downwards from the throat, should now be removed in one mass, in order to examine them in detail on a table. But pre- viously two ligatures should be applied on the gullet, just above the cardiac orifice of the stomach, and the division made between them. 32. The organs in the abdomen ought to be turned over, like those of the chest, before any one of them is minutely examined, but before the thorax is opened, for the reasons given in Sect. 22. In the subsequent examination that organ is to be first proceeded with in which there may appear to be disease. Y. — Examination in Cases of Wounds and Contusions, 33. In a post-mortem examination, the most approved mode of examining these injuries is, if they be situated over great cavities, to expose the successive structures in the manner of an ordinary dissection, observing carefully what injuries have been sustained by the parts successively exposed before they are divided. Wounds ought not to be probed, especially if situated over any of the great cavities. The depth of a wound is best ascertained by careful dissection and exposure of the parts involved ; but after this is done, the thickness of the tissues penetrated may be measured by the probe. 34. The seat of the wounds must be described by actual measurement from known points, their figure and nature also carefully noted, and their direction ascertained with exactness. 35. Before altering by incisions the external appearances of injuries, care must be taken to consider what weapon might have produced them ; and if a particular weapon be suspected, it should be compared with them. 36. Apparent contusions must be examined by making inci- sions through them; and the inspectors will note whether 48 FOKENSIC MEDICINE. there be a swelling or puckering of the skin ; whether the sub- stance of the true skin be black through a part or the whole of its thickness ; whether there be extravasation below the skin or in the deeper textures, and whether the blood be fluid or coagu- lated, generally or partially ; whether the soft parts below be lacerated, or subjacent bones injured ; and whether there be blood in contact with the lacerated surfaces. By these means the question may be settled whether the contusions were inflicted before or after death. 37. In the cases of wounds, too, the signs of vital action must be attended to, especially the retraction of the edges, adhesion of blood to their surfaces, or the injection of blood into the cellular tissue around, or the presence of the signs or sequelae of inflammation. 38. When large arteries or veins are found divided, care must be taken to corroborate the presumption thus arising by ascer- taining, in the subsequent dissection, whether the great vessels, lungs, liver, and membranous viscera of the abdomen be unusu- ally free of blood. 39. In the course of the dissection of wounds, a careful search must be made for foreign bodies in them. "When fire-arms have occasioned them, the examination should not be ended before discovering the bullet, wadding, or other article, if any, lodged in the body ; and whatever is found must be preserved. When the article discharged from fire-arms, or when any other weapon, has passed through and through a part of the body, the two wounds must be carefully distinguished by their respec- tive characters, especially as regards their comparative size, inversion or eversion, smoothness or laceration of their edges, their roundness or angularity, and the comparative amount of bleeding from each. In gunshot injuries, the presence or absence of marks of gunpowder should be noted. 40. When wounds are situated over any of the great cavities, they ought not to be particularly examined till the cavity is laid open ; and in laying open the cavity, the external incisions should be kept clear of the wounds. 41. When the discoloured state of a portion of the skin is such as to render it doubtful whether it is due to injury or to changes after death, an incision should be made to ascertain whether there is blood effused into the textures, constituting true ecchymosis, or merely gorging of the vessels of the skin, or discoloration from infiltration of the colouring matter of the blood, which takes place in depending parts of a dead body. The term suggillation should be avoided, as it has been used in opposite senses by Continental and British authors. The respec- tive expressions, discoloration from extravasated blood, 9 and 'lividity after death,' are preferable. INSTRUCTIONS TO MEDICAL INSPECTORS. 49 VI. Examination in Cases of Poisoning. 42. In examining a body in a case of suspected poisoning, the inspectors should begin with the alimentary canal, first tying two ligatures round the gullet, above the cardiac orifice of the stomach, two round its pyloric end, and a third at the sigmoid flexion of the colon, then removing the stomach and entire intestines ; next dissecting out the parts in the mouth, throat, neck, and chest in one mass ; and, finally, dissecting the gullet, with the parts about the throat, from the other organs of the chest. The several portions of the alimentary canal may then be examined in succession. 43. Previous to commencing the dissection in cases of sup- posed poisoning, the inspectors should make such inquiries as may enable them to form an opinion as to the class of poison to which the death may be traceable, and thus to guide them as to the conclusions to be come to from the presence, or it may be the complete absence, of any marked appearance explaining the cause of death. 44. The medical inspectors may afford most important aid to the law officers in investigating the history of cases of supposed poisoning. For this purpose minute inquiry should be made into the symptoms during life, their nature, their precise date, especially in relation to meals, or the taking of any suspicious article, their progressive development, and the treatment pur- sued. It is impossible to be too cautious in collecting such information, and, in particular, great care must be taken to fix the precise date of the first invasion of the symptoms, and the hours of the previous meals. The same care is required in tracing the early history of the case, where the inspector hap- pens to visit the individual before death ; and if suspicions should not arise till his attendance has been going on for some time, he ought, subsequently to such suspicions, to review and cor- rect the information gathered at first, especially as to dates. All facts thus obtained should be immediately committed to writing. 45. Besides inspecting the body and ascertaining the history of the case, the inspectors may afford valuable assistance to the law officers in searching for suspicious articles in the house of the deceased. These are — suspected articles of food, drink, or medicine ; the vessels in which they have been prepared or afterwards contained ; the family stores of the articles with which suspected food, etc., appears to have been made. All such articles must be secured according to the rules in Sect. 13, for preserving their identity. In this examination the body- clothes, bed-clothes, floor, and hearth should not be neglected, as they may present traces of vomited matter, acids spurted out or spilled, and the like. D 50 FORENSIC MEDICINE. 46. When a medical man is called to a case during life, where poisoning is suspected, he ought as soon as possible to follow the instructions laid down for securing articles in which poison may have been administered. 47. In the same circumstances, it is his duty to observe the conduct of any suspected individual, were it for no other reason than to prevent the remains of poisoned articles from being put out of the way, and to protect his patient against further attempts. 48. The whole organs of the abdomen must be surveyed, and particularly the stomach and whole tract of the intestines, the liver, spleen, and kidneys, the bladder ; and in the female, the uterus and its appendages. The intestines should in general be split up throughout their whole length ; and it should be remembered that the most frequent seat of natural disease of their mucous membrane is in the neighbourhood of the ileo- cecal valve, and that, next to the stomach, the parts most generally presenting appearances in cases of poisoning are the duodenum, upper part of jejunum, lower part of ileum, and rectum. 49. In cases where the possibility of poisoning must be kept in view, and where matters may require to be procured for chemical analysis, it is essential to be sure that all instruments, vessels, and bladders used are scrupulously clean. 50. When any unusual odour is perceived, either in the blood in the course of making the dissection, or in the stomach when opened, it ought to be carefully observed, and if possible identi- fied by all the medical men present. In this way alcohol, opium, prussic acid, oil of bitter almonds, and other odorous poisons may be recognised. The smell of the contents of the stomach ought always to be noted whenever it is opened, as the smell often alters rapidly. 51. The stomach and intestines should be taken out entire, and their contents emptied into separate bottles. If the stomach or part of the intestines present any remarkable appearance, examination may be reserved, if convenient, till a future oppor- tunity ; but in every circumstance it must be preserved and car- ried away, as it may itself be an important article for analysis. The throat and gullet may be examined at once, and preserved with their contents, which, if abundant, may be kept apart in a bottle. In addition to the alimentary canal and its various contents, portions of the solid organs of the body, ought to be secured for analysis. The most important are the liver, spleen, and kidneys. A part of the liver, at least a fourth part, should be secured in every case of supposed poisoning ; and in cases where the fatal illness has been of long duration, and therefore only traces of the poison may remain in the body, the whole of INSTRUCTIONS TO MEDICAL INSPECTORS. 51 the liver, the spleen, and both kidneys should be secured. A portion of the blood, especially when the odour of any volatile poison is perceived, should be at once put into a bottle, closed by a good cork or stopper. 52. No person ought to undertake an analysis in a case of suspected poisoning, unless he be either familiar with chemical researches, or have previously analysed with success a mixture of organic substances, containing a small proportion of the poison suspected. 53. All persons undertaking an analysis should bear in mind that the opinion of some other person practised in toxicological researches may be required ; and they should therefore take care, when practicable, to use only a portion of the several articles preserved for analysis. The identity of the subjects of analysis must be secured by the rules in Sect. 13. VII. Examination in Cases of Suffocation, 54. In cases of suspected drowning, the inspectors will observe particularly whether grass, mud, or other objects be clutched by the hands, or contained under the nails ; whether the tongue be protruded or not between the teeth ; state of the penis ; whether any fluid, froth, or foreign substances be contained in the mouth, nostrils, trachea, or bronchial ramifications*; whether the stomach contain much water ; whether the blood in the great vessels be fluid. When water with particles of vegetable matter or mud is found within the body, these must be compared with what may exist in the water in which the body was discovered, and should be preserved for further scien- tific investigation if requisite. Marks of injuries must be com- pared diligently with objects both in the water and on the banks near it, and especial attention given to the question whether any observed injuries had been sustained by the body before or after death. 55. In cases of suspected death by hanging, strangling, or smothering, it is important to attend particularly to the state of the face as to lividity, compared with the rest of the body ; the state of the conjunctiva of the eyes as to vascularity ; of the tongue as to position ; of the throat, chin, and lips, as to marks of the nails, scratches, ruffling of the scarf-skin, or small contusions, the state of the blood as to colour and fluidity ; the state of the heart as regards the amount of blood in its several cavities ; the state of the trunk and branches of the vena cava in the abdomen as regards distension with blood, and the state of the lungs as regards congestion, rupture of any of the air cells, and small ecchymoses under the pleura, or the pericardium. The mark of a cord or other ligature round the neck must be atten- 52 FORENSIC MEDICINE. tively examined ; and here it requires to be mentioned that the mark is often not distinct till seven or eight hours after death, and that it is seldom a dark livid mark, as is very commonly supposed, but a pale greenish-brown streak, present- ing no ecchymosis, but the thinnest possible line of bright redness at each edge, where it is conterminous with the sound skin. Nevertheless, effusions of blood and lacerations should be also looked for under and around the mark, in the skin, cellular tissue, muscles, cartilages, and lining membrane of the larynx, and trachea. Accessory injuries on other parts of the body, more especially on the chest, back, and arms, must also be looked for, as likewise the appearance of blood having flowed from the nostrils or ears, and the discharges of fasces, urine, or semen. In cases where death may be due to the emanations from burning fuel or other poisonous vapours, a small phial should be filled with the fresh blood and securely corked for further investigation, if requisite. VIII. Examination in Cases of Burning, 56. In supposed death by burning, the skin at the edge of the burns should be carefully examined for redness, or the appear- ance of vesicles containing fluid. IX. Examination in Cases of Criminal Abortion. 57. In suspected criminal abortion, when the woman survives, the chief points for inquiry are — The proofs of recent delivery, the ascertaining of facts tending to show that she has been sub- jected to manoeuvres with instruments, and the occurrence of symptoms traceable to the action of any of the drugs reputed as capable of causing abortion. When the woman has died, the points requiring special atten- tion at the dissection are — The state of the womb, as regards its size and the condition of its lining membrane, in reference to the probable period of delivery ; the condition of the intestinal canal, in reference to the action of irritant drugs ; of the mucous membrane of the bladder, in reference to the action of can- tharides ; close inspection of the womb and vagina, in reference to mechanical injuries, especially punctured wounds ; and any appearances that the death may have been caused by inflamma- tion in the organs of the pelvis, or by bleeding from the womb. X. Examination in Cases of Infanticide. 58. In cases of suspected infanticide, certain specialities must be borne in mind. The cavity of the head should be laid open with a pair of scissors. In opening the abdomen, the navel INSTRUCTIONS TO MEDICAL INSPECTORS. 53 should be avoided, so that the state of the vessels of the navel- string may be examined correctly. This is done by carrying two incisions from the ensiform cartilage to each of the anterior superior spines of the ilia, and by deflecting downwards the triangular flap thus formed. 59. The inquiry in cases of infanticide should be conducted with reference to the five following distinct questions : — 1. The probable degree of maturity of the child ? 2. How long it has been dead ? 3. Whether it died before, during, or after delivery, and how long after ? 4. Whether death arose from natural causes, neglect, or violence ? and, 5. Whether a suspected female be the mother of the child ? 60. The points to be attended to for ascertaining the pro- bable degree of maturity of the child are: — The general appear- ance and development, the state of the skin, its secretions, and its appendages ; the hair and nails ; the presence or absence of the pupillary membrane ; the length and weight of the whole body ; whether the navel corresponds or not with the middle of the length of the body ; the situation of the meconium in the intestines ; the site of the testicles in the case of males, and in either sex the size of the point of ossification in the lower epiphysis of the thigh-bone. This is easily observed by making an incision across the front of the knee into the joint, pushing the end of the thigh-bone through the cut, slicing off the car- tilaginous texture carefully until a coloured point is observed In the section, and then, by successive very fine slices, ascertaining the greatest diameter of the bony nucleus. This does not exist previous to the thirty-sixth week of gestation, and in a mature child is about one-fourth of an inch in diameter. Has the infant been washed ? Absence or presence of vernix caseosa. Nature and character of the wrappings, if any, found on the child. 61. The points of chief importance in reference to the period which has elapsed after death are those specified in the last clause of Sect. 17, — it being borne in mind that the bodies of infants are often concealed in ash-pits and dunghills, and that in these circumstances putrefaction is very rapid. 62. The circumstances which indicate whether the child died before, during, or after parturition, and how long after it, are the signs of its having undergone putrefaction within the womb ; the marks on the crown, feet, buttocks, shoulders, etc., indi- cating presumptively the kind of labour, and whether it was likely to have proved fatal to the child ; the state of the lungs, heart, and great vessels, showing whether or not it had breathed ; the nature of the contents of the stomach and of the intestines ; the presence of foreign matters in the windpipe; the state of the umbilical cord, or of the navel itself, if the cord be detached. 54 FORENSIC MEDICINE. 63. In order to examine properly the state of the lungs, heart, and great vessels, with a view to determine whether or not the child had breathed, the inspection should be made in the following order : — Attend, first, to the situation of the lungs ; how far they rise along the sides of the heart ; to their colour and texture ; whether they crepitate or not. Then secure a ligature round the great vessels at the root of the neck, and another round the vena cava above the diaphragm. Cut both sets of vessels beyond the ligatures, and remove the heart and lungs in one mass, which must be weighed, and put into water, to ascertain whether the lungs, with the heart attached, sink or swim. In the next place, put a ligature round the pul- monary vessels, close to the lungs, and cut away the heart by an incision between it and the ligature. Lastly, ascertain the weight of the lungs ; whether they sink or swim in water ; whether blood issues freely or sparingly when they are cut into ; whether any fragments swim in the instances where the entire lungs sink ; and in every instance of buoyancy, whether frag- ments of them continue to swim after being well squeezed in a cloth. 64. The general question to be considered in relation to the cause of death is, whether the appearances are such as to be traceable to the act of parturition, or whether they indicate some form of violent death. The directions given in Divisions V. , VI., and VII. apply to infants as well as adults ; but the fol- lowing points are specially to be noticed in cases of supposed infanticide : — In relation to wounds and contusions, the possibility of minute punctured wounds of the brain or other vital organs ; in reference to injuries of the head, the effusion of blood under the scalp not in the situation where it could have been produced during labour, or fracture of the bones not producible by compression of the head during labour, and not connected with defective ossifica- tion of the skull ; in reference to the allegation that the head was injured by the child suddenly dropping from the mother, when not recumbent, the presence of sand or other foreign matters on the contused scalp, and the existence of more than one injury of the head ; in rela- tion to suffocation, the external and internal signs of this form of death — marks of compression of the mouth, and nose, and throat, and the presence of foreign matters in the mouth and throat, air passages, gullet, or stomach, especially if the body be found in contact with similar substances ; in reference to bleeding from the navel- string, a bloodless state of the body, without any wound to account for it ; in reference to poisons, most com- EXHUMATIONS. 55 monly narcotics, the absence of any of the above appear- ances, with an otherwise healthy state of the body ; in reference to starvation and exposure, emaciation of the body, absence of food from the stomach, and an empty, contracted condition of the intestines ; in reference to • the possibility of the child having been suddenly ex- pelled, and having fallen on the floor or into privies, etc., the state of the navel-string is to be noted — whether long or short, whether remaining attached to the child and connected with the after-birth, indicating rapid labour, or, if divided, whether it had been cut or torn across. Nature of the ligature used, if any. 65. The circumstances noticed in Sects. 60, 61, 62, 63, 64, compared with the signs of recent delivery in the female, will lead to the decision of the question whether the suspected female be the mother of the child. These circumstances may be shortly recapitulated as being the signs of the degree of maturity of the child — the signs on the body of the kind of labour, the signs which indicate the date of its death, and the interval which elapsed both between its birth and death, and between its death and the inspection. EXHUMATIONS. It becomes necessary sometimes to exhume the bodies of persons who have been buried. The cases which generally call for this, always unpleasant, and in most cases disgusting, proceeding, are those where a suspicion of poisoning or violence has arisen some little time after the burial of the supposed victim. Or the necessity may arise to show that the body buried is that of a person whose death it is absolutely necessary to prove. In the case of Livingstone, though this can scarcely be called a case of exhumation, yet an examina- tion some months after death of the arm of the corpst alleged to be that of Livingstone, proved the existence of a badly united fracture which the deceased was known to have had. In conducting the exhumation, it is necessary that the medical experts should be present to see the body 56 FORENSIC MEDICINE. removed from trie coffin, and also any person or persons who may be in a position to speak as to the identity of the corpse, as, for instance, those who dressed it and prepared it for burial. The person who made the coffin may also be of assistance to speak as to its identity. As soon as the medical men are armed with the proper authority, no time should be lost in -vrder to get the body as fresh as possible, and at once prove or disprove the accusation of the crime, which, in the case of innocent persons, cannot be too quickly removed. The best time to take up the body, if in the summer, is early in the morning. Disinfectants may be sprinkled on the grass, on the coffin, and around, but not on the body when lying on the table during the inspection. Everything necessary for making a medical inspection should be taken; and also a table on which to place the body. A pail containing a solution of chloride of lime, for the inspectors to wash their hands, should be close at hand. And it is as well to expose the body for a short time to the air before beginning the inspection. There is seldom any risk to health in removing a single body, yet certain precautions are necessary ; thus it is as well to take a dram, and also to stand on the windward side of the corpse. No post-mortem should ever be con- ducted on an empty stomach. Carefully note the amount of preservation of the coffin, and, if broken, if any of the surrounding earth is in contact with the body. This precaution is necessary in cases of suspected mineral poisoning (see Arsenic, p. 244), and it is as well also to save one or two pounds of the earth immediately above the coffin for analysis. The body may then be examined externally ; any hair left on head or face preserved for identification ; and then an inspection of all the cavities made, the contents of the stomach and bowels being placed in dry earthenware or glass bottles, corked and capped with thin india- rubber skin, and so tied and sealed that the string must be cut or the seals broken in order to open the EXHUMATIONS. 57 jars. The ends of the string should be sealed in the presence of the authorities. In the examination, great care should be paid to the condition of the heart, brain, and lungs, and the signs of death from natural causes should not be overlooked. Beyond wliat period is it useless to exhume a corpse ? There is no scientific limit, for even the bones may show that violence has been used, or may point to the identity of a corpse, as in the case of Livingstone just mentioned. Pregnancy may be detected. Casper mentions the case of a man, whose body was three times exhumed for different purposes. In Scotland the law imposes a limit of twenty years, but in England the law is silent on the point. In France a limit of ten years from the date of the supposed crime; in Germany the limit is thirty years, if the offence is that punishable with death, the time varying, from three to thirty years with the nature of the crime. Examination of Localities. This is generally done by the police, but it may sometimes be undertaken by experts, and it is desirable that the medical inspectors shall have an opportunity of viewing the body before it is undressed, or moved from the spot where it was first found. If the body have been previously removed or meddled with, they ought to inform themselves accurately as to its original position. In many cases it is material that they personally visit the place where it was first seen, and they should inquire minutely into all the particulars connected with the removal of it. Important articles of evidence are often overlooked, owing to the absence of a medical man, to whom alone their importance would have been apparent. Casts of foot-prints may FORENSIC MEDICINE. be taken with wax, or perhaps better, with equal parts of Koman cement, fine sand, and plaster of Paris. Sprinkle this mixture over the foot-print, and then place a cloth over it. Gradually moisten the cloth, so that the water may slowly percolate, until the mixture is quite moist ; now lift the cloth, and allow the cement to harden. Another method suggested by M. Hougolin is as follows : — The foot-print on the mark is gradually heated by holding over it a pan containing burning charcoal, and then powdered stearic acid is sprinkled into the foot-print so heated, and allowed to cool. From the mould so taken, a plaster of Paris cast can be made. ASSAULTS AND HOMICIDE. Assault. — Every act of attack upon the person of another is an assault in law, whether it injure or not, nor is it necessary that the act done take effect. Spit- ting on any one is an assault. No provocation by word, whether written or spoken, can justify an assault, though it may mitigate the offence. If a medical man unnecessarily strip a female patient naked, under pre- tence that he cannot otherwise judge of her illness, it is an assault if he himself take off her clothes (E. v. Eosinski, 1 Mood C.C., 12). So, where a medical man had connection with a girl fourteen years of age, under the pretence that he was thereby treating her medically for the complaint for which he was attending her, she making no resistance solely from the bona fide belief that such was the case, this was held to be certainly an assault, and probably a rape (E. v. Case, 1 Den. 580; 19 L.J. (M.C.) 174). Battery. — This includes beating or wounding. A touch of the finger, however slight, is included under this term. 0 ASSAULTS AND HOMICIDE. 59 Homicide. — In Scotch law homicide is held to he committed only where a distinctly self-existent human life has been destroyed. Destruction of an unborn child, however short a time before delivery, may be criminal, but is not homicidal. In the same country criminal homicide is divided into two classes : — 1. Murder. 2. Culpable Homicide. 1. Murder is constituted in law by any wilful act causing the destruction of human life, whether plainly intended to kill, or displaying such utter and wicked recklessness as to imply a disposition depraved enough to be wholly regardless of the consequences. Murder may be the result of personal violence, poison, or by the committal of some other serious crime, as where any one causes the death of a woman in the attempt to procure criminal abortion, or by the exposure of an infant which results in its death. The use of weapons is not essential. 2. Culpable Homicide. — The name applied in law to cases where the death of a person is caused or materially ' accelerated by improper conduct of another, and where the guilt does not come up to the crime of murder. a. Intentional killing of another in circumstances implying neither murder on the one hand, nor justifiable homicide on the other. Every charge of murder is held to include a charge of culpable homicide, and the jury, if they see cause, may find that culpable homicide only has been committed. b. Homicide by doing of any unlawful, or any rash and careless act, from which death results, though not foreseen as probable. c. Homicide resulting from negligence or rashness in the performance of lawful duty ; as a sig- nalman on a railway forgetting to alter the points, and thus causing a collision and loss of life. In England this would amount to manslaughter. 60 FORENSIC MEDICINE. . Justifiable Homicide. — Self-defence, hanging prisoner properly sentenced to death, killing another to prevent murder, if prevention can avail in no other way. In self-defence the person killing must be in reasonable dread of death at the hand of his adversary. In England there is — 1. Murder. 2. Manslaughter. 3. Justifiable Homicide. Murder, according to Lord Coke (3 Inst. 47), is constituted ' where a person of sound memory and discretion, unlawfully killeth any reasonable creature in being, and under the king's peace, with malice aforethought, either express or implied/ In England the killing must be committed with malice aforethought. Malice may be express or implied. In Scotland malice aforethought is not necessary (5 Irv. 525, and 40 S.J. 92, and 5 S.L.E. 20). The law in both countries appears to differ more in terms than in practice. In England, if an injured party live for one year and a day, and then die, death is not attributed to the injury ; but in Scotland nothing short of an interval of twenty years will suffice. WOUNDS. Legal definition. — According to the statute (24 and 25 Vict., c. 100, s. 18) the word ' wound' includes incised, punctured, lacerated, contused, and gunshot wounds. But to constitute a wound within the mean- ing of the statute, the ivhole shin, not the mere cuticle, or upper skin, must be divided (E. v. M'Laughlin, 8 C. and P. 635). But a division of the internal skin, e.g., within the cheek or lip, is sufficient to constitute a wound within the statute (E. v. Warman, 1 Den. C.C. 183). If the skin be broken, the nature of the instrument with which the injury is inflicted is imma- terial, for the present statute extends to wounding, etc. , ' by any means whatsoever' A wound from a kick WOUNDS. 61 with a boot is within the statute (R. v. Briggs, 1 Mood C.C. 318). Injuries, burns, and scalds — which, in accordance with the above definition of a wound, are not wounds — are provided for under the clause, ' or cause any grievous bodily harm to any person. 5 Casper defines 6 an injury' to be ' every alteration of the structure or function of any yart of the body pro- duced by any external cause' Dr Taylor proposes the following as the best definition which we can at present give to the word 6 wound/ whether in a medical or legal sense, that it is ' a breach of continuity in the structures of the body, whether external or internal, sud- denly occasioned by mechanical violence This would include dislocations, fractures, either simple or com- pound, injury to the skin or mucous membrane, and to internal organs. Burns and injuries due to the action of corrosives are excluded from the category of wounds. Concerning Wounds in general. — Great care should be taken to ascertain the exact site and course of the injury on the body, as this precaution will greatly assist > in answering the questions : Ts the wound dangerous to life 1 Is the wound suicidal, that is, inflicted by the person on himself, or homicidal, inflicted by another ? The solution of the question of the dangerous character of the wound is left to the professional knowledge of the witness, who may be required to state his reasons for considering the wound dangerous to life. His mere assertion will not be accepted. As a general rule, only those wounds in which the danger to life is imminent should be stated as dangerous to life. Compound fracture of the bones of the cranium, injury to any large arterial trunk, or to any of the internal organs, may be considered as ' dangerous to life ; ' but where the danger is more remote, as in the probable super- vention of tetanus, erysipelas, eta, the medical opinion must be more guarded. But the medical witness should always bear in mind that death may follow the slightest injury. A case is recorded of death in 62 FORENSIC MEDICINE. forty-eight hours after extraction of a tooth. The con- trary also holds good, for the most fearful injuries have been followed by recovery. The following suggestions may help the practitioner in the formation of his opinion as to the probable danger of a wound : — 1. The extent of the injury. 2. The character of the instrument used in the inflic- tion of the wound. 3. The violence suffered by the parts. 4. The size and importance of the blood-vessels and nerves injured. 5. Is the wound healing or likely to heal well, and is the constitutional disturbance severe or slight t 6. Age of the sufferer. 7. Is there any constitutional taint likely to render even a slight wound more severe or even danger- ous to life ? 8. Has the previous medical treatment been skilful or otherwise ] Should the injured party be found dead, a careful post-mortem examination will alone determine the pro- bable part the injury bore to the production of the fatal result. Injuries to the Head. — All injuries to the head are more or less severe and dangerous. Scalp wounds are dangerous from erysipelas, etc. The symptoms of compression are not infrequently retarded, and this consideration should render the opinion more guarded. Concussion and compression differ in this ; in the former, the effects are instan- taneous ; in the latter, a short time elapses before the symptoms make their appearance ; and these become more and more marked, whereas in concussion they gradually pass off. The structural form of the cranium may have much to do with the danger to be expected from blows, some skulls being thinner than others, and WOUNDS. 63 in a few rare instances the fontanels may not have become ossified during life. The possibility of an unhealthy condition — atheroma — of the arteries of the brain, or of disease of the heart, must be taken into consideration before venturing an opinion as to the tendency or ultimate cause of death. It may be stated that the patient died of apoplexy. This, which is a disease of old age, seldom occurs in the young, although it is just possible it might occur. When violence is used, the effusion is on the surface of the brain ; this is not the case in apoplexy. Blood may be found in the cavity of the arachnoid in the great majority of severe injuries to the head, and even in trifling cases where least expected. The blood is chiefly found over the cerebrum, next over the cerebellum, and least of all over the medulla oblongata. The effused blood after a time becomes changed, and forms a false membrane on the parietal arachnoid, seldom on the visceral surface. Elood cysts may even be formed, in the course of time, having all the ajopearances of a serous membrane. There are no symptoms to aid the diagnosis as to the presence of extravasation into the arachnoid. The blood may spread to parts remote from the seat of injury. Fits of passion have been pleaded as a cause of apoplexy, but this cause is rare. The extravasation does not always occur at the exact spot of the application of the blow, but often at a spot directly opposite. Two extravasations may be the result of one blow. Fracture of the cranial bones may be due to counter-stroke — contre-coup — or to falls on the nates, etc. Punctured wounds of the cranium are always dangerous, but the patient may survive many days. The writer was once called in to see a boy shortly after he had been kicked by a pony in the region of the left temple, and although a small portion of brain substance was squeezed out through the wound, the boy recovered without a bad symptom. Dr Bigelow, Professor of Surgery in Harvard University, relates a case in which an iron bar, weighing thirteen 64 FORENSIC MEDICINE. and a quarter pounds, three feet seven inches in length, and one inch thick, was driven through the head, fol- lowed by recovery, the patient only losing the use of the injured eye. For the detection of brain substance on weapons the microscope is alone reliable, and then only the tubular portion of the brain is of any use. Wounds of the face are not generally dangerous, unless they penetrate the brain. Wounds of the throat are more or less dangerous, due to the possibility of severe haemorrhage, emphysema, and bronchitis. Wounds of the chest are dangerous, on account of the amount of the haemorrhage which may take place, and the importance of the organs which may be injured. Persons wounded in the chest may be able to walk a short distance, and then to drop dead. It is often difficult to make out the direction of the wound, as the lungs change their position during respiration. Wounds of the abdomen, penetrating the intestines, may cause peritonitis, due to the escape of the intestinal fluids, and death be the result. The cceliac plexus may be much damaged by a blow on the stomach, and death may result, without leaving any trace of the injury externally. Coagulable lymph, the effect of a wound of a serous membrane, may be thrown out in twelve hours or less. Wounds on the genital organs of the female may cause fatal hemorrhage, which takes place from the plexus of veins in those parts. A kick may rupture the labia, and death may be the result. An important question here arises before we consider the characters of the several kinds of wounds. That question is: Have the wounds and injuries found on the body been produced during life, or after death ? The answer is by no means easy, and considerable caution will be necessary to avoid falling into grievous error. Signs of vital reaction are important, as showing the ante-mortem infliction of the wound ; but these may, to WOUNDS. 85 some extent, be removed by the action of water, as in cases where the body is found in a pond. In this latter case the evident signs of drowning — water in the stomach — will assist the diagnosis. The presence of putrefaction also greatly obscures the diagnosis. The presence of coagulated blood between the edges of the wound is not a safe guide, as experiment has shown that as long as the body remains warm coagulation may take place. Coagulation even in contused wounds, effected before death, may be retarded from various unknown causes, disease, scurvy, mode of death, apnoea. The amount of haemorrhage on or around the body is, other things being equal, a safe criterion as to the time when the wound was inflicted. A consider- able amount of arterial blood points to ante-mortem injury, the presence of venous blood to post-mortem injury. The Several Kinds of Wounds. 1. Incised. 2. Punctured. 3. Lacerated and contused. 4. Gunshot. 1. Incised Wounds. Made by sharp instruments. The Germans divide incised wounds into £ cut ' and 6 hewing ; wounds. General Characters. — Incised wounds are longitudi- nal, somewhat spindle-shaped; the edges are smooth and slightly everted, and always larger than the weapon which inflicted them — due to retraction of the divided tissues. If a wound be in a line with the fibres of a muscle, there will be less 'gaping' than when the wound is directly or obliquely across the muscle. Due to muscular contraction, or the elasticity of the skin, an incised wound may assume a crescentic form. The cellular tissue is infiltrated with blood, and coagula E 06 FOEENSIC MEDICINE. are found at the bottom and between the lips of the cut. It must be borne in mind that a wound with smooth edges may be made by a Hunt weapon over bones near the surface, as on the scalp and over the tibia or shin, but a certain amount of contusion may, in most cases, be detected by careful inspection a short time after the receipt of the injury. It is often of importance to distinguish where the weapon entered, and where it was drawn out. The end where the weapon entered is usually more abrupt than the other, which is naturally more drawn out. But in some cases where the weapon is simply drawn across the part, both ends of the wound may be alike. The danger from incised wounds is due to haemorrhage. Death from Hcemorrhage. — The surface of the body, lips, and gums, are pale and exsanguine. The venous trunks, lungs, and other organs contain but little blood, but the veins of \hepia mater are generally not emptied. Hypostasis, both external and internal, occurs on de- pendent parts of the body. Blood is found round the body, unless the haemorrhage has been internal. It is often impossible to detect the particular vessels from which the blood has flowed ; but this is not of much importance. The signs of death from this cause may be rendered obscure by putrefaction ; but if nothing be found to account for death but the presence of a wound, we must conclude that death has been caused by it. 2. Punctured Wounds. The orifice is generally a little smaller than the weapon. A stab may sometimes jDresent the appear- ance of an incised wound ; the depth will, however, help to distinguish the one from the other. The wound may not at all correspond with the shape of the weapon, and the same pointed instrument may produce very different-shaped wounds in different parts of the body. On dissection, two or more punctures may be found in WOUNDS. 67 the soft parts, with only one external orifice ; these are due to the weapon being only partially withdrawn at each stab. Punctured wounds are always more dangerous than incised. They cause little haemorrhage externally, unless a large vessel, as the femoral artery, be injured. The wound generally heals by suppuration, and not in- frequently an abscess is found in and around the track of the wound. Perforating wounds have generally a large entrance wound with inverted edges, and a small exit with everted edges ; but if the weapon be rough, the reverse may be the case. 3. Lacerated and Contused Wounds. The edges of these wounds are never smooth, and generally do not correspond at all with the weapon. Haemorrhage from them is usually slight. A point of considerable interest may arise in connection with this class of wounds ; the defence may declare that the injury was the result of a fall, and not due to a blow^ The history of the case will often afford the only solution of the difficulty. Lacerated wounds heal by suppuration, generally with ' more or less sloughing. Scratches with the finger-nails may be considered as lacerated wounds, but the skin is merely abraded, not divided. They are never important as wounds, but often as a proof of a struggle in cases of rape, etc. Bites are also lacerated wounds. 4. Gunshot Wounds. The appearance which gunshot wounds present will to a great extent depend upon the form of the projectile, and the distance at which the firearm was discharged. Pound balls make a larger opening than conical. Small shot, fired within a short distance of the body, make one large ragged opening. The scattering of the shot depends on the calibre of the gun, on the charge of powder, and essentially on the distance. A charge of 68 FORENSIC MEDICINE. ordinary — No. 5 — shot, to make a single hole, must have been fired at less than one foot ; but experiments should always be made with the alleged weapon. A patent cartridge would make a single hole at a consider- able distance — five or six yards. Bound bullets may split, but this conical ones seldom do. The edges of wounds produced by the discharge of firearms are always more or less ecchymosed ; this condition appears in about an hour after the infliction of the injury. If the ball strike obliquely, the edges of the wound may be much lacerated, or the opening may be valvular. The wound may be of small size, if the skin over the part be in any way tightened. The injury to bones is greater from conical than from round balls. The track of the ball ividens as it deepens. This is the reverse of an ordinary punctured wound. The ball may either lodge in a part, or perforate it. Should it have lodged, it must be preserved and compared with the alleged firearm. The old round balls were easily deflected ; the conical are not so easily turned aside. Bits of clothing or wadding may be carried into the wound. The latter should be carefully kept, as they may prove important as a means of identification. The aperture of entrance and exit must, if possible, be determined. On this point there is much difference of opinion. The wound of exit is always smaller than the wound of entrance (Casper). In this opinion Casper agrees with M. Malle and Ollivier d' Angers, but is opposed by Taylor, M. Matthysens, and others. i The characters of a gun- shot wound/ says Assistant-Surgeon Neill, ' are those of a contusion and laceration of all the tissues. Some- times they are so simple as to bear resemblance to a punctured wound, particularly if a rifle-ball (conoidal), revolving on its long axis, has passed through the soft parts at a great speed, but within a few hours it resembles a contusion. The wound of entrance, as it has been termed, bears no comparison in size or shape to that of the exit when a rifle-ball has caused the WOUNDS. 69 injury. In the former you see the edges of the wound curving inwards, and the circumference small, with little or no haemorrhage. In the latter, the wound is large, with torn and irregular edges projecting out- wards, and perhaps only slight oozing of blood. In a short time, averaging an hour, round the entrance wound slight redness begins, gradually extending to about two inches around its orifice. Again this colour changes to a blue or greenish black, and you see all the appearances of a severe bruise, with a small wound of the skin, its edges still curved inwards. In the exit wound the discoloration of the skin is not apparent. 7 The probable reason for the discrepancies in the state- ments of observers as to the characters of entrance and exit wounds, may be found in the fact that experiments have been conducted with different sized balls, and with varying velocities and distances. The opening of en- trance made by the ball has generally, but by no means always, inverted edges. The edges of the exit opening are everted ; but both may be everted in fat persons, due to protrusion of the fat ; and this eversion may also result from the expansive power of the gases, generated during putrefaction, should this condition be present. Wounds made by double shots, as from double- barrelled guns or pistols, or from slugs fired from one barrel, diverge after their entrance into the body. In the examination of gunshot wounds we have to consider — 1. Direction in which the gun was fired. 2. Distance at which the charge was fired. 1. Direction in which the gun was fired. — The track and position of the ball in the body, coupled w r ith the relative position of the body to a window or door through which the gun may have been discharged, and the place where the ball is found, should it have passed through the body, may assist us in forming an opinion. It is often impossible to trace the course of 70 FORENSIC MEDICINE. the ball through the cavities of the body, but through the muscles and denser structures this is more easily accomplished. The effects of the ball on surrounding objects may assist very much in finding the direction of its course. 2. Distance at which the Charge ivas fired. — In the case of wounds inflicted by small shot, the scattering of the shot must be our guide. The absence of scorch- ing, or marks made round the wound by the half -burnt powder, allows of the assumption that the shot must have come from some distance rather more than four feet. The absence of any of the above, however, is not an absolute proof that the shot has come from a distance. There is no means of deciding, from an examination of a pistol or gun, when the weapon was last used. Dying Declarations. — The greatest care must be taken by the medical man who is called in to see a person supposed to be dying, with regard to any decla- ration he or she may wish to make. The medical attendant should simply take the statement as it is made, writing it down on the spot, or as soon after as possible. The identical words used should be com- mitted to paper, and no suggestions or interpretations of his should be made. Leading questions should never be put, or any attempt made to induce the patient to make any statement. When we consider the con- dition of the patient, the possibility of delirium induced by the severity of the injury, together with the dread of death, it is, to say the least, injudicious to intro- duce the suspected party into the room for the purpose of identification, though this procedure has been sug- gested by some writers. In every case, however, it is advisable for the medical attendant, as soon as he sees that the case must end fatally, to acquaint the patient in the presence of others of the fact, when any state- ment made may then be taken. It should also be WOUNDS. 71 borne in mind by those receiving dying declarations that ' it must be shown that the deceased, at the time he made the statement, was under the impression that death was impending ; not merely that he had received an injury from which death must ensue, but that, as the popular phrase goes, he then believed he was on the point of death' (R. v. Forester). In the case of E. v. Fagent, 7 C. & P., 238, it was held that a decla- ration was inadmissible, because the person making it asked some one near her whether he thought she would 4 rise again;' and it was held that this showed such a hope of recovery as rendered the previous declaration inadmissible. The declaration should be signed by the person making it, and witnessed by some one pre- sent at the time. In Scotland, 6 the written deposition of a person who is dead is admissible, whether the person were the party injured or not, if he would have been a competent witness. It is not necessary that the deceased believe himself to be dying when he emits the deposition. Such depositions are generally taken - by a magistrate, but a declaration deliberately made, though without an oath, and taken down " by a credit- able person," is admissible.' — Macdonald, Scot. Grim. Laiv, p. 512. Is the Wound Suicidal or Homicidal ? — In cases of suicide, punctured, incised, and gunshot wounds are more frequently present, seldom contused wounds, unless the person threw himself from a height. Very large wounds are seldom suicidal. It is important to note the direction of a wound, in order to show whether it was caused by a fall on the weapon or not. Wounds made by suicides are generally over vital parts, and a multiplicity of wounds do not point to suicides, except in maniacs or in very old people, where the skin hangs in folds about the neck. Gunshot wounds, when suicidal, are generally found over the region of the heart, temple, or in the mouth. Pre- sence of scorching and powder-marks are important, as 72 FORENSIC MEDICINE. pointing to the probable distance at which the firearm was discharged ; but their absence is no proof that the weapon was not discharged close to the body. The presence of the weapon being close to the body affords a presumption as to the possibility of suicide, its absence, the probability of homicide ; but the weapon may be stolen from the side of the suicide. The hands should be examined for marks suggesting the proba- bility of suicide ; contusion or abrasion of the fingers from the recoil of the pistol held unsteadily. It may be suggested that the weapon was placed in the hand by the murderer, and that contraction, the result of the rigor mortis, had retained it. This is a fallacy, as it has been proved that, even when the weapon has been placed in the hand prior to the accession of the rigor mortis, and there kept by bandages, it can be removed with ease. This is not the case, however, when the retention of the weapon is due to convulsion imme- diately preceding death. It is strong evidence in favour of suicide if the gun or pistol have burst by the explosion, as suicides have a predilection for overload- ing the weapon employed. The oldness, uselessness, or the novelty — old gun barrel — of the weapon used points also to suicide. BLOOD-STAINS. Blood-stains may have to be examined on clothes, on weapons, and on articles of furniture. The stains may be either recent or old; in either case, the method of identification is the same. There is not much diffi- culty in ascertaining whether a suspected coloration is due to blood or not ; but when the question arises as to whether the blood be human or that of some other animal, the identification is in most cases im- possible. BLOOD-STAINS. 73 On weapons, the question may arise, Is the stain blood or rust ? Heat the metal ; the blood-stain will peel off; that due to rust will remain. But something more is necessary than this rough test. The stain, if large, may be scraped off and placed in some distilled water in a watch-glass, and the solution filtered, to separate any oxide of iron. The stain is not that of blood if the water thus treated do not acquire a red or reddish-brown colour. Another method is to moisten a piece of glass with water, and lay the weapon on it in such a manner as to dissolve off the stain. A por- tion of the solutions thus obtained may be tested with tincture of guaiacum and peroxide of hydrogen for blood, ammonia for vegetable colours, and with ferro- cyanide of potassium for iron. Stains of citrate of iron have been mistaken for blood-stains ; the know- ledge of this fact should prevent an opinion being given from a mere ocular inspection of the stain. The stains of the citrate may be thus distinguished : — The filtered solution is yellowish, not red; ammonia pro-* duces no change of colour ; guaiacum, a blue colour if a persalt of iron be present ; confirmed by the produc- tion of prussian blue on the addition of ferrocyanide of potassium to a portion of the original solution. The method of procedure for the detection of blood may be as follows : — If the stain exist on cloth or linen, a strip of the stuff is cut off and suspended in some distilled water contained in a small test-tube. Streaks of colouring matter will gradually appear de- scending from the cloth to the bottom of the tube, where a coloured layer will eventually be formed. If the stain be recent, the colour will be deep red ; but if of older date, of a reddish-brown hue. If one strip of the stuff do not yield a solution of sufficient intensity of colour, other strips may be treated in a similar way till the requisite degree of intensity is obtained. In stains on wooden articles, a splinter may be cut off and treated as above. 74 FORENSIC MEDICINE. The solution thus obtained may be divided into several portions, and treated as follows : — To one por- tion add a little dilute ammonia, when, if the colour present be due to blood, no other alteration than a slight heightening of the colour will take place. If, however, the coloration be of vegetable origin, the addition of the ammonia will change it to green, crim- son, etc. If another portion of the solution be carefully boiled, the colour will disappear with the formation of a dirty- brown precipitate. Any stain which gives, when thus treated, the above reactions, is almost sure to have arisen from the presence of blood. A third portion, dropped on blotting paper, may be next treated with tincture of guaiacum and peroxide of hydrogen, with the production of the characteristic blue colour if blood be present. The form of the corpuscles should be noted. Tor this purpose a small quantity of the sediment should be removed by means of a pipette, placed on a glass slide, and examined under the microscope. The blood corpuscles will, of course, be always more or less shrivelled and disfigured, but their general appearance may be noted. The corpuscles of human blood are minute, round, flattened cells, about ;3 ^ Q Q to ^wo °^ an inch in diameter, slightly depressed, and concave in the centre, consisting of a colourless envelope contain- ing a red fluid. To obtain the corpuscles, if the stain have not been rubbed or washed, Koussin recommends the following procedure : — The portion of the cloth containing the stain is cut out and placed on a glass slide. On it is dropped, from a pipette, a mixture of three parts by weight of glycerine, one of sulphuric acid, and water, so that the mixture thus formed shall have a specific gravity of 1028. The material, when thoroughly moistened, is teased out, the fibres removed, and the fluid left on the slide. The blood corpuscles of all the mammalia are of the same shape and charac- BLOOD-STAINS. 75 ter, differing only to a slight degree in size. In birds, reptiles, and fishes, the blood-cells are more or less , oval in form. The stain, or a portion of the solution obtained as before described, should likewise be examined for crys- tals of hamrin. In order to procure them, the solution should be treated with a little glacial acetic acid, and : then gently evaporated on a glass slide. If, on sub- mitting the residue to microscopical examination, no crystals be observed, fresh acetic acid must be added, together with a minute quantity of common salt, and ; the solution again evaporated ; in the event of this failing to produce them, the above process may be repeated a third or fourth time. The form of the crystals differs in the blood obtained from different animals. In man the crystals are rhombic, of a dark ; red or yellowish-red colour, frequently arranged in stel- i late groups, and are very uniform and characteristic. The spectroscope has lately afforded valuable help in the identification of blood-stains. A solution of the colouring matter is placed on a narrow glass cell, and ; examined with the spectroscope, when the modifications in the spectrum noticed on p. 77 will be seen. Table recapitulating the Characters of Blood-stains, under the following heads : — a. Ocidar Inspection. — Blood-stains on dark-coloured materials, which in daylight might be easily overlooked, may be readily detected by the use of artificial light, as that of a candle brought near the cloth. Elood-spots, when recent, are of a bright-red colour if arterial, of a purple hue if venous — the latter becoming brighter on exposure to the air. After the lapse of a few hours, blood-stains assume a reddish-brown tint, which they maintain for years. b. Microscopic Demonstration. — With the aid of the microscope, blood may be readily detected by the pre- 76 FORENSIC MEDICINE. sence of the characteristic blood-cells ; but even this means of diagnosis may be rendered impossible, by — 1. The blood being long effused. 2. The spot being wetted and then dried. 3. The blood being mixed with other substances. 4. The spot on the cloth having been much rubbed, or the cloth washed. c. Action of Water. — Water has a wonderfully sol- vent action on blood, the stains rapidly dissolving when the material on which they occur is placed in cold water — a bright red solution being formed. Eust is not soluble in water. d. Action of Heat. — Blood-stains on knives, etc., may be readily removed by heating the metal, when the blood will peel off, at once distinguishing it from rust. Should, however, the blood-stain on the metal be long exposed to air, spots of rust may be mixed with the blood, when the test will fail. The solution of blood obtained in water is coagulated by heat, the colour entirely destroyed, and a flocculent, muddy brown precipitate formed. e. Action of Caustic Potash. — The solution of the blood obtained in water is boiled, when a coagulum is formed, soluble in hot caustic potash ; the solution so prepared is greenish by transmitted, and red by reflected light. /. Action of Nitric Acid. — Nitric acid added to a portion of the solution of blood in water produces a whitish-grey precipitate. g. Action of Guaiacum. — Tincture of guaiacum pro- duces in a watery solution of blood a reddish-white precipitate of the resin ; but on the addition of an etheral solution of peroxide of hydrogen, a beautiful blue colour is almost immediately developed. This test is so delicate that one drop of blood in six ounces of water may be detected by it ; and, according to Dr Taylor, is, with the spectroscope, the only certain method of discovering washed blood. Washed stains BLOOD-STAINS. 77 on colourless cloth may be detected by pouring a drop of the tincture guaiacum on them, and then adding the peroxide of hydrogen. The tincture of guaiacum should be made from fresh resin, and preserved in the dark. The peroxide of hydrogen may be obtained under the name of ozonised ether. Other red colouring matters give a reddish colour to the precipitated resin, but the blue colour does not appear when treated with the per- oxide of hydrogen, as above described, except after the lapse of some time, and this at once marks the absence of blood. Dr Ogston states that he has obtained the blue colour with the guaiacum and peroxide of hydro- gen from sweat stains. li, Hcemin Crystals. — These are produced by treating a drop of blood, or a watery solution of it, with glacial acetic acid in a watch-glass, and then evaporating the mixture. The dried residue now contains the crystals of haemin, which may then be examined under the microscope. The crystals are rhomboidal in form, tubular, or £ otherwise/ of a yellowish, yellowish-red, or" dirty blood-red colour. "When the stain is old, a minute quantity of table-salt should be added to the acetic acid solution of the colouring matter of the blood. i. Spectroscopic Appearances. — Two dark absorption bands appear in the spectrum, one situated at the junction of the yellow with the green rays, and the other in the middle of the green rays of the spectrum. These may, however, from various causes be modified. The spectrum of alkanet root in solution of alum is like that of recent blood, but differs in having a third absorption band between the green and the blue. In a solution of cochineal and ammonia, one black band obliterates the yellow and orange rays. This test requires care and considerable practice at spectrum analysis. There is no means of detecting menstrual blood from human blood, the result of a wound. 78 FORENSIC MEDICINE. Points of Importance to be noticed in the Examination of a Person found wounded. cl Note situation, extent, depth, breadth, length, and direction of wound. Take careful measurements, in order to determine the character of the weapon, and the organs of the body injured. b. Is there any appearance of ecchymosis, or is the effused blood liquid or coagulated ? c. Examine wound as to presence of pus, adhesive inflammation, gangrene, or foreign bodies. Why ? Presence of pus, etc., will show that death must have taken place some time after the wound was inflicted. d. In all examinations of wounds, be careful to dis- turb as little as possible their outward appearance, in order to compare the wound with the suspected weapon. e. All notes should be taken during such examination, or immediately after. /. Make a careful examination of all the important organs of the body. Why 1 In order to disprove the suggestion that death was due to other causes — poison, disease, etc. g. Only facts should be stated in the report ; no inferences should be drawn or suggested. h. In describing the appearance of wounds, use simple untechnical language, and avoid superlatives and high- flown words to describe and explain simple facts. i In gunshot wounds, note position of body, state and contents of the hands, and the direction of the wound in relation to external objects. Note also in all kinds of wounds the relationship of the wound to cuts or rents in the clothes of the de- ceased. BURNS AND SCALDS. 79 CONCUSSION OF THE BKAIN", ETC. Concussion of the brain may arise from falls on the nates, or from blows on the head. Symptoms. — The face becomes pale, the pupils con- tracted, the pulse weak and small, the respiration scarcely perceptible, and the sphincters relaxed. Ee- action succeeds ; the pulse quickens, the skin is hot and dry; there is great confusion of thought, and vomiting is present in most cases. Concussion often passes into compression, due to haemorrhage from lacerated cerebral vessels. Great care is required in forming a prognosis with regard to the ultimate effect of an injury to the head. Inflammation of the brain and membranes may be delayed for some weeks. It is often a difficult matter to distinguish the effects of concussion from those common to drunkenness or narcotic poisoning. The odour of the breath and the history of the case will assist in forming an opinion. BUENS AND SCALDS. A burn is caused by the direct action of flame, or the application of any highly heated substance to the surface of the body. A scald is due to the action of boiling water or other fluid on the body. Burns some- times present little more than a slight redness of the skin, which may pass off in a few days ; at other times blisters are formed, the base of the blister being red, with a narrow red line round it. Burns may result from only a slight application of heat, due probably to the thinness of the skin in some individuals. Often troublesome ulcers are formed, or the skin may be charred. On the same person the appearance of each | burn may be different. The danger from burns depends more on the extent of surface injured than on the 80 FORENSIC MEDICINE. intensity of the burn. Burns of a half or third part of the body must be regarded as fatal. They may prove fatal by shock, by asphyxia, or by constant and pro- fuse discharge from the burnt surface. Children are most obnoxious to burns and scalds, the simplest often proving fatal. Persons have often been murdered and then burnt in order to conceal the crime. Was the burn inflicted before or after death ? — Two characteristic appearances — redness and vesication — are present in burns inflicted during life, when the surface of the body is not charred and the tissues destroyed. The redness affects the surface and entire substance of the true skin, which is dotted by the deep red openings of the sudoriferous and sebaceous ducts. This appearance cannot be produced after death. Blisters are formed by a temperature somewhat less than that of boiling water. Vesication, according to Orfila, is characteristic of a burn inflicted during life ; and Sir Eobert Christison found that in burns caused before and after death the former contained serum, the latter air. In anasarcous subjects, however, serous blisters are formed, especially if the heat employed be not too severe. In burns produced after death, the surface and sub- stance of the true skin is of a dull white colour, dotted with grey openings of the sudoriferous and sebaceous ducts, and the subcutaneous tissues are uninjected. It may be necessary to distinguish the vesicles due to a burn from the phlyctsenae, the result of advanced putre- faction. The vesications produced by a burn before death have & purple-red line at their circumference, and a more or less red base. Bullce, the result of putrefac- tion, possess none of these characteristics. Their base does not differ in colour from that in the immediate neighbourhood of the vesicle. It appears possible to produce vesication by the application of intense heat after death; but these vesicles possess none of the appearances of vital reaction. The bullae thus produced CONTUSIONS, BRUISES, ETC. 81 soon burst, and never, except in the cases before men- . tionecl, contain serum, but only a thin watery vapour. The redness of the base, and the red bounding line round their circumference, so characteristic of burns inflicted before death, are also absent. Was the burning homicidal, suicidal, or accidental? — ]STo general rules for guidance can be here laid down. : In most cases, the conditions under which the body is found will point less to suicide than to homicide or accident. In cases of murder, the body is often burnt j to destroy all traces of the crime. The conjunction of robbery will greatly assist in helping to solve the , difficulty. It may be very confidently stated that to dispose of a body by burning is no easy matter. The possibility of ' spontaneous combustion ' is too absurd to be more than noticed here. It is only, how- jever, fair to state that there are some medico-legal ^authorities who still believe in its possibility. Dr r Ogston, who cautiously avoids committing himself to ithe belief in spontaneous combustion, yet thinks that >the subject of preternatural combustibility in certain -'■conditions of the body may, perhaps, to say the least of it, be set down as one still sub. judice. CONTUSIONS, BKUISES, ETC. w - These injuries are accompanied with swelling, and Kmore or less discoloration of the part affected. They [toiay be confounded with sprains or with scurvy. From a sprain they are distinguished by pain in the joint, and the history of the case. From scurvy, by i the condition of the gums common to that disease, and kby the state of the general health. Some persons ;i are very easily bruised. A pinch, by no means severe, i.will cause on the arms of some persons a severe ■ bruise. Discoloration — ecchymosis — may take place in \teSi 82 FORENSIC MEDICINE. the skin, cellular tissue, muscles, or internal organs. Not infrequently the discoloration does not appear over the seat of injury, but at some distance from it ; and when the effusion is deep-seated, days may elapse before any discoloration of the skin takes place, and then it is not blue, as in superficial parts, but of a violet, greenish, or yellowish hue. A blow given dur- ing life may not appear as an ecchymosis till after death. Contusions in deep-seated parts may give rise to abscess. The change of colour in bruises begins at the circumference, and travels inwards. During the first three days the colour of the bruise is blue, bluish- black, or black ; greenish on the fifth or sixth day ; and yellow from the seventh to the twelfth. The extent of an ecchymosis depends to a great extent on the loose- ness of the cellular tissue. A slight contusion causes a slight redness and swelling, and may leave no mark on the dead body unless death have taken place within thirty-six hours. Injuries of this kind sometimes leave a parchment-like hardness and discoloration of the skin. The part looks slightly depressed, due probably to the epidermis having been partly rubbed off, and the skin then drying. Similar marks are sometimes made by blisters. These marks may be produced on the dead body by friction and exposure to the air. Ecchymosis is to be distinguished from a post-mortem stain — hypostasis — by cutting into the part. In the latter, only a few bloody points are seen ; in the former, coagulated blood. In scourging, there are parallel ecchymosed lines, or small spots resembling petechias An internal organ may be ruptured, and yet there may be no appearance of injury externally. The liver is most commonly ruptured. The rupture is almost always longitudinal, and in some cases a portion of the gland is more or less detached. The spleen is also not infre- quently ruptured ; and this occurs most frequently in countries where ague prevails. Eupture of the lungs SUFFOCATION. 83 and brain is rare. When the pelvis is fractured, the bladder is found not infrequently ruptured. Death in most cases is due to internal haemorrhage when any of the internal organs are ruptured. Can the appearance of a bruise be produced after death ? — It appears that all the appearance of a bruise inflicted during life may be produced within two hours after death, and in some rare cases even after the lapse of three hours and a-quarter. The size and form of a bruise should be noted. Why? 1. In hanging and strangulation. — The mark due to pressure of the cord on the neck may cause a welk defined ecchymosis. 2. In throttling. — The pressure exerted on the throat of the deceased by the fingers of his assailant may leave marks which may point to the means used to cause death. In other cases of death by violence. — The impression made by the weapon used may lead to the identification of the murderer. The marks left by the wards of a large door-key once led to the identification of the assailant. SUFFOCATION. Death from suffocation is said to result from any impediment to the respiration which does not act by 1 compressing the larynx or trachea. Death from apncea may rise from the following i causes : — 1. Cessation of the action of the muscles of the i chest. i 2. Arrest of the action of the lungs. jj 3. Exclusion of atmospheric air from the lungs by j foreign bodies lodging in the trachea. 84 FORENSIC MEDICINE. Suffocation may be caused by pressure on the chest, as in persons crushed in a crowd. It may also be due to the respiration of certain gases, or the presence of pulverulent substances in the air, which act by choking up the air-passages. Strychnia, by contracting the muscles of the chest, produces death by suffocation. Abscesses may burst into the trachea, or vomited matters in drunken persons may lodge in the windpipe, and death from suffocation be the result. Signs of Death by Suffocation. — The first effect of arrest to the passage of air into the lungs is the stagna- tion of blood in the capillaries of the lungs. Non- arterial blood then goes to the brain, and consciousness is soon lost. The respiratory sensation is then arrested by the circulation of venous blood. The left side of the heart becomes emptied, and then weak ; the right side full and engorged. The great venous trunks are also more or less full. The arrest of the heart's action is a secondary effect ; the right side is paralysed by being too full, the left by being empty. The heart continues to contract after the lungs have ceased to perform their duty. Death is thus' due to apnoea — that is, death beginning at the lungs — and not to syn- cope. Death in some cases is from neuro-paralysis or nervous apoplexy. In death by shock, which in most cases is instantaneous, both sides of the heart are equally filled. Death, the result of disease, may present all the signs of death from suffocation, and no suspicion may be aroused as to the cause of death from the post- mortem appearances, especially if putrefaction have set in. The following table is given as an aid to diagnosis in this form of death. Points to be noticed in forming a Diagnosis of Death by Suffocation. 1. The Blood. — There is unusual fluidity of the blood found in death by suffocation, however produced. SUFFOCATION. 85 This condition is sometimes present in deaths due to certain diseases, fevers, etc.; and in cases of narcotic poisoning. Even with the blood in this condition, the presence of coagula in the cavities of the heart is not infrequent. The colour of the blood is changed to a dark purple. 2. Animal Heat. — In persons dead from suffocation the animal heat is long retained. 3. Cadaveric Rigidity. — Other things being equal, the rigor mortis is as well marked in this kind as in other X forms of death. 4. The Lungs. — Hyperemia of the lungs is rarely j absent. In most cases both lungs are engorged in i about equal proportions. Hypostasis — post-mortem stains — must not be mistaken for capillary engorge- ment. 5. The Heart. — Engorgement of the right side of !: the heart, the left being empty, or nearly so. It is ad- visable always to examine the heart first, and then the ; lungs. The pulmonary artery is also much congested. * 6. Capillary Ecchymoses. — These appear as purplish- ! red spots on the pulmonary plurte, on the surface of the heart, aorta, and even on the diaphragm. They may appear on the above-mentioned parts in a foetus suffocated in utero by pressure on the cord. These ecchymoses are rarely seen on adults, most frequently on infants, due probably to the thinness of the coats of the capillaries, which are ruptured in the efforts made to breathe. 7. Condition and Appearance of the Trachea. — The mucous membrane of the trachea is injected, and ap- pears of a cinnabar-red colour. This is present in every case of death by suffocation, and must not be confounded with the dirty cherry-red or brownish-red coloration due to putrefaction. If suffocation be slowly produced, a quantity of frothy mucus may be found in the windpipe, and also in the smaller tubes of the lungs. Always examine the trachea for foreign bodies, 8G FORENSIC MEDICINE. the presence of soot, etc. The presence of sand, ashes, etc., in the oesophagus and stomach in persons buried in these materials is presumptive of the person having been placed in them prior to death. 8. Kidneys, Vena Cava, etc.^— The quantity of blood in the kidneys is always considerable. The abdominal veins are all more or less congested, and the external surface of the intestines presents numerous traces of venous congestion. 9. The Brain. — Apoplexy of the brain, as secondary to the pulmonary apoplexy, may be more or less pre- sent, attended with its well-known appearances. 10. — Face, Tongue, and Mouth. — The expression of the face is not characteristic of death by suffocation, and differs in no particular from that common to other forms of death, being more frequently pale than turgid ; and the starting of the eyes, popularly ascribed to this form of death, is not often seen. The tongue may or may not be protruded beyond the teeth. The presence of froth about the mouth is not constant, and is of common occurrence in those dying from natural causes. Was the suffocation homicidal, suicidal, or accidental ? — Suffocation may occur accidentally during the act of swallowing, and by foreign bodies placed carelessly in the mouth and then forced suddenly into the windpipe. Examine the lips for the presence of ecchymosis and other marks of violence. A man, some years ago, was accused of having caused the death of his wife by strangulation, for which he was indicted, and tried before the High Court of Justiciary in Scotland. The post-mortem examination revealed the cause of death as due to suffocation, and the following injuries were found on dividing the windpipe, which contained a quantity of frothy mucus. In the interior of the larynx there was a considerable extravasation of blood lying beneath the investing membrane, and passing up on both sides and behind, as far as the chink of the SUFFOCATION. 87 glottis, or orifice by which air is admitted into the windpipe, and above that opening into the ventricles of the larynx. There was here, also, a fracture of the right wing of the thyroid cartilage, by which its lowest i horn was wholly detached, and the cricoid cartilage was broken in two places at opposite sides of its ring. The defence was that she had fallen accidentally while in a state of drunkenness, and had thus produced the fatal injuries. The man was acquitted, the legal opinion in favour outweighing the medical opinion against the theory of accident. The above case created some discussion at the time, and induced Dr Keiller to make several experiments as to the possibility of fracturing I the cartilages of the larynx. The following are his conclusions : — 1. That ordinary falls on the human larynx are apparently not capable of producing fractures of its cartilage, and even falls from a height with super- added force appear to be unlikely to do so. 2. That severe pressure applied from before back-^ wards, so as strongly to compress the larynx against the : vertebral column, or violent bloics inflicted over the larynx, by means of a heavy body, are sufficient to cause fractures of the larynx. Fractures so produced, however, will be most discernible on the internal (or posterior) surface, and generally^ or near the mesial line. 3. Violent compression applied to the sides of the larynx (as in ordinary manual throttling or strangida- tion by grasping) is, of all applied forces, the most likely to produce fractures of the alae of the thyroid cartilage, or even of the cricoid cartilage, and fractures so produced are most perceptible, as well as most extensive, on the external (or anterior) surface of the larynx. By this lateral mode of applying force, the hyoid bone is also most readily broken. 4. That the condition of the larynx in regard to the absence or presence of ossiflc deposit materially 88 FOEENSIC MEDICINE. influences its liability to fracture from external violence. If altogether cartilaginous, partial slits or splittings may be produced. If partially ossified, fractures may be produced by a comparatively moderate degree of applied violence, and if extensively or entirely ossified, extreme violence will generally be required to pro- duce laryngeal fracture. — Edinburgh Medical Journal, 1855-56. In France a favourite mode of committing suicide by suffocation is the use of irrespirable gases — carbonic acid, carbonic oxide, and the like. Collateral circum- stances must be taken into consideration, and will more or less help to point to the true cause of death. HANGING, STRANGLING, AND THROTTLING. Hanging. — Death by hanging is caused by the more or less perfect suspension of a body by a cord applied round the neck, the weight of the body acting as the constricting force. Strangling. — Death due to pressure made on the neck by any form of ligature carried circularly round the neck. The cord in hanging is placed more obliquely than in strangulation. Throttling. — Death due to the constant pressure of the fingers on the throat. The cause and nature of the death in all of the forms just mentioned are in general the same. Pressure on the trachea — thus arresting respiration — and also on the important vessels and nerves of the neck, results in death, which may be brought about in four different ways : — 1. Cerebral congestion, or apoplexy. 2. Congestion of the lungs and heart — apnoea- asphyxia. HANGING. 89 3. Combination of the above — apoplexy and asphyxia or apnoea. 4. Neuro-paralysis — nervous apoplexy. The following table will show the relative frequency of each form of death : — Remer. Casper. Apoplexy .... 9 9 Asphyxia .... 6 14 Mixed .... 68 62 83 85 Hanging. — Death may occur in any of the forms above stated. Sensibility is soon lost, and death rapid. The external appearances are more or less those de- scribed under death from suffocation. In the greater number of cases, the face bears a quiet, placid ex- pression, no turgidity or lividity being noticeable. The eyes are not protruded. The tongue does not hang out of the mouth, nor is it bitten by the teeth. This accords with account given of the appearance of the face of the murderer Peace lately hanged at Leeds. Turgescence of the male and female genitals is said by some to take place. Casper states that in not one of the many cases he had examined of persons hanged has he ever 'found an erection of the male organ,' and he also asserts that the emission of semen is extremely rare. Seminal emissions take place more frequently in persons who have been shot, and also in those who have been poisoned by irrespirable gases and by hydro- cyanic acid. As a test of strangulation, it is therefore worthless. The escape of urine and faeces is of common occurrence, although Tardieu only noticed it in two out of forty-one cases ; it is by no means a test of hanging, as it may occur after death if the body be shaken in a cart, or roughly used when first found. A fat person dying of apoplexy may have a mark round the neck as if strangled. Injury to the spinal cord due to fracture 90 FOKENSIC MEDICINE. or dislocation of the cervical vertebrae is rare in suicidal hanging. Fracture of the spinal ligaments and of the hyoid bone is also rare. Eupture of the internal and middle coats of the carotid arteries sometimes occurs. Dr Dyer, in the New York Medical Journal, vol. iii., 1866, has recorded some experiments he made on the eyes of a man and some dogs killed by hanging. He found certain transverse fissures across the lens, which he is inclined to think are characteristic of this mode of death. Death from hanging may take place although the toes or other parts of the body rest on the ground. Death is complete in four or five minutes. Marks of the Cord. — The mark of the cord is nearly always present, but is often interrupted, sometimes only seen on one side. In strangling, the mark is low down, most frequently encircling the neck ; in hanging, the mark is generally above or on the thyroid cartilage, and carried obliquely upwards. The mark of the cord may be of a dirty yellowish-brown colour, and when cut into, feels more or less hard and leathery. In general appearance it is not unlike the mark left by mustard plasters or blisters applied within a short time of death. This effect is probably produced by the rubbing off of the epidermis, and subsequent drying up of the cutis on exposure to the air. At other times the mark may be of a dirty reddish or bright-blue colour; or, lastly, there may be little or no mark present, or the edges may assume a livid red coloration, being nothing more or less than a post-mortem stain. The marks left by the act of throttling are the same as those produced by hanging and strangulation, only differing in form. The impression of the fingers is upon opposite sides of the throat; and are more or less separated. The skin presents at times the parchment-like appearance just described, with slight ecchymosis under the patches. The impressions left by the nails may some- times be seen. HANGING. 91 May the mark of the cord be produced after death? On this point Casper says : ' That any ligature with which any body may be suspended or strangled, not only within a few hours, but even days after death, especially if the body be forcibly pulled downwards, may produce a mark precisely similar to that which is observed in most of those hanged while alive? And the same authority also adds that ' the mark of the cord is a purely cadaveric phenomenon? Suicide or Homicide? — The answer to this question must be framed in accordance with the history of the case, and the attendant circumstances under which the body was found. Homicidal hanging is so rare as scarcely to require notice, and it also pre-supposes a considerable amount of strength on the part of the assailant to accomplish his purpose. Suicidal hanging — a favourite mode of death with suicides — is common enough. The absence of marks of injury on the body found suspended, and the want of evidence as to a previous struggle having taken place, all point to suicide. Throttling is never suicidal ; strangulation may or may not be the act of a suicide, but the evidence is in favour of homicide. It must also be remembered that murderers not infrequently suspend their victims after death, to give an air of suicide to the transaction. The presence of considerable injury about the neck militates greatly against the possibility of suicide. In all doubtful cases, therefore, the stomach should be examined for poison, and the body for bruises, which latter may, however, be inflicted by the suicide on him- self in his struggles before death ensues. The fact that the feet are found in contact with the ground does not militate against the probability of suicidal hanging. 92 FORENSIC MEDICINE. PRETENDED ASSAULT. How may wounds, alleged to have been the result of an assault, be shown to have been self-inflicted ? — By considering — 1. The Character of the Wounds. — In these cases the wounds are generally slight, and may consist in a series of small superficial wounds. 2. The Parts of the Body where they are^ and those iclier e they are not. — They are never found on vital parts, but always where there is little danger of doing much harm. 3. The clothes of the Person pretending to have been assaulted. — The cuts in the clothes do not, as a rule, correspond with those on the body ; for instance, a long cut in the coat, and a short one in the body, or vice versa. DROWNING. Death by drowning occurs when the breathing is arrested by watery or semi-fluid substances, blood, urine, or the muddy semi-fluid matter found in cesspools and marshes. It is not necessary for the whole body to be submerged. Death may result if the face alone be immersed, as in the case of a man in a fit of drunken- ness being drowned in the water contained in the im- print of a horse's hoof left in the mud. In addition to the changes in the internal organs identical with those present in persons who have died from suffocation or hanging, water is found in the lungs and stomach. Death may be due to — a. Apoplexy. b. Asphyxia. c. A combination of the two. d. Neuro-paralysis. Death from pure apoplexy is rare. DROWNING. 93 It is more difficult to restore the drowned than those dying from mere stoppage of air from entering the lungs. Few if any persons recover who have been submerged four minutes, and even in cases where this time has been reached, followed by recovery, this result is probably due to the person fainting before entering the water. In death from drowning, the lungs are distended and overlap the heart, and have a peculiar spongy feel. They also contain a quantity of frothy fluid, which, according to Casper, cannot be produced in the dead body, as it is the result of the violent efforts made by the individual to breathe in the act of dying. This frothy condition of the fluid in the lungs is an im- portant sign of death by drowning, especially if the fluid correspond with that in which the individual is said to have perished. It is just possible, however, that the person may have been first suffocated, and then thrown into the water, froth in the trachea being found in those suffocated. Water in the stomach is an. important indication of death from drowning, especially if the water contained in the stomach can be identified with that in which the body was found. The value of this sign is enhanced by the fact that water does not enter the stomach in those submerged after death, unless putrefaction be far advanced. Casper concluded that a person had been drowned by finding a small quantity of mud in the stomach after putrefaction had set in. Water, however, may be absent from the stomach if the person fall into the water in a state of syncope, from whatever cause produced. Of the external signs, the presence of sand, gravel, or mud under the nails, may or may not be an important sign, for sand or mud may collect under the nails dur- ing the efforts to drag the body from the water. The cutis anserina — goose skin — present generally on the anterior surface of the body, and not, however, peculiar to death from drowning, is important as a sign of recent 94 FORENSIC MEDICINE. vitality. The face of those who have been drowned, and then quickly removed from the water, is pale, and in most cases not swollen, the eyes closed ; and not in- frequently round the mouth there is more or less froth, especially when death is due to asphyxia. In summer, however, after two or three days, and longer in winter, the face assumes a reddish or bluish-red coloration, putrefaction taking place about the head and upper extremities earlier than in other forms of death. The contraction or retraction of the penis is a well-marked sign of death by drowning, and Casper asserts that he has £ not observed anything similar so constantly after any other kind of death/ The question as to how long a body may remain in the water before it floats has given rise to considerable discussion, without, however, arriving at any very definite conclusion. It may be stated in general terms that as floating depends to some extent on the rapidity in which putrefaction supervenes on submersion, bodies float earlier in summer than in winter, in salt than fresh water, clothed than naked. Females and children float more readily than males. A body from various causes may float within a few hours of its submersion, especially if the person drowned be a female, fat and clothed. The old idea that the body of a person thrown into water during life sinks, but that a dead body under like conditions floats, is a fiction now exploded. Suicide or Homicide? — Homicide by drowning is rare, except in children. Accidental drowning is common enough. The signs to be sought for in the drowned are — 1. Absence of any injury. 2. Cutis anserina and retracted penis. 3. Water and mud in the stomach. 4. Froth in the air-passages. 5. Distended lungs. 6. General signs of death by asphyxia. It should be remembered that the fact of the hands DROWNING. 95 being tied together, or to the feet, does not militate against suicide by drowning. If wounds and other injuries be found on the body, the question arises as to whether the injuries were suf- ficient in themselves to cause death, and then as to whether they were caused during life. A person jumping from a height into the water may sustain severe injuries — dislocation of both arms, fracture of the skull and of the vertebrae, or even lacerated wounds of more or less severity. The absence of the signs proper to death by drowning, coupled with the presence of external injuries, would point to death by violence prior to immersion. The following considerations may assist in forming an opinion : — 1. Previous history of person found in the water. a. Any history of suicidal tendency. b. Any motive that would render suicide pro- bable. 2. Height from which the person fell. 3. Absence or presence of signs of death by drowning. The time required to cause death by drowning is so short, that persons seldom recover after submersion for three or four minutes ; but the cessation of respiration is no guide to the extinction of life, and an attempt at resuscitation should always be made ; for if the respira- tion be fairly restored, the heart will soon act. Nay, more, as pointed out before in cases of so-called asphyxia, the heart may continue to act for several minutes after the entrance of air to the lungs has been arrested. Recapitulation of the Post-mortem Appearances in the Drowned. 1. External. a. In the Skin. — The presence of goose shin — cutis anserina — is hardly ever absent, even in summer. The 90 FORENSIC MEDICINE. cutis anserina is not, however, characteristic of drowning, as it may be present in other forms of violent death, and also in some persons during life. It is a vital act, the result of nervous shock, and does not depend upon the temperature of the water for its production, still it points to recent vitality. b. The Tongue. — 6 The tongue is just as often found behind the jaws as between them ' (Casper). c. TJie Hands and Feet. — The hands and feet acquire a greyish-blue colour when the body has lain in the water from twelve to twenty-four hours. The skin also becomes corrugated in longitudinal folds. The nails may contain particles of sand and weeds. ' No corrugation or discoloration of the skin of the hands or feet is ever observed on the body of any one drowned, who has been taken out of the water within half-an- hour, within two, six, or even eight hours' (Casper). The same authority states he has produced these effects by laying the hands of a body in water, or wrapping them in cloths kept constantly wet for a few days. d. The Genitals. — Contraction of the penis is an almost constant symptom, and Casper has ' not observed anything similar so constantly after any other kind of death.' It is due, probably, to the same cause as the cutis anserina, which Brettner attributes to i bundles of unstripped muscular fibres lying in the upper stratum of the true skin, surround the sebaceous glands, and force them forwards by their contraction, thus making the cutis anserina. Precisely similar unstripped muscles are found in the subcutaneous cellular tissue of the penis; they run principally parallel to the long axis of the member, but very often large bundles run across it.' The action of cold and fright is to induce con- traction of these cutaneous muscles, with a resulting contraction of the penis. 2. Internal. a. The Brain. — Cerebral hyperemia is most rare in DROWNING. 97 the drowned, but cerebral hypostasis is not infrequently mistaken for it. b. The Trachea, — The mucous membrane of the } trachea and larynx is always more or less injected, and is of a cinnabar-red colour, which must not be mistaken for the dirty brownish-red, the result of putrefaction. : A white froth, but seldom bloody, is also found in varying quantity in the trachea, and is a most impor- tant sign of vital reaction, but its diagnostic value is destroyed by putrefaction. c. The Lungs. — The lungs are completely distended, almost entirely overlapping the heart, and pressing close : to the ribs. They are spongy to the feel, and when cut into, a considerable quantity of bloody froth escapes. The froth found in the lungs is the result of the powerful attempts to breathe, and cannot be pro- duced by artificial means. The distension of the lungs is due partly to an actual hyperaeria, partly to inhaled fluid, and partly to hyperemia. d. The Heart and Great Vessels. — As is common to, other forms of asphyxia, the left side of the heart is entirely, or almost entirely, empty. It is therefore not a diagnostic sign of drowning, and is absent in the drowned when death takes place by neuro-paralysis. The same may be said of the accompanying congestion of the pulmonary artery. e. The Blood. — As is common in all forms of death where respiration has been arrested, the blood is found to be remarkably fluid, and of a cherry-juice colour. /. The Stomach. — Casper considers that the presence of fluid in the stomach, corresponding to that in which the body is found, is ' an irrefragable proof of the actual occurrence of death from drowning? and that f the swallowing of it must have been a vital act of the individual dying in the water.' N.B. — Putrefaction in the drowned in most cases commences in the upper part of the body, and extends G FORENSIC MEDICINE. downwards. The face, head, and neck are first attacked. This is the reverse of putrefaction in air. Restoration of the Drowned. — Several methods for the restoration of the drowned have been proposed, those by Marshall Hall and Silvester being the best known. More recently, Dr Benjamin Howard has pro- posed a new plan, called by him the ' direct method. A detailed account of the various methods is given in the Medical Examiner for August 1877. The mode of procedure recommended by Dr Howard is as follows ; — The clothes are rapidly removed and rolled up into the form of a bolster ; the patient is then turned on his face, with the bolster under the pit of the stomach, the head being the most dependent part. The object is to allow all fluid to escape from the mouth and throat. This is more effectually accomplished by the operator placing both hands upon the back of the patient im- mediately above the bolster, and forcibly compressing the stomach and lower part of the chest against the bolster for a few seconds two or three times, with very short intervals. He now quickly turns the patient on his back, the bolster beneath it again making the epigastrium and anterior margins of the costal cartil- ages the highest point of the body, the shoulders and occiput barely resting on the ground. The operator now seizes the patient's wrists, and having secured the utmost possible extension with them crossed behind the patient's head, pins them to the ground with his left hand, so as to maintain the required extension. With the right thumb and forefinger, armed with the corner of a dry pocket-handkerchief, he withdraws the tip of the tongue, holding it out at the extreme right corner of the mouth. In this position, two-thirds of the entrance to the mouth is quite free, and the tongue is immov- ably fixed forward. The epiglotis, by this backward curvature of the neck, is precluded from pressure and partial closure from the undue flexion of the neck so frequently observed. The free margins of the costal STARVATION. 99 cartilages are as prominent as they can be made, and there is a degree of fixed thoracic expansion not obtainable in any other manner. The epigastrium being the highest point, the abdominal viscera, instead of em- barrassing the movements of the diaphragm, tend to gravitate away from it. Having given the wrists and tongue into the care of an assistant, the operator now kneels astride the patient's hips, resting the ball of each thumb upon the corresponding costo-xyphoid ligaments, the fingers falling naturally into the lower intercostal spaces. Now, resting his elbows against his sides, and using his knees as a pivot, he throws the whole weight of his body slowly and steadily forward until his mouth nearly touches the mouth of the patient, and while he might slowly count — one — two — three ; then suddenly, by a final push, he springs back to his original erect posture on his knees, remains there while he might slowly count — one — two — three ; then repeats, and so on about eight or ten times a minute. As soon as respiration is sufficiently restored, the patient may be placed in a hot bath, then well dried, and placed in blankets, and given hot coffee or tea to drink. STARVATION. Death from starvation comes in as an item in the ill- treatment of children, and it has also been known as a form of suicide, chiefly among lunatics. Little is known for certain as to the length of time required to cause death by starvation, but it is certain that life may be prolonged for some time without food, if water be allowed. The morbid appearances are extreme anaemia and emaciation, together with remarkable attenuation of the coats of the intestines. The eyes are red and open. This appearance is uncommon from other causes of 100 FOKENSIC MEDICINE. death. The tongue and throat are dry, even to aridity, and the stomach and intestines are contracted and empty; this last mark has been repeatedly noticed (Beck). Diagnosis. — The absence of any other cause for death, and the previous history of the case, will alone assist in forming an opinion. Legal relations. — Although rare as an act of homi- cide, it must be remembered that the law does not require the absolute deprivation of food to be proved, but only that the necessary quantity and quality of food has been withheld • but malice at the same time must be proved. Recapitulation of the Post-mortem Appearances of Death by Starvation. 1. In the body generally. — Marked general emacia- tion of the body. The skin is dry and shrivelled, sometimes more or less covered with unhealthy-looking pimples, the muscles soft, reduced in size, and free from fat. A peculiar foetid acrid odour is given off from the body. 2. In the solid viscera of the Thorax and Abdomen. — The liver is small, the gall bladder puffed with bile, and the heart and kidneys deprived of any surrounding fat. All the internal organs are shrivelled and bloodless. 3. In the Stomach and Intestines. — The stomach in some cases is quite healthy, but more or less stained with bile ; in others it is found collapsed, contracted, empty, and the mucous membrane more or less ulcerated. The intestines are thin, contracted, empty, and so shrunken that the canal is almost obliterated. Accord- ing to the late Dr Duncan, the intestines are frequently found inflamed and ulcerated. DEATH BY LIGHTNING. 101 DEATH FEOM COLD. This form of death is rare in England, but is more common in countries where the winters are severe. Anything that depresses the vital powers renders the individual more or less amenable to cold; such, for instance, as drunkenness, previous illness, or deficiency in the amount of food. There are no post-mortem appearances which are characteristic of death due to cold, if we may except the almost constant presence of extreme venous congestion in the organs of the body. Sir Benjamin Brodie considered that the effect of cold is to destroy the principle of vitality equally in every part, and that it does not exclusively disturb the func- tions of any particular organ. The fact of a body found frozen is no proof that death has been thus brought about. Diagnosis.. — The general appearance of the deceased, and the absence of any other cause of death, will alone assist in forming an opinion on this difficult subject When a person is found dead from the effects of extreme cold, there are no marks of external violence nor internal suffering. The body lies as if in a deep and calm sleep, without any external appearance to guide us as to the cause of death, except perhaps a swelling of the extremities, which has come on prior to death. If a body be found buried in snow, and putrefac- tion present, death did not in all probability take place from cold, provided that the cold has been severe and continuous. Death from cold is generally accidental, except in newly-born children, when it may be either accidental or homicidal, according to circumstances. DEATH BY LIGHTNING. Death is not always immediate. Sometimes the clothes have been torn off the body with scarcely any personal injury. Steel articles worn about the person 102 FORENSIC MEDICINE. may become magnetic. Wounds on the body some- times appear in the form of punctured wounds, at others as lacerated wounds. Not infrequently those killed by lightning are found in the same position that they occupied during life. The question may be raised as to whether the deceased died by lightning or by violence. The presence of a storm at the time when the death is stated to have occurred, and other attendant cir- cumstances, will in most cases point to the true cause of death. SUICIDE. In medico-legal inquiries, it not infrequently becomes a question of the greatest importance to decide whether the death of a person found under peculiar circum- stances was brought about by accident, suicide, or by the hand of a third party. Unfortunately, there are no infallible rules to be laid down on this subject ; and Casper sagaciously remarks that 'the exercise of a sound judgment, which is of far more value in medico- legal matters than all the subtleties of the ancient medicina forensis, must be our guide.' But in order to attract the attention to some important matters in the inquiry, a few points worthy of notice will be placed in a tabular form : — 1. Has the deceased made any oral statement, or left any written declaration of his intention to com- mit suicide. 2. Has there been any marked peculiarity in the con- duct and manner of the deceased to point to any mental derangement. 3. Conditions under ivhich the dead body was found. a. If in a room, ivas the door locked on the inside ? b. Position of the hand with regard to the vjeapon alleged to have been used. SUICIDE. 103 c. If weapon be found firmly grasped in hand, probability is in favour of suicide, as iceapons placed in the hand after death to simulate suicide can be removed with ease, even when the rigor mortis is present. 4. Nature and character of the wounds found on the body. On suicides, incised and punctured wounds are generally found — seldom lacerated wounds, unless a jump from a height have been the means adopted to cause death. 5. Evidence to be derived from a medico-legal exami- nation of the body. a. Do the wounds correspond with the zoeapon alleged to have been used ? b. Examination of stomach for poison. Why 1 Persons may have been poisoned first, and then cut about the body after death. c. Direction and course of tvound. d. Were the wounds inflicted during life ? Too much care cannot be taken in answering this question, as its solution is involved in considerable difficulty, and the medical jurist must not be dis- couraged if in many cases he be unable to give a decided opinion one way or the other. If death have followed instantaneously on the receipt of a wound, as in the case of injury to a large artery, none of the signs of vital reaction will be present, and the wound cannot be distinguished from another made by its side after death. Only in those cases where some time has elapsed between the receipt of the injury and death, will any of the signs of vital reaction be present, and even these may be more or less modified, so as to render the diagnosis, if not impossible, at least doubtful. With regard to the legal relations of suicide, an attempt to commit suicide is not, within the meaning of sec. 15 of 24 and 25 Vict., c. 100, an attempt to 104 FORENSIC MEDICINE. commit murder, but it still remains a common law mis- demeanour, triable at quarter sessions (E. v. Burgess). If two persons mutually agree to commit suicide by poison or other means, and one survive, the survivor is guilty of murder (E. v. Dyson, R. & R, 523). Also, if any one, in attempting to commit suicide, cause the death of another, lie himself recovering, he shall be guilty of manslaughter (E. v. Gathercole). In most of the English insurance offices, suicide is held to invalidate a policy, but in most cases where insanity is proved, the amount of the policy is paid, as in the case of Schwabe v. Clift. Suicides are deprived of the rites of Christian burial (4 Geo. iv., c. 52, s. 1). OFFENCES AGAINST CHASTITY. Eape. (Statute 24 and 25 Vic., c. 100, s. 48.) Eape is defined as the 6 carnal knoioledge of a woman against her will. 9 To constitute the offence of rape, there must be penetration, but proof of the actual emission of seed is not now necessary. Before the statute 9 G. 4, c. 31, s. 18, it was also necessary to prove emission, which might be proved either positively by the evi- dence of the woman that she felt it, or it might be pre- sumed from circumstances, as, for instance, that the defendant, after having connection with the prosecutrix, arose from her voluntarily without being interrupted in the act. The slightest penetration of the male organ within the vulva will be sufficient, and the hymen need not be ruptured (E. v. Eussen, 1 East P.C., 438, 439). The resistance of the woman must be to the utmost of her power ; if, however, the woman yield through fear or duresse, it is still rape, but of course much will depend upon the previous character of the woman, and her conduct subsequent to the alleged out- KAPE. 105 j • rage. A rape, according to Scotch law, may be com- j mitted on a common strumpet ; and in England the , law goes even further, and admits the possibility of rape on the concubine of the ravisher (1 Hale 729), ' although such circumstances should certainly operate strongly with the jury as to the probability of the fact that connection was had with the woman against her will. , Carnal knowledge of a woman by fraud, which induces her to suppose it is her husband, does not amount to a rape (E. v. Barrow, 1 C.C. 156), but the . party may be indicted for an assault. This is also the law in Scotland (see case of Will Fraser, H.C., June 21, 1847 ; Ark 280). But if a man get into bed with a woman while she is asleep, and he know she is asleep, and he have connection with her while in that state, he is guilty of rape (R v. Mayers, 12 Cox, 311, per Lush. J). Upon an indictment for rape, there must be some evidence that the act was without the consent of the woman, even where she is an idiot. In such a case, where there was no appearance of force having been used to the woman, and the only evidence of the con- nection was the prisoner's own admission, coupled with the statement that it was done with her consent, the Court held that there was no evidence for the jury (E. v. Fletcher, L.E. 1 C.C. E. 39). In another case, where the prisoner was caught in the act by the father of an idiot girl, the learned judge told the jury that if the prisoner had connection with the prosecutrix by force, and if she was in such an idiotic state that she did not know what the prisoner was doing, and if the prisoner was aware of her being in that state, they might find him guilty of rape. But if, from animal instinct, she yielded to the prisoner without resistance, or if the prisoner, from her state and condition, had reason to believe she was consenting, they ought to acquit him. The jury found that he was guilty of an attempt at rape (E. v. Barratt, 2 C.C. 81). Where the 106 FORENSIC MEDICINE. prosecutrix, an apparent idiot, proved that the prisoner had had connection with her, but it appeared from her examination that although she knew he was doing wrong, she made no resistance, and the prisoner, on 4 being apprehended and charged with committing^ rape upon the prosecutrix ' against her will,' said, 1 yes, I did, and I'm very sorry for it/ it was held that there was evidence to go to the jury of a rape (E. v. Pressy, 10 Cox 635). In Scotland, in the case of Hugh M'lSTamara, H.C. July 24, 1848, Ark 521, where the woman was only one degree removed from idiocy, it was laid down that if 6 she had shown any physical resistance, to however small an extent, the offence would be complete, in consequence of her inability to give a mental consent/ In the case also of a quack doctor who, under the pretext of performing a surgical operation on a young girl of nineteen years of age, had connection with her, she at the time re- sisting, but believing that she was undergoing an operation, it was held, on appeal, that he was guilty of the crime of rape, and the former conviction confirmed (E. v. Hattery, C.C.). Carnally abusing children under ten years of age constitutes a felony ; above ten and under twelve, a misdemeanour. Under the age of ten years the evidence is the same as in rape, with the exception, however, that it is immaterial whether the act was done with or without the consent of the female. Between the ages of ten and twelve it will be no defence to say that the girl consented. Above twelve years of age, consent does away with any legal offence. A boy under the age of fourteen in England is presumed by law incap- able of committing a rape (E v. Groombridge, 7 C. & P. 552), nor is evidence admissible against him to show that in fact he has attained the full state of puberty, and was capable of committing the crime (E. v. Philips 8 C. & P. 736). In Scotland there is no such provision, and a boy thirteen and a-half years RAPE. 107 I j of age was committed for rape (Eob. Fulton, jun., Ayr, Sept. 20, 1841). It is a question of proof, not of theory. The crime of rape appears to be most frequently perpe- trated against children, probably due to the popular idea that an attack of gonorrhoea may be cured by con- nection being had with a virgin or healthy female. The following table from Casper gives the result of his examination of one hundred and thirty-six cases of rape : — From 2J (!) to 12 years old . . . , 99 „ 12 „ 14 .... 20 „ 15 ,,18 „ . . . .8 „ 19 „ 25 „ . . . .7 47 . 1 68 . 1 136 In the examination of a case of alleged rape, several points of interest will have to be considered, which, for the sake of convenience, will be placed in a tabular form. 1. An Examination of the Parts of Generation. a. Inflammatory redness and abrasion of the parts. b. A muco-purulent secretion. c. Hemorrhage or dried blood about the genital organs. d. Destruction of the hymen. e. Dilatation of the vagina. /. General signs of rape. 2. An Examination of the Body and Limbs of the Female. 3. Examination of the Linen worn by the Female and the Male for — a. Marks of semen. b. Marks of blood. c. Marks of other discharges, gonorrhoea, etc. 108 FORENSIC MEDICINE. 1. An Examination of the Parts of Generation. a. More or less inflammatory redness and abrasion of the mucous membrane lining the parts, which is never absent in children, and may last for some weeks. ' In adults, virgins up to the time of the commission of the crime, this appearance is either not found at all, or only faint traces of it. In those previously deflowered it is never observed.' In the case of young children the genitals may be so injured as to cause death in a few hours. The parts may therefore present all varieties of injury, from slight bruising and redness to the most fearful lacerations. Caution. — Inflammatory irritation due to catarrh, may occur, and be apt to mislead. b. A muco-purident secretion, from the mucous mem- brane lining the vagina, of a greenish-yellow colour, more or less viscid, and soiling the linen of the girl. This secretion, in colour and consistence, cannot be dis- tinguished from that the result of gonorrhoea. Caution. — Unhealthy children, and those recovering from some debilitating diseases — fever, etc. — may suf- fer from purulent discharges from the vagina. Small ulcers may also be present. Infantile leucorrhoea is not uncommon. c. Haemorrhage or Dried Blood about the Genital Organs. 1. Frequently absent in young children. 2. Always found in adults, virgins at the time the rape was committed, when the vessels of the hymen are ruptured. d. Destruction of the Hymen. — Most frequently, and especially in young girls, one or more lacerations of the hymen may be seen. These lacerations must be looked for within three or four days of the alleged rape, as they soon heal up, and then no certain opinion can be given as to the date of their infliction. They may also KAPE. 109 be produced by any foreign body to substantiate a charge of rape. e. Dilatation of the Vagina, — This condition may be produced by the passage of hard bodies in order to substantiate a false charge of rape. Casper once examined a girl, only ten years of age, whose mother had gradually dilated her vagina with her fingers, in order to fit her for sexual intercourse with men. /. General Signs of Rape. — To the above are added certain general signs, as a difficulty in ivalking, attended with an involuntary separation of the thighs, common to both children and adults ; pain in passing water, and when the boivels are relieved, is also not infre- quently present. In determining the truthfulness of the statements made as to an alleged rape, the character of the woman, and the obvious inconsistencies of her statements, must be taken into consideration. More- over, if, in addition to the injuries found on the exter- nal genitals, spermatozoa be detected in the vagina, a presumption in favour of the injuries being due to sexual intercourse will be clearly made out. Care, however, must be taken not to confound with sperma- tozoa an animalcule — trichomonas vagina — described by M. Donne as being sometimes found in the vaginal mucus. The head of the animalcule is larger than that of a spermatozoon, and is surrounded by a row of cilia. In the case of young children, the anxiety on the part of the parents of the child to push the charge, and the story of the child and that of the parent heard apart, may assist in guiding the opinion. The lesson- like way in which the child tells her story, even to the minutest details, is always suspicious. The proof of a previous defloration negatives the pretended loss of vir- ginity at the time of the commission of the deed for which the accused is being tried. In most cases, it is best to let the patient tell her own tale, and then cross- examine. An injudicious question may put her on her guard. 110 FORENSIC MEDICINE. 2. Examination of the Limbs and Body of the Female for Bruises, etc. Little value is to be placed on injuries said to be inflicted on the person of the female, the result of a struggle, as these may be produced by the woman on herself in order to substantiate her story. In children, for obvious reasons, they do not occur. 3. Examination of the Linen. In all cases a careful examination of the body linen of both parties should be made. Mistakes may arise from — a. The garments being intentionally soiled with blood. This is not infrequently done in cases of false accusations. b. The menstrual discharge may be readily mistaken for that due to violence, as the two kinds of blood cannot be distinguished. c. The red juice of fruits and grease-spots have been mistaken for marks of blood and seminal stains on linen. The identification of blood-stains is not difficult when the stains occur on pieces of white linen ; but when, as it not infrequently happens, they have to be detected on the coarse, dirty, often stinking linen of the poor, the task becomes somewhat more difficult. The same may be said with regard to seminal spots. As a means of diagnosis in stains due to semen, the appearance and smell of the stains are of no assistance whatever. The microscope will alone give any trustworthy evidence as to the nature of the stain; and even here a caution must be added : for the fact is beyond doubt that the semen even of a healthy young man varies much, and is scarcely ever twice alike, so that the absence of sper- matozoa is no proof that the spot is not seminal in its origin. EAPE. Ill The following are the tests used for the detection of semen : — a. Characteristic smell when the spot is moistened. This test is of no use, for the reasons before stated. b. Appearance when held to the light ; as uncertain as the preceding. c. Doubtful spots upon cotton or linen — not upon tvool, which usually contains sulphur — should be cut out and moistened with a few drops of oxide of lead, dissolved in liquor potassae, and then dried at a temperature of 68° F. The stain in a few minutes becomes of a dirty yellow or sulphur-yellow colour. This change in colour proves that the mark is not a seminal stain. Semen does not contain albumen. This test only shows that the stain is not caused by albu- minous compounds, which contain sulphur ; but it does not follow therefore that the spot must be seminal ; for marks made by gum, dextrine,- and some other substances of a like nature, are not changed in colour. d. The Microscope. — This is by far the most reliable test, but care is required in its manipulation. 1. The cloth must not be rubbed between the fingers, as the spermatozoa may be damaged by the operation. 2. The suspicious spot on the linen should be carefully cut out and placed in a clean watch-glass or small porcelain vessel, and then moistened with a small quantity of distilled water. The cloth may be gently moved about in the water with a glass rod, and gentle pressure made so as to thoroughly wet the cloth, which, in most cases, will be accomplished in about a quarter-of-an-hour. A single drop should now, by gentle pressure 112 FORENSIC MEDICINE. with the fingers, be squeezed on to a clean slide, and then placed under the microscope. Can a Rape be committed by one man on a Healthy, Vigorous Woman ? — The answer to the question will, to a great extent, depend on the relative strength of the conflicting parties. Every case of rape has to be judged on its own merits. In any case, the medical jurist has simply to state, from the examination of the parties, that sexual intercourse has taken place, leaving the jury to decide whether a rape or not has been perpetrated. A case is mentioned by Casper where a healthy, strong adult of twenty-five years old was violated by a single man. Can a Woman be violated during Sleep ? — By this is intended natural healthy sleep, and not that induced by narcotics. In natural sleep, rape is scarcely pos- sible in a virgin, especially if the hymen be found recently ruptured, though it may be possible in a woman accustomed to sexual intercourse. Can a Woman become pregnant by an act of Rape ? — The answer to this question is most decidedly in the affirmative. It is not necessary for a woman to experience any sexual pleasure during connection in order that she may conceive. Signs of Rape in the dead. — In the case of a woman found dead, the question may arise as to her having been violated prior to death. The reply to the question is by no means easy. Severe injury to the genitals is a presumption in favour of rape. The presence of sper- matozoa in the vaginal mucus is good evidence of a late coitus, but is no direct evidence of rape. Collateral evidence will in most cases decide the point. General Directions as to manner of making a Medico- Legal Examination in case of cdleged Rape. a. Give the female no time for preparation, but make your visit, and at once proceed to an examination. RAPE. 113 1. Note time of visit. 2. Note time of alleged offence. Why ? May prove the accused party innocent by an alibi. 3. Avoid leading questions. b. Age, strength, and condition of the health of the complainant. Examine the wounds asserted to have been inflicted, and see if they correspond with the history given of their infliction. c. Examine organs of generation. 1. Any recent signs of violence — blood, abraded, ulcerated. 2. Condition of hymen, and of the carunculce myrtiformes. 3. Was the woman menstruating at the time ? Signs modified or obliterated by menstrua- tion. d. Preserve any spots on linen, etc., for future exami- nation. e. In case of death after violence. 1. Examine mouth for foreign bodies, etc. 2. Eractures or bruises on the body. f. Examine spot where the crime is stated to have taken place. g. Examine person of the accused. 1. Muscular development and strength. 2. Any abrasion about the penis, rupture of the frsenum, etc. 3. On linen, blood-stains, seminal spots, etc. 4. Marks on his body, scratches, etc., as evi- dence of resistance. N.B. — The lapse of a few days may be sufficient to remove all traces of the violence done to the parts ; and in most cases days, weeks, and even months may elapse before an examination is made of the alleged victim. H 114 FORENSIC MEDICINE. Physical Signs of Rape in the Adult and in the Child. In the Adult. 1. If examined soon after the commission of the offence, the hymen of the adult virgin majr he ruptured, and the fourchette may be lacerated, and the parts covered with blood. 2. Difficulty in walking, in passing water, and sometimes when the bowels are relieved. These signs in the adult pass off in a day or two. 3. Injuries on the person abused, such as scratches and ecchymoses, may be present as the result of a struggle. These may be self-inflicted. In the Child. 1. There may not be sufficient penetration to rupture the hymen ; consequently there will be no haemorrhage. In other cases the external organs will be bruised, and in many cases severely lacerated, the lacera- tions depending on the amount of penetration and force used. 2. Same as in the adult, but lasting for a longer time — from eight to fourteen days. 3. For obvious reasons, these do not occur on children. There is no one sign which may be considered as an absolute test for virginity. The presence or absence of the hymen is of no probative value one way or the other. Its very existence has been denied by Pare, Buffon, and others. It may be absent as the result of disease, or as the result of a surgical operation to allow of the free discharge of the menstrual flow. Its pre- sence is no bar to conception ; and cases are on record where it has been found necessary to incise it, to allow of the passage of the foetus into the world. The changes in the breasts which proceed from impreg- nation do not occur where only defloration has taken place. The rugose condition of the vagina is only affected by the first birth, and not by sexual inter- course. What has been said of the above signs as tests for virginity may be said of a host of others, Avhich from time to time have, with varying success, been advanced as aids to the diagnosis. Casper, how- ever, considers ' that where a forensic physician finds PREGNANCY. 115 A HYMEN STILL PRESERVED, EVEN ITS EDGES NOT BEING TORN, AND ALONG WITH IT ill yOUllg persons A VIR- GIN CONDITION OF THE BREASTS AND EXTERNAL GENI- TALS, HE IS THEN JUSTIFIED IN GIVING A POSITIVE OPINION AS TO THE EXISTENCE OF VIRGINITY, and vice versa. 3 Pregnancy. It not infrequently happens that a medical man is called upon to make an examination of a woman for legal purposes, in order to decide — a. Existence of cm alleged pregnancy. h. The possibility of a previous pregnancy. c. As to the existence of concealed pregnancy. The following are some of the reasons why preg- nancy may be feigned : — a. By a married woman, to gratify the desire of her husband for issue. b. To influence the jury in a case of breach of pro-, mise of marriage as to the assessment of the damages. * c. To extort money from a seducer or paramour. d. To produce a spurious heir to property. The late insane attempt of Lady Gouch to pro- duce an heir is a case in point. e. By a single or married woman, to stay the inflic- tion of capital punishment. Pregnancy may be concealed — a. In order to procure abortion. b. In order to commit infanticide. c. In the married and the unmarried, to avoid dis- grace. Besides the above, other important questions may arise with regard to this state. a. Is pregnancy possible as the result of coitus in a state of unconsciousness f— There appears no reason for doubting the possibility of this occurrence. b. Can pregnancy occur before the appearance of the catamenia? — That pregnancy may occur before men- 116 FORENSIC MEDICINE. struation is undoubted ; and it appears probable that the changes in the ovaries and uterus may go on at the regular monthly periods, and yet there be no discharge of blood from the uterus, which, as pointed out by Bischoff, is only a symptomatic though usual occur- rence. Hence, pregnancy is possible prior to men- struation. c. What is the earliest and latest age at which preg- nancy is possible ? — In our climate — England — the earliest age at which pregnancy may occur is about the eleventh or twelfth year ; but the youngest age at which this condition is reported to have occurred is nine years (Meyer). In hot climates — as in Bengal — mothers under twelve years of age are by no means rare. The limit to child-bearing appears to be between the fiftieth and fifty-second years ; but even here consider- able variation has been recorded, and women have been delivered of children at the age of sixty. Haller even reports one at seventy. As long as menstruation con- tinues a woman may become pregnant ; but even the cessation of this flow for some months is no bar to con- ception. d. Is it possible for a woman to become pregnant eight iveeks after her last confinement ? — This is un- doubtedly possible, but it is of rare occurrence. It is also probable that a woman may abort at the end of the time above mentioned. I knew a woman, since dead, who for several years bore a child every ten months. At common law, in cases of disputed inheritance, the following may occur, and give rise to the necessity of medical evidence on the subject : — A woman who has just lost her husband may dis- appoint the expectant heirs to an estate by alleging that she is pregnant. At criminal law, pregnancy may be used as a stay to the infliction of capital punishment. In the first case, a jury of matrons is empannelled by PREGNANCY. 117 a writ de ventre inspiciendo, to decide the existence of pregnancy, and if the fact be proved, to watch till such time as she be delivered. In the second case, in England, the pregnancy must be proved, and also whether she be quick with child. In Scotland the pregnancy must be proved, but with- out reference to quickening, and the jury of matrons is unknown in that country. In the same country, if it can be shown that a woman is pregnant, and that her life or that of the child is endangered by her imprison- ment, she may be admitted to bail till after delivery. A pregnant female also cannot be compelled to appear and give evidence, if on competent authority it be shown that her delivery will probably take place at the time fixed for the trial. Signs of Pregnancy. The diagnosis of early pregnancy is by no means easy ; but to the medical jurist it is still more difficult, as he has to deal with cases where he can scarcely expect much candour. No opinion should, however, be given without taking into consideration the collective value of the signs, as no one sign will afford sufficient data on which to base an opinion. The following may be taken as among the most important signs of pregnancy, given in the usual order of their occurrence : — Uncertain Signs. a. Cessation of menstruation. b. Morning sickness. c. Salivation. d. Mammary sympathies. e. Enlargement of the abdomen. f. Quickening. g. Kiesteine. h. Jacquemier's test. 118 FORENSIC MEDICINE. Certain Signs. 1. Ballottement. 2. Uterine souffle. 3. Pulsation of the foetal heart. a. Cessation of Menstruation. — The non-appearance of the catamenia, though a most valuable sign, is by no means a conclusive one, as menstruation may be arrested by diseases of various lands ; while, on the other hand, there are many well-recorded cases of women who have menstruated regularly during the whole period of their pregnancy. There have been also cases in which the menses only occurred during pregnancy ; and in a few still more curious cases, women who have never menstruated have been known to have borne several children. In cases of concealed pregnancy, the woman may smear her linen with blood to imitate the menstrual flow. b. Morning Sickness. — Nausea, often ending in vomiting, generally occurs soon after rising in the morning, and may commence almost immediately, but more frequently not till the expiration of the fifth or sixth week after conception. It is not a reliable sign, and is often very irregular in its occurrence. When present, it varies in degree, from a feeling of nausea to the most violent vomiting, very distressing to the patient. c. Salivation. — The excessive secretion of the sali- vary glands, due to the irritation caused by pregnancy, was first mentioned by Hippocrates as a sign of this condition. 4 It is to be distinguished from ptyalism induced by mercury by the absence of sponginess and soreness of the gums, and of the peculiar foetor, and by the presence of pregnancy.' 1 It is oftener absent than present. d. Mammary Sympathies. — As the breasts may enlarge from various causes — such, for instance, as the 1 Dr Montgomery. PREGNANCY. 119 distension of the uterus from hydatids, or, as is the case with some women at each menstrual period, when the catamenia are suspended, or after they have ceased — this is by no means a sign on which much reliance should be placed. The change in the colour of the nipple and areola, more apparent in women of dark complexions, is more to be relied on as a diagnostic sign of pregnancy. The first observable alteration, which occurs about two months after conception, is 6 a soft and moist state of the integument, which appears raised, and in a state of turgescence, giving one the idea that, if touched by the point of the finger, it would be found emphysematous. This state appears, however, to be caused by infiltration of the subjacent cellular tissue, which, together with its altered colour, gives us the idea of a part in which there is going forward a greater degree of vital action than is in operation around it ; and we not infrequently find that the little glacidular follicles, or tubercles as they are called by Morgagni, are bedewed with a secretion sufficient to damp and colour the woman's dress. During the progress of the next two months, the changes in the areola are in general perfected, or nearly so, and then it presents the following characteristics : — ' A circle round the nipple, whose colour varies in intensity according to the parti- cular complexion of the individual, being usually much darker in persons with black hair, dark eyes, and sallow skin, than in those of fair hair, light-coloured eyes, and delicate complexion. The extent of the circle varies in diameter from an inch to an inch 'and a-half, and increases in most persons as pregnancy advances, as does also the depth of colour. In the centre of the coloured circle, the nipple is observed partaking of the altered colour of the part, and appearing tinged and prominent, while the surface of the areola, especially that part which lies more immediately around the base of the nipple, is studded over, and rendered unequal by the prominence of the glacidular follicles, which, vary- 120 FORENSIC MEDICINE. ing m number from twelve to twenty, project from the sixteenth to the eighth of an inch. And, lastly, the integument covering the part appears turgescent, softer and more moist than that which surrounds it ; while on both there are to be observed at this period, especially m women of dark hair and eyes, numerous round spots or small mottled patches of a whitish colour, scattered over the outer part of the areola, and for about an inch or more all around, presenting an appearance as if the colour had been discharged by a shower of drops falling on the part/ 1 The value of the above changes in the nipple and areola as a diagnostic sign of pregnancy is greatly lessened by a previous pregnancy. It should also be remembered that milk may occur in the breasts of women who are not pregnant. a Enlargement of the Abdomen.— -For the first four months of pregnancy the entire uterus is contained in the cavity of the pelvis ; it then gradually rises, so that at about the fifth month it is mid-way between the pubes and umbilicus, which latter it reaches at the end of the sixth month ; during the seventh month it may be felt half-way between the umbilicus and ensiform cartilage ; at the end of the eighth month it is level with the cartilage, now quite filling the abdomen. Still increasing in size during the ninth month, it does not ascend higher, the abdominal walls yielding to its increased weight, allowing it to fall somewhat forward. A caution is necessary with regard to this sign. The abdomen may enlarge from causes other than pregnancy. Pregnancy and ascites, or ovarian dropsy, may co-exist in the same patient, and the diagnosis rendered anything but easy. The enlarge- ment of the abdomen may lead to unfounded suspicions detrimental to the happiness and health of the unfor- tunate object of them. The cervix uteri in the latter months of pregnancy presents the following characteristics : — 1 Dr Montgomery. / PREGNANCY. A/v^il ^ 1 At the sixth month it loses one-fourtri'oM ;V ,'tat the seventh it is only half of its original length; ( f at the eighth it loses another quarter ; and at the ninthly ^Jjie neck is entirely obliterated. ^This shortening is \. ("more apparelrTTnan real, and its occurrence is denied ) ry^ Nervous women, anxious to have children, sometimes : complain of sensations which they ascribe to quickening, pregnancy being absent. Pregnancy may occur without quickening. g. Kiesteine. — This is no test of pregnancy, as it may be found in women not pregnant, ^yvv { \r^^^f^ K h. Jacquemier's Test — A violet or port-wine colour of the vagina and inner surface of the vulva, due to venous congestion of the parts from pressure of the gravid uterus. A flattening of the upper wall of the vagina, pro- duced by the enlargement and anteversion of the uterus, which, forcing the os towards the sacrum, makes the anterior wall of the vagina tense, has been added by Dr Barnes as a sign of pregnancy. This ends the account of those signs of pregnancy which are least to be relied on in forming a diag- nosis, and which are only useful when taken in the aggregate. 1. Ballottement. — This test of pregnancy is applied by causing the patient to stand upright ; the finger of the right hand is then passed into the vagina and placed on the mouth of the womb, the other hand being placed lightly over the abdomen in order to steady the uterine tumour. If the finger be now jerked upwards against the head of the child, it will be felt to float upwards in the liquor amnii, and then by its own weight gradually 122 FORENSIC MEDICINE. to return to its former position. Tumours in the uterus, attached to its walls by a pedicle, may give the same sensation. Scanty supply of liquor amnii, or mal-position of the child, may sometimes prevent the adoption of the test. 2. Uterine Souffle. — Under this head are included the placental bruit, and the pulsations of the umbilical cord. Both these sounds require a most skilled auscultator to detect them. The uterine murmur, or bruit placentaire, is heard best at the lower and lateral portions of the uterus, just above Ponpart's ligament. It is isochronous with the pulse of the mother, and is heard most distinctly about the fourth or fifth month of utero-gestation ; in some cases, however, it may be heard as early as the tenth week. The sound is inter- mittent, and varies in character, being sometimes hissing, whirring, or cooing, at others rasping. Pulsation of the Foetal Heart. — The sounds of the foetal heart were first noticed by Mayar in 1818, and those of the placenta, or placental souffle by Kergaradec in 1822. The sound of the foetal heart is composed of a rapid succession of short, regular double pulsations, differ- ing from that of the adult heart in rhythm and frequency. It can be heard more or less over the whole of the abdomen about the middle of the fourth month, and is not unlike the muffled ticking of a watch. In frequency it varies from 100 to 140. The auscultator should be careful not to hang his head down, or he may be apt to mistake the throbbing of his own arteries for sounds communicated from the patient. The medical jurist must be prepared for the follow- ing among many other questions which will come under his notice : — 6 An unmarried woman with abdominal enlargement has been wrongfully accused of being pregnant. Enumerate the various conditions which produce abdominal enlargement, and give the PSEUD 0 -PREGNANCY. 123 diagnosis of them.' 1 Pregnancy may be simulated by ascites, by fibrous tumours of the uterus, by ovarian dropsy, and by enlargement of the uterus from reten- tion of the catamenia due to an imperforate hymen, and lastly, from the singular disease about to be described below. The breasts may also become affected by uterine tumours. Pseudo-Pregnancy, In the examination of cases of alleged pregnancy, the medical jurist should bear in mind the possibility of enlargement of the uterus and abdomen from the presence of tumours. The probable occurrence of pseudo-pregnancy should also be considered. Tumours and pseudo-pregnancy may occur in the married and unmarried; and as the latter is not infrequently accompanied with many of the signs and symptoms of pregnancy, an early diagnosis is of the utmost import- ance. The diagnosis will consist in — a. Careful examination of all the symptoms present, when, in most cases, a break in their order of sequence may be observed, or certain signs may be added which do not occur in true pregnancy. b. Presence or absence of the hymen. c. Condition and appearance of the os uteri (see p. 120). d. If the patient be placed well under the influence of chloroform, the tumour, if the result of pseudo-pregnancy, will subside, gradually re- turning as the effects of the anesthetic pass off. Whilst the patient is under the influence of the anaesthetic, the hand may be pressed on the 1 See the author's Collection of Mecliccd and Surgiccd Questions, published 1876. Second Edition. London. 124 FORENSIC MEDICINE. abdomen at each expiration, and there retained, the pressure being continued during the inspira- tions. It is stated that Liston once cut into a woman for a phantom tumour, and declared that he had never seen more healthy bowels in his life. Diagnosis of Pregnancy. Dropsy. — Use of the stethoscope, examination of the breasts for milk, and the urine for albumen. Fibrous Tumours. — Absence of foetal movements and other signs of pregnancy. Ovarian Dropsy. — Tumour on one side of the abdo- men ; breasts unaffected, and auscultation giving nega- tive results. Retention of the Catamenia. — On examination, the hymen found perfect and bulging. This condition cured by a crucial incision. Delivery. This subject is best discussed under three heads : — A. Signs of Recent Delivery in the Living. B. Signs of Recent Delivery in the Dead. C. Signs of Previous Delivery. A. Signs of Recent Delivery in the Living. a. Transitory signs of delivery. b. Persistent signs of delivery. a. Transitory Signs of Delivery. 1. General Indisposition. — The face is pale or flushed ; the eyes sunken, and surrounded by a dark areola ; there is considerable debility, and a tendency to faint ; the skin is warm and moist, and the pulse DELIVERY. 125 quick. It must be borne in mind, that a woman who is anxious to conceal her recent delivery may, by an effort of the will, to a great extent hide her real condition. 2. The Breasts. — The breasts feel firm and 6 knotty/ and on pressure yield a small quantity of colostrum or milk, which may be distinguished by the aid of the microscope. 3. The Abdomen. — The skin of the belly shows signs of recent distension ; it is relaxed, and more or less thrown into folds, the lower part marked by irregular broken streaks of a pinkish tint, becoming white and silvery as time goes on. 4. The Lochia, or i the Cleansings.' — This consists in a discharge from the uterus, which, for the first three or four days after delivery, is more or less bloody. During the succeeding four or five days it acquires a dirty-greenish colour — ' green waters/ with a peculiar sour, rancid odour. In a few days this is succeeded by a yellowish milky mucous discharge, which may con- tinue for four or five weeks. 5. External Parts of Generation. — The labia and vagina bear distinct marks of injury and distension. 6. The Uterus. — The uterus is enlarged, and may be felt by the hand for two or three days after delivery, as a round ball, just above the pubis. The orifice of the uterus, if examined a few hours after delivery, appears as a continuation of the vagina. This condi- tion completely disappears in about a week after de- livery. 7. After-Pains. — These are of no use from a diagnostic point of view, as we have no means of testing their presence or absence. b. Persistent Signs of Delivery. 1. Entire obliteration of the hymen. This is no proof of actual delivery. 126 FOKENSIC MEDICINE. 2. Destruction of the fourchette. 3. The vagina dilated, and free from ruga3. 4. Dark colour of the areola round the nipples. This varies among women ; and I know of one case where there was no areola either during pregnancy or after delivery. 5. Shin of the Abdomen. — Due to the great distension of the abdomen, the skin in places appears streaked with silvery lines varying in breadth. These markings in some cases may be scarcely perceptible, especially if the female have worn a tight abdominal belt during her pregnancy. The same appearance may be produced by dropsy, or the prolonged distension of the abdominal walls, the result of other causes. I once saw these markings most characteristically present in a young man just recovered from an attack of ascites. His sex precluded any error in diagnosis as to the cause of the marks. Attention to the other signs present will assist the diagnosis. After the lapse of seven to ten days, the recent delivery of a woman cannot be certainly proved by an examination of the living woman, especially if it be known that she had previously borne children. In primipara, the pink-coloured streaks on the abdomen, and the transverse condition of the os uteri, may strongly point to recent delivery. B. Signs of Recent Delivery in the Dead. Should the woman die immediately after delivery, the external parts will present the same appearance as just described in the living. On opening the abdomen, the uterus will be found flat and flabby, between nine and twelve inches long, and with the os uteri wide open. The cavity of the uterus may contain large bloody coagula, and its inner surface lined by the decidua. The attachment of the placenta is easily detected by its dark colour, and by the semi-lunar open- ings of the arteries and veins on the surface of the uterus. DELIVERY. 127 Of course all the appearances just described will be greatly modified by the time that has elapsed between delivery and death. Can a Woman be delivered unconsciously ? — This question may arise in cases of infanticide. Setting aside cases of epilepsy, in a fit of which disease I once attended a woman who was confined during the fit without being aware that she had been delivered, cases of apoplexy, coma, and narcosis from chloroform, opium, etc., it may be stated that delivery is possible during profound sleep. I once attended the wife of a police- man, who informed me that i she always had her pains during her sleep/ and only woke up just as the head came into the world. When it is borne in mind how easily some women pass through labour, it is quite possible that, after a busy day, sleep may be so profound as not to be disturbed by the pains of labour. In primi- para, the occurrence is more problematical. Women have often declared that they have been unconsciously delivered whilst at stool. This is also probable, but the circumstances of the case must be severely sifted. Delivery after death — The foetus has been known to have been expelled from the uterus by the force of the gases generated by putrefaction. Dr Aveling, in a paper published in the Obstet. Transactions, 1873, arrives at the conclusion that 'post-mortem delivery is possible even where no symptoms of parturition were noticed before death. He also thinks that the child may live in utero for some hours after the death of the mother. Table showing the size of the Uterus at different periods after Delivery. Two to three days. — About seven inches long and four wide. Seven days. — Between five and six inches long and two wide. 128 FOKENSIC MEDICINE. Fourteen clays. — From four to five inches long and one-and-a-half wide. Twenty -eight days. — Normal size. C. Signs of a Previous Delivery. a. Marks on the abdomen, consisting in shining silvery lines, due to the distension of the skin. These may result from distension other than that the result of pregnancy — tumours, dropsy, etc. b. Marks similar to those on the abdomen appear on the breasts. These, in conjunction with the above, are important. c. Peculiar jagged condition of the os uteri felt by the finger. This condition may be the result of disease. cl. Marks of rupture of the fourchette or perineum. e. Dark colour of the areola round the nipples. /. Negative evidence from absence of any of the above. FCETICIDE, OE CEIMINAL ABORTION. (Statute 24 & 25 Vict., c. 100, s. 58.) Every woman, being with child, who, with intent to procure her own miscarriage, shall unlawfully administer to herself any poison or other noxious thiyig, or shall unlawfully use any instrument, or other means whatsoever, with the like intent ; and whosoever, with intent to procure the mis- carriage of any woman, whether she be or be not with child, shall unlawfully administer to her, or cause to be taken by her, any poison or other noxious thing, or shall unlawfully use any instrument, or other means whatsoever, with the like intent, shall be guilty of felony, and being convicted thereof shall be liable, at the discretion of the court, to be kept in penal servitude FOETICIDE. 129 j life, or for any term not less than five years, or to b ajnprisoned for any term not exceeding two years, with O'^QvitJwut hard labour, and with or without solitary Ct he Inement. hihe 59th section of the same statute also takes into consideration the unlawfully supplying or procuring any poisbn, or other noxious thing, or instrument, or thing whatsoever for a woman, for the purpose of inducing abortion. The person so doing shall be guilty of a misdemeanour, and be kept in penal servitude for a term of five years, or be imprisoned for any term not exceeding two years, with or without hard labour. It will be seen from the passages above quoted that there is no distinction between a woman quick, or not quick with child. ' The offence is, to procure the mis- carriage of any woman, whether she be or be not with child, 1 and with a felonious intent (E. v. Goodhall, 1 Din. C.C. 187 ; 2 C and K 293). But although the law does not regard c quickening ' in cases of abortion, yet the fact of having 6 quickened ' may be pleaded a£ a bar to immediate capital punishment. It has been decided in Scotland that drugging or operating to procure abortion is criminal, though un- successful, but it is not certain whether the woman alone can be charged with taking drugs to procure abortion. To make the procuring of abortion criminal 6 there must be felonious intent.' The term abortion is understood in medicine to mean the expulsion of the contents of the fecundated uterus before the sixth month of pregnancy, that is, before the child is considered viable. After this period it is said to be a premature labour. In law, however, no distinc- tion is made, and the expulsion of the contents of the uterus at any period before the full time of pregnancy is considered an abortion ; in popular language, a mis* carriage. Abortion, when not produced by criminal means, generally occurs at or a little before the thira 1 month of 1 \ 130 FORENSIC MEDICINE. utero-gestation, and then usually in first pregnancie- and during the latter part of the period of child-beai It is also more frequent among the rich than an g the poor. Of the two thousand cases of pregnant women x- aminecl by Dr Whitehead of Manchester, the sum of whose pregnancies was 8681, or 4*38 for each, rather less than 1 in 7 had aborted. When abortion is criminally induced, it generally takes place between the fourth and fifth month, that is, about the time the woman becomes certain of her con- dition. The causes of abortion are — A. Maternal — belonging to the mother. B. Fostal — belonging to the ovum. C. Violent. a. Mechanical: b. Medicinal. A. Maternal. Among the maternal causes may be mentioned exces- sive lactation \ any irritation of the rectum or bladder ; loss of blood, which, by increasing the amount of carbonic acid in the blood, acts as an excitant to the spinal cord. Certain states of the system conduce to abortion — albuminuria, syphilis, certain fevers, scar- let, small-pox, etc. Abortion may become habitual in some women. Great joy or sudden sorrow have not in- frequently been the cause of abortion. The tendency to abortion is greatest at the menstrual periods, that is, at the time when, had not the woman become pregnant, menstruation would have taken place. Slight causes acting at these times are very liable to produce abor- tion. B. Fcetal. Death of the ovum, or a diseased condition of its uterine coverings, or of the placenta, probably of an inflammatory nature. FOETICIDE. C. Violent. a. Mechanical. — Under this head may be mentioned the passage of certain instruments into the cavity of the womb ; the rupture by violence of the membranes which surround the foetus. In some cases it is by no means easy to procure abortion, and women have been known to undergo a considerable amount of violence without abortion taking place. In some women, on the other hand, however, the slightest violence — such, for instance, as slipping from a step or low chair — will cause them to abort. b. Medicinal. — Certain drugs, among which may be mentioned ergot, savin, pennyroyal, and a host of others, c^ 1 ^/ have been used for the induction of abortion. It is scarcely necessary to mention each drug individually, but it must be remembered, i that there is not one single internal medicament of which it can be consistently with experience asserted, that even when an abortion has Followed its use, it must have produced this abor- tion, and that cause and effect are in such a case in direct and necessary connection.' All the so-called abortives are most uncertain in their action, and their us_e i.SL attended with considerable risk to the woman. Be this as it may, they are more frequently used to induce abortion than mechanical procedure, from the fact that the latter requires some amount of anatomical knowledge and manipulative skill. A medical man may be required to — a. Examine into the Nature and Characters of the Substances expelled from the Womb. b. Examine the Female supposed to have Aborted. a. The substances expelled from the womb often become the subject of judicial inquiry, and the medical man may be required to give his opinion as to their probable nature. 132 FOKENSIC MEDICINE. The questions may be asked — 1. Is it a foetus 1 2. Is it a mole ? If so, Is a mole also a foetus ? 3. Is it merely the coats of the uterus, and unconnected with pregnancy ? 1. Is it a Foetus ? — The development of the foetus is given, page 147. 2. Is it a Mole ? — This question gives rise to another, Is a mole a foetus ? To this the answer must be in the affirmative 1 Moles, being the diseased append- ages of the foetus, vary in character, and have been described by obstetrical writers under the following heads : — a. Hydatiginous ; b. Carneous ; and c. Fatty Moles. a. Hydatiginous moles are the result of a diseased condition of the villi of the chorion. The villi become dropsical, and hang in masses like a bunch of grapes. b. Carneous. These are the result of haemorrhage into the chorion. The blood becomes organised, and a fleshy mass is formed, to which in some cases a withered foetus is attached. c. Fatty Moles. Death of the foetus and fatty degeneration of the placenta, or fatty degenera- tion of the placenta and death of the foetus, produces this variety of mole. A withered foetus with a mass of fatty placenta are ex- pelled. 3. Is it merely the Coats of the Uterus, and uncon- nected with Pregnancy ? — Fleshy masses may be expelled from the womb, which may not be the result of sexual intercourse. The description just given of true moles will, it is hoped, assist in forming a correct diagnosis. Considerable care will be required, for the honour of the woman accused depends upon the opinion given as to the nature of the substances submitted for examination. It must also not be forgotten that moles FOETICIDE. 133 may be retained for many months in the uterus, and be then expelled. The knowledge of this fact may rebut an accusation of infidelity against a wife. Polypi may be discharged from the womb ; the presence of a pedicle will point to their true character. All substances expelled from the uterus should be carefully washed in water, and all clots removed. The examination of the woman may also help in the formation of the diagnosis. The absence of the signs of defloration or of recent delivery will be in her favour. b. Examination of the woman stated to have aborted. — It is by no means easy to answer the question whether an alleged abortion has really taken place or not. The signs of recent delivery are in most cases absent, for the woman can better hide her condition during the early than during the later months of utero-gestation ; con- sequently suspicion may not have been aroused against her for some weeks or months after the event. The history of the case, with other attendant circumstances — milk in the breasts, change in the colour of the areola round the nipples, absence of the hymen, trans- verse condition of the os uteri in contradistinction to its circular form after delivery, etc., etc. — will in most cases assist in forming a correct diagnosis. In ca ses \n^ which death has f ollow ed a^n a ttemp t ig procure abortion, an e xaminati on qfThe ovaries for false or true mrporci lute a should be made. The opinions on the character and differences of these bodies are so dis- cordant as to destroy all confidence in their value as proof of conception or the reverse. Taylor says : 4 The discovery of the ovum in the uterus in process of development could alone, in the present state of our knowledge, warrant an affirmative opinion on this point in a court of law, and this I believe to be the safest view at present of this much-contested question. On the other hand, the absence of a corpus luteum from the ovary would not in all cases warrant an opinion that conception had not taken place/ 134 FOKENSIC MEDICINE. Criminal Abortion. Recapitulation. In medicine, abortion occurs before the sixth month of pregnancy, premature labour after that period. In law, abortion may take place any time before the full period of utero-gestation. Abortion may be due to — a. Natural or unavoidable causes. b. Violence, with criminal intent. a. Natural or Unavoidable Causes. 1. Maternal. 2. Foetal. b. Violence, vrith Criminal Intent. 1. Mechanical. 2. Medicinal. INFANTICIDE. Synopsis. a. Not regarded as a specific crime. b. To be tried by the same rules of evidence as apply to murder. c. The law presumes that every child is born dead, till proof to the contrary is given. d. Onus of proving live birth devolves on the pro- secution. e. The body need not be found in order to obtain conviction of the suspected party. The medical evidence, however, depends on the body being found and examined. The medical witness may be examined on one or more of the following points : — 1. The recent delivery of the accused. For signs of recent delivery see p. 125. 2. Maturity of the child found. INFANTICIDE. 135 3. Was the child still or live born 1 4. Cause of death. 5. Lastly, as to the mental condition of the mother. Puerperal mania, etc. /, In absence of proof of infanticide the woman may be tried for concealment of birth, that is, disposing secretly of the body, whether the child be born dead or alive. Sec. 60 of 24 and 25 Vict., c. 100, enacts that ' if any woman shall be delivered of a child, every person who shall, by any secret disposition of the dead body of the child . . . endeavour to conceal the birth thereof, shall be guilty of a misde- meanour. 1 g. In Scotland a woman may be tried for conceal- ment of pregnancy when the child is dead or amissing, if she do not call for or make use of help or assist- ance in the birth ; but the case is quashed if the child be shown alive by the mother to others. Legal Definition. — According to the present state. of English law, infanticide — murder of a new-born child — is not regarded as a specific crime, but is treated and tried by those rules of evidence which are applicable in cases of felonious homicide. As far as the legal estima- tion of the crime is concerned, it matters not whether the child have been killed immediately on its entrance into the world, or within a few days afterwards. An English judge, at a late trial, stated that if the jury were of opinion that the prisoner had strangled her child before wholly born, she must be acquitted of murder. The law also, on the score of humanity, presumes that every child is born dead until direct evidence to the contrary, from medical or other sources, is given. The onus of the proof of live birth, there- fore, devolves on the prosecution. It may also be difficult to decide as to the maternity, and the woman accused will have to be examined as to the possibility of her recent delivery. The decision will, to a great 136 FOEENSIC MEDICINE. extent, rest on the condition of the mother, and the apparent age of the child found dead. The discovery of the body of the child is not necessary to conviction. In most cases of alleged infanticide tried in England, juries appear more inclined to fall back on the minor offence, concealment of birth, than to convict of the capital offence. In Scotland, concealment of pregnancy is a statutory crime, chargeable when the child born is found dead or is amissing, and there is no proof of its having been murdered. Pregnancy up to a period when a child might be born alive must be proved — that is, during the whole period of her pregnancy. If the accused can bring forward a witness to whom she communicated her pregnancy, or called for assistance at the birth, or (it is believed) can prove that the child was born dead, she is entitled to an acquittal. It has also been said that a woman ought not to be convicted of i conceal- ment of pregnancy ' if at the time of delivery the foetus do not appear to have reached the seventh month of intra-uterine existence. The birth of a ' child,' whether dead or alive, is essential; therefore, if the woman accused 6 can prove that that which she brought forth was not " a child/' but an abortion, or a foetus which, from some accident, was in such a condition that, though there had been assistance, it could not have been in a condition to be called " a child," then the case is not of the statute.' The punishment is imprisonment not exceeding two years. 1 The statute applies to married as well as to single women - but the penalty is seldom enforced unless foul play is suspected. Definition of the Term 6 Live Birth.' — ' The entire delivery of a child/ There must be an independent circulation in the child before it can be accounted alive (E. v. Enoch). The entire child must be actually born into the world in a living state (R. v. Poulton, 5 C. and P. 329). But the fact of the child being still 1 Burton's ' Scotch Law. ' INFANTICIDE. 137 connected with the mother by the umbilical cord will not prevent the killing from being murder (E. v. Keeves, 9 C. and P. 25). To kill a child in its mother's womb is no murder, because the person killed must be i a reasonable creature in being, and under the king's peace.' But if the child be injured in the womb, and be then born alive, and then die as a result of such injuries, it may be murder in the person who inflicted them (K. v. Senior, 1 Mood. C. C. 346). A distinction must be drawn between medical or physiological life and legal life. A child may have breathed, as it not infrequently does, before it is com- pletely born into the world ; and this might, in a medical point of view, be considered as a live child, but it is not one legally. The entire delivery of the child is necessary in law • and i it must also be proved that the entire child has actually been born into the world in a living state, and the fact of its having breathed is not a conclusive proof thereof.' Signs of Live Birth Prior to Eespiration, and Independent of it. a. Negative. — Signs of intra-uterine death ; Putrefac- tion, or ' Intra-uterine Maceration.' b. Positive. — Injuries to the child showing that it must have been born alive. a. Negative. — Intra-uterine Putrefaction. — This con- dition differs in some remarkable points from putre- faction in air. The body is extremely flaccid and flattened, the bones of the cranium moving easily on one another. The skin of the hands and other parts of the body bear the evidence of prolonged soaking in fluid. In parts, the skin is whitish, or of a reddish-brown or coppery red colour, without any trace of green, which is always present when putrefaction takes place in the air. The cuticle may be raised in blisters, and be easily detached 138 FORENSIC MEDICINE. from the true skin. The denuded patches are moist and greasy, and exude a stinking, reddish-coloured serous fluid. The face is flattened, and the features distorted. In most cases that I have attended of intra- uterine death of the foetus, and where putrefaction has far advanced, especially in primipara, the scalp has burst during delivery, and the brain poured out. Should, however, the child be exposed to the air, it may soon acquire the appearances proper to putrefac- tion in that medium. b. Positive. — Evidence that injuries found on the body could not have been inflicted during birth, or accidentally after birth. On this subject it is scarcely possible to give an opinion one way or the other. All the medical witness can fairly state is that, from the condition of the lungs, respiration has or has not taken place ; that in the former case it is not easy to state whether the injuries were the cause of death or inflicted after death. Appearances Showing that a New-Born Child has Breathed. 1. Walls of the Chest. — ' The vaulting of the thorax is of not the slightest diagnostic value.' Casper quotes from Elsasser the following remarks : — i It is irrefutable that the variations in the circumference of the thorax (and, of course, in its diameters) are so considerable that no certain normal mean for a thorax that has breathed, and for one that has not breathed, can be laid down. In most cases the measurements of the thorax are incapable of determining whether the lungs contain air or not. The reason for these variations is, without doubt, to be referred to the congenital differ- ences in the volume of the osseous thorax ; partly, also, to the thickness of the soft parts, particularly of the subcutaneous fat and the thoracic muscles ; partly, also, in the differences in the degree and amount of INFANTICIDE. 139 the dilatation of the thorax by respiration, with which the distension of the lungs also corresponds/ etc. 2. Diaphragm. — The position of the diaphragm may be considered as a good diagnostic sign ; for it is found that, in children born dead, the highest point of the concavity is between the fourth and fifth ribs, whereas in those born alive it is between the fifth and sixth. The position of the diaphragm may be affected by the gases produced during putrefaction, and also, in children who have breathed, from distension of the stomach and intestines with gas. 3. Lungs. a. Size. — In the foetus, prior to respiration, the lungs do not fill the cavity of the chest, and the left lung is never found even partially covering the heart. After respiration they fill the thorax more or less completely, the amount of distension depending, of course, upon the completeness of the respiratory acts on the part of the child. b. Consistence. — Before respiration has taken place, the lungs feel firm, compact, and resistant, and are of the consistency of liver. After respiration they are spongy, crepitant, and yielding when pressed between the fingers. They also present a marbled appearance. These signs of respira- tion are more or less modified by disease, and the atelectasis pulmonum of Jorg, jun. Casper denies the existence of atelectasis pulmonum as a distinct disease of newly-born childen, and con- siders that 'it is nothing else than the original foetal condition, from which it differs in no anatomical respect' — an opinion supported by Meigs, who says, ' They, in fact, resemble exactly the foetal lung.' It is simply the result of the child dying from some cause before respiration has had time to become fully established, and has possibly been confounded with hepatisation. 1 1 For a full discussion on this subject, see Casper, vol. iii., p. 54 et seq., Syd. Trans. 140 FORENSIC MEDICINE. It must also be remembered that eases are on record of infants having lived for some hours, and then died, and yet the lungs sank as a whole, and when cut in pieces. c. Colour. — The colour of the foetal lungs is ' exceed- ingly various,' and it is by no means easy to convey the idea of colour by words. Speaking in general terms, the lungs of children who have not breathed are of a reddish-brown liver-colour, this colour changing to a brighter red at their margins. In children who have breathed, the lungs are of a slaty-blue colour, more or less mottled with circumscribed red patches. This cir- cumscribed mottling is never found in perfectly foetal lungs. When the lungs are inflated artificially, they swell up and present a uniform cinnabar-red colour, destitute of insular marbling. The insular marbling of the lungs is characteristic of lungs that have breathed. d. Buoyancy in Water. — Lungs which have respired float in water. But the objection may be raised that lungs that have not respired may yet float from — a. The result of artificial respiration. b. The result of putrefaction. The value of these objections will be discussed in the following pages. Hydrostatic Lung Test. (Docimasia pulmonum liydrostatica.) The value of this test is founded on the supposition that a lung in which respiration has taken place will float if placed in water, and that when this has not occurred it will sink. Admitting that a lung floats as a result of respiration, it has been objected that this is no proof of live birth, for respiration may take place in — a. The womb, vagitus uterinus. b. The maternal passages, vagitus vaginalis. INFANTICIDE. 141 c. Cases when the head protrudes, the body not yet being born. "With regard to the two first objections, it will be sufficient to say that, in all the cases of so-called intra- uterine respiration, the respiratory acts have occurred in difficult or instrumental labours, where it is justi- fiable to suppose that, in the endeavour to remove the child, a certain amount of air may have been unavoid- ably admitted into the maternal passages. But the cases with which the medical jurist has to deal cannot be classed with these, for in all those brought under his notice delivery has been more or less rapid and unassisted. To the last objection the same reply may be given, that rapid delivery in doubtful cases must be con- sidered as the rule, and that the time which elapses between the birth of the head of the child and its com- plete delivery is so short as not to lead to any great error in diagnosis. N.B. — Any pressure exerted on the umbilical cord during the process of delivery gives rise to respiratory acts on the part of the foetus. The presence of what Casper calls petechial ecchymoses beneath the pleurse, upon the aorta, and even on the heart, is a proof that attempts at respiration have been made. These pete- chial ecchymoses are sometimes found on the same parts in the drowned. What is the Hydrostatic Test ? how is it performed ? and ivhat are the objections to its use ? As this test was first used, it consisted in placing the lungs, with or without the heart, into water, and then noting whether they sank or floated. A glass vessel, eighteen inches high and twelve in diameter, half filled with distilled water at 60° F. should be used. In summer water at the ordinary temperature of the room will answer the purpose. To this rough test pressure is now added ; the lung, or portions of it, are greatly 142 FORENSIC MEDICINE. compressed in a linen cloth, and then thrown into water as before. If the lungs thus compressed float, respiration is held to have taken place ; should they sink, the contrary is presumed. Pressure is used for the following reason : The air generated by putre- faction, and which may cause the lungs to float, is removed by pressure, but no amount of pressure short of entirely destroying the lung tissue will remove that the result of respiration or inflation, and between these the medical expert must decide from collateral evidence. 1 . Try if lungs will float, the heart attached to them. 2. If they will float without the heart. 3. Try if portions will float, with or without pressure. The following are the objections to this test : — 1. The lungs may sink as a result of disease. 2. Kespiration, even in healthy lungs, may be so imperfect that they may sink. 3. Emphysema pulmonum neonatorum. 4. Putrefaction. 5. Artificial inflation. 1. That in consequence of disease the entire lungs or portions of them may sink, and yet respiration had taken place. Disease of the lung may occur previously to birth or soon afterwards, but it is scarcely probable that the disease should attack every portion of the lung. Parts, doubtless, small in proportion to the diseased part, may yet have been sufficiently inflated to float. The presence of disease is also not difficult of detection. 2. That respiration, even in healthy lungs, may be so imperfect that they may sink. This objection can scarcely be considered valid against the general application of the test, for in these cases there is no known test by which respiration or its absence can be determined. They are therefore out of the pale of the test, as they are out of every other mode of investigation. INFANTICIDE. 143 3. Emphysema pulmonum neonatorum. — Emphysema is generally the result of excessive dilatation of the air cells of the lung, rupture of the cell walls, and infil- tration of the intra-lobular areola tissue. This con- dition may be brought about by — a. Eespiration. b. Inflation. The fact of the matter is simply this, that the so-called emphysema pulmonum neonatorum, or emphysema of new-born children, is nothing more or less than incipient putrefaction, induced by certain unascertained condi- tions. Casper sums up his conclusions on this subject in the following words : — 6 That not one single well- observed and incontestable case of emphysema develop- ing itself spontaneously within the lungs of a foetus, born without artificial assistance, is known, and it is not therefore permissible in forensic practice to ascribe the buoyancy of the lungs of new-born children brought forth in secrecy, and without artificial assistance, to this cause? 4. Putrefaction. — It must be admitted as proved that the lungs of new-born children in a state of decom- position will float in water. But this admission does not render the test valueless, for it must be remem- bered — a. That air generated by putrefaction is found in bubbles under the pleurae, or in the fissures between the lobuli of the lungs, and not in the air cells of the lungs. b. That air as a result of putrefaction can readily be removed by compressing the lungs or portions of them. c. That crepitation in putrefied lungs is absent, owing to the fact stated under a. d. That the lungs are among those organs which putrefy late. e. That negative evidence may be obtained if the lungs in a highly putrescent body sink in water. The tendency of putrefaction, as above stated, is to cause them to float. 144 FORENSIC MEDICINE. 5. Inflation. — In the first place, it is to be remarked that to inflate the lungs is by no means an easy task. Elsasser states c that in forty-five experiments performed on children born dead, without opening their thorax and abdomen only one was attended with complete success, thirty-four with partial success, and ten with none whatever ; and it must also be remembered that these experiments were conducted without disturbance, and with the greatest care.' Professor Gross states his opinion on this subject thus: — 'We are decidedly of opinion that artificial inflation of the lungs is a very difficult matter ; and we believe that the complete dis- tension of these organs can only be effected where a tube is introduced into the mouth of the larynx/ In the cases that come before the medical expert, the question naturally arises, Who would inflate the lungs % Surely not the mother, who would be only too glad that the child was dead, and who would be in no hurry to resuscitate it. If not the mother, who else % It has been suggested that some malicious person might inflate them to sustain a charge of infanticide. Is this probable 1 The following points may be noticed on this subject : a. Known difficulty in inflating the lungs. b. Absence on the part of the mother of any pre- paration to save the life of her child. c. Presence of air in the stomach and intestines, the result of attempted inflation. d. Bright cinnabar-red colour of the lungs, without trace of mottling. e. Absence of frothy blood when the lungs are cut into. /. 1 When, therefore, we observe the following pheno- mena, a sound of crepitation, without any escape of blood-froth on incision, laceration of the pulmonary cells with hyperseria, bright cinnabar-red colour of the lungs without any marbling, and perhaps air in the (artificially inflated) stomach and intestines, we may INFANTICIDE. 145 with certainty conclude that the lungs have been arti- ficially inflated.' It may be further noted that natural respiration is accompanied with, first, the distension of the air cells of the lungs with air ; and, second, with an increased flow of blood into the organs beyond that necessary for their nourishment and growth. They thus increase in absolute weight, while their specific gravity is lessened. The objections just mentioned apply to the hydro- static test, as originally employed. It will now be necessary to notice those against the same test when modified by pressure. These are two in number : — a. That no amount of pressure, short of entirely destroying the lung tissue, can expel the air from a lung that has been inflated, or from one in which respiration has taken place. I). Pressure is therefore no test of natural respiration or of artificial inflation. In answer to the above, it will only be necessary to refer to what has been already said with regard to the difficulty of inflation, and the more probable event of the condition of the lungs being the result of re- spiration. Casper thus sums up the result of his views with regard to the probative value of the Docimasia pul- monaris : — 6 That a child has certainly lived during and after its birth — c 1. "When the diaphragm stands between the fifth and sixth ribs. 6 2. When the lungs more or less completely occupy the thorax, or at least do not require to be sought for by artificial separation of the walls when cut through. ' 3. When the ground colour of the lungs is broken by insular marblings. ' 4. When the lungs are found by careful experiment to be capable of floating. ' 5. When a bloody froth flows from the cut surface of the lung on slight pressure/ K 146 FORENSIC MEDICINE. The lung test is unnecessary when — a. The umbilical cord has dropped off, and cicatrisa- tion has followed. b. Where food is found in the stomach. c. Where there are evident signs of putrefaction in utero. d. Also in the case of the birth of monsters, or where, from congenital malformation, the possibility of live birth is excluded. Besides the hydrostatic test, the following have been proposed, and may be dismissed in a few words : — Ploucquefs Test. — This test is based on the relative weight of the lungs, before and after respiration, to that of the entire body of the child. The variations found in practice between the relative weights render the test worse than useless. Absolute Weight of the Lungs. — This test consists in a comparison of the weight of the lungs before and after respiration. Like the last, it is unworthy of con- fidence. [Table of Development. INFANTICIDE. 147 Ph £ P £ ^ ,2 ° ss a § 1 ^s— -53 ®I^Sp £ 2 ■g 8 g^g-s 0^3^ 1 S I « 0 ^ 3 i§-a*.g s g.a IJ d « ^ a, O g rj r-T Ph PV3 8J JO [3 si ^ pTrtO,- ' .2 e 8 p a . £po a- EH p o 8| so HH • g a) t? 0 ® . © i-C 3 © ES Cm © o £ ti P 148 FORENSIC MEDICINE. i 6 s CD I .S'o «=8 _2 rH £ o go •a cd a^a 8^ CD _, CD CD } ^3 J CD o , d 2 d -3 08 8 ^ w m d 13 CD CD CDr^ M >• H X 03 CD rd 32 o r c? ^ IS d d w ^ t- •rH d GO g § a e +- 1 CD ,d -2 ^EH d .n ^ ,2 K Si o p^! a 5 I^r3 . CO <5i rrt ^ rrt +> a g g I CD « -~ J! CD rj ^ PR 2 8 o CD « d 03 c8 c8 d .d ^.s'a'o <» ®^ 8 ^ CD- 'S J§ a a 8 ~ H © rH § ?D d c3 T3 d o o 1 ^ •75 cd -nr CD C-t O (D'H rd »° £+2 d a ft w cD^r CD CD - g^cl O OP CD .Xh CD W .3 rd cd o -e Eh §.s d ^ o d rd CD d * bb •EJ r-t CD o d CD EH ^ d rd d CD Fourth. End of sixt( week. ) Fifth. (End of tw< weeks. ) Sixth. (End of twe fourth we( INFANTICIDE. 149 0 ^ co J±j 03 so ~ m O ■+-> .a ^ § * p£ 4i 1 2 a £ «g "3 - ° rd !»i d i ^ ffl £ c3 b .T5 ^ ^ ©^ cr 1 „r CD <-> 2^ r J2 rj ^ d • 03 "73 S rj £ «. . ^Pnegc^ g a © © 3£ c3 © 03 03 '3 »fi 2 o- ! .fl-9 = -S " 2 ° S3 m > H to o o 43 3 -.2 O CD !=J p O Ph EH as co o 2 03 rj t>5^ -4-3 - • 03 0) S> OS is* ■s^ 2 h3 150 FORENSIC MEDICINE. Table showing signs of Maturity of Child at Birth. As regards — a. Average Length of Body — Nineteen inches. b. Average Weight of Body — About seven pounds. c. Eyes. The pupillary membrane is not found in the mature child. d. Navel — Said to be exactly midway between the pubis and the ensif orm cartilage. e. External Genitals — Testicles found in the scrotum, and the labia majora cover the vagina and clitoris. f. Os Femoris — Ossification of the inferior femoral epiphysis. The osseous nucleus measures from three- quarters of a line to three lines in diameter. [Table of Measurements. INFANTICIDE. 151 a * * * • rClcOO^fNH J .-1 . . CO (M (Nl CO CO CO CD CO 1> K N W (M CO (N (M d - - - oo oo oo io vo S £ 3 d -3 3 03 tD^Hf^ ! N CO ^ Jo .CO co H § "a •§!§! | «1 ■a & -H CO M d 152 FORENSIC MEDICINE. Cause of Death to the Fcetus. Death may be due to — a. Immaturity on the part of the foetus. b. Complications occurring during or immedi- ately after birth. c. Congenital disease in one or more of the foetal organs. d. Neglect and exposure. a. Immaturity on the part of the Foetus. — From some cause or other, the child may die immediately after birth, in spite of every attempt to save it. In many of these cases no disease adequate to account for death can be detected. b. Complications occurring during or immediately after birth. L Unavoidable or inherent in the process of parturition. 2. Induced with criminal intent. 1. Unavoidable or Inherent in the Process of Par- turition. — The immediate cause of death may be either maternal or foetal. In the former, the presence of tumours in the pelvic passages, or disease of the bones, causing a narrowing of the canal, may lead to fatal compression of the head of the child. Death may also be due to protracted labour from debility on the part of the mother. A congested state of the brain may be present in these cases. In the latter — foetal — pressure on the umbilical cord from mal-position of the child during labour, or an abnormal increase in the size of the head, may cause death. There is also a greater mortality both during and after delivery among male than female children. The child may be also acciden- tally suffocated in the fasces of the mother, or in a fold of her dress ; or it may be born while the woman is straining at stool, and be drowned in the contents of the pan. The writer once met with a case of accidental death of a child from suffocation in the drawers of the INFANTICIDE. 153 mother, who persisted, from motives of delicacy (?) in wearing these articles of dress during her confinement. Death may also result from strangulation, occasioned by the pressure of the funis round the child's neck. The death in this case can scarcely be considered as due to strangulation, as the child had never breathed, but is probably the result of the arrest of the flow of blood along the cord from the tightness of the folds round the neck. Some congestion of the brain may, however, be found resulting from the pressure on vessels of the neck. Lastly, death may ensue from the falls on the floor in cases of sudden and quick labours, especially if the woman be in the erect posture at the time of delivery. 2. Induced ivith Criminal Intent. — Was the death due to violence ! The answer to this question is by no means easy. In all doubtful cases, the attendant cir- cumstances must be taken into consideration. A woman may unintentionally injure her child in her efforts to drag it from her. The presence of respira- tion, more or less complete, is strongly presumptive against the death being the result of accident. But even here considerable caution is necessary, for the injury may not be immediately fatal, although acciden- tally inflicted, sufficient time elapsing between its infliction and the death of the child to allow of respira- tion. Foreign bodies found in the mouth and fauces is also corroborative of death by violence. A case is recorded in which the child's fauces, upper portion of the oesophagus, the larynx, and the trachea were closely packed with a coarse, green sand, and yet the lungs sank when the hydrostatic test was applied to them. ~No light was ever thrown as to when the packing of the fauces was effected. If dead, Why % If alive, How was respiration prevented during the operation % The same may be said of strangulation and of injuries to the head. Strangulation may be produced by the constriction of the umbilical cord round the neck, and for this reason marks round the child's neck cannot 154 FORENSIC MEDICINE. always be ascribed to intentional violence. Of 327 cases collected by Elsasser, in which the cord was from one to four times round the children's necks, there was not in a single instance any mark of the cord per- ceptible, even though in some cases the cord had to be cut to permit the completion of labour. With regard to marks round the neck of a new-born child, Casper remarks that it is possible 6 to mistake the folds of the skin, produced by the movements of the head, and which remain strongly marked in the solidified fat, and are very prominent, particularly in short necks, for the marks of the cord/ The mark left by the funis is broad, corresponds with the breadth of the cord, runs without interruption round the neck, and is everywhere quite soft, and never excoriated. Ecchymoses may be present irregularly, following the line made by the cord. On the other hand, * a mummified, parchment- like, unecchymosed depression, points in every case to strangulation by a hard rough body/ and this more especially if there be any abrasion of the cuticle or laceration of the skin. Death sometimes ascribed to strangulation is probably death the result of suffocation, and happens thus : Any pressure exerted on the cord gives rise to respiratory attempts on the part of the child, the blood from the placenta is cut off, and the child dies suffocated, or from the engorgement of the lungs with liquor amnii drawn into them at every effort to breathe. An infant may be poisoned. This cause of death is very rare, but deaths have resulted from the use of poisonous gases. While on this sub- ject it may be advisable to state here, that ulcerations have been found in the stomach and intestines more or less accompanied with a collection of dark-brown or black bloody fluid, which have given rise to suspicions of poisoning. An infant may be thrown into water and drowned. JNTo traces of this mode of death would be discoverable in the infant unless respiration had taken place prior to its immersion. The plea of accidental INFANTICIDE. 155 drowning may be put forward ; it is therefore well to examine the cord ; has a ligature been placed upon it % has it been cut by a sharp instrument ? The nature and character of the fluid found in the stomach should be noted. Fractures of the skull may happen — a. In the Womb. — The parturient female may fall from a considerable height, and thus cause injury to her child. These cases are of no judicial importance, as the presence of intra-uterine putrefaction or an examination of the lungs will at once show that the child has not breathed. It must be borne in mind, however, that dislocations may take place in the womb, and this fact may be brought forward in defence. The history of the case and the absence of any other signs of violence will decide the truth or falsity of the plea. b. During Labour. — Fracture of the cranial bones during labour generally occurs in difficult and pro- tracted labours, which, from this very cause, seldom become the subject of judicial inquiry. In some cases the defective ossification of the bones of the skull may give rise to fractures, which may lead to dangerous mis- takes. This deficiency in the process of ossification is thus described by Casper : — c If the bone in question is held up to the light, this is seen to shine through the opening, which is closed only by the pericranium. When the periosteal membrane is removed, the defi- ciency in the ossification is seen in the form of a round or irregularly circular opening, not often more than three lines in diameter, though frequently less ; its edges are irregular and serrated ; these edges are never depressed, as is the case in fractures ; and neither they nor the parts in their neighbourhood are ever observed to be ecchymosed. , The child in these cases may breathe for a short time, and then die without any apparent cause. c. By Falls. — It is beyond doubt possible for a child to be born so precipitately as to fall on the floor and be severely injured, and that even fatally. In cases of 156 FORENSIC MEDICINE. alleged precipitate birth, to account for injuries found on the child, the following points should be remem- bered, and will assist in forming a diagnosis : — L In favour of Precipitate Birth and Accidental Injury. a. Eupture of the umbilical cord. In all cases it would be advisable to measure the length of the cord, and then the distance of the vulva from the ground, allowing of course for the woman not being quite erect at the time of delivery owing to a separation of the legs. A disproportion between the two measurements may or may not account for the rupture of the cord. The following measurements may be taken ; usual length of cord eighteen to twenty inches ; distance of vulva from the ground twenty-six inches, but allowing for stooping two-thirds of the above. To the length of the cord must be added about nine inches, the distance from the navel to the top of the head of the child. Thus a fall of about thirty inches will put no strain on the cord. A case is on record of a rupture of the cord taking place while the woman was in a recumbent position, but in that case the labour was precipitate and the cord very short and small. b. Placenta not detached from the child. c. Fracture of the parietal bones ; the fracture radiating into the frontal and squamous portion of the temporal bone. In expe- riments on twenty-five children dropped from a height of thirty-inches, one parietal bone was found fractured in sixteen of the cases, both parietals in six cases. The fractures in most cases occurred about the parietal protuber- ances. d. Imperfect ossification of the bones of the skull. e. Absence of other injuries. INFANTICIDE. 157 2, In favour of Criminal Violence. a. The fact of the umbilical cord being divided by some sharp instrument, and not torn. b. Extensive fracture of one or more of the bones of the cranium. c. Fracture and dislocation of the neck. d. Presence of incised wounds, and other evi- dence of violence. N.B. — In all doubtful cases, a guarded opinion should be given, stating simply that the dissection does not reveal anything contrary to the statements offered as to the cause of the death. Has the Infant Bled to Death ? — Fatal hemorrhage from the cord may occur, especially if it be divided by a sharp instrument close to the body of the child. As a rule, haemorrhage does not occur from a ruptured cord. The signs of death from haemorrhage have been noticed, page 66. Hoiv long did the Child survive its Birth ? — The answer to this question is by no means easy, and the/ data on w T hich a decision can be based are not very reliable. The presence or absence of the vernix cas- cosa should be noticed. In still-born children the closed eyelids, when raised, do not remain open ; in the live-born, on the other hand, the eyes remain half open even after repeated attempts to close them. Another guide to the determination of the length of time the child survived its birth may be found in the absence or presence of the meconium in the intestines. The meconium — from its resemblance to inspissated poppy- juice — is found in the large intestine as a dark-greenish pasty mass, more or less filling that portion of the bowel. In the upper portions of the intestines it varies from a light-yellowish or greyish to a greenish- brown colour, till in the large intestine it assumes the colour and consistence above mentioned. It is gene- rally discharged by the infant in from four or five to 158 FORENSIC MEDICINE. forty-eight hours after birth. In breech presentations it may be passed during the process of delivery, although the child be still-born • but its entire absence from the intestines is presumptive of existence for some days after birth. The following are some of the points to be considered in forming a diagnosis :— a. Changes in the skin. b. Changes in the umbilical cord. c. Changes in the circulatory system. a. Changes in the Skin. — Exfoliation of the cuticle. The time at which this occurs is so variable as to be of little value in a medico-legal inquiry. b. Changes in the Umbilical Cord. — Mummification of the cord is not of the slightest value as a proof of extra-uterine life ; but the separation of the cord which occurs between the fourth and seventh day, especially when cicatrisation has taken place, is a sure sign that the child must have lived four or five days at least. Two other appearances of some value may also be noted, namely : — 1. In fresh bodies, the appearance of a bright-red ring, about a line in breadth, which surrounds the insertion of the cord, and which is formed within the uterus. 2. A similar red ring, about two lines broad, around the insertion of the cord, accompanied with 6 thickening, inflammatory sivelling of the por- tion of the skin affected, and slight purulent secretion from the umbilical ring itself This latter condition Casper considers . as affording ' irrefragable proof of the extra-uterine life of the child' c. Changes in the Circulatory System. 1. Ductus Arteriosus. — Arterial duct. A contracted condition of this duct is of no value as a proof that a child has survived its birth ; for the duct is liable to become contracted, and even oblite- rated, before the birth of the child. INFANTICIDE. 159 2. Ductus Venosus. — Nothing certain is known as to the exact time when this duct closes ; the con- dition of the vessel is, therefore, of no assistance in determining the possibility of the child having survived its birth. The duct has been found closed in a still-born child ; and in one child, which lived for a quarter of an hour, both the ductus arteriosus and the foramen ovale were found closed. Cases are also on record in which the foetal channels were found open after thirty days of extra-uterine life. 3. Foramen Ovale. — What has been said of the pre- ceding may be said with regard to the foramen ovale. N.B. — To sum up, therefore, in the fewest words, any attempt at forming an opinion on the docimasia circulationis may result in a fatal error on the part of the medical witness, as it is impossible to determine with any accuracy by days the period of their closure. As a general statement, however, the following, accord- ing to Bernt and Orfila, is the order in which oblitera : tion of the foetal vessels takes place: — L The umbilical arteries. 2. Ductus venosus. 3. Ductus arteriosus. 4. Foramen ovale. Live Birth in Civil Cases. — The ' entire delivery of the child ' has generally been considered in criminal law to constitute birth ; but on this point the civil law of England has not proffered a definition. Separation from the mother by cutting the umbilical cord does not appear to be necessary in criminal cases, provided the entire body of the child be without the body of the mother. But a child may be alive at birth, and yet not born alive; that is, part of the body may be born, and life, physiological life, be present ; but in criminal law the child is not considered as born alive till it is free of the maternal passages. The inference unfortunately follows from this ruling, that a mother 160 FOKENSIC MEDICINE. may kill her child without fear of punishment, if she do so before the entire body has slipped from her. The evidence of live birth in civil is somewhat dif- ferent to that required in criminal cases. The viability of the child is determined in Scotland by its crying ; in France, by its respiration ; but in England the pul- sations of the child's heart, or any tremulous motion of the muscles, however slight, have been considered as satisfactory proof of live birth. 1 According to Blackstone, c crying, indeed, is the strongest evidence, but it is not the only evidence ; ' and Coke remarks : c If it be born alive, it is sufficient though it be not heard to cry, for peradventure it may be born dumb/ According to the common law of Germany, ' the live birth of a child is to be held proven when it has been heard to cry by witnesses of unimpeachable veracity present at its birth/ A foetus in the womb (en ventre sa mere) may — a. Have a legacy or estate made over to it. b. A guardian assigned to it. That these conditions may take effect, it must be born alive. c. Be an executor. To exercise this post-partum function, the child must, in England, have attained the age of twenty-one. INHERITANCE, This subject will be discussed under the following heads : — a. The child must be born alive. b. The child must be born during the lifetime of the mother. 1 See case of Fyshe or Fisher y. Palmer, in 1806. INHEKITANCE. 161 c. The child must be born capable of inheriting. d. Tenancy by courtesy, and possessio patris. a. The Child must be born alive. This has been discussed in the preceding section. b. The Child must be born during the Lifetime of the Mother. Death terminates the marriage contract. Would a child born after the death of the mother, and, there- fore, not during marriage, be entitled to inherit 1 On this point Lord Coke writes-: ' If a woman, seised of lands in fee, taketh husband, and by him is bigge with childe, and in her travell dyeth, and the childe is ripped out of her body alive, yet shall he not be tenant by the curtesie, because the child was not born during the marriage nor in the life of the wife ; but in the meantime her land descended.' It appears from this that the husband is not entitled to the life-rent. c. The Child must be born capable of inheriting. Monsters cannot inherit according to law. Black- stone says : c A monster which hath not the shape of mankind hath no inheritable blood/ and cannot, there- fore, inherit ; but if ' it hath human shape, it may be an heir/ Buffon classes monsters under three divi- sions : — a. Monsters by excess of organs. b. Monsters by defect of organs. c. Monsters by alteration or wrong position of parts. An hermaphrodite inherits or not property according to the prevailing sex. d. Tenancy by Courtesy and Possessio Patris. 6 When a man marries a woman seised of an estate of inheritance, and has by her issue born alive, which L 162 FOBENSIC MEDICINE. was capable of inheriting her estate; in this case he shall, on the death of his wife, hold the lands for his life as tenant by the courtesy of England.' There is yet another case bearing closely on this subject, known in law as possessio patris. On this subject Mr Amos writes : — c In the event of a man twice married dying, and leaving a daughter by each marriage, his estate would be equally shared by the daughters of the two marriages ; but if we suppose that there is also a son by the second marriage, born in a doubtful state, the legal effect of his momentarily surviving birth would be to disinherit the daughter of the first marriage entirely, and transfer the whole of the estate to the daughter of the second marriage, she being sister to the male heir, while the daughter of the first marriage is only half-blood. ' In both of these cases proof of live birth, as before mentioned, is of the slenderest kind. LEGITIMACY. Every child born in wedlock is presumed to have the husband of the woman as its father ; but this presump- tion may be denied for the following reasons : — a. Absence or death of the reputed father. Impotence or disease in the father, preventing matrimonial intercourse. c. In the case of a premature delivery in a newly married woman. • d. Want of access. e. The paternity of the child may be disputed when the woman marries immediately after the death of her husband. In Scotland a child is held to be legitimate if born ten lunar months after the death or absence of its LEGITIMACY. 163 alleged father ; and the absence of the supposed father must continue till within six lunar months of the birth of the child, to prove its illegitimacy. In the same country a child born before marriage is rendered legitimate by the subsequent marriage of the parents. This is not the case in England. A child born during wedlock is legitimate, although the date of conception may be before marriage. A child born after the death of its mother is held to be legitimate. A child may, as Taylor remarks, be conceived before marriage, and born after the death of the mother, and yet be legitimate, though neither conceived nor born in wedlock. The Code Napoleon prohibited the contraction of a second marriage until ten months after the death of the first husband ; and this is also the case in Germany. The Anglo - Saxon law prohibited re- marriage for twelve months. In Britain no time is fixed by law. Duration of Pregnancy. — The consideration of this subject is of importance in its relation to the legitimacy of a child. The natural period of human gestation is usually stated at forty weeks, ten lunar months, nine calendar, or 280 days. In Prussia the period is extended to 302 days, and in the Code Napoleon to 300 ; in Scotland ten months is held as the limit. The duration of human gestation is subject to considerable variation : in some females it is always protracted ; in others, always pre- mature. Several modes of calculation are adopted by women : — a. Ascertained date of impregnation from one coitus. b. Supposed sensations of female at time of con- ception. c. Suppression of the catamenia. This is open to the objection that causes other than that of impregna- tion may arrest them. The catamenia may be stopped by cold or other causes for two or three months, and 164 FORENSIC MEDICINE. then, before their return, pregnancy may occur, thus upsetting all calculations. The usual mode of calcula- tion is from two weeks after the last menstruation, and the period so fixed is corrected by the time at which quickening occurs. d. Period of quickening. 1. Quickening supposed when pregnancy is absent. 2. Pregnancy without quickening. 3. Variations in the time of its occurrence. Whichever may be the mode of calculation adopted, it may be stated that, as a rule, the period of human gestation is from 275 to 280 days, and that cases of alleged pregnancy beyond 300 days must be received with considerable caution. The pregnancy of the Countess of Gloucester was held, in the reign of Edward II., to be legitimate, although her husband had been dead one year and seven months at the date of the application. Premature Births. — The question may be asked, At what period of gestation may a child be born viable — that is, capable of living and attaining to maturity 1 Seven months, or 210 days, is considered as the limit; but cases have been recorded of children born at six months being reared. The Eoman law admitted the legitimacy of seven-months children. For signs of immaturity see table of the development of the embryo, page 147, et seq. SuperfoetaMon. — This term is used to imply the con- ception of a second embryo in a woman already preg- nant, and the birth of two children at one time, differing considerably in their maturity, or of two births, a considerable period of time elapsing between each. The possibility of this occurrence has been doubted. Churchill, in his work on Midwifery, writing on this subject, says : — 1 In conclusion, I would say, 1. That the theory of superfoetation is unnecessary to explain the birth of a mature foetus and a blighted ovum, of a mature and immature foetus born together, IMPOTENCE AND STEKILITY. 165 or within a month of each other, or of foetuses of different colours, as they may reasonably be supposed to be the product of one act of generation, or of two nearly contemporaneous. 2. That, in cases of double uterus, it is possible for a second conception to take place, and (judging from the subsequent birth of the second child in the only case on record) at a later period than the first. 3. That in the remaining cases, where one mature child succeeded the birth of another after a considerable interval, we have no proof of a double uterus in any, and positive proof that in one case it was single ; and that to the explanation of these cases no theory as yet advanced is adequate, that of superfoetation being opposed by physical difficulties which are insurmountable in the present state of our knowledge.' Dr Matthews Duncan has, however, shown that the mouth of the womb is not immediately closed by conception, and that the communication between the vagina and ovary is not destroyed for some months after impregnation, and that there is no impediment to the ascent of the spermatozoa. Milne, while admitting this form of pregnancy as possible, though very rare, remarks : — 6 This variety we should not think due so much to mechanical hindrances as to the absence of • proper ovules. It would imply extraordinary vigour were perfect ovulation to be achieved for any length of time after impregnation. 1 IMPOTENCE AND STERILITY. Impotence in the male may arise from — L Functional causes. 2. Organic causes. 1 . Fun ctional. — Excessive use of alcoholic stimulants, excessive venery, masturbation, and certain debilitating diseases. 2. Organic. — Malformation of the genital organs, 166 FOKENSIC MEDICINE. deficiency of the penis, fistula in perineo, or malforma- tion of the urethra — hypospadias — especially when the opening of the urethra is at a considerable distance from the glands. Absence of the testicles from the scrotum does not necessarily imply incapacity for pro- creation, for persons (crypsorchides ) in whom the testicles were retained in the abdomen have been capable of begetting children. Cancer of the testicle, or the presence of any other organic disorganisation of the gland, may be considered as a bar to procreation. Sterility may be present without impotency. Sterility in the female may arise from — 1. Organic causes. 2 Functional causes. 1. Organic Causes. — Absence of the ovaries, uterus, or vagina, imperforate hymen, tumours in the vagina, etc. Dr Ogston, in referring to this subject, states : — ' If I may judge from what I have since met with in the dead-house, these last affections [fibroid of the uterus] and also obstructions of the fallopian tubes, seem to be usual in prostitutes, and may account in these instances, independently of other alleged causes, for their frequent sterility. 2. Functional Causes. — Extreme debility — though this is not always an impediment, for some weak debilitated women conceive rapidly. Constant leu- corrhoea may be a cause of sterility; so also may dysmenorrhoea, menorrhagia, and amenorrhoea. To sustain an application for divorce on the ground of impotence, the cause or causes must have existed before marriage. - In one case, a nullity of marriage was granted because every attempt at sexual intercourse brought on an attack of hysteria in the wife (H. v. P., 3 P. and M. 126). A medical man may be required to ascertain the capability or incapability of a man for sexual intercourse in — a. Cases of contested legitimacy. b. Suits for divorce. c. Accusations of rape. SURVIVORSHIP. 167 SUKVIVOKSHIR The question of survivorship is not infrequently raised when a mother and her new-born infant are found dead, or where several persons have perished by a common accident. In the first case, the mother is generally presumed to have lived longest ; and this presumption may be borne out by the fact of the delivery being premature, or if there be considerable disproportion between the size of the child and the maternal passages. As pointed out before, important civil rights may depend upon the question as to the live birth of an infant; and the husband's rights to be tenant to the courtesy will, of course, depend upon the view taken as to the probable survivorship or not of the child. With regard to the second question, much will depend upon the relative ages and strength of the individuals. Sex will also have to be taken into con- sideration. In the case of one or more persons found dead, either from wounds or other causes, the fact of some being warm and others cold, the presence of the rigor mortis in one and absence in the other, will point to the probable survivorship. The severity of the wounds and injuries to large arterial trunks must also be considered. See test case, Underwood v. Wing, (1 Jur. N.S., 169). In this case a man, his wife, and three children were washed overboard and drowned, one child, however, being seen alive a few minutes after the others were submerged. The question at issue was, Did the husband survive the wife, or the wife the husband? and on this Wightman J., in sum- ming up said : — 6 We may guess, or imagine, or fancy, but the law of England requires evidence, and we are of opinion that there is no evidence upon which we can give a judicial opinion that either survived the other ; 168 FORENSIC MEDICINE. in fact, we think it unlikely that both did die at the same moment of time, but there is no evidence to show ' who was the survivor.' Verdict for the plaintiff. MALPEAXIS AND NEGLECT OF DUTY. A medical man is liable to a civil action for damages, who, by a culpable want of care and atten- tion, or by the absence of a competent degree of skill and knowledge, causes injury to a patient. And it is not necessary that the patient should have employed or was to have paid him, provided always that there be no negligence or carelessness on the part of the patient. It has also been decided that if the defendant acted honestly, and used his best skill to cure, and it does not appear that he thrust himself in the place of a competent person, it makes no difference whether he was at the time a regular physician or surgeon or not. E. v. Yan Butchell ; R. v. Williamson ; etc. A sur- geon does not undertake to perform a cure, nor does he profess to bring the highest professional skill into the consideration of the case; but he does undertake to bring a fair and reasonable amount. ' So, if a physician or surgeon give his patient a potion or plaster to cure him, which, contrary to expectation, kills him, this also is neither murder nor manslaughter, but mis- adventure.' A medical man is only liable for gross negligence, not for every slip he may make ; but the distinction between criminal and actionable negligence cannot be defined ; but it appears that the negligence must be so gross as to come under the legal meaning of the word 6 felonious. ' FEIGNED DISEASES. 169 FEIGNED DISEASES. Human ingenuity is not wanting among those who, for private ends, pretend to be suffering from disease. The soldier or sailor, anxious to escape the dangers of active service, finds a ready means of evading his duties by shamming ; the prisoner, in order to lighten the burden of his punishment, does the same. A man declares himself impotent, to save the expense of keep- ing an alleged bastard child, or to avoid punishment for rape. Beggars appeal to the public by feigning some painful disease, and incautious benevolence becomes the dupe of the clever impostor. Any attempt at classification is here out of the ques- tion, nor does it appear necessary to give a long list of diseases which have been feigned, or the means that have been employed by artists in deception. To give some general hints for guidance is all that will be attempted here, leaving matters of detail to the acumen of the medical examiner, who, if in active practice, will have many opportunities of testing his powers of discernment. 1. Never be satisfied with one visit, but pay a second at a short interval, and unannounced. 2. Have the patient carefully watched in the interval of your visits. 3. Examine each organ of the body separately, care- fully comparing the state of each with the symptoms described by the patient. 4. Note the discrepancies in the statements of the patient as to his symptoms, and their known occurrence in real disease. 5. Sometimes ask questions the reverse of his state- ments, or take his statements for granted, when in all probability he will contradict himself. 6. Eemove all bandages and other dressings. 7. The administration of sham physic, or the sug- 170 FOEENSIC MEDICINE. gestion of some heroic mode of treatment ; the applica- tion of the actual cautery may have a beneficial effect. 8. Pay little attention to the reports of bystanders, or of the culprit's fellow-prisoners. 9. Anaesthetics may be employed, if necessary, for the purpose of detection. 10. The motives for deception should be inquired into, and borne in mind, in the examination of all cases. EXEMPTION EEOM PUBLIC DUTIES. The existence of certain diseases may be claimed as a bar to active service, both in a civil and in a military capacity; and the opinion of a medical man may be required as to the fitness or unfitness of the individual for the service from which he claims exemption. In giving certificates of this nature, the medical practitioner cannot be too guarded in wording them ; and each case must be treated on its merits, so that strict justice may be done. Among the diseases which may incapacitate a man for active employment, may be mentioned — syphilis ; hernia ; phthisis ; affections of the eyes, attended with dimness of vision ; varicose veins, and some other diseases. Eor the army a man is not considered fit for active service until he is twenty-one years of age. 1 MENTAL UNSOUNDNESS. In the whole range of medical jurisprudence there is no subject more interesting, more difficult, or more important than the diagnosis of insanity, and its rela- tion to the criminal responsibility of individuals. It is impossible, in the short space at our disposal, to do 1 See Aitken's ' Growth of the Recruit and Young Soldier.' MENTAL UNSOUNDNESS. 171 more than to offer a few remarks which may assist the student in the elucidation of some of the most important cases which may engage his attention. Legal defini- tions. — Three forms of mental disorder are recognised in law: — 1. A nativitate, vel dementia, naturalis, idiocy or natural fatuity. 2. Dementia accidentalis, vel adven- titial general insanity, either temporary or permanent, lunacy. 3. Dementia affectata, acquired madness from intoxication, etc. Bee Delirium Tremens, p. 187 Under the term lunacy are included the mania, monomania, and dementia of medical writers. Another term fre- quently used in legal proceedings, the meaning of which it is not easy to give, is non compos mentis, unsoundness of mind. According to the late Forbes Winslow, ' un- soundness of mind is not lunacy 1 in the legal accepta- tion of the phrase. This term was first used in a statute passed in the reign of Henry VIII., relating to the punishment of treasonable offences ; and is defined by the early law text-books to be strictly one who gaudet lucidis intervallis — a definition not psychologi- cally exact. The phrase 1 unsoundness of mind ' was first used by the late Lord Eldon to designate a state of mind not exactly idiotic, and not lunatic with delu- sions, but a condition of intellect occupying a place between the two extremes, and unfitting the person for the government of himself and the management of his affairs.' The above definition has been acted upon by other judges, Lyndhurst, Brougham, etc. As a rule, a medical witness will consult his own interest in not attempting to define insanity, bearing in mind the philosophic caution of Polonius, who, when addressing Hamlet's mother, says — ' Your noble son is mad. Mad call I it ; for, to define true madness, "What is't but to be nothing else than mad.' To the legal mind, the chief character of insanity is the presence of delusion. 172 FORENSIC MEDICINE. As laid down by English lawyers, madness absolves from all guilt in criminal cases. "Where the depriva- tion of the understanding and memory is total, fixed, and permanent, it excuses all acts ; so, likewise, a man labouring under adventitious insanity is, during the frenzy, entitled to the same indulgence, in the same degree with one whose disorder is fixed and permanent. Beverley's case, Co. 125, Co. Litt. 247, 1 Hale 31. 1 4 But the difficulty in these cases is to distinguish between a total aberration of intellect and a partial or temporary delusion merely, notwithstanding which the patient may be capable of discerning right from wrong; in which case he will be guilty in the eye of the law, and amenable to punishment. ' Lord Hale, who first pointed out the distinction to be drawn between total and partial insanity, offered the following as the best test he could suggest : ' Such a person as labouring under melancholy distempers, hath yet as great under- standing as ordinarily a child of fourteen years hath, is such a person as can be guilty of felony.' On this subject see E. v. Ld. Ferrers, 19 St. Tr. 333 ; K. v. Arnold, 16 St. Tr. 764, etc. To excuse a man from punishment on the ground of insanity, it appears that it must be distinctly proved that he was not capable of distinguishing right from wrong, and that he did not know, at the time of committing the crime, that the offence was against the laws of God and natiwe. K. v. Offord, 5 C. and P. 186. I shall here quote from Macdonald's £ Criminal Law of Scotland' : — 1 Insanity or idiocy exempts from prose- cution. But there must be an alienation of reason such as misleads the judgment, so that the person does not know " the nature of the quality of the act" he is doing, or if he does know it, that he does not know he is doing what is wrong. If there be this alienation, as connected with the act committed, he is not liable to punishment, though his conduct may be otherwise 1 Archbold's Crimimal Cases. MENTAL UNSOUNDNESS. 173 rational. For example, if lie kill another when under an insane delusion as to the conduct and character of the person, e.g., believing that he is about to murder him, or as an evil spirit, then it matters not that he has a general notion of right and wrong. For in such a case "as well might he be utterly ignorant of the quality of murder.' 7 He does the deed, knowing murder to be wrong, but his delusion makes him believe he is acting in self-defence, or against a spirit. Nor does it alter the effect of the fact of insanity at the time that the person afterwards recovers. . . . But the alienation of reason must be substantial. Oddness or eccentricity, however marked, or even weakness of mind, will not avail as a defence. Even monomania may be insuffi- cient as a defence, where the delusion and the crime committed have no connection, or where the person, though having delusions, was yet aware that what he did was illegal.' Mere moral insanity — where the intellectual faculties are sound, and the person knows what he is doing, and. that he is doing wrong, but has no control over him- self, and acts under an uncontrollable impulse — does not render him irresponsible. R. v. Burton, 3 F. and F. 772. Some medical writers cortend that there are two forms of insanity, moral and intellectual. The law only recognises the latter, owing probably to the difficulty of distinguishing between so-called moral insanity and moral depravity. Taylor says : — 6 Further, until medical men can produce a clear and well-defined distinction between moral depravity and moral insanity, such a doctrine, employed as it has been for the excul- pation of persons charged with crime, should be rejected as inadmissible.' The day may not be far distant when the term ? moral depravity ' will be unknown, and future generations ceasing to believe in absurd superstitions will come to look on crime as the result of mental disease, and learn to treat, instead of to punish, the morally diseased. 174 FORENSIC MEDICINE. The fact of the sanity or insanity of the prisoner at the time the crime was committed is left to the jury to decide, guided by the previous and contemporaneous acts of the party, and it has been laid down by Lord MoncriefF in Scotland, and Lord Westbury in England, that the mental soundness or unsoundness of any indi- vidual is to be decided by the jury on the ordinary rules of every day life, and that on these principles they are as good judges as medical men. The whole tendency of legal practice when dealing with the plea of insanity, is to entirely ignore the medical evidence. Lunacy, ivliat Constitutes? — (8 and 9 Vict., c. 100, sees. 90 and 114.) Imbecility and loss of mental power, whether arising from natural decay, or from paralysis, softening of the brain, or other natural cause, and although unaccompanied with frenzy or delusion of any kind, constitute unsoundness of mind, amounting to lunacy within the meaning of 8 and 9 Vict., c. 100. E. v. Shaw, 1 C.C. 145. The above is the last definition of lunacy up to 1875. The law on this subject is so constantly changing, that the student will find it best to consult the ' law reports ' from time to time. See the account of the case of E. v. Treadaway, law reports. Also the Lancet on the same case, vol. i., 1877. For some valuable remarks on the subject of the irresponsibility of madmen, the student is referred to the works of Prichard, Eay, Hoffbauer, Georget, and others. The following suggestions are offered for considera- tion on this subject : — a. Was the act an isolated event in the life of the culprit 1 Has it the appearance of spontaneity, or was it the culminating point of a life spent in criminal acts % b. Absence of a motive for the committal of the deed. The absence of an apparent motive is no proof of an unsound mind ; the moving principle may be MENTAL UNSOUNDNESS. 175 ' the conscious impulse to the illegal gratification of a selfish desire.' c. The presence or absence of a well-concerted plan of action is a diagnostic sign of little value. Casper remarks that 6 only in one case can the examination of the syste- matic planning of the deed afford any information, and that is when these plans and preparations themselves evince the stamp of a confused intellect, and betray the hazy consciousness, the mental darkness, in which the culprit was involved.' d. A dominant delusion may be so concealed, as to be for a time undiscoverable. The case of the man who gave no indication of his madness till he was asked to sign the order for his release, when he signed Christ, is an example how care- fully a delusion may be concealed even during a most careful examination. Questions directed to this point showed that he laboured from all the errors which such a delusion might suggest. e. It may 6 easily be conceived that insane persons, whose unreason affects only one train of thought more or less restricted, yet labour in other respects under disorders of feeling which influence their conduct and their actions and behaviour, without materially affect- ing their judgment ; and that many of such deranged persons, who often conduct themselves tolerably well in a lunatic asylum, and while living among strangers, with whom they have no relations, and against whom they have no prejudices or imaginary reason of com- plaint, subjected besides to the rules of the house, and to an authority that nobody attempts to dispute, would nevertheless, if restored to liberty, and residing in the midst of their families, become unsupportable, irri- table at the slightest contradiction, abusive, impatient of the least remark on their conduct, and liable to be provoked by trifles to the most dangerous acts of vio- lence. If, under such circumstances, a lunatic should commit any act of injury or serious damage to another, 176 FORENSIC MEDICINE. would it be just to punish him, because it cannot be made apparent that the action has any reference to, or connection with, the principal illusion which is known to cloud his judgment, it being apparent that his moral faculties have undergone a total morbid perversion]' /. Insanity with lucid intervals. Haslam, Kay, and others appear to deny the possibility of lucid intervals ; but M. Esquirol, on the other hand, fully recognises the existence of this form of insanity. In a legal sense a temporary cessation of the insanity constitutes a lucid interval, but the cessation must be complete, and not merely a remission of the symptoms. The interval must be of some duration, and when continuous insanity has been proved, the onus of proving a lucid interval in civil cases rests with the party trying to support the validity of a deed executed during the alleged interval. ' If you can establish,' says Sir W. Wynne, £ that the party afflicted habitually by a malady of the mind has intermissions, and if there was an inter- mission of the disorder at the time of the act ; that, being proved, is sufficient, and the general habitual insanity will not affect it, out the effect of it is this : it inverts the order of proof and presumption; for, until proof of habitual insanity, the presumption is that the party agent, like all human creatures, was rational ; but when an habitual insanity in the mind of the person who does the act is established, then the party who would take advantage of the fact of an interval of reason must prove it'. In civil cases the law recognises the validity of wills made during lucid intervals, and has even taken the reasonableness of a will as a proof of a lucid interval. g. Have measures been taken by the culprit to escape punishment IDIOCY. 177 The classification adopted here is that given by Eay, and is sufficient for all practical purposes. 1. Resulting from congenital defect. 2. Resulting from an obstacle to the development of the faculties superven- ing in infancy. '1. Resulting from congenital defect. 2. Resulting from an obstacle to the development of the faculties supervening in infancy. Intellectual — ■ 1. General. 2. Partial. Affective — 1. General. 2. Partial. 1. Consecutive to mania, or injuries of the brain. 2. Senile, peculiar to old age* Defective Development of the Faculties. Idiocy, Cretinism. Imbecility. Idiocy is congenital, and was defined by Esquirol thus : — Idiocy is not a disease, but a condition in which the intellectual faculties are never manifested, or have never been developed sufficiently to enable the idiot to acquire such an amount of knowledge as persons of his own age, and placed in similar circumstances with him* self, are capable of receiving. Idiocy commences with life, or at an age which precedes the development of the intellectual and affective faculties, which are from the first what they are doomed to be during the whole period of existence. Since the days of Esquirol, much M / Defective / develop- ment of the faculties. Idiocy. Imbecility. Lesion of the facul- ties subse- quent to their de- \ velopment. ' Mania. Dementia. 178 FORENSIC MEDICINE. improvement lias been made in the care and treatment of the idiot ; and it appears that he is capable of some, though in most cases slight, mental culture. The cases in which improvement takes place probably belong to imbecility, leaving the idiot in the same condition as described by Esquirol. Cretinism differs from idiocy in being endemic ; it is also more curable, or at least more susceptible of im- provement, than the latter. In the idiot the malady is congenital ; the cretin, on the other hand, may to all appearances be free from disease for a time. 6 Every cretin is an idiot, but every idiot is not a cretin; idiocy is the more comprehensive term, cretinism is a special kind of it.' The enlarged thyroid gland, high-arched palate, and brown or yellow colour of the skin, are characteristic of the cretin. Local causes seem to be at work in the production of cretinism; but what the exact nature of these causes is has not been definitely settled. It has been attributed to miasma, to over- crowding in low-lying, badly-ventilated houses, and to ill-assorted marriages. Smallness of the brain, prema- ture ossification of the cranium, and want of symmetry in the brain, have also been mentioned among the causes of cretinism. The idiot is usually cunning, mischievous, and dirty in his habits. The derivation of the word idiot, from the Greek i8l6t7)s — a private person, or an ill-informed ordinary fellow — is peculiar. A person suffering from any form of mental unsoundness, and thereby rendered incapable of taking care of himself or of his property, was for- merly called in English law ' sua. idiot/ and this word was not infrequently joined with ' fatuus ' in old writs. Imbecility. — This is a minor form of idiocy, and may or may not be congenital ; it also admits of considerable degrees of intensity. Hoffbauer has divided imbecility (Blodsinn) into five degrees, and stupidity (Dummheit) into three. MANIA. 179 Legal Relations of Idiocy and Imbecility. — The legal definition of an idiot is 6 one who is of non-sane memory from his birth by a perpetual infirmity, without lucid moments. 7 With regard to responsibility or irresponsi- bility of idiots and imbeciles, much will depend upon the degree of mental weakness present. Mania. Mania is the result of a morbid condition of the brain, to express which ' the term raving madness may be used with propriety, as an English synonym for mania. All maniacs display this symptom occasionally, if not constantly, and in greater or less degrees.' Like other diseases, mania observes the same pathological laws. There is a period of incubation, during which the true state of the patient is in most cases misunder- stood, or not appreciated. Mental exaltation may exist from the first onset of the disease, or the attack may be ushered in by a stage of gloom or despondency. The general health shows signs of impairment, the liver becoming sluggish, and the bowels confined or relaxed. In some cases a febrile condition of the system is among the premonitory symptoms of an attack of mania. The physical health is not usually much affected during the paroxysm. Dr Conolly remarks that c even acute mania is not always accompanied by the ordinary external signs of excitement. It would seem as if we had yet to learn the real symptoms of cerebral irritation. Certainly, in recent cases of mania — cases which have lasted more than six weeks, and in young persons in whom I have seen the maniacal attack pass into dementia — I have known the most acute paroxysms of mania exist, rapid and violent talking, continual motion, inability to recog- i nise surrounding persons and objects, a disposition to tear and destroy clothes and bedding, without any 180 FORENSIC MEDICINE. heat of the scalp or of the surface, without either flush- ing or paleness of the face, with a clean and natural appearance of the tongue, and a pulse no more than eighty or eighty-five. 7 This may occur in some cases, but in the majority there is always some amount of physical derangement; the system, however, gradually becoming tolerant of the undue excitement to which it is subjected. Following the classification adopted, Intellectual Mania will now be briefly considered under its two divisions, General and Partial. General Intellectual Mania. — By many medical writers general intellectual mania is divided into mania and melancholia. The mind in the former form of the disease is involved in the most chaotic confusion pos- sible, and there is also considerable bodily derange- ment. The moral faculties become more or less affected, and the patient's social and domestic relations are greatly altered. At one time he is subject to violent fits of immoderate laughter, at another he is gloomy and taci- turn ; sometimes quiet and tractable, at others wild and excited, necessitating close confinement. He is haunted by wild delusions, which at times take entire possession of him, and under the influence of which he acts in the most extraordinary manner. In the latter, melancholia, or mania with depression, delusion may be absent, or, rather, for a time undetectable. The sufferer is gloomy and troubled with unhappy thoughts, which sometimes lead him to self-destruction. He is sleepless, and rejects his food as unnecessary. He may be aroused for a short time by questions addressed to him; his replies to which are usually given correctly, most fre- quently in monosyllables; but the moment his ques- tioner leaves him he relapses into his former gloomy state. It may be as well to define in this place the difference between a delusion and an illusion. A delusion is a chimerical thought ; an affection of the mind. MANIA. 181 An illusion is a perversion of the senses ; a mockery • false show ; counterfeit appearance. A delusion of the mind, an illusion of the senses. Dr Taylor remarks that hallucinations are those sensations which are supposed by the patient to be produced by external impressions, although no material objects act upon his. senses at the time. Illusions are sensations produced by a false perception of objects. When the hallucination or illusion is believed to have a positive existence, and this belief is not removed either by reflection or by an appeal to the other senses, the person is insane ; but when the false sensation is immediately detected by the judgment, and is not acted on as if it were real, then the person is sane/ Partial Intellectual Mania. — The term monomania, first suggested by Esquirol, is now generally given to this variety of insanity. The patient, in the simplest form of this disorder, becomes possessed of some single notion, which is alike contradictory to common sense and to his own experience. Thus, he may fancy him- self made of glass; and influenced by this idea, he walks with care, and in dread of being broken by con- tact with other bodies. In the case of an inmate at the City of London Asylum, the presence of a weasel in the stomach was stated by one woman. Esquirol mentions the case of a woman with hydatids in her womb, who believed that she was pregnant with the devil. Most of these strange fancies appear to be dependent on errors of sensation. Monomaniacs are ready enough to declare their pre- dominant idea, yet at times, and that without the occurrence of a lucid interval, they will as carefully conceal it. ' In the simplest form of monomania, the understanding appears to be, and probably is, perfectly sound on all subjects but those connected with the hallucination. When, however, the disorder is more complicated, involving a longer train of morbid ideas, we have the high authority of Georget for believing 182 FORENSIC MEDICINE. that, though the patient may reason on many subjects unconnected with the particular illusion on which the insanity turns, the understanding is more extensively deranged than is generally suspected/ Moral Mania. Pinel first drew attention to this form of madness. Prichard defines it as 1 consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, and moral dispositions, without any notable lesion of the intellect, or knowing and reasoning faculties, and particularly without any maniacal hallu- cinations. It is divided into — General Moral Mania. Partial Moral Mania. General Moral Mania. — ( There are many individ- uals/ says Prichard, living at large, and not entirely separated from society, who are affected in a certain degree with this modification of insanity. They are reputed persons of a singular, wayward, and eccentric character. An. attentive observer will often recognise something remarkable in their manners and habits, which may lead him to entertain doubts as to their entire sanity; and circumstances are sometimes dis- covered on inquiry which add strength to this suspicion. In many instances, it has been found that a hereditary tendency to madness has existed in the family, or that several relatives of the person affected have laboured under other diseases of the brain. The individual him- self has been discovered to have suffered, in a former period of life, an attack of madness of a decided cha- racter. His temper and disposition are found to have undergone a change, or to be not what they were previously to a certain time ; he has become an altered man, and the difference has perhaps been noted from the period when he sustained some reverse of fortune MORAL MANIA. i83 which deeply affected him, or the loss of some beloved relative. In other instances, an alteration in the cha- racter of the individual has ensued immediately on some severe shock which his bodily constitution has under- gone. This has been either a disorder affecting the head, a slight attack of paralysis, or some febrile or inflammatory complaint, which has produced a per- ceptible change in the habitual state of his constitution. In some cases, the alteration in temper and habits has been gradual and imperceptible ; and it seems only to have consisted in an exaltation and increase of pecu- liarities, which were always more or less natural and habitual. Persons labouring under this disorder are capable of reasoning, or supporting an argument upon any subject within their sphere of knowledge that may be presented to them; and they often display great ingenuity in giving reasons for the eccentricities of their conduct, and in accounting for, and justifying, the state of moral feeling under which they appear to exist. In one sense, indeed, their intellectual faculties may be termed unsound ; they think and act under the influence of strongly excited feelings ; and persons accounted sane are, under such circumstances, proverbially liable to error, both in judgment and conduct.' For interesting cases of this form of madness, see Kay's Jurisprudence of Insanity. Partial Moral Mania. — In the case of the unfor- tunate sufferers from this malady, one or two only of the moral powers are perverted. This division admits of several sub-divisions. Kleptomania. 1 — A marked propensity to theft. ' There are persons/ says Eush, 6 who are moral to the highest degree as to certain duties, but who, neverthe- less, lie under the influence of some vice. In one instance, a woman was exemplary in her obedience to every command of the moral law except one — she could 1 For some valuable remarks on this and on the following forms of madness, see Casper, vol. iv., Syd. Trans. 184 FORENSIC MEDICINE. not refrain from stealing. "What made this vice more remarkable was, that she was in easy circumstances, and not addicted to extravagance in anything. Such was the propensity to this vice, that when she could lay her hands on nothing more valuable, she would often, at the table of a friend, fill her pockets secretly with bread. She both confessed and lamented her crime.' Pyromania. — This consists in an insane impulse to set fire to everything — houses, churches, and property of every kind and description. Erotomania and Nymphomania. — This is known as amorous madness, and consists in an inordinate and uncontrollable desire for sexual intercourse. The un- fortunate victims of this disease often express the greatest disgust and repugnance for their conduct. Homicidal Mania. — In this form of madness the propensity to homicide is very great, and in most cases uncontrollable. (See the case of Henrietta Cornier, given by Prichard, Ray, and others.) The following suggestions may be of assistance in forming a diagnosis as to the existence or non-existence of this form of madness. 1. Previous history of the individual. Melancholy, eccentric, morose, etc. 2. Absence of motive. Gain, jealousy, revenge, hatred, etc. 3. A number of victims are often sacrificed at one time. The murderer, on the other hand, seldom sheds more blood than is necessary for his success. 4. Proceedings of the murderer before and after the crime. Absence of attempts at concealment or escape on the part of the madman. 5. Character of the victims. Not unfrequently, in the case of madmen, their victims are those whom, token sane, tkey loved most, and to wkom tkey were most attacked. DEMENTIA. 185 Suicidal Monomania, or the Propensity to Suicide. — Much discussion has arisen on this subject. Suicide is not always the result of unsoundness of mind. Some, like M. Esquirol, are inclined to consider suicide as always a manifestation of insanity. In the present day, the dislike of coroners' juries to bring in any other verdict but that of suicide whilst in a state of unsound mind is proverbial. Dementia, or Fatuity. Dementia consists in a failure of the mental faculties, not congenital, but coming on during life. 8 A man/ says Esquirol, ' in a state of dementia is deprived of advantages which he formerly enjoyed. He was a rich man who has become poor. The idiot, on the contrary, has always been in a state of want and misery. 1 In this state there is always more or less incoherence, and maniacal paroxysms are not infrequent. In mania, inco- herence may be present, but then it is characterised "^y sustained and violent excitement. In dementia, on the other hand, there is apparent torpor and exhaustion of the mental faculties. Closely allied to this form of mental unsoundness is that interesting disease known as 6 general paralysis of the insane/ or perhaps a better term progressive paralysis of the insane. It is con- sidered by some to precede the psychical derangement, a contrary opinion being held by others. General paralysis may accompany any of the forms of mental derangement, but it is generally preceded by a stage of melancholy. As the paralytic affection becomes more marked, there is a concurrent loss of memory and incapability of mental association, and all sense of duty is lost ; the patient becomes careless as to his person, and clirty in his habits. He expresses himself as possessed of great property, and boasts of the wonderful deeds that he can or has accomplished. Gradually he sinks into a state of complete mental and physical 186 FORENSIC MEDICINE. decay. He cannot give expression to his thoughts, and has to be fed, the food being pushed into his mouth. Symptoms. — The symptom which first attracts the attention, and which is perhaps the first in order of sequence, is a modification in the articulation. 6 This is neither stammering nor hesitation of speech. It more closely resembles the thickness of speech observ- able in a drunken man. It depends upon loss of power over the co-ordinate action of the muscles of vocal articulation.' If the tongue be now examined, it will be found that when it is protruded it is not inclined to one side, but that it is tremulous, and is protruded and withdrawn in a convulsive manner. Griesinger was the first to call attention to the fact — and his statement has since been confirmed — ' that this motory disorder is at the commencement not so much paralytic as convulsive in its nature.' The gait becomes unsteady, the patient walks stiffly, and stumbles over the slightest uneven- ness in the floor. Step by step the paralysis progresses, till at last the unfortunate sufferer takes to his bed, on which he may lie for some months. Sometimes, especially during the earlier stages, he may suffer from terrible delusions, from maniacal paroxysms, or from epileptic fits, the latter possessing certain peculiarities. The tongue during the fit is seldom bitten, which is so commonly the case in epilepsy; and the convulsions are not so general, being limited more to one side than to the other. It is also remarkable that each fit is in most cases followed by an increase of the mental de- rangement. Prichard recognises four stages of dementia or fatuity : — First Stage. — Forgetfulness and impaired memory. This is common to old age. In most cases, passing- events produce little, if any, impression, whilst the past is remembered with tolerable freshness. Second Stage. — Incoherence and unreason, character- ised by a total loss of the reasoning faculty. DELIRIUM TREMENS. 187 Third Stage. — Incomprehension. The person so affected is quite incapable of comprehending the mean- ing of the simplest question ; and should he attempt to reply, his answer is generally remote from the subject. Fourth Stage. — Inappetency. The animal instincts are lost. The unfortunate sufferer lives, and that is all, being scarcely conscious of life. Organic life is all that is left. Delirium Tremens. Simple Delirium. A temporary form of insanity, the result of excessive indulgence in spirituous liquors. The drunkard, under the effects of intoxication, ' can derive no privilege from a madness voluntarily contracted, but is answerable to the law equally as if he had been in full possession of his faculties at the time' (1 Hale 32; Co. Litt. 247). The intoxication of the defendant may be taken as a mitigating circumstance, showing that the deed was unpremeditated. A person rendered incapable of using his reason by intoxication brought about by others, is not liable for his actions. Delirium. — Acts performed during attacks of certain diseases — fever, sunstroke, etc. — accompanied with de- lirium, do not render the individual liable to punish- ment ; and wills made during the continuance of the disorder, if they contain no statement inconsistent with the known wishes and desires of the party during health, are valid, the law looking more to the good sense of the will as a proof of a lucid interval, than to the proved existence of such lucid interval. Directions for Signing Medical Certificates for the Restraint of the Insane. a. In the case of pauper patients the signature of one medical man only is required, but the order must be signed by a Justice of the Peace, or by the officiating 188 FORENSIC MEDICINE. clergyman and the relieving officer of the parish in which the lunatic for the time being resides. In cases of great emergency, a person, if not a pauper, may be received into an asylum or hospital upon a certificate signed by one medical practitioner, provided that within three days the proper certificates be duly signed and delivered. To retain a person beyond the three days renders the keeper of the asylum liable to an action for misdemeanour. b. In all other cases — 1. The signatures of two medical men are required. Any one signing the certificate unless duly qualified is liable to a prosecution for misdemeanour (R v. Ogilvy). 2. A relation or friend must also sign the order of admission into the asylum. 3. The medical men must not be in partnership, as principal and assistant, or have any direct or indirect interest in the patient or in his keeping. 1 4. They must make separate visits, and at different times. 5. Each must write clearly in the proper place, on the form prescribed by law. 2 (a) The facts observed by himself, as evidence of insanity. (b) The facts observed by others as evidence of insanity. The name of his informer must be given. 6. The correct address of the patient and the date of the visit must be stated. The addresses of the certifying medical men must also be stated. 8. The certificate need not be filled up, signed, and dated on the day of examination of the patient, but the examination must take place within seven clear days of the admission of the patient into an asylum. Neglect of this rule invalidates the certificate (Hall v. Semple). 1 16 & 17 Vict., c. 96, s. 4. 2 All the Lunacy Forms can be procured at Messrs Shaw & Sons', Fetter Lane, Fleet Street, London, E.C. LUNACY CERTIFICATE. 189 The certificate remains valid for seven days ; after the lapse of that time, before admission to an asylum can be obtained, new certificates must be procured. 8. Great care must be taken to follow carefully the marginal directions on the certificate form. The most trivial omission will invalidate the certificate, and in the case of Greenwood, the omission of the name of the street and number of the house was held sufficient to set it aside. A medical man should remember that, although his certificate may have passed the scrutiny of the commissioners, it is liable to be made the subject of discussion in a Court of Law, and in cross-examination he will have to support the statements therein made. According to Dr Millar of Bethnal House Asylum, very few of the medical certificates of insanity are properly filled up. I therefore copy the certificate, properly filled up by himself, and given in his little book on 6 Hints on Insanity.' Medical Certificate properly filled up. (Millar.) 1 Here set forth the qualifica- tion entitling the person certifying to practise as a physician, surgeon, or apothecary. 2 Physician, surgeon, or apothecary, as the case may be. 3 Here insert the street and number of the house (if any), or other like par- ticular. 4 Insert residence, and pro- fession or occupation (if any). I, the undersigned, John Millar, being a (*) Licentiate of the Royal College of Physicians, Edinburgh, and being in actual practice as a ( 2 ) Physician, hereby certify that I, on the fourth day of April, One Thousand Eight Hundred and Seventy-seven, at ( 3 ) 600 Cambridge Road, Bethnal Green, in the county of Middlesex, separately from any other medical practitioner, personally examined James Thompson, sen., of ( 4 ) 600 Cambridge Road, Bethnal Green, gentleman, and that the said 190 FOKENSIC MEDICINE. 5 Lunatic, or an idiot, or a person of unsound mind. 6 Here state the facts. 7 Here state the information, and from whom. James Thompson, sen., isa( 5 )^er- son of unsound mind, and a pro- per person to be taken charge of, and detained under care and treat- ment ; and that I have formed this opinion upon the folio wing grounds, viz. : — 1. Facts indicating insanity ob- served by myself ( 6 ) : — He is incoherent in his con* versation, violent in his con- duct, and quite unable to take care of himself. 2. Other facts (if any) indicat- ing insanity, communicated to me by others ( 7 ) : — His son, James Thompson, jun., informs me that he has threatened to commit suicide, and has twice at- tempted it with a razor. (Signed) Name.— JOHN MILLAR. Place of abode. — Bethnal House, Bethnal Green. Dated this fourth day of April, One Thousand Eight Hundred and Seventy-seven, [Table of Insanity. FACTS OF INSANITY. 191 03 «rH ft H cs««^ S S g ° IB QjH rt §/> a ^ § 2 Q =! ^ -t-s "t* © 53 to O ra CD t> S-t £ &ops ...as , £ P3 '+? r d d> ft O 03 O O £ £ R 32 M Lr3 © 0 CO . C3 t-i ft * § a- „ 03 ^ ai,o ,. 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Effects on the nerves of 1 belladonna, and tingling of motion and sensation. ) the tongue and skin from ( aconite. 2. Remote. a. Common- — not to be distinguished from the effects of injury or disease. b. Specific — peculiar to the poison itself. 1. General — affecting the whole system. — Antimony. 2. Partial — acting on a particular organ. — Antimon}^ Modifying Causes. a. Quantity. b. Form. Point of ap- plication. 1. Quantity of the poison increases its rapidly fatal action. 2. Action changed by the size of the dose. Thus, oxalic acid in large doses acts as a corrosive ; in small, on the heart, brain, or spinal cord. (Solubility increases the activity of poisons. I Chemical combinations. Baryta is poisonous, -J sulphate of baryta is inert. | Mixture. Dilution may retard or accelerate I the action of a poison. 1 Skin, mucous membrane, serous membrane. lessens the action of 'Habit — generally poisons. Condition of . Idiosyncracy — increases or may lessen the the body. ] action of poisons. Disease — generally lessens the action of L poisons. 1 Dilution lessens the activity of some poisons, by prolonging the time necessary for their absorption ; but in the case of powerful irritants, which act through the blood, moderate dilution increases their activity, by enabling them to enter the vessels more easily. Oxalic acid is an example of the effect of dilution as a modifying agent in its action. A small con- centrated dose acts as an irritant : diluted, it is soon absorbed, and quickly causes death. 200 FORENSIC MEDICINE. General Evidence of Poisoning. It will now be necessary to consider briefly the general evidences of poisoning, in order to determine whether a death alleged to be due to poison is not really the result of disease. For convenience of description, this subject will be divided into five sections. 1. Evidence from the symptoms. 2. „ „ post-mortem appearances. 3. „ „ chemical analysis. 4. „ „ experiments on animals. 5. Moral evidence. 1. Evidence from the Symptoms. — As a general rule, except in cases of slow poisoning, the symptoms come on suddenly, while the person is in apparent health. In cases of homicide, this suddenness in the accession of the symptoms is particularly to be noticed. But it must also be borne in mind that the invasion of many diseases is sudden, as is the case with cholera, gastritis, and some others. Certain conditions of the system more or less modify the effects of some poisons. Thus, sleep delays the action of arsenic ; and this may also be the case with other poisons. Intoxication has also been said to exert a retarding power over the action of certain poisons. This is probably more apparent than real, the fact being that the symptoms in the cases observed are masked. Much more important, however, is the influence of disease. Large doses of opium are well borne in mania, delirium tremens, dysentery, and tetanus ; whereas it is well known that even small doses of mercury in cases of Bright's disease of the kidney, or in children recover- ing from any of the eruptive fevers, have produced dangerous salivation. The symptoms of poisoning go on from bad to worse in a steady course ; but there may be remissions, fol- lowed, under treatment, by their entire disappearance, TOXICOLOGY. 201 no ill effect remaining. In nervous affections, all the syniptoms must be taken into consideration, and these will be found to differ from those of any known poison. The history of the case should also have due attention paid to it. In poisoning, the symptoms appear soon after food or drink has been taken. This is open to the objection that apoplexy has occurred immediately after a meal. The probative value of the above statement is, however, increased if several persons have been similarly affected after partaking of the same dish, especially if the symptoms followed within a short time of the meal. But it must also be remembered that all persons are not affected alike by the same poison. A whole family may be attacked with symptoms which point strongly to the use of poison, and yet death may be the result of disease. Again, the diagnostic value is weakened if it can be proved that the person or persons affected have taken nothing in the way of food for two or three hours pre- viously. Poisons may be introduced into the system otherwise than by the mouth; that is, they may be placed in the vagina or rectum, or inhaled when volatile poisons are used. Sometimes a poison has been intro- duced into the medicine, or a poisonous draught substi- tuted for the one prescribed. In any case, where suspicious symptoms suddenly occur, the poison has most probably been taken in from half-an-hour to an hour previously, and it is of special importance to note the period of time that may have elapsed between the accession of the symptoms and the last meal. 2. Evidence from Post-mortem Appearances. — The morbid appearances found in cases of poisoning will be treated more in detail when each poison, or group of poisons, comes to be separately considered. A caution may be given here against allowing the post-mortem signs of disease or external injury to exclude the idea of poisoning ; for death may to all appearance be the 202 FORENSIC MEDICINE. result of disease or injury, and yet caused by poison. An attention to the post-mortem appearances is impor- tant in all cases; for in many instances where the symptoms were unknown to the experts at the time the inspection was made, they were subsequently found to correspond with the morbid changes which the autopsy revealed. 3. Evidence from Chemical Analysis. — The detection of poison in the body is of course the most important proof of poisoning ; but it may be suggested that the poison was introduced after death, which, to say the least, is a most ingenious line of defence, but which at the same time must be held to be highly improbable. Again, granting that poison has been taken, is it the cause of death % This question may arise when injuries are found on the body, and it then becomes a matter of importance to know something of the symptoms which preceded death, and the morbid appearances found after death. The poison may disappear from the body. This may be effected by vomiting and purging ; or becoming absorbed and decomposed, it may be discharged by the urine and other excretions. Some poisons, especially those which are sparingly soluble, are with difficulty removed from the stomach even by the most incessant and violent vomiting. This is notably the case with arsenic, which adheres to the mucous coat of the stomach with considerable tenacity. But even after all traces of the poison have left the stomach, it may be detected in the solid viscera. "With regard to arsenic, the following table, taken from Taylor, is of importance, as showing the amount of the poison which may be found in the liver at certain intervals. After taking the poison. Total weight of arsenic. In 5 J to 7 hours . . . . 0*8 grains. 15 17 to 20 10 J davs 14 „ 1- 2 2- 0 1-3 1-5 0*17 TOXICOLOGY. 203 Is it necessary that the poison should be found in the body or in the evacuations, to lead to a conviction for poisoning ? On this point, Christison is of opinion that if the symptoms, post-mortem appearances, and moral evidence are very strong, it is not necessary that the poison be found in order to establish a charge of poison- ing. This opinion was also supported by the late Dr Geoghehan, professor of medical jurisprudence in the Eoyal College of Surgeons, Ireland, and was also virtu- ally acted upon in the case of Palmer, where the non- detection of strychnia was strongly dwelt upon by the counsel for the defence, but without success. Many of the vegetable poisons almost defy detection, except by the symptoms and post-mortem appearances. The de- tection of poison in the food taken, or in the vomited matters is of great importance ; but it is of still greater importance if it can be found in the urine, this being a proof that it has passed through the system. Here again a caution is necessary ; for it must be remembered that poisoning may be feigned or imputed — the poison being mixed with the food and evacuations, and an innocent person accused. 4. Evidence from Experiments on Animals. — The evidence derived from experiments on animals with the contents of the stomach and vomited matters must not be too implicitly trusted, as these may give rise to vomiting and other symptoms when no person is pre- sent. All animals are not alike affected with man by the same poisons ; and it appears that the dog and the cat are the only animals that at all approach man with regard to the effects produced. Experiments . on the lower animals are useless to decide — a. The fatal dose of any poison. b. The rate of absorption, deposition, or elimination of poisons. c. The rapidity of the action of certain poisons. In the case, however, of some vegetable poisons, the 204 FORENSIC MEDICINE. effects produced on animals by a portion of the sub- stance taken by the person suspected of having been poisoned, may afford corroborative evidence of poison- ing. The flesh of animals poisoned by accident, or inten- tionally, may seriously affect those who eat it. As a case in point, may be mentioned the injurious effects produced in some persons who had partaken of the Canadian partridges imported to this country some years ago, and which had probably eaten of some poisonous berries during the severe winter of that year. 5. Moral Evidence. — The moral evidence of poisoning is generally left to the jury to decide j but the value of this kind of evidence, in many cases, can only be fully appreciated by a medical witness. To render this part of the subject as complete as possible, a few re- marks may not be out of place. The suspicious con- duct of the prisoner before and after the event, the recent purchase of poison, the mode of administration, the object of the prisoner in getting rid of his supposed victim, and the fact of several persons being alike affected, should be carefully noted down. The anxiety evinced during the illness of the deceased, and the hurry in the funeral arrangements, as showing an over- anxiety to remove all traces of his guilt, are suspicious. The probability of suicide is weakened by the state of the mind and the nature of the dying declarations of the deceased. In the case of a person indicted for poisoning, evidence to show motive in another case is admissible. E. v. Geering, 18 L.J. (M.C.) 215 ; E. v. Heeson or Johnson. Lastly, it remains to be considered — What is the duty of a medical man who suspects the action of poison in a patient on ivhom he is in attendance ? In the case of E. v. Wooler, Baron Martin, who tried the case, in his charge to the jury, stated that, in his opinion, the medical men in attendance ought, ' when the idea of poisoning struck them, to have com- TOXICOLOGY. 205 municated their suspicion to the husband, if they did not suspect him; and if they did suspect him, they ought to have gone before a magistrate.' Suppose they had acted as the learned judge suggested, and spoken to the husband, he would, in all probability, have desisted from his terrible design for a time, and a great criminal would have been let loose on society, and without punishment. Then, again, had they applied to the magistrates, the delay caused by the indecision of the magistrates how to act in so delicate a case would have allowed the criminal to remove all traces of his design, and the means of testing their suspicions would have been lost ; and, along with this, would have been lost the professional character and fortunes of the authors of the investigation. ' There is a third course,' says Sir E. Christison, 6 and in my opinion it is the fittest of all. When the medical attendant is satisfied of the fact of poisoning, he should communicate his conviction to the patient himself. His predicament, in every other way, is so embarrassing, that he ought not to be deterred by the chance of injury to his patient from making so dreadful a disclosure. 1 See an account of the same course being adopted in the case of Mr Blandy by his physician, Dr Addington, reported in Howell's 1 State Trials,' vol. xviii. Summary of the general Evidence of Poisoning, placed in a Tabular Form. Poison. 1. The symptoms come on suddenly, and rapidly progress. 2. The symptoms begin while the person is in sound health. Natueal Causes. 1. Many diseases come on suddenly — cholera, gastritis — and run a rapid course to a fatal termination. 2. Most acute diseases begin under like circumstances. 1 See also Sir R. Christison's paper on the Wooler case, ' Edinburgh Medical Journal,' vol. i., 1856. 206 FORENSIC MEDICINE. 3. The symptoms of poison- ing go on from bad to worse in a steady increase. 4. Uniformity in the nature of the symptoms. 5. The symptoms come on immediately after a meal. 6. Several persons are at- tacked after partaking of the same meal with the same symp- toms. 7. Poison found in the food, vomited matters, urine, etc. 3. This is also the case with many common diseases. 4. The uniformity of the symptoms is common to many diseases ; but in some cases the absence of uniformity may be a proof of disease. 5. Apoplexy, colic, cholera, and some other diseases, may follow a meal. But the fact that some hours have elapsed since the last meal is against the probability of poisoning. 6. As a general principle, it may be stated that there is no disease likely to attack several persons at once, but cases are on record of this having oc- curred. 7. Poison may be mixed with the food, etc. , in cases of imputed poisoning. Poison may not be found in the body, due to the following causes: — a. Discharged by vomiting and purging. b. The poison may have been absorbed. c. The excess of the poison may have become de- composed. (I Absence of the poison due to absorption and ultimate elimination by the kidneys, etc. TOXICOLOGY. 207 The following Table gives the names of the diseases whose symptoms resemble those the result of irritant poisons, together with such points of difference as may assist in distinguishing the one from the other : — IRRITANT POISON". Symptoms of vio- lent irritation in one or more portions of the alimentary canal. Pricking and burn- ing of the tongue and mouth, con- striction of the throat, and intense thirst. Great abdo- minal pain and ten- derness. Yomiting and purging are also usually present. The skin is hot and cold at intervals ; the pulse small, frequent, and irregular. In the last stage the skin may become icy-cold. An acrid, metallic, or burning taste in the mouth precedes the vomit- ing. The vomit is generally mixed with blood. Death occurs in from six hours to two days and a-half. CHOLERA. Extreme and sud- den prostration. The breath is cold to the hand in the last stages. The body is cold, shrivelled, and livid, or of a leaden hue. Yomiting and purging are present; the former is never bloody, the latter re- sembling rice water. The thirst is intense, and in this particu- lar alone resembles the effects of irritant poison. Death in from one to two days, or even less. ENGLISH CHOLERA. In this disease all the symptoms of irritant poisoning are present. Pain in the belly, and vomit- ing. But in this disease the vomit is never bloody, most frequently bilious. An acrid taste in the mouth and throat succeeds the vomit- ing. This is due to the acrid nature of the vomited mat- ters. The stools contain bile in Eng- lish cholera, in irri- tant poisoning some- times blood. Death is rare within three days. 208 FORENSIC MEDICINE. Table continued. GASTKITIS. Acute gastri- tis is so rare in this country as scarcely to need description. Most of the cases recorded of acute gastri- tis have been found to be due to irritants. ENTERITIS. Though more common than gastritis, en- teritis is a rare disease. The bowels are generally con- fined. Tuber- cular and aph- thous inflam- mation of the intestines may simulate irri- tant poison- ing, especially chronic poi- soning by arsenic. The post - mortem will reveal the true cause of death. PERITONITIS. In the early stages of the disease vomit- ing is rare, and constipation is the rule. The morbid ap- pearances in the peritone- um are seldom caused by irri- tants. PERFORATION OF THE STOMACH The symp- toms supervene immediately after a meal; the pain, which is very acute, gradually ex- tending over the abdomen. In most cases the patient suf- fers for some time pre- viously from dyspepsia. TOXICOLOGY. Table continued. 209 HERNIA. Examine the seat of pain, the cause will be soon detected. But an omental hernia may be present, giving rise to twisting pain at um- bilicus. Post- mortem will decide. INTUSSUSCEP- TION OF THE BOWELS. Pain, sudden and confined to one spot below the stomach. Yomiting is present with- out purging, thus differing from diarrhoea and cholera. After a time the vomit be- comes fsecal. COLIC. May be con- founded with poisoning by the salts of lead. If lead be taken in large doses, it produces the symptoms common to ir- ritant poisons added to those of colic. In chronic lead poisoning, the blue line round the gums, the as- pect of the patient, and history of the case, point to the true cause of the symp- toms. Lead colic is also generally ac- companied with extreme depression of spirits. INTERNAL RUPTURE OF ORGANS. Eupture of the stomach, duodenum, gall bladder, and impreg- nated uterus is of rare occur- rence. The autopsy will show the true cause of death. 210 FORENSIC MEDICINE. Tlie f allotting Table gives the names of the diseases whose symptoms resemble those the result of narcotic poisoning, together with such points of difference as may assist in distinguishing the one from the other : — NARCOTIC POISONING. Giddiness, head- ache, drowsiness, and considerable diffi- culty in keeping awake. Paralysis of the muscles, convul- sions, ending in pro- found coma and death. The symp- toms of narcotic poisoning begin not later than an hour, or at most two hours, after the poison is taken, except in the case of poisonous fungi and spurred rye, when a day or two may elapse. The symptoms of narcotic poisoning advance gradually. The per- son may, in most cases, be roused from the deepest lethargy. The pupil in opium- poisoning is almost always contracted. Recovery seldom oc- curs after twelve hours ; in most cases, death takes place in six or eight hours — the shortest time being three hours. APOPLEXY. In some cases apo- plexy is preceded by warning symptoms — headache and gid- diness. As a rule, apoplexy is a dis- ease of old age, and of stout, plethoric people. If the symp- toms do not come on for some hours after food or drink has been taken, this disease is to be ex- pected ; but it may occur at or immedi- ately after a meal, too soon to be the result of the action of narcotics — ten to thirty minutes always elapsing be- fore these poisons act. Apoplexy gene- rally comes on sud- denly, coma at once present. Seldom possible to rouse the person when the sopor of apo- plexy is fully formed. The pupil in apoplexy is usu- ally dilated. Apo- plexy may last for days, or death may occur in an hour. EPILEPSY. Loss of conscious- ness and presence of convulsions mark this disease ; and in these it resembles poisoning by prussic acid. Epilepsy is in most cases a chronic disease. Warnings — aura epileptica — are often present. The fit begins vio- lently and abruptly. The paroxysm gene- rally lasts for some time, and death rarely occurs during the first attack. CORROSIVE POISONS. 211 Table shotting Points of Difference in the Action of Corrosive and Irritant Poisons. Corrosives. 1. Destruction of the parts to which they are applied. No remote action on the system. 2. Symptoms supervene im- mediately they are swallowed, and consist of a burning, scald- ing pain felt in the mouth, gullet, and stomach. 3. Death may result from — a. Shock. b. Extensive destruction of the parts touched. c. Starvation. cl. Suffocation, the re- sult of oedema, or spasm due to acid in larynx. 4. Post-mortem appearances : corrosion and extensive destruc- tion of tissue. Irritants. 1. Irritation of the parts to which they are applied pro- ducing inflammation. Kemote action present in most of the irritants. 2. The symptoms may rapidly supervene after they are taken, or some delay may occur, due to the state of concentration or dilution of the poison. Pain in the stomach and bowels, more or less severe, is always present with the other signs of irritation. 3. Death may result from — a. Shock. b. Irritation causing con- vulsions. c. Protracted suffering. d. Starvation. 4. Post-mortem appearances : irritation, and signs of inflam- mation, ulceration, etc. CHEMICAL. Corrosive. The Mineral Acids. General Characters. — The mineral acids have no remote effects on the system; their action is purely local. They are seldom used for the purpose of homi- cide, except in the case of young children. Ey suicides they are more frequently employed. 212 FORENSIC MEDICINE. The symptoms common to the action of these acids supervene immediately they are swallowed, and consist in a sensation of burning in the mouth and gullet. Dreadful pain is felt in the stomach, attended with constant eructations, and vomiting of a brownish or blackish matter, mixed with blood. Mucus, together with, in severe cases, portions of the mucous membrane of the stomach, may be detected in the vomited matters, which have an intensely acid reaction, changing the colour and destroying the texture of cloth or other material on which they may fall. The act of swallow- ing is attended with intense pain, and not infrequently is rendered quite impossible. The thirst is intense ; the bowels are confined, and the urine is diminished in quantity. The pulse is small and weak, and the skin clammy and cold. Respiration is performed with diffi- culty, and the countenance expresses the most intense anxiety. Sometimes, when the upper part of the wind- pipe is implicated, there is more or less cough, and difficulty of speech. The mouth is excoriated, the lips shrivelled and blistered. In children, when the acid has been poured far back into the mouth, by forcing the bottle backwards before emptying it of its contents, the mouth may more or less escape injury, and the signs of corrosive poisoning be absent. The teeth may become loose, and fall out of the mouth. The mental faculties remain clear, death generally coming on suddenly, the patient dying convulsed or suffocated. The period at which death ensues is very variable. Some cases recover, leaving the coats of the stomach more or less injured, and the general health greatly impaired. Post-mortem Changes. — The body externally is healthy. The lips and external parts of the body, which have come in contact with the acid, are charred. The mucous membrane of the mouth, shrivelled and eroded, is whitish, yellowish, or brownish, sometimes appearing ' as if it had been smeared with white paint.' CORROSIVE POISONS. 213 Much of the appearance above described will depend upon the rapidity with which death has followed the swallowing of the poison. The month, gullet, and trachea may alone show any signs of the corrosive action, the acid never having reached the stomach. The stomach, in some cases more or less contracted and perforated by the corroding action of the acid, may con- tain a dark grumous liquid, the acidity of which will depend upon the treatment adopted, or the length of time that may have elapsed from the swallowing of the acid to the fatal termination. The stomach also appears as if carbonised, this being due to the action of the acid on the effused blood; no such appearance being produced when sulphuric acid is poured into the dead stomach. The blood, Casper states, is never fluid in acute poisoning by sulphuric acid, but always ' syrupy at least, and sometimes ropy; it has a cherry-red colour, and acid reaction' There are two things which may render the diagnosis difficult — 1. Gastric Ulcer. 2. Post-mortem Digestion of the Stomach. Gastric ulcers vary in size from that of a fourpenny piece to that of a florin, or larger. In shape, they are round or oval, and present the appearance of shallow but level pits, with sharp, smooth vertical edges, ap- pearing as if they had been punched out. The peri- toneal opening is smaller than that on the internal surface of the stomach. The absence of injury to the mouth and gullet will distinguish postmortem softening from the action of corrosive poisons. Sulphuric acid is said to possess powerful antiseptic properties, and that bodies of those who have died from its effects remain long fresh. General Treatment. — Chalk, carbonate of magnesia, the plaster from the walls or ceiling of the apartment stirred in water, and followed by diluent drinks — 214 FORENSIC MEDICINE. barley water, linseed tea, etc. The use of the stomach- pump is contra-indicated. Sulphuric Acid. Forms. — Sulphuric acid occurs in two forms, concen- trated and diluted. Characters. — Concentrated sulphuric acid, as it is found in commerce, is a heavy, oily, colourless, or slightly brownish-coloured liquid, not fuming when exposed to the atmosphere ; but when added to water, causing a rapid increase of temperature, which may crack the glass vessel in which the mixture is made. Sulphuric acid chars and destroys the texture of organic bodies placed in it. Dilute sulphuric acid is a colourless, strongly acid liquid, reddening litmus, and charring paper dipped into it when subsequently dried, care being taken not to scorch the paper. Symptoms, etc. — The symptoms and post-mortem signs have been already described, p. 212 et seq. Chemical Analysis and Tests. — The acid will have to be examined under the following heads : — 1. Simple, concentrated acid. 2. Dilute acid. 3. Mixed with organic liquids, food, vomit, etc. 4. On the clothes of the person injured. 1. Concentrated Acid. a. Chars Organic Matter. — A piece of wood or paper placed in the strong acid rapidly becomes blackened. b. Heat tvhen added to Water. — Equal quantities of acid and water added together produce intense heat. c. Evolution of Sulphurous Acid. — When boiled with chips of wood, copper cuttings, or mercury, fumes of sulphurous acid are evolved, detected by their sulphur- like odour, and by their power of first bluing and then bleaching starched paper dipped in iodic acid. SULPHUKIC ACID. 215 2. Dilute Acid. a. Chars Paper. — This only occurs when the paper is dried by the aid of heat, subsequently to moistening it in the dilute acid. b. Precipitation of Sulphate of Barium. — A solution of the nitrate or of the chloride of barium is precipitated by sulphuric acid in the form of a white insoluble powder, unaffected by nitric or hydrochloric acid, even when heat is applied. This test is so delicate, that a liquid containing 1-2 5, 00 Oth by weight of the acid is precipitated by either of the test solutions. c. Action of Heat. — The dilute acid is entirely vola- tilised by heat. 3. Mixed with Organic Liquids, etc. In tea, coffee, or beer, the mode of applying the tests are the same, the mixture being previously fil- tered. The following cautions are necessary : — Objection A. — Alum, or any acid sulphate, would give all the reactions with the nitrate and chloride of barium. Answer A. — Evaporate a portion of the doubtful liquid; if pure acid, there will be no residue, some- times only the slightest trace of sulphate of lead. ' Objection B. — Erroneous estimation of free sulphuric acid, in consequence of the presence of some saline or neutral sulphates. Answer B. — Evaporate as before. The free sulphuric acid separated by warming the liquid is then added to a known weight of powdered carbonate of baryta until effervescence ceases. The resulting precipitate, when weighed, represents the free sulphuric acid present. Calculate in the following manner BA,C0 3 + H 2 S0 4 = BA,S0 4 +H 2 + OC0 2 . BA,C0 3 = 197. H 2 S0 4 = 98. C0 2 = 44. In the above equation, 98 parts of H 2 S0 4 take the 216 FORENSIC MEDICINE. place of 44 parts of C0 2 . If, therefore, 100 grains of BA,C0 3 renders the liquid nentral, the amount of free S0 4 present will be represented by the increased weight of the precipitate in the proportion of 54 to 98, the differ- ence between 44 and 98 the equivalent of C0 2 + S0 4 . 4. Stains on the Clothes, etc. a. The strong acid changes the colour of black woollen cloth to a dirty brown, the edges of the spots assuming a reddish tint after a few days. The dilute acid on the same cloth produces a red stain, which in time becomes brown. b. The spots made by the strong acid remain damp for some time; strong sulphuric acid having a great affinity for water, continually absorbs moisture from the atmosphere. c. The spot should be cut out, boiled in water, fil- tered and tested for free sulphuric acid. d. A portion of the cloth not touched by the acid should be tested, in order to show that the sulphuric acid found is not due to sulphates present in the cloth. e. An acid sulphate — bisulphate of potash — gives a reddish stain to black cloth like that produced by the dilute acid. Test for this salt by incineration. Fatal Period. — Average time before death ensues is from two to twenty-four hours. The shortest time was one hour, but in children death may be instantaneous. Life, however, may be prolonged for some weeks, or even months. Fatal Dose. — One drachm in a healthy adult has proved fatal ; on the other hand, however, four ounces have been swallowed without being fatal. Treatment. — As before mentioned. N.B. — This acid of late years has given rise to several actions, it having been employed to disfigure the person by throwing it in the face. NITRIC ACID. 217 Nitric Acid. Forms. — Strong nitric acid, and dilute nitric acid. Characters. — This acid is commonly known as aqua fortis, or red spirit of nitre. It is seldom used as a poison. The strong acid varies in colour from a pale yellow to a deep orange. The colour is due to admixture with peroxide of nitrogen. On cloth and articles of dress it produces yellow stains, which are darkened by the application of an alkali. If poured on copper cuttings, reddish fumes of nitrous acid are given off. The vapour of this acid has caused death. Dilute nitric acid is a colourless acid liquid, not precipitated by nitrate of barium or nitrate of silver, showing absence of sulphuric and hydrochloric acids. All its alkaline salts are soluble in water. Symptoms. — The symptoms have been before de- scribed, and are similar to those produced by sulphuric acid, though not quite so severe. Chemical Analysis. — Nitric, like sulphuric acid, will be examined under four heads : — L Strong, concentrated acid. 2. Dilute acid. 3. Mixed with organic liquids, etc. 4. On the clothes of the person injured. 1. Concentrated Acid. a. Volatility. — When exposed to the atmosphere, strong nitric acid gives off colourless or orange-coloured acid fumes. Heated in a watch-glass, it is evaporated without residue. b. Action on Organic Matter. — The acid leaves on woollen clothes a yelloio-colowed stain, which is dark- ened by the addition of an alkali. The colour of the stain is due to the formation of picric acid. c. Action on Metals. — Gently heated in a test tube with copper filings, orange-coloured fumes are given off, 218 FOKENSIC MEDICINE. which redden but do not bleach litmus paper. Starch paper treated with iodide of potassium becomes purple. d. Solution of Gold. — If a small portion of gold leaf be put into the acid, no effect is produced ; but on the addition of concentrated hydrochloric acid, the metal is rapidly dissolved. 2. Dilute Acid. a. Absence of sulphuric and hydrochloric acids, proved by no precipitate being formed with nitrate of barium and nitrate of silver. b. If a piece of filtering paper be dipped into a solu- tion of the acid saturated with carbonate of potash, it will burn like touch-paper. c. The acid liquid saturated with carbonate of potash and evaporated, deposits fluted prisms. d. A crystal, so formed, moistened with distilled water on a plate, and then heated with strong sulphuric acid, and allowed to cool, gives with — a. A piece of green sulphate of iron — a dark green ring round the crystal. b. A small portion of morphia — a rich orange colour, a yellow liquid being formed. c. A small portion of brucia — a blood-red colour. 3. Mixed with Organic Liquids, etc. Due to the measures employed by way of treatment, the vomited matters may be neutral and yet nitric acid be present. The method adopted with viscid and turbid organic mixtures is to dilute them with pure water, and then filter. If the filtrate be acid, it is neutralised with carbonate of potash, evaporated, and then set aside to crystallise, the crystals purified by digesting them in ether or alcohol. The crystals are again dissolved and re-crystallised. The tests just mentioned should then be employed. It should be remembered that nitric acid HYDROCHLORIC ACID. 219 has a strong tendency to combine with solid organic structures, and to become decomposed. The parts of the body stained by the acid should therefore be digested in water at a gentle heat, the liquid cooled, fil- tered, and neutralised with carbonate of potash, and then examined for nitre. 4. Stains on the Clothes, etc. Macerate the piece of cloth in distilled water by the aid of heat. If the solution be acid, neutralise with carbonate of potash, and filter. Test the solution as before mentioned. The action of a dilute solution of caustic potash on the following stains on cloth is characteristic : — Nitric acid stain becomes of a clear orange tint. Iodine stain disappears. Bile stain remains unchanged. Fatal Period. — Death may take place in an hour and a-half, or life may be prolonged for some months. Fatal Dose. — Two drachms. Treatment. — As before mentioned when speaking of the acids generally. Hydrochloric Acid. Syn. Muriatic Acid. Spirit of Salt. Forms. — Strong and dilute acid. Characters. — Strong hydrochloric acid is either colourless or has a bright-yellow tint, due to the pre- sence of the perchloride of iron. It fumes in the air, and gives rise to dense white fumes when a glass rod moistened with ammonia is held over the surface of the acid. The dilide acid is colourless. Symptoms. — Poisoning with muriatic acid is so rare that the symptoms have not been well studied, but 220 FOKENSIC MEDICINE. they do not appear to differ much from those produced by the action of the other acids. Chemical Analysis. — The acid will have to be examined under the following heads : — 1. Simple, concentrated acid. 2. Dilute acid. 3. Mixed with organic liquids, food, etc. 4. On the clothes of the person injured. 1. Concentrated Acid. a. Action on Organic Matter. — The strong acid tinges most organic tissues, when immersed in it, a yellow colour. The stains on black cloth are at first distinctly red, becoming reddish-brown after a few days. b. Action on Metals. — This acid does not act on copper or mercury. c. Hydrochloric acid added to peroxide of manganese, and then warmed, gives off chlorine gas, detected by its greenish-yellow colour and suffocating odour. The vapour thus produced bleaches litmus paper, and causes a blue coloration on starch paper moistened with iodide of potassium. 2. Dilute Acid. a. Decomposes alkaline carbonates, chlorides being formed, which, when heated in the solid state with strong sulphuric acid and peroxide of manganese, evolve chlorine gas, known by the before-mentioned tests. b. ^ Precipitation of Chloride of Silver. — A white curdled precipitate of chloride of silver is thrown down when a solution of nitrate of silver is added to hydro- chloric acid. This precipitate becomes grey on exposure to light. If a portion of the precipitate be added to ammonia, it will dissolve ; another portion, when boiled with nitric acid, is unaffected, and a third portion, ignited in a capsule, becomes converted into a horny mass. In any case where there is a doubt as to whether the HYDROCHLORIC ACID. 221 hydrochloric acid exists in the free state, or is only pre- sent in the form of chlorides, the following test should be resorted to, which will not only discriminate between the two forms, but give the relative amounts of each present : — Take two equal measures of the acid liquid. Pre- cipitate one with nitrate of silver, after the addition of nitric acid, and weigh the precipitate. Evaporate the second portion of the acid liquid to dryness, and dry the residue in a water-bath ; dissolve this residue in distilled water, and treat the solution with nitrate of silver as before, weighing any precipitate which occurs. The weight of chloride of silver obtained from the first portion of the liquid will give all the hydrochloric acid present, both in the free state and in combination, while the weight of the silver precipitate in the second portion of liquid only gives the chlorides, all free hydrochloric acid having passed off during the process of evaporation. 3. Mixed with Organic Liquids, etc. The suspected acid liquid should be filtered, and then distilled almost to dryness. The portion of the distillate which comes over at first may be thrown away ; but the latter portion will give all the reaction before described for hydrochloric acid, if that be pre- sent. Distillation is adopted in the case of this acid, as it is more volatile than either sulphuric or nitric acid. It may be objected that the acid found in the vomited matters is from the gastric juice. In answer, it may be stated that the free hydrochloric acid in normal gastric juice is only about five grains in sixteen ounces, an amount which would give but slight reaction with the tests. 4. Stains on the Clothes, etc. The spots produced by the action of the acid on black cloth are at first of a bright-red colour, changing in ten or twelve days to reddish-brown. These spots 222 FORENSIC MEDICINE. may be cut out and macerated in warm water; the liquid thus obtained being tested by nitrate of silver and the other tests before noticed. Another portion of the cloth should be treated in the same manner, and the resulting liquid tested, as a set off against the objection that the acid was present in the cloth. Hydrochloric acid has been used to erase writing from paper, in attempts at forgery, etc. The paper must be treated in the same manner as mentioned for the cloth, and the tests used. Sometimes oxalic acid is employed for a like purpose, in which case the nitrate of silver will give a precipitate ; but the oxalate of silver is soluble in nitric acid ; the chloride is not soluble even when boiled. Fatal Period. — From four or five hours to thirty hours or more. Fatal Dose. — One ounce. Treatment. — The same as for the other acids. Table showing the Colour Produced by the Action of the Mineral Acids on the Skin. Nitric Acid. Bright-yellow, due to the formation of picric acid. Colour heightened by alkalies. Sulphuric Acid. Brown colour. Hydrochloric A cid. White colour. Carbolic Acid. Phenic Acid. Coal-tar Creosote. Oil of Tar. Carbolic acid is obtained in the dry distillation of coal, and forms the acid portion of coal-tar oil, from which it is subsequently extracted by shaking the crude coal- tar oil with a mixture of slaked lime and water. After allowing the mixture to stand for some time, the watery CARBOLIC ACID. 223 portion is separated from the undissolved oil, the former treated with hydrochloric acid, and the resulting oily fluid purified by careful distillation. Pure carbolic acid forms long colourless prismatic needles, which melt at 35° C. into an oily liquid. It boils at 180° C, and greatly resembles creasote, for which it is very frequently substituted in commerce. Sp. gr. 1-065. It possesses a penetrating, characteristic odour, burning taste, slightly soluble in water, but freely so in glycerine, ether, and alcohol, and with no acid reaction to test paper. When undiluted, it attacks the skin, which it shrivels up. Creasote is obtained from wood-tar, to which it imparts its caustic properties. Carbolic acid acts as a corrosive on the skin and mucous membranes, and as a narcotic on the brain. Its poisonous properties are equally exerted whether it be swallowed or merely applied to the skin, especially if a wound be present. Effects on the Skin, etc. — Strong carbolic acid, when applied to the skin, corrugates, hardens, and destroys its sensibility, and is said to whiten, though in two cases I have seen, one where the acid had been taken with a suicidal intent, there was after death a dark-brownish ring about half-an-inch wide surrounding the mouth; the other, a child who, in climbing to a shelf, poured over its face and neck about half a saucerful of the acid. The colour of the skin touched by the acid was yellowish-white and yellowish-brown, dry and parch- ment like. The action of the acid on mucous membranes is similar to that on the skin, but the corrugation is more marked, and considerable softening and peeling may also take place. Effects on the Nervous System. — Eapidly supervening stupor, total muscular relaxation, anaesthesia, and ster- torous breathing, are among the most prominent symptoms. Nearly all the sufferers die comatose. General Symptoms. — As soon as the acid is swal- 224 FORENSIC MEDICINE. lowed the patient complains of intense burning pain in the month, throat, and stomach, the pupils are con- tracted, the conjunctiva insensible to touch, the skin cold and clammy, the temperature rapidly falls, and the pulse becomes weaker and weaker, till it is almost imperceptible. The breathing is laboured, and, as the fatal issue approaches, becomes stertorous ; vomiting of frothy mucus occurs in some cases. The invasion of the symptoms is most rapid, and many of the patients have been in an insensible condition when found. These symptoms have even supervened when the strong acid has been used for dressing wounds. Dr. J. Hamilton {British Medical Journal, p. 226, vol. i., 1873) records a case where the acid was used as an application to a wound four inches long in a child four and a-half years of age. Direct contact of the acid with the wound was prevented. About an hour after the dressing was applied he saw the patient, who was then supposed to be suffering from the effects of chloroform used during the operation on the child's arm. She was suffering from symptoms like those before described. On removing the dressing, some of the carbolic acid, it was found, had melted and run into the wound, and to this Dr Hamilton attributed the symptoms. The child idtimately died. The urine and faeces, when passed, are of a dark colour. Post-mortem Appearances. — If the poison have been drunk, a dark-brownish horny rim may be found soon after death round the lips, the mucous membrane of the mouth and stomach is whitened, corrugated, and softened, and looks as if smeared with white-lead, in some cases horny in patches, inflammatory signs being absent or only slightly visible. The blood is uniformly fluid, becoming a bright-red on exposure. The smell of carbolic acid is detected in the stomach, and some- times in the small intestine, and even in the spleen, liver, and kidneys. In Dr Ferrier's case, the urine found in the bladder after death had a slight olive CARBOLIC ACID. 225 oreenish tint with a peculiar mixed odour, which gave the usual reactions to the tests for carbolic acid. The left ventricle of the heart is, in most cases, found con- • ' tracted, the right flaccid. The lungs are congested, and this may also be the case with the vessels of the bram. Chemical Analysis.— Bromine water, as recommended by Landolt, gives a bulky yellowish precipitate of tribromophenol. The precipitate should then be col- lected, well washed, and gently warmed in a test tube with sodium-amalgam and water. The liquid poured into a dish and acidulated will, if phenol be present, give the characteristic odour of that substance, and may be seen floating in the liquid as an oily fluid. By this test, one part of phenol in 43*700 of water may be detected. It must be remembered that, according to Landolt, carbolic acid is normally present in the urine, but Hoppe Seyler contends that it is not originally present in urine, but is formed by the action of sulphuric acid, probably from indican. A solution of carbolic acid, mixed with one fourth ot its volume of ammonia and a few drops of bleaching- powder solution (1 in 20 of water), and then warmed, but not boiled, assumes a blue colour (green in very dilute solutions), becoming red on the addition of sul- phuric or hydrochloric acid. Fatal Period— One hour or more. Fatal Dose— An ounce, probably less. Treatment— Stomach-pump, and the administration of oil and demulcent drinks. Oil is the best outward application to the skin. 226 FORENSIC MEDICINE. THE ALKALIES. Potash. Soda. Ammonia. Poisoning by the use of the alkalies is very rare. For the sake of convenience, and as the symptoms pro- duced by soda and potash, taken in large doses, do not greatly differ, one description will do for both : — Potash is found in commerce as — 1. Caustic potash, either solid or in solution. 2. Carbonate and bicarbonate. 3. Pearl-ash and soap-lees. Soda is found as — 1. Caustic soda. 2. Carbonate and bicarbonate. 3. Soap-lees, carbonate of soda mixed with caustic alkali. General Characters, — Like the inorganic acids, the alkalies destroy the animal tissues with which they come in contact. Their action is local, no specific remote effects being produced. They are seldom, if ever, used for the purpose of homicide; the deaths caused by them are in most cases the result of accident. When injected directly into the veins of animals, the action of potash and soda appears to differ, the former arresting the action of the heart, the latter arresting the circulation of the pulmonary capillaries— death ensuing in both cases. Symptoms. — During the act of swallowing, the patient complains of a caustic taste, accompanied with a sensa- tion of burning in the mouth and throat, extending into the stomach. Vomiting may or may not be present ; but in severe cases, when it does occur, the vomited matters may be mixed with blood. The surface of the body is cold, and bathed in a cold sweat. Purging is generally present, accompanied with intense pain and AMMONIA. 227 straining. The pulse is weak and quick, and the countenance anxious. The post-mortem appearances are inflammation and softening of the mucous membrane of the mouth, gullet, and stomach, which may also be covered with chocolate or black-coloured spots. Where life has been pro- longed for some months the stomach may become con- tracted, the pyloric orifice scarcely admitting the passage of a fine probe. Chemical Analysis. — The following table will show the reaction of these alkalies with reagents. The carbonates effervesce on the addition of an acid. To distinguish Caustic Potash from Caustic Soda. POTASH. SODA. Bichloride of Pla- tinum. Canary - coloured pre- cipitate in solutions acidulated with hy- drochloric acid. ISTo precipitate. Strong solution of Tartaric Acid. Precipitate in granular white crystals. No precipitate. Colour given to flame. Kose or lilac tint. Yellow Tint. In Organic Mixtures. — If the mixture be strongly alkaline, filter and test as before. Fatal Period. — From three hours to as many years. Fatal Dose. — About half-an-ounce of the caustic alkali. Treatment. — Water freely. Drinks containing citric or acetic acid, vinegar, lemon juice, oil, linseed tea, and other demulcent drinks. Ammonia. In vapour, in solution, or solid. Symptoms. — The vapour may cause death by pro- ducing inflammation of the larynx and lungs. The 228 FOEENSIC MEDICINE. symptoms to which it gives rise are a feeling of choking, and a suspension of the power of breathing. Intense heat and pain are felt in the throat, which may remain for some time. When ammonia is swallowed in solu- tion, the symptoms produced are not unlike those the result of the action of soda or potash, only more intense. Dr Patterson records the history of a case of a poor man who drank about an ounce of the liquid ammonia. When seen his lips were livid, breathing stridulous, aspect anxious, extremities cold, pulse 100, inside of mouth, tongue, fauces, as far as visible, red, raw, and fiery-looking. He died suddenly, nineteen days after the accident, of laryngismus stridulus. The jpost-mortem appearances are those found in most cases of poisoning by corrosives. CJiemical Analysis. — The vapour of ammonia is easily set free and recognised by its pungent odour. The carbonate effervesces when an acid is added to it, and gives a white precipitate with salts of lime. Fatal Period. — Death has been known to occur in four minutes, but life may be prolonged for some time, the person dying of some thoracic trouble. Fatal Dose. — A tea-spoonful of the strong solution. Treatment. — Vinegar and water, lime-juice and oil, and leeches to the throat if the inflammatory symptoms be severe. The rest of the treatment will depend upon the symptoms present. CHLORIDE OF ZINC. 229 CAUSTIC SALTS. Chloride of Antimony ; Chloride of Zinc ; Chloride of Tin ; Nitrate of Silver, Chloride of Antimony. Butter of Antimony. Chloride of antimony is a corrosive liquid. The colour varies from a light-yellow to a dark-red. Though a powerful poison, it is seldom taken for that purpose. It has been taken by mistake for ginger beer. On the addition of water, the white oxycliloride is precipitated. Symptoms. — The symptoms produced by swallowing this substance are those of corrosive poisoning. The mouth and throat are excoriated, the skin cold and clammy, and the pulse feeble and quick. Severe pain is felt in the stomach, and vomiting is incessant. Post-mortem Appearances. — Those found after cor- rosive poisoning. Chemical Analysis. — When poured into water, the chloride is ' precipitated ; the precipitate, soluble in tartaric acid, becomes orange-red on the addition of hydrogen sulphide. The supernatant liquid will give a white precipitate with nitrate of silver, showing the presence of hydro chloric acid. Treatment. — Milk, magnesia, and infusions contain- ing tannin. Chloride of Zinc. This substance is a powerful corrosive. It is em- ployed as a disinfectant, and is sold to the public under the name of ' Sir W. Burnett's Fluid.' This prepara- tion, which is a strong solution of the chloride of zinc, has caused death by being mistaken for 1 fluid magnesia,' 230 FORENSIC MEDICINE. and in one case for pale ale. It is also used in the treatment of cancer and other tumours as an external application. Symptoms. — The symptoms come on immediately after the poison is swallowed. Chloride of zinc acts as a powerful corrosive, accompanied with all the symp- toms which have been before described when speaking under the head of corrosive poisons. The nervous sys- tem is also powerfully affected. Post-mortem Appearances. — Those of corrosive poison- ing in its most violent form. The mouth, throat, stomach, and intestines are often found hardened, white, opaque, and corrugated. Chemical Analysis. — Ammonium sulphide gives a white precipitate, insoluble in caustic alkalies. Hydro- gen sulphide a white precipitate in neutral solutions, but no precipitate when the free mineral acids are present. Potassium ferro-cyanide gives a white precipitate. Test for chloride with nitrate of silver. Treatment. — "White of eggs, emetics, followed by demulcent drinks. Tin. This metal requires but little notice; but the two chlorides — protochloride and the perchloride — form a mixture used in the arts, and known as Dyer's Mixture. They act as irritant poisons, but are seldom used as such. Silver. The only preparation of silver requiring notice is the nitrate ; lunar caustic, or lapis infer?ialis. It acts as a powerful corrosive. If administered for some time in small doses, it is deposited in the skin, which acquires a permanent dark colour. It does not appear to be eliminated by the urine, and has been dis- covered in the liver five months after its administration was discontinued. VITAL POISONS 231 The symptoms come on immediately; the vomited matters becoming blackened on exposure to light. The dark spots on the skin will also help to point to the nature of the poison. A dose of salt and water may be given by way of treatment. VULNEKANT. Glass, Enamel, and Needles. None of the above can be considered as poisons ; but should they be taken, they give rise in most cases to irritation of the stomach and bowels. Pins and needles have been swallowed without doing much harm. Mix- ing ground glass in food is a favourite mode of killing adopted by the West Indian negroes. VITAL. IRRITANTS. METALLOID. Phosphorus. Iodine. Phosphorus. Poisoning by this substance is more common in Prance than in England. In England, the deaths due to this poison are more frequently the result of accident from the incautious use of phosphorus paste for the destruction of vermin. Children have also been poisoned by sucking the heads of lucifer matches. In one case, that of a child, death followed from sucking about forty matches. It has most frequently been employed as a 232 FORENSIC MEDICINE. means of suicide, but seldom for the purpose of homi- cide. One case, however, occurred at the Bodmin Assizes in 1857. Kopf relates a case of a young woman, cet twenty-four, who died on the fourth day after swal- lowing the heads of six packets of lucifers. 1 The size of the packets is not stated. In this case the bowels were confined, and the post-mortem revealed only the redness of inflammation in the stomach and bowels. General Characters. — There are two kinds, ordinary waxy, crystalline phosphorus, and a peculiar form known as allotropic or amorphous phosphorus. As found in the shops, phosphorus is preserved in water in the form of translucent white or slightly yellow-coloured cylin- ders. It is sparingly soluble in oil, alcohol, and other hydro-carbons, but greatly so in bisulphide of carbon. White vapours are given off when it is exposed to the air, these consisting of phosphorous and phosphoric acids. Symptoms. — Phosphorus acts as an irritant poison, but some days may elapse after the poison is taken before the injurious effects become apparent. The patient may then complain of a garlic-like taste in the mouth, peculiar to poisoning by this substance. This is followed by a burning sensation in the throat, accom- panied with severe pain in the stomach and intense thirst. The belly becomes swollen, and there is vomit- ing, in some cases, of blood from the stomach, which may continue till death. The vomited matters are of a dark-green or black colour, with an odour of garlic, and sometimes appearing phosphorescent in the dark. This condition may also be observed in the motions passed. The pulse is feeble, the countenance anxious, and the surface of the body bathed in a cold sweat. In males priapism is not infrequent. The nervous and muscular debility is intense, and the patient may die in a state of collapse or during a fit of convulsions. 1 4 Allg. Wien. Med. Ztg./ No. 47, 1819; Schmidt, vol. cv., p. 296. PHOSPHORUS. 233 The liver shares in the general disorder, and jaundice, more or less intense, not infrequently occurs. Chronic poisoning, accompanied with all the symp- toms just mentioned, may result from the action of the vapour on those engaged in the manufacture of phos- phorus or of lucifer matches. In persons thus employed, necrosis of the jaws and caries of the teeth are not of infrequent occurrence. Mr Lyons states (St. Barthol. Hosp. Eep., vol. xii.) that this form of necrosis cannot attack persons who have perfectly sound teeth, but only those whose teeth are carious. Post-mortem Appearances. — Those of acute irritant poisoning, including extensive destruction of the coats of the stomach, by softening, ulceration, and perfora- tion. The stomach may contain a quantity of white vapour, having a strong smell of garlic. This white vapour has been noticed to pass from the vagina and anus of those poisoned by phosphorus. 1 The blood appears to be thoroughly disorganised; the blood-cells are colourless and transparent, their colouring matter being dissolved in the uncoagulated liquor sanguinis. In a case recorded in the Brit. Med. Joti7\, 1873 r fatty degeneration of the liver and kidneys was found a week after the poison was taken. Chemical Analysis. — The smell of phosphorus is cha- racteristic, as is also its luminosity when exposed in the dark. The following process, suggested by Mitscherlich, may be adopted for its detection : — To render the suspected matter quite fluid, water is added, previously acidulated with sulphuric acid, in order to neutralise any ammonia present. The liquid is then transferred to a glass retort, fitted with a long condensing tube passing into a receiver. Distillation is conducted in the dark, when the minutest trace of phosphorus may be detected by the luminous appear- ance of the vapour during condensation. Other modifications of this process have been suggested, See Casper, * Handbook For. Med.,' vol. ii., p. 100. 234 FORENSIC MEDICINE. in order to increase the space occupied by the phos- phorescence. By the above process one part of phosphorus may be detected in 100,000 parts of substance. Another method for the detection of this poison in very minute quantities is that proposed by Dusart (Compt. Rend. xliii., 1126), and modified by Blondlot (Compt. Rend. Hi., 1197). The test is based on the fact that when phosphorus is exposed to the action of nascent hydrogen in a Marsh's apparatus, it burns with an emerald-green flame. In order to avoid the yellow colouring of the flame produced by the sodium in glass, Blondlot recom- mends the use of a platinum jet. As the green colour is more or less interfered with by the presence of organic matters, he passes the gas through a solution of nitrate of silver; the resulting precipitate is then placed in another hydrogen apparatus, as just mentioned, and the colour of the flame of the issuing gas noted. As phos- phoric acid is taken in most articles of food, the only satisfactory evidence of phosphorus having been taken is to produce it in its free state, or at least to exhibit its luminosity. The detection of the colouring matter of lucifer matches in the stomach or vomited matters will point to the probable nature of the poison, and whence it is derived. Fated Feriod. — From four hours to twenty days or more. Fatal Dose. — One grain and a half. Treatment. — Emetics, use of the stomach-pump, and the administration of demulcent drinks, in which the hydrate of magnesia is suspended, will form the best mode of treatment. Oil should not be given, as phos- phorus is soluble in it. Turpentine has been suggested as an antidote, an emetic having been previously ad- ministered. With turpentine phosphorus forms a sper- maceti-like mass consisting of turpentine phosphorous acid. It has an acid reaction, and is converted, on ex- posure to the air, into a resinous substance, smelling like PHOSPHORUS. 235 pine-rosin. With earths and metallic oxides it forms insoluble salts. The acid is not poisonous; doses of 0*03 to 0*3 grain may be given to dogs and rabbits without any other effect than lowering of the bodily temperature. To the formation of this compound the antidotal properties of turpentine in phosphorus poison- ing are attributed. (Kohler a. Schempf DingL, pol., Jcxcix.) Synopsis of the Effects due to Poisoning by Phosphorus. 1. Which variety of phosphorus is poisonous? — The ordinary yellow phosphorus usually kept in water. The allotropic form is inert. 2. What quantity is sufficient to kill an adult ? — One grain and a-half. Case quoted by Christison, Poisons, p. 188. 3. Symptoms as regards — a. Alimentary Canal. — Pain in the stomach and belly, eructations of gas smelling like garlic, vomiting, and sometimes purging, with other signs of irritation. b. Circulatory System. — Tendency to haemor- rhage from the mouth, stomach, lungs, bladder, etc. If the case be prolonged, anaemia may be present. Pulse small, weak, and scarcely perceptible. c. Nervous System. — Cramps, creeping sensa- tions in the limbs, delirium, convulsions, paralysis, and extreme nervous prostration. d. Period of Invasion of the Symptoms. — Obscure and insidious; some hours or even days may elapse before the appearance of * the symptoms. e. Period of Fatal Termination. — In some cases as short as four hours. 4. Post-mortem Appearances — a. Alimentary Canal. — Signs of irritation and 236 FOKENSIC MEDICINE. inflammation in the stomach and intestines. Gangrene and perforation have been noticed. Strong smell of garlic when the abdomen is laid open. Appearances not unlike scurvy may be found. b. Cellular Tissue. — Ecchymosis may be present in the cellular tissue of the abdomen, chest, and other parts of the body. c. Muscular Tissue. — Fatty degeneration has been noticed in some cases. d. Liver. — Fatty degeneration of the gland. e. Blood entirely disorganised, the cells trans- parent, and their contents dissolved in the uncoagulated liquor sanguinis. The colour cherry-red. 5. Name special affection produced by phosphorus in lucifer match makers. — Necrosis of the jaws, usually of the lower jaw. The disease begins in a decayed tooth. 6. Name a natural disease which phosphorus poison- ing has been supposed to resemble. — Acute yellow atrophy of the liver. Iodine. Iodine is seldon used as a poison, owing to the difficulty experienced in disguising its colour. In the form of a strong solution it has been, however, em- ployed for throwing on the person with intent to cause grievous bodily harm, as in this form it is corrosive, and destroys the part which it touches. General Characters. — Iodine is a dark grey solid, with a bright metallic lustre. It melts at 107°, boils at 175°, and gives off at the ordinary temperature a faint odour not unlike chlorine. Eut slightly soluble in pure water, it is readily dissolved when a soluble iodide is added to the water. IODIDE OF POTASSIUM. 237 Symptoms. — Those produced by irritant poisons generally; the severity of the symptoms being increased by the strength of the solution, iodine possessing cor- rosive as well as irritant properties. Post-mortem Appearances. — Those the result of acute irritant poisoning. Fatal Period. — Two days. Fatal Dose. — One drachm or less. Treatment. — The stomach should be emptied by the aid of the stomach-pump, and then diluent drinks — arrowroot and barley water — may be given. Chemical Analysis. — Add bisulphide of carbon to the suspected mixture, and shake them together. The sulphide will dissolve out the iodine which may be obtained on evaporation and sublimed. The charac- teristic reaction of iodine, the development of a blue colour, on the addition of a small quantity of starch, will be conclusive evidence of its presence. Iodide of Potassium. This salt is largely used in medicine ; and though poisonous effects may be produced, due probably to some constitutional idiosyncrasy, it has been seldom used as a poison. It must, however, be placed among noxious irritant substances. General Characters. — Iodide of potassium — hydrio- date of potash — occurs in cubical crystals of a white or faint yellow colour, very slightly deliquescent when pure, and with a feeble odour of iodine. Symptoms. — Iodide of potassium acts as an irritant in large doses, producing also many of the symptoms which attend a violent catarrh. Small doses — three to five grains — have produced in some persons most un- pleasant and even alarming symptoms. In chronic poisoning, certain glands, the mammary and testicles, are said to waste away. Salivation is not infrequently present. See the account in Brit. Med. Jour., 1878, 238 FORENSIC MEDICINE. of a case of purpura in a child five months old, after a dose of two-and-a-half grains of the salt. Treatment. — The use of emetics and the stomach- pump, starch, etc. Chemical Analysis. — In solution, iodide of potash gives the following characteristic reactions : — a. "With a salt of lead . . Bright yellow precipitate. b. With corrosive sublimate Bright scarlet precipitate. C -^ndsS g n ! trk ? CM S A blue colour. In organic mixtures the mode of detecting it is more complicated. Sulphuretted hydrogen should be first passed through the mixture in order to convert any free iodine into hydriodic acid. The excess of the gas is then driven off by the application of heat and potash added, the resulting liquid filtered, and the filtrate evaporated to dryness. To get rid of any organic matter, the residue left after evaporation is charred at a low red heat, reduced to powder, and dissolved in water. This solu- tion is then concentrated, and strong nitric acid and solution of starch added, when, if iodine be present, the blue colour will be developed. METALLIC IKBITANTS. Arsenic. Arsenic is found as metallic arsenic, as arsenious acid, in the form of two sulphides — realgar and orpiment — and as a constituent of several ores — iron, copper, etc. Metallic arsenic is of a steel-grey colour, brittle, and sublimes at a temperature a little below 400° F., without, however, previously fusing. The vapour of the metal has a peculiar garlic-like odour, which is not possessed by any of its compounds. ARSENIC. 239 Avsenious Acid. Arsenions acid — white arsenic, the most important of all the compounds of arsenic — is colourless, odourless, and almost devoid of taste. As found in commerce, it occurs under two forms, as a white powder, and as a solid cake, which is at first nearly transparent, but soon becomes opaque, and then resembles white enamel. At a temperature of about 380° F. it sublimes, but is again deposited on cool surfaces in the form of octahedral crystals. It is but slightly soluble in cold water, only about half a grain to a grain being taken up by an ounce of water. Stirred in boiling water, and then allowed to cool, from a grain to a gram and a quarter is dissolved in the same quantity of water ; but when it is boiled for an hour, about twelve grains are dissolved in the ounce of water. This solubility is, however, diminished by the presence of any organic matter in the liquid. It is therefore less soluble in infusions of tea or coffee than in pure water. Arsenious acid is used in the arts in the manufacture of certain green colours, in dyeing, and in calico-print- ing. A weak solution is employed in medicine ; in the treatment of certain diseases of the skin, in ague, and in other diseases. It has been proposed to use arsenious acid, on account of its caustic properties, as an application for cancerous tumours. The employment of this substance for this purpose is by no means new; but its use has been revived from time to time by the charlatan. In the year 1844, a man was tried at the Chester Winter Assizes — E. v. Port — for the murder of a woman whom he pretended to cure of a cancer by the use of an arsenical plaster. In another case, recorded by M. Flandin, where death occurred, the quack declared that he had not applied more than four or five grains to the woman's breast. The powder used by these gentlemen is generally com- posed of arsenious acid, realgar, and oxide of iron. The 240 FORENSIC MEDICINE. above cases, to which many more might be added, attest to the danger which attends the application of arsenic to the surface of the body; it should therefore never be used, especially as a more safe and potent caustic for this purpose is found in the chloride of zinc. Farmers employ arsenious acid — white arsenic — for destroying vermin ; for steeping corn in order to destroy any spores of fungi ; and it also forms an ingredient in the wash for sheep. Injurious effects have followed the accidental use of the corn thus treated, and those employed in washing the sheep have suffered more or less severely. By an Act of Parliament, 14 Vict., cap. xiii., sec. 3, it is ordered that if sold in small quantities, it must be mixed with soot or indigo, ten pounds being the smallest quantity allowed to be sold unadulterated. The presence of this adulteration must be remem- bered, as a medical man may be led into an error when the vomitted matters are coloured blue or black. Arsenic is not as a rule a corrosive poison, nor does it act chemically on the animal tissues. One case is, however, on record where it acted as a corrosive. Its action is that of an irritant, causing inflammation in the stomach and bowels of those who have taken it ; and it appears that these effects are produced whether the poison be swallowed or introduced into the system in any other way, i.e., by injection into the rectum or vagina, or applied to the surface of the body. Arsenic cannot be considered in the light of an accu- mulative poison. Given in medicinal doses, it is elimi- nated in fifteen or twenty days. The kidneys speedily get rid of the poison from the body. Death may result from the application of arsenic to sores, or even if it be applied to a considerable surface of the body. It has also been injected into the vagina and into the rectum with an enema. ARSENIC. 241 Symptoms of Arsenical Poisoning. ACUTE. CHRONIC. The rapidity and virulence of the symptoms are more or less modified by the form {i.e., solution) and the quantity of the dose taken. ■ From half-an-hour to an hour is the usual time which elapses before the symptoms of poisoning present themselves. In one case, when the poison was in solution, the symptoms came on immediately after it was swal- lowed ; in another, after the lapse of ten hours. The patient first complains of a feeling of faintness and depression, followed by intense burning pain in the stomach, increased by the slightest pres- sure. Nausea and vomiting, the latter increased by the act of swallowing, now occur. The vomited matters may be darkbrown, black, or bilious ; or they may be greenish from the admixture of the indigo with the arsenic coming in contact with the yellow colouring matter of the bile. Blood may also be vomited. Purging, accompanied with straining at stool, and cramps in the calves of the legs may occur ; the purging, like the vomiting, being incessant, and affording no relief to the sufferer. The thirst is intense, the pulse feeble and irregular, and the skin cold and clammy. As a rule, the symptoms in this form of poisoning are continuous ; but cases occur in which there are distinct remissions, and even intermissions. Coma, paralysis, or tetanic convulsions, may supervene before death closes the scene. Certain anomalies may occur. — The pain may be absent or but slight. Vomiting and purging do not occur in all cases, nor is thirst, a most persistent symptom, always present. In some cases the symptoms resemble those which accompany an attack of cholera. In others, signs of collapse first make their The symptoms are not so well pronounced as in acute poisoning. The eyes become in- flamed and watery. The skin may be irri- table, and in some cases patches of a vesicular eruption — * ekzema arsenicale ' — appear. Dr Prosper de Pietra Santa describes a disease to which workers in manufac- tories of paper colour- ed with Schweinfurt- green are liable, characterised by the appearance of vesicles, pustules, * -plaques muquenses, 9 and ul- cerations on the ex- posed parts of the body, fingers, toes, and scrotum. Ar- senical poisoning has been mistaken for nettle rash and scar- let fever. Paralysis, more or less general, is not of infrequent occurrence. The suf- ferer emaciates, the hair falls off, and he dies from exhaustion. The tongue in some cases is excoriated, and salivation is also present, fcetor of the breath being well marked. Jaundice has also been noticed in some cases. The 242 FORENSIC MEDICINE. appearance, from which the patient may rally, or he may die outright. The severity of the symptoms does not appear to be affected by the form or quantity of the poison. It should also be remem- bered that arsenic may produce symp- toms closely resembling those the result of narcotic poisoning. symptoms of this form of poisoning are frequently so mislead- ing, that death due to the action of arsenic has been referred to ' spontaneous inflam- mation of the bowels.' Post-mortem Appearances. — The appearances found after death depend upon the quantity of the dose and the length of time which supervenes between the taking of the poison and death. Inflammation of the stomach is a marked effect of the action of this sub- stance on the system; and this condition is in most cases present whether the poison be swallowed, sprinkled on an ulcerated surface, or rubbed into the skin. When the poison has been swallowed, the stomach may be found covered with white patches of arsenic, embedded in dark-coloured thick mucus, mixed with blood. In the case of Pierre Emile L'Angelier, for whose murder Madeleine Smith was tried, Dr Perry found 88 grains in the stomach, although the deceased survived eight or ten hours after the probable period of taking the poison, and vomited repeatedly during the interval. At the above trial, the question was suddenly started, that if such a large quantity was found after death in the stomach, it was scarcely possible to infer the ad- ministration of a much larger quantity; and thus that the quantity must have been larger than another party could have secretly administered, or naturally would attempt to administer. Drs Mackinlay and Wylie, of Paisley, obtained 60 grains, and Sir E. Christison 30 grains more, from the stomach of a man poisoned by arsenic administered in whisky-punch sweetened, and the arsenic kept in suspension by constant stirring. The inflammatory redness is sometimes found spreading over the entire surface of the stomach; at others, at the cardiac end only. Dr Paterson thus describes ARSENIC. 243 tlie condition of a stomach he examined : — Its lining membrane was generally very red and injected ; but in addition there were very numerous stellated patches of vivid red, leading to a darker tint; in the centre of some of them was noticed a minute clot of blood ; in others, an exceedingly rough particle of a crystal- line substance, which was afterwards found to be arsenious acid. The red colour is increased on ex- posure to the air. Perforation of the stomach is very rare. Inflammation of the stomach has been known to occur within two hours after swallowing the poison. Ulceration of the same organ has occurred in a person who died from the effects of arsenic in five hours (Christison On Poisons, p. 340). The mouth, pharynx, and gullet are generally found free from any inflammatory action. The small intes- tines may or may not be affected; in most cases the duodenum alone shows any signs of irritation. The rectum is that part of the large intestine most prone to inflammation. The other internal organs — the liver, spleen, and kidneys — do not appear to be appreciably affected by arsenic. Due probably to the antiseptic properties of arsenic, the stomach and intestines retain for a long period after death the appearances of irritant poisoning. In two cases this was so well marked as to be visible, in the one case after twelve months, and in the other nineteen months after interment. The Period which may elapse after Death when Arsenic may be Detected. Arsenic is an indestructible poison, and may be found in the body after many years. In one case it was detected after the lapse of fourteen years. Arsenic has the power, to a certain extent, of arresting putre- factive changes ; the stomach may, therefore, be found well preserved, and with the signs of inflammatory 244 EOKENSIC MEDICINE. action present after the lapse of many months, and after putrefaction has far advanced in other parts of the body. When a person is suspected to have been poisoned with arsenic, and nothing but the skeleton is left for investigation, the arsenic should be looked for especially in the bones of the pelvis, and the neigh- bouring spinal vertebrae (Watt's Die. CJiem., last Sup.). The following table is taken from Taylor, and shows the amount of arsenic which may be found in the liver at the following periods : — After taking the Poison. In 5 J to 7 hours . 99 8f „ „ 15 „ . „ 17 to 20 „ . „ lOjdays „ H ,, Total Weight of Arsenic. . 0*8 grains. . i-3 ,, . 1-5 „ - 017 „ In trials for arsenical poisoning, where an exhuma-' tion has been made, the question may arise whether the arsenic found in the body has been carried into it from the earth surrounding the coffin. In reply, the following points must be kept in mind : — 1. Arsenic may occur in certain calcareous and ochrey soils. 2. In these soils no arsenical compound soluble in water has been found. 3. The arsenic of these soils is dissolved out by hydrochloric acid, proving their previous insolubility. 4. The arsenic is, therefore, probably in the form of an arsenite or arseniate of iron, lime, etc. 5. Careful experiments have rendered it evident that even 6 under the most favourable circumstances the dead human body does not acquire an impregnation of arsenic from contact with arsenical earth 1 (Taylor). 6. It has been suggested that the arsenical compound in the soil may be rendered soluble by the ammonia ARSENIC. 245 formed during putrefaction. This suggestion is nega- tived by the following facts : — a. The production of ammonia ceases before the body arrives at that stage of decomposition when it is at all likely to be exposed to the action of the soil of the cemetery. b. The production of hydrosulphuret of ammonia during decomposition would tend to the . production of sulphuret of arsenic forming yellow patches in the substance of the organs, thus rather fixing the arsenic in particular parts than allowing it to perco- late through the tissues of the body from external application. Analysis of the Suspected Earth. — About two pounds of the earth should be boiled for some time in water ; the supernatant liquid should then be poured off from the insoluble residue, and filtered. The filtered liquid, after concentration, may then be examined by the tests about to be described. If no arsenic be found, the residue may be boiled with dilute hydrochloric acid, filtered, concentrated, and then tested as before. Detection of Arsenic, General Directions. — In cases of suspected poisoning by arsenic or antimony, the contents of the stomach should be mixed with distilled water acidulated with hydrochloric acid and filtered, the filtrate placed in a stoppered bottle, and. lettered or numbered A or 1. The liver should be cut into pieces, some of which should be bruised in a mortar with distilled water acidulated as above-mentioned, pressed and filtered, the filtrate placed in a bottle, and marked B or 2. The kidneys and portions of the other solid organs may also be treated as above. Each solution so obtained may be then tested by the processes about to be de- scribed. By these means the amount of poison in each organ may be estimated. 246 FORENSIC MEDICINE. Before subjecting the organic mixture to Marsh's or Keinsch's tests, Brancle and Taylor strongly recommend a modified course of procedure. The liquid mixture, or the finely divided solid, is mixed with an excess of strong hydrochloric acid in a flask, and slowly distilled by means of a sand bath, the distillate carried into a receiver containing a little water, and the process continued nearly to dryness. If arsenic be present, the distillate contains the arsenic as chloride, and can be at once subjected with great facility to the usual tests for the presence of that metal. This mode of proceeding both facilitates and expedites the ordinary methods of testing, as it separates the arsenic present from the complex organic mixtures with which it is associated, and presents it in a com- paratively pure form for identification. Marsh's Test. This method for the detection of arsenic is founded on the fact that this metal forms a gaseous compound with nascent hydrogen, from which it may be readily separated by appropriate treatment. The usual form of the apparatus is that of a U-shaped glass-tube, about one inch in diameter and eight inches high, supported in a vertical position on a wooden stand, One end of the tube is fitted with a tap, and terminates in a glass-tube drawn to a fine point ; the other end is closed with a cork. The apparatus is used as follows: — A piece of pure zinc is dropped into the tube, and shaken into such a position that it occupies the bottom of that limb of the tube which is furnished with a tap. Water is then added, and subsequently sufficient pure sulphuric acid to cause a moderately brisk evolution of hydrogen. The gas being allowed to accumulate for a short time, the tap is then partially turned on, and the gas ignited ; if, on depressing a piece of white porcelain momentarily in the flame, no ARSENIC. 247 deposit or discoloration occur, the reagents used may be taken as pure. The tap is now connected with a tube of thin, hard glass drawn out to a fine point at the end, and having a constriction in the middle. The liquid to be tested being now placed in the apparatus, the gas is again ignited, and a piece of white procelain momentarily depressed in the flame, when, if arsenic be present, a black metallic- looking stain will appear. E. Davy {Jaliresb. 1858, p. 609) recommends the use of thick platinum plate (not thin foil), instead of porcelain or glass for receiving the stains formed by ignited arsenetted hydrogen. The stains adhere closely to the metal, and disappear with a garlic odour when gently heated. Antimony spots do not disappear when thus treated. Blondlot {Jaliresb. 1863, p. 681) states that the presence of nitric acid in the liquid, even in small quantity, prevents the formation of gaseous hydride of arsenic, the solid hydride As 4 H 2 , being then deposited in brown flocks upon the zinc. While the gas is passing, the exit tube should be heated to redness a little before the constricted part, when a dark ring will appear if arsenic be present. The black deposit on the porcelain may be either arsenic or antimony, but may be distin- guished as follows : — ANTIMONY. ARSENIC. Heated with a little nitric acid, Oxidises to a white insoluble powder. Dissolves. Warmed with a strong solution of chloride of lime, Is not dissolved. Dissolves. The nitric acid solution evapo- rated to dryness gives, with nitrate of silver, No reaction. A brick-red precipi- tate. 248 FOKENSIC MEDICINE. The portion of the tube on which the dark ring has been deposited is now cut off, broken into fragments, and heated in a small, hard glass-tube ; when, if arsenic be present, a white sublimate will be obtained of well- defined octahedral crystals. If the sublimate be treated with sulphide of ammonium, it will dissolve, and on evaporation of the solution to dryness — a residue of the yellow sulphide of arsenic — will remain, which, if heated with strong nitric acid, and evaporated again to dryness, will give a brick-red precipitate with nitrate of silver solution. Reinsch's Test, First obtain a clear solution by filtration or other- wise, and then proceed as follows : — Strongly acidify the liquid with hydrochloric acid, introduce some pieces of copper foil, and heat to near the boiling-point of the liquid. Both the acid and metal must be previously tested to ensure their freedom from arsenic. Any arsenic present will then be deposited on the copper in the metallic state, either in the form of a black lustrous deposit, when the arsenic is present in any quantity, or else as a steel-grey coating, when a minute quantity only is present. In either case, the copper foil, after remaining for some time in the suspected fluid, is taken out, introduced into the bottom of a hard glass-tube, and heated to low redness, when the arsenic will sublime as arsenious acid in octahedral crystals, forming a ring in the cooler portion of the tube. The deposit is identified as arsenious acid by the form of the crystals, and by its deportment with the various reagents, as in the treatment of similar sublimates mentioned under Marsh's Test. A solution containing arsenic acid or an alkaline arsenite, mixed with sulphuric acid, does not produce any deposit on metallic copper even after long boiling, unless the quantity of the arsenic present be considerable ; the deposition may, however, be AKSENIC. 249 ensured by adding sulphurous acid or a sulphite, whereby the arsenic is reduced to arsenious acid (G. Werther J. pr. chem. lxxxii., 286; Jahresb. 1861, p. 851). Objections to Bei?isch's Test. The chief objection to Reinsch's test is the possible impurity of the reagents used — both these reagents, even when supplied as pure, being liable to contain traces of arsenic. As met with in commerce, both hydrochloric acid and metallic copper invariably con- tain minute quantities of arsenic, the former generally containing the larger quantity of that impurity. Although, by purchasing the purest possible reagents, especially prepared for analysis, it may be possible to ensure their freedom from arsenic, yet in all cases they should be tested before using them. Some of the hydrochloric acid should be diluted with distilled water, and gently heated with the copper foil. If no tarnishing or deposit of any kind occurs on the metal after a lapse of several hours, the reagents may be taken as pure, and the trial of the suspected substance at once made. Bloxam 1 s Method for the Detection of Arsenic. Professor Bloxam has recently suggested an admir- able and delicate process for the detection of small quantities of arsenic. The method is, like that of Marsh, founded on the property possessed by nascent hydrogen, of forming a gaseous compound with arsenic ; but instead of the hydrogen being generated by the action of dilute sulphuric acid on zinc, Professor Bloxam generates the gas by an electric current. The wires from the extremities of a battery terminate in small plates of platinum foil, which are plunged into the liquid to be tested, the apparatus being so arranged 250 FORENSIC MEDICINE. that the hydrogen gas evolved from the negative pole is alone collected. The issuing gas is tested in a similar manner to that obtained in Marsh's process. This method of Professor Bloxam is exceedingly delicate, and possesses one great advantage, that no zinc being used, there is no danger of contamination by the use of impure metal ; while, as nothing foreign is introduced during the process of testing, the liquid under examina- tion is left pure for the application of other tests if necessary. Fatal Dose, — Two grains in solution have been known to cause death. Recoveries have, however, occurred after an ounce or more of the poison has been taken. Much will depend upon the fulness or emptiness of the stomach at the time the poison is taken, and also upon the vehicle in which the poison is administered. Vomit- ing and purging are more urgent when the dose is large, probably assisting to get rid of the arsenic before its fatal action is produced. Fatal Period. — From twenty minutes to two or three weeks, and even later from the secondary effects of the poison. Any thick medium, cocoa or soup, will of course delay the action of the poison. Treatment. — Vomiting should be promoted, and diluent drinks largely given. The stomach-pump, if it can be procured without much delay, should also be employed to empty the stomach. Emetics of sulphate of zinc should be given without delay, followed by the administration of milk, lime-water, and albumen. Symptoms as they occur must be treated on general principles. The hydrated sesquioxide of iron, and the hydrated oxide of magnesia, and animal charcoal have been pro- posed and used as antidotes. The sesquioxide of iron can be prepared ready to hand by saturating the tincture feri sesquichloridi with ammonia. It should be given freely. Reputed antidotes are useless when the poison is in the solid state. ARSENIC. 251 Other Poisonous Compounds of Arsenic, Arsenical Vapour. — The vapour from the flues of copper and arsenic smelting-works in Cornwall escaping into the air may cause death to cattle, and the destruc- tion of vegetation. The workmen in these works not infrequently suffer from eruptions on the skin, and from great constitutional derangement ; but on the whole, taking into consideration the dangerous nature of their employment, the men appear to enjoy average health. Actions for damage and nuisance have resulted from the escape of this vapour from the factories. Arsenite of Potash. — A solution of arsenite of potash, mixed with the tincture of red lavander. (The solution contains iv. gr. of arsenious acid in 1 oz.). Better known as Fowler's Solution, or as "Fowler's Mineral Solution, or Tasteless Ague Drop. It is probably a solution of arsenious acid in carbonate of potash, and not a true arsenite of potash. This preparation is much used as a domestic remedy in ague in the Fens of Cam- bridgeshire. Death from its use is rare • but it is nevertheless too dangerous a medicine to be used reck- lessly. Idiosyncracy has much to do with the action of the drug, some persons taking even large doses with impunity, whilst in others the smallest medicinal dose has produced alarming symptoms. Donovan's Solution. — A solution of hydriodate of arsenic and mercury. Not officinal, but still used by many practitioners. The mixture used for washing sheep, composed of tar- water, soft soap, and arsenic, has caused death in twenty- four hours. The men engaged in dipping the sheep may suffer both locally and constitutionally from the effects of the arsenic in the solution. Treatment. — As before described. Analysis. — See p. 245 et seq. Arsenite of Copper. — Scheele's green, and the aceto- arsenite of copper, Schweinfurt-green, are met with in 252 FORENSIC MEDICINE. commerce and tlie arts as green pigments. Among workmen they are familiarly known as Emerald-green, Brunswick-green, or Vienna-green. In France the term vert Anglais, or English-green, has been given to them. Scheele's green contains about 55 per cent, of pure arsenious acid ; the other, Schweinfurt-green, about 58 per cent. These colours are employed for various purposes, among which the following may be mentioned : — a. Artificial flowers and other articles of dress. h. Confectionery, pastry ornaments, and toys. c. As green paint for the insides of houses. d. In the green-colour for wall papers. e. In the green-coloured paper lining boxes, etc. The employment of Emerald-green in the colouring of wall papers is so extensive, that in the year 1860 an English paper-stainer stated that he used two tons of arsenic weekly. In 1862 the amount of this colour manufactured during the year was from 500 to 700 tons. As the colour is only loosely applied to the surface of the paper by means of a weak solution of size, it is easily brushed off, and may so impregnate the air of a room as to produce injurious effects on those who inhabit the apartment. In the case of ladies' dresses, the following method is adopted : — 6 The colouring material is made by thoroughly stirring together a mixture containing, in definite proportions, the green pigment, cold water, and starch, gum arabic, or some similar substance which shall give the colour consistence and adhesiveness. Not infrequently in this process the hand and forearm are freely used in the liquid to expedite the work. Of this mixture, pro- perly prepared, the workman takes a quantity in his fingers and roughly spreads it over the muslin or fine calico. The fabric is then beaten and kneaded between the hands until it is uniformly coloured. The longer this process is continued, the more perfect is the result. The cloth is now fastened to a frame for drying. In ORPIMENT. 253 all this process of colouring, the hands, forearms, and frequently also the face of the operative, must become soiled with the green-colour. It will be also observed that the colour is but loosely applied, no mordant being used, as in calico printing, to fix the pigment in the texture of the cloth.' Symptoms. — All the effects produced by arsenic may result from the use of articles coloured with these pig- ments. Chronic inflammation of the stomach and bowels, and irritation of the eyes, accompanied in some cases with extreme nervous debility and prostration, are by no means uncommon in those employed in the manufacture of this ' cheerful,' but poisonous, colour. The skin of the hands, arms, and scalp is often attacked by a vesicular eruption or an erythematous redness. When it is borne in mind that, according to the analysis of Hofman, a single twig of twelve artificial leaves may contain as much as ten grains of pure arsenic, it is not to be wondered at that the most serious results have occurred from the reckless use of these colours. In Prussia and Trance the use of the arsenical colours is prohibited. Analysis. — Scheele's green is insoluble in water, but is soluble in ammonia, the solution having a blue-colour, from the separation of the arsenious acid from the oxide of copper. A few drops of the blue ammoniacal solution poured on some crystals of nitrate of silver, the yellow arsenite of silver is formed. The tests before described are applicable for the detection of this sub- stance. Orpiment. Orpiment, or yellow-arsenic, one of the sulphurets of arsenic, has been used occasionally as a poison. It is also largely ^employed in the arts for paper-staining and for colouring toys. In cases of arsenical poisoning, it is this compound that is commonly found adhering to the stomach and intestines. It is formed by the 254 FORENSIC MEDICINE. sulphuretted hydrogen, the result of decomposition, acting on the white arsenic swallowed. Eealgar. Eealgar, or red-arsenic, is another of the sulphurets of arsenic, and, like orpiment, is largely used in the arts as a colour. It is also employed, like orpiment, as a depilatory, fatal results having followed its use for this purpose. The colour of this substance prohibits its frequent use as a poison. Both of these compounds owe their poisonous pro- perties to the amount of free arsenious acid which they contain, and which may be as much as 30 per cent. Symptoms. — The symptoms produced by these sub- stances are similar to those caused by arsenic. The fatal dose will depend on the amount of free arsenious acid which they may each contain. Treatment. — Emetics and demulcent drinks. Analysis. — As before. Metallic arsenic, fly powder, arsenic acid, and the arseniates of potash and soda, are all poisonous. The papier moure of the shops consists of blotting-paper steeped in a solution of arsenite of j)otash. Macquer's neutral arsenical salt is the binarseniate of potash. The symptoms are those of arsenical poisoning. Treatment. — When metallic arsenic has been taken, vomiting must be promoted by the use of proper emetics. Tartar emetic should never be used. In the treatment for poisoning with arsenic acid, or of the arseniates of potash and soda, the hydrated, oxide of iron, or the acetate of iron, should be used, as the arseniates are precipitated by the iron. Arsenuretted Hydrogen. This gas has proved fatal in several cases. It is generated in the process known as Marsh's test for TARTAR EMETIC. 255 arsenic, and is so poisonous that a very small quantity has caused death. In most cases death has been the result of accident. Symptoms. — Giddiness, fainting, constant vomiting, pain in the stomach, and suppression of urine are among the most prominent. The post-mortem appearances are inflammation of the stomach, with more or less softening of its coats. The liver and kidneys are also more or less affected, and have been found of a deep indigo colour. Analysis. — This has been described when speaking of Marsh's test for arsenic. Antimony. Antimony, the Stibium of the ancients, is obtained from the native sulphide. Metallic antimony is of a bluish-white colour, crystalline and brittle. It melts at about 840° F., and is slowly volatilised at a white heat. Two compounds of antimony — tartar emetic and chloride of antimony — are alone of any toxicological interest. Tartar Emetic. Antimonium Tartaratum. Tartarated Antimony. Tartar emetic occurs as a white powder, sometimes, however, with a yellowish tint. It may contain minute portions of arsenic. It is soluble in about three parts of boiling water and fifteen of cold, and insoluble in alcohol. The vinum antimoniale of the Pharmacopoeia contains two grains of the salt in an ounce of wine. Before 1856 poisoning by antimony was of rare occurrence, but since that year several cases of chronic poisoning have occurred, giving to this substance con- 256 FOKENSIC MEDICINE. siderable importance. The Bravo case is still in the memory of all, with its terrible miscarriage of justice. Symptoms. — Tartar emetic is an irritant poison, but possesses slight corrosive properties. When taken in large doses, two or three drachms, it gives rise to a metallic taste in the mouth, which is not easily removed. In most cases violent vomiting follows immediately after the poison is swallowed, the vomiting continuing even after the stomach is emptied of its contents. Burning pain is felt at the pit of the stomach, accom- panied with cramps in the belly and purging. There is considerable difficulty in swallowing, and the patient complains of tightness and constriction in the throat. The mouth and throat in some cases are excoriated, or covered with whitish aphthous-looking spots, which ultimately become brown or black. In some cases the thirst is intense ; in others absent, or nearly so. Cramps in the lower extremities, almost amounting in some cases to tetanic spasms, followed by extreme depression, are generally the precursor of a fatal termi- nation. The urine is not suppressed, as is the case in arsenical poisoning. The skin is in some cases covered by a pustular eruption, not unlike that of small-pox. Such is an imperfect description of acute poisoning by antimony; it now remains to consider the symptoms which mark the chronic form of poisoning. These differ chiefly in being less intense and less rapid, the fatal termination being more prolonged. Chronic poisoning by small closes is that form of poisoning which appears most in vogue of late years. The unfor- tunate victim complains of constant nausea and retching. Pood is objected to, as it only increases the vomiting. The matters vomited are at first merely mucus, but after a time they become mixed with bile. Each time the poison is repeated the symptoms become aggravated. Emaciation gradually sets in, and the person dies from complete exhaustion, or from the effects of a larger dose than usual. TARTAR EMETIC. 257 Post-mortem Appearances. — The mucous membrane of the throat, gullet, and stomach is inflamed, and in some places softened and corroded. Aphthous-looking spots are not infrequently found on the mucous mem- brane of the stomach, and these may also be observed on the throat and on the small intestines. The liver has been found in some cases of chronic poisoning, where the fatal termination has been for some time retarded, enlarged, and its structure so soft as to be easily broken down. The appearances above detailed may be more or less absent or present, according to the time that may have elapsed from the swallowing of the poison to the time at which death has occurred. Elimination of Antimony from the System. — Anti- mony, taken in a large dose, or in small doses fre- quently repeated, appears to be rapidly absorbed and then eliminated from the system by the kidneys. Dating from the time at which the poison was swal- lowed, it will be found in the organs of the body in -the following order : — a. Stomach and bowels, but slightly in the liver. b. Absent from the stomach, but present in the liver, spleen, and kidneys — traces in the blood. c. Present in the fat and bones, with traces in the liver, fseces, and urine. d. The period required for its complete elimination from the vital organs varies from fifteen to thirty days. In other words, the presence of antimony in the stomach and intestines points to the recent administra- tion of the poison ; and its absence from those organs, and presence in the others above mentioned, to a more remote period of administration. It has been suggested that in some cases the poison may be eliminated by the mucous membrane of the stomach. This assumption is negatived by the fact that antimony has been found in the other organs of the body, and not in the stomach. Fatal Dose. — It is impossible to state with certainty R 258 FORENSIC MEDICINE. the exact amount of antimony — tartar emetic — which may prove fatal, as recoveries have taken place even after an ounce had been taken. Large doses are un- certain in their effects, as the severe vomiting which they produce generally helps to get rid of the poison. In small doses, death may result from the depressing action which it exerts over the heart. Fatal Period. — From a few hours to several weeks, and even months. Treatment. — Promote vomiting by the administra- tion of warm water, or warm greasy water, and then give any vegetable infusion containing tannin, viz., tea, oak bark, or cinchona bark. The Detection of Antimony. Prepare the solutions of the liver and other solid organs, and also the contents of the stomach, as de- scribed under the detection of arsenic. Through a portion of one of the solutions pass a current of sul- phuretted hydrogen, which will produce, if antimony be present, an orange-coloured precipitate of the sul- phide of antimony. The precipitated sulphide is dis- solved by hot hydrochloric acid with the evolution of sulphuretted hydrogen; and if the resulting solution be poured into water, a white precipitate is formed of oxychloride of antimony, soluble in tartaric acid. Marsh's and Beinsch's tests may also be used for the detection of antimony. The former is, however, open to the objection that antimony, when present in any quantity, rapidly precipitates on the zinc in the form of a flocculent black deposit, while the issuing gas is found to contain only traces of the metal. Eeinsch's test is, however, very delicate, and its application is in every respect similar to that in use for the detection of arsenic. The acid liquid should, however, be boiled down to a small bulk with the copper, before a conclusion is drawn as to the entire absence of the metal. TARTAR EMETIC. 259 The following Table gives the characteristic reaction of the Antimonial and Arsenical Deposits : — The colour of the de- posit on copper by Reinsch's test is The coated copper heated in the end of a small tube, The deposit on porce- lain from Marsh's test is The deposit heated with hydrosulphuret of ammonium, and evapo- rated to dryness, and residue treated with am- monia, The black deposit dis- solved in strong nitric acid, evaporated to dry- ness, leaves Nitrate of silver gives, with this, The black deposit warmed with a strong solution of chloride of lime, A solution acidulated with hydrochloric acid, free from nitric acid, placed in a platinum cap- sule with a piece of metal- lic zinc. ANTIMONY. Yiolet hue. No effect, or only a trifling white sublimate, non - ^crystalline, non-volatile. Black, not lus- trous. Insoluble. White insoluble powder. No reaction. Not affected. A precipitate of metallic anti- mony, either brown or black, adhering close to the platinum, in- soluble in hot or cold hydrochlro- ric acid, but easily oxidised by boil- ing nitric acid. Black and lus- trous. Well - marked sublimate of oc- tahedral crystals, readily volatile. Lustrous, of a hair-brown colour by transmitted light. Dissolves. Deliquescent residue. Brick-red preci- pitate. Dissolves. Arsenetted hy- drogen is given off, and a deposit is formed which partly adheres to the zinc, never to the platinum, and partly floats like flocks in the liquid. 260 FORENSIC MEDICINE. It may be noted that mercury likewise yields a deposit on copper with. Reinsch's test ; but the coating is in this case either of a grey colour or white, and silvery on the application of friction. When the coated copper is heated in a glass tube, there is a sublimate of metallic mercury readily aggregating into globules on being rubbed with a glass-rod. If the deposit is trifling in quantity, a magnifying-glass should be used to iden- tify the metallic globules. This test at once distin- guishes a deposit on copper due to mercury from that pro- duced under similar conditions by arsenic or antimony. Mercury. Metallic mercury possesses no toxicological interest, as it appears to be almost inert, even in very large doses. Corrosive Sublimate. This is the most important of the preparations of mercury. It either occurs in crystalline masses of prismatic crystals, or as a white powder. It is now known among chemists as the perchloride, though it is frequently spoken of as the bichloride, chloride, and oxymuriate of mercury. It has a powerful metallic and styptic taste, and is soluble in about sixteen parts of cold water and three of boiling water. Alcohol and ether readily dissolve it, the latter having the poicer of abstracting it from its solution in ivater. This property of ether is of importance as a means of separating cor- rosive sublimate from its solution in other liquids. It is important to remember that corrosive sublimate is soluble in alcohol (see R. v. Walsh, Kilkenny Sum- mer Assizes, 1850). The Liquor Hydrargyri Perchlo- ridi of the Pharmacopoeia contains half-a-grain of the salt to a fluid ounce of water. Haif a-grain of the muriate of ammonia is added to increase the solubility of the mercurial salt. CO-EROSIVE SUBLIMATE. Symptoms : — 261 ACUTE. The symptoms come on almost immediately the poison is swallowed. A strong metallic cop- pery taste in the mouth is experienced, and a choking sensation in the throat. Pain of a burn- ing character is felt, ex- tending from the mouth to the stomach. Nausea and vomiting of stringy mucus, more or less tinged with blood, accompanied with violent purging, the evacuations being also mixed with blood and mucus. The pulse is feeble, quick, and irre- gular ; the countenance flushed or pale, and the tongue white and shri- velled. This appearance of the tongue is not pre- sent in all cases. The skin is cold and clammy, and the functions of the kid- neys are arrested, there being in many cases com- plete suppression of urine. As is the case with other irritant poisons, the symp- toms and effects produced admit of considerable variation. Thus there may be no pain in the stomach, and no purging. Salivation is present in some cases, but chiefly in those in whom the fatal termination is some- what prolonged. This sign is not infrequently absent. The symptoms presentjin this form of poisoning are modified by the size of the doze, and the interval allowed to elapse between each dose. Nausea, followed by occasional vomiting and pains in the stomach, are complained of by the patient. There is general constitutional disturbance, and con- sequent mental depression. Saliva- tion, as might be expected, is a more prominent symptom than in acute poisoning ; but the salivation may be intermittent, that is, it may cease and then reappear, even after the lapse of months, without an addi- tional dose of mercury having been given in the interval. Salivation may also come on in the course of certain diseases, attacking the sali- vary glands, and it may also be pro- duced by other causes — pregnancy, etc. The glands of the mouth be- come swollen and painful, the gums tender, and the teeth loosened fall out of the mouth. The breath has a peculiar, offensive smell. The bowels are irritable, and diarrhoea is not infrequently present. It must be borne in mind that in certain diseases — granular disease of the kidney — the smallest dose of any mercurial preparation may produce profuse ptyalism. And the toxicologist must be careful not to mistake the affection known as cancrum oris, or * the canker,' most common in delicate, ill- fed children and adults, for the effects of mercury. The nervous system is more or less affected, neuralgic pains and mercurial tre- mors being present in many cases. Paralysis may also occur, especially in those exposed to the vapour of mercury. 262 FORENSIC MEDICINE. Post-mortem Appearances. — The morbid appearances are chiefly confined, as in the case with arsenic, to the stomach and bowels; but the corrosive action of the mercurial sublimate is more marked. Inflammation more or less intense is always present in the stomach, the mucous membrane of which may be found of a slate-grey colour, corroded, and so soft as to scarcely admit of the removal of the organ without tearing it. The caecum and rectum are also sometimes found in- flamed, and the mucous membrane softened. Perfora- tion of the stomach is very rare, only one case having been recorded in which this was present. The mouth, throat, and gullet may also present signs of the action of the poison similar to those just described as seen in the stomach. Fatal Dose. — The smallest dose was three grains in the case of a child, but the exact amount to cause death in an adult has not been accurately determined. Fatal Period. — "From half-an-hour. ISTo exact time can be stated. Treatment. — Vomiting, if present, must be encour- aged; if absent, it must be produced by emetics. Albumen, the white of egg, or vegetable glutin pro- cured from flour by washing it in a muslin bag, should be given. The rapid removal of the poison from the stomach, however, is the end to which all our exer- tions must tend. The stomach pump should not be used if it can possibly be avoided, as it may greatly injure the softened mucous membrane of the gullet and stomach. Calomel. Calomel, or the subchloride of mercury, is not used as a poison. In large doses it may act as an irritant poison, and death has not infrequently occurred even from comparatively small doses. Profuse salivation and gangrene of the mouth have resulted from its use, CINNABAR. 263 and cases are recorded of death resulting from these. In many cases idiosyncracy appears to modify, more or less, the action of this preparation of mercury. The poisonous effect of calomel has been attributed to — a. Adulteration with corrosive sublimate. b. Conversion of the calomel into corrosive sublimate by the action of the hydrochloric acid of the gastric juice. N.B. — The free acid of the gastric juice is in too small a quantity to materially alter the composition of the calomel. Ammonio-chloride of Mercury. White precipitate may, if taken in large doses, pro- duce alarming effects, but it cannot be regarded as an active poison. Its action is that of an irritant, accom- panied with, in some cases, severe salivation. Bed Precipitate. Ked oxide of mercury possesses poisonous properties, but it is seldom employed as a poison. The symptoms most frequently present are vomiting, coldness of the surface of the body, stupor, pain in the abdomen, and cramps of the muscles of the lower extremities. The vomited matters are generally mixed with some of the red oxide. Cinnabar. Vermilion. A compound of sulphur and mercury in the form of a dark-red crystalline mass is known as cinnabar ; and to the same substance reduced to a fine powder the name vermilion has been given. It is used as a red pigment. It can scarcely be considered as a poison, Orflla asserting that it is not poisonous. The vapour of this substance appears, however, to be capable of pro- ducing severe symptoms, and in one case profuse saliva- 264 FORENSIC MEDICINE. tion resulted from the application of the vapour to the body. Cyanide of Mercury. This substance, though an active poison little inferior to corrosive sublimate, is seldom used as a poison, probably from its being better known to chemists than to the general public. It differs from corrosive sublimate in having no local corrosive action. It has been supposed, but proof is wanting, that its injurious effects are due to its decomposition by the acids of the stomach and the formation of prussic acid. Death has occurred in nine days from a dose of ten grains. It acts as an irritant. Turbith Mineral. A powerful irritant poison, but seldom used. A drachm has caused death in a boy sixteen years of age. Coldness of the surface, burning pain in the stomach and bowels, with other symptoms of irritant poisoning, were present. After death the mucous membranes of the throat, stomach, and bowels were found considerably inflamed. Nitrates of Mercury. These substances — the nitrate and sub-nitrate — are used in the arts for various purposes, They act as powerful irritant poisons, with symptoms and post- mortem appearances not unlike those before described when speaking of the action of other irritants. Detection of Mercury in the Tissues and in the Contents of the Stomach, Mercury is particularly liable to be absorbed by the tissues \ it also readily combines with various organic substances, gelatine, etc. A. If the contents of the stomach are under examina- DETECTION OF MERCURY. 265 tion, tliey should be filtered, the residue pressed and reserved for further examination. The liquid may be concentrated, and while still warm slightly acidified with hydrochloric acid. A slip of zinc foil, with a piece of gold foil twisted round it, is introduced. If mercury be present, the gold will, sooner or later, lose its yellow colour, and its surface become white and silvery, while the zinc is wholly or partially dissolved. The gold being removed, separated from the zinc, washed, first with water and then with ether, is divided into two equal parts. One half may be heated in a reduction-tube, when it will yield a sublimate of metallic mercury, identified by the spherical form of the globules under a magnifying-glass, and their metallic reflection and complete opacity. The other half of the gold may be treated with nitric acid and heated, which will dissolve off the mercury. The resulting solution, after expelling the excess of acid by evaporation, will give a scarlet precipitate with iodide of potassium soluble in excess, and with protochloride of tin, a black precipitate of metallic mercury. B. For the detection of mercury in the insoluble form, the residue from A is dried ; or if the tissues are under examination, they should be finely divided, and freed from superfluous moisture. In either case the substance is boiled in moderately strong nitric or hydro- chloric acid (about one part of acid to four of water). After digestion for some time the liquid is filtered, con- centrated, and tested as in A. When there is reason to infer the presence of corrosive sublimate in consider- able quantity in an organic liquid, advantage may be taken of the solubility of the salt in ether, and the power possessed by this liquid of abstracting it from its aqueous solutions. The liquid is agitated with an equal volume of ether, the ethereal solution poured off and allowed to spontaneously evaporate, when the corrosive sublimate will be left in white silky prisms, yielding all the characteristic reactions of the salt. 266 FORENSIC MEDICINE. Table shoiving the Reaction of Corrosive Sublimate with Reagents : — 1. With solution of iodide of potassium, 2. With potash solution, 3. With hydrosulphuret of ammonia, 4. Heated in a reduction-tube, 5. With ether, 6. Heated with carbonate of soda in a reduction-tube, 1. Bright-scarlet-colour. 2. Bright-yellow colour. 3. First a yellowish and then a black-colour is produced. 4. It melts, boils, is volatilised, and forms a white crystal- line sublimate. 5. It is freely soluble in ether, and the ethereal solution, when allowed to evaporate spontaneously, deposits the salt in white prismatic crys- tals. 6. Globules of metallic mercury are produced. According to Bonnewyn, the presence of an extremely small quantity of corrosive sublimate, 50000 in calomel may be detected by immersing a clean knife blade, moistened with alcohol or ether, in the suspected calomel. A black spot is formed on the steel very difficult of removal. ~No spot is formed when the calomel is pure. Lead. Metallic lead is not poisonous ; but it appears pro- bable that when it is acted upon by the acids of the intestinal secretions, it may become so changed as to produce unpleasant symptoms. Any salt of lead is poisonous when in a condition to be absorbed into the system. Sugar of Lead and White Lead are alone important, and will therefore be briefly considered. Sugar of Lead. Acetate of Lead, Subacetate. Goulard's Extract. General Character. — The acetate of lead, better known WHITE LEAD. 267 as sugar of lead, is not unlike loaf sugar in its general appearance. It is usually met with in the form of solid crystalline masses of a white or brownish-white colour. To the taste it is sweet, a metallic astringent taste being left in the mouth. Acetate of lead is soluble in water and in alcohol. The subacetate is a more active poison than the neutral acetate. Sugar of lead is popularly considered as an active poison, but this does not appear to be the case. Sir E. Christison has given eighteen grains daily in divided doses for eight or ten days with no other unpleasant symptoms than slight colicky pains in the abdomen. Lead is probably eliminated from the system by the urine, and also by the milk ; but there is reason to believe that when once deposited in the body, some considerable time is required for its complete elimination. Dr Wilson is of opinion that in chronic lead-poisoning the lead is more largely deposited in the spleen than in any other organ of the body. This organ should therefore always be carefully examined in suspected cases of poisoning by this metal. Goulard's Extract is a solution of the subacetate of lead. It may be of a reddish colour from the employ- ment of common vinegar in the place of pure acetic acid in the manufacture. Goulard's Lotion is the extract diluted with water. "White Lead. Carbonate of Lead, Ceruse or Kremser Wliite. White Lead is used as a pigment. It is generally in the form of white, heavy, chalky masses, insoluble in water, and, when taken in large closes, poisonous. It is this substance which, in the majority of cases, causes chronic lead-poisoning, or painter's colic. The chloride and nitrate, the oxides, litharge and red lead, are all poisonous ; but the sulphate, due probably to its insolubility, appears to be inert. 268 FORENSIC MEDICINE. Lead poisoning may result from — a. Constant contact with lead and its salts in manu- factories. b. Its use in the arts and as a pigment. The injurious effects of this substance are strikingly seen among painters, the makers of glazed cards, and the workmen engaged in preparing Brussels lace — this material being whitened by beating white lead into the fibre. All thus employed are liable to suffer more or less from chronic poisoning. c. Its application to the surface of the body in the form of ointment, plasters, cosmetics, and hair-dyes. d. Drinking water impregnated with lead, from being- stored in leaden cisterns or conveyed in leaden pipes. 4 The action of water upon lead is much modified by the presence of saline substances. It is increased by chlorides and nitrates, and diminished by carbonates, sulphates, and phosphates, and especially by carbonate of lime, which, held in solution by excess of carbonic acid, is a frequent ingredient of spring and river water. But water highly charged with carbonic acid may become dangerously impregnated with lead, in the absence of any protecting salt, in consequence of its solvent power over carbonate of lead. In general, water which is not discoloured by sulphuretted hydrogen may be considered as free from lead ; but there are few waters which have passed through leaden pipes, or have been retained in leaden cisterns, in which a minute analysis will not detect a trace of the metal; and were it not for the great convenience of lead, iron pipes and slate cisterns would, in a sanitary point of view, be in all cases pre- ferable. ' Another cause of contamination by lead may arise from electric action, as where iron, copper, or tin is in contact with or soldered into lead ; and in these cases, owing to the action of alkaline bases as well as of acids upon the lead, danger may occur when it is thrown into an electro-negative as well as into an electro-positive state. POISONING BY LEAD. 269 ' Cisterns are sometimes corroded, and their bottoms are perforated by jDieces of mortar having dropped into them, the lime of which has caused the oxidation of the metal, and a solution of the oxide ' (Brande and Taylor's Chemistry). e, Lead may also find its way into the system by means of the food. The use of leaden vessels in the manufacture of cider is attended with danger, and also the keeping of pickles in glazed earthenware jars. The celebrated ' Devonshire Colic/ was the result of cider-making in leaden vats. Rum has been known to have been dangerously im- pregnated with lead, leaden worms having been used attached to the stills. Many tobacconists are in the habit of using lead foil to wrap up their tobacco and snuff; this practice has resulted in several cases of chronic lead-poisoning. Symptoms. ACUTE. A metallic taste in the mouth, accompanied with dryness in the throat and intense thirst, is experienced by the patient soon after the poison is swallowed. In some cases, however, two or more hours may elapse before the effects of the poison begin to show themselves. Yomiting may or may not be present. Twisting colicky pains are felt in the abdomen, relieved in some cases by pressure. The parox- ysms of pain may be separated by intervals of ease. The bowels are, as a rule, obstinately con- fined, and the faeces are of a dark colour, from the formation of the sulphuret of lead. The skin is cold, the pulse quick and weak, and there is considerable CHRONIC. This form of poisoning gene- rally occurs among painters, manufacturers of white lead, pewterers, and others. The early symptoms are those of ordinary colic, only more severe. The patient generally complains, in the first instance, of feeling unwell, and of general debility. He then suffers from pain of a twisting, grinding nature, felt in the region of the navel. The bowels are obstinately confined. The appetite becomes capricious, and may be entirely lost. The mouth is parched, the breath fcetid, the countenance sallow, the skin dry, and general emaci- ation sets in. A nasty sweetish metallic taste in the mouth is present in most cases. Not 270 FORENSIC prostration of strength. In some cases the patient suffers from cramps of the calves of the legs, and sometimes, in protracted cases, paralysis of one or more of the extremities may supervene. The effect on the nervous system is marked by giddiness and stupor, terminating in coma, or convulsions and death. MEDICINE. infrequently the subjects of lead poisoning experience a peculiar form of paralysis of the upper extremities, well known as 'dropped hand.' It appears that this condition is the result of paralysis of the extensor muscles of the wrist. The muscles undergo a form of fatty degeneration. The lead appears to act primarily on the muscles, then on the nerves, and lastly on the nerve centres. One other symptom of importance has yet to be noticed. The gums, at their margins where they join the teeth, present a well-marked blue line, absent where atooth has been removed. This is not pre- sent in all cases, but it should be looked for. N.B. — The symptoms produced by white lead — carbonate of lead — are those of colica pictonum, or painter's colic, described under the head of chronic lead- poisoning. Post-mortem Appearances. — In acute poisoning the mucous membrane of the stomach and intestines is inflamed, and is in some cases covered by layers of white or whitish-yellow mucus, more or less impreg- nated with the salt of lead swallowed. Corrosion of the mucous membrane may occur if the dose be large, and this condition is more frequently present when the neutral salt is taken. In chronic poisoning there are no constant post- mortem appearances. The muscles of the paralysed ex- tremity are usually found flaccid, of a cream colour, and the subject of fatty degeneration. Fatal Dose. — Sugar of lead is not an active poison, recovery having taken place after one ounce had been swallowed. DETECTION OF LEAD. 271 Fatal Period. — Uncertain. Treatment. — The free administration of the sulphates of soda and magnesia. The carbonates should not be given, the carbonate of lead being poisonous. Vomit- ing should be promoted, and a powerful cathartic ad- ministered. Albumen and milk should also be given, as these precipitate the oxide. In the chronic form of poisoning, the iodide of potash and aperients, notably the sulphate of magnesia, should be administered. Sulphur baths are also useful in removing the lead from the system. Lately the galvanic bath has been tried with great success. By way of prophylaxis, it has been recommended that all those engaged in lead manufactories, or who are obliged to handle this metal frequently, should partake largely of lemonade made with sulphuric acid. Detection of Lead in Organic Mixtures. The contents of the stomach or vomited matters must be diluted with water and filtered. The residue left on the filter, washed with distilled water, should be set aside for further examination; the filtrate and washings acidified with nitric acid. A current of sulphuretted hydrogen passed through the solution will then throw down the whole of the lead, should any of that metal be present, in the form of a brown-black sulphide, which may be collected on a small filter and dried. The sulphide, boiled with dilute nitric acid, is partially converted into insoluble sulphate, and in part dissolved as nitrate. The carefully neutralised solution may be either tested at once or carefully concentrated. In either case, the production of a bright-yellow preci- pitate, with a solution of bichromate of potash, and a similar one with a solution of iodide of potassium, may be taken as conclusive of the presence of lead. The portion of lead deposited as sulphate will be found to be soluble in a solution of pure potash, the resulting 272 FORENSIC MEDICINE. liquid giving a brown-black precipitate on the addition of sulphide of ammonium. The insoluble residue left on the filter should be incinerated in a porcelain crucible, either with or without nitric acid, care being taken not to raise the temperature more than is necessary to produce the desired effect ; the carbonised mass boiled with dilute nitric acid and then filtered, the filtrate tested as before-mentioned. It is often useful, as a preliminary test for the presence of lead in a soluble form, to dip a piece of bibulous paper into the clear liquid obtained by submitting the contents of the stomach or vomited matters to filtration, and then exposing the paper to the action of a current of sulphuretted hydrogen. If lead be present, blackening of the paper will take place. Copper. Metallic copper, like metallic lead, is not poisonous, but its oxides are; it should, therefore, not be swallowed, as it is rapidly acted on by the intestinal secretions and poisonous compounds formed. An alloy of copper is used for ornamenting gingerbread, etc. All the salts of copper are poisonous. The most im- portant, are, however, the sulphate, blue-stone, or blue vitriol, and the subacetate or verdigris. Copper is eliminated to a slight extent by the urine. It has been found in the stomach, liver, and intestines eight months after its administration has been discon- tinued. It has also been detected more readily in the bronchial secretion than in the urine. COPPER. 273 Symptoms. Acute. The primary action of the sulphate of copper is that of a powerful irritant ; but when absorbed, it appeal's to act chiefly on the brain and nervous system. Its irritant action is marked by nausea, vomiting, griping pain in the belly, which is greatly distended, and in- creased flow of saliva. The vomited matters are of a bluish or greenish colour, and the dis- charges from the bowels greenish and containing blood. The above mentioned symptoms usually follow immediately after the poison is swallowed, and rapidly increase in severity. After a time the remote effects supervene, marked by headache, giddiness, laboured breathing, quick, irregular pulse, coma, or convulsions, paralysis, and death. In poisoning by this substance the convulsions are most violent, and wild incoherent delirium not infrequent (see Lancet, vol. i.,— p. 331, 1877). The subacetate of copper or verdigris produces symptoms not unlike those just described. Jaundice and suppression of urine may result when either is taken. A purple line along the margins of the gums is present in some cases. CHRONIC. Constant and troublesome irritation of the stomach and bowels ; vomiting and purging, attended with considerable straining at stool ; loss of appetite, loss of power, and general emaciation set in. The patient is subject to frequent trembling of the limbs, which may end in paralysis. The mouth is unpleasant, and a coppery metallic taste is experi- enced. Cramps or colicky pains in the belly are not infrequently present. Jaundice is sometimes present. The vomited matters are greenish ; but the practi- tioner must not be led away, and thus mistake the coloui\of the vomited matters, which occur in some morbid states of the bile, for that the result of poisoning by a salt of copper. A form of chronic poisoning "affecting workers in this metal, has been described by some French pathologists as 1 copper- colic. ' A cachectic condition of the system, accompanied with one or more of the symptoms already detailed, marks this form of poisoning. Copper poisoning may result from — a. Introduction into the system by nsing for culinary purposes copper vessels not properly tinned. An inter- 274 FORENSIC MEDICINE. esting account of poisoning from this source may be found in the second volume of the ' Medical Observation and Inquiries by a Society of Physicians in London,' published 1764. The cases there recorded occurred on board ship, with most alarming symptoms. b. By constant application of the metal to the sur- face of the body, necessitated by certain processes in its manufacture, and in its application for industrial purposes. c. The use of certain preparations of this metal as pigment. d. The use of German silver — an alloy of copper, zinc, and nickel — may be rendered dangerous by the action of acid food upon the compound. e. The use of a salt of copper to give a green fresh colour to certain tinned vegetables and fruits, peas, etc. now introduced into this country from France. Post-mortem Appearances. — The mucous membrane of the stomach is inflamed, the inflammation extending sometimes into the gullet. The intestines are some- times found perforated. The lining membrane of the whole alimentary canal presents a deep green colour, distinguished from that the result of a morbid condition of the bile by being turned blue on the addition of ammonia. Fatal Dose. — Nothing certain is known as to the exact quantity that may prove fatal. It appears to be more dangerous in small doses than in large ones. Fatal Period. — The shortest time on record is four hours. Treatment. — Induce vomiting, and assist the emetic action of the copper salts by the free use of warm water, milk, or any demulcent drink. As an anti- dote, large quantities of albumen and iron-filings have been given, of which the former appear to be most efficacious. ZINC. 275 Detection of Copper in Organic Liquids. A. The finely divided tissue, or the contents of the stomach, are thrown on a filter, and the insoluble portion set aside for further treatment (B). The filtrate and washings may now "be concentrated, acidified with sulphuric acid, and a polished needle inserted in the liquid; and should no immediate de- position of metallic copper occur, it may be allowed to remain for several hours. The colour of the metallic deposit is highly characteristic of copper. As a cor- roborative proof, the concentrated liquid may be placed in a platinum capsule with some fragments of zinc, when the copper will be deposited on the platinum capsule at the parts in contact with the zinc. The liquid poured off, and the excess of zinc adhering to the platinum removed by dilute hydrochloric acid. The copper may now be dissolved off the platinum by nitric acid, the excess of acid driven off by heat, and the solution subjected to the following reagents : — Ammonia precipitates a blue hydrate of copper dis- solved in excess of the reagent, and forming a blue solution. Sulphuretted hydrogen gives a deep chocolate-brown precipitate, even in acid solutions. Ferrocyanide of potassium, a rich red-brown precipi- tate. B. The insoluble portion from A is incinerated in a porcelain crucible. The ash thus obtained is digested in hydrochloric acid with the aid of heat, and evapo- rated nearly to dryness. The residue, dissolved in water, may be tested as under (A). Zinc. The sulphate and the chloride are alone important. Sulphate of Zinc. — White vitriol or white copperas. Symptoms. — The sulphate of zinc acts as a pure 276 FORENSIC MEDICINE. irritant. Violent vomiting, accompanied with pain in the abdomen, and purging, are the symptoms which first make their appearance. These may be followed by symptoms which betoken collapse, viz., coldness of the limbs, paleness of the face, irregular pulse, and fainting. Post-mortem Appearances. — Presence of inflammatory action. Fatal Dose. — Uncertain. Fatal Period. — Death has occurred in four hours. Chemical Analysis. — Distinguished from oxalic acid by remaining fixed when heated on platinum foil. In solution — Ammonia — gives a white precipitate soluble in excess. Ferrocyanide of potassium , a white precipitate. Sulphuretted hydrogen, a milky-white precipitate in a neutral pure solution. Nitrate of baryta, a white precipitate, showing the presence of sulphuric acid. In organic mixtures pass sulphuretted hydrogen, collect sulphuret, and decompose with boiling hydro- chloric acid, then test for zinc. Treatment. — Tea, coffee, milk, warm water, albumen, and in some cases enemata of gruel and other emollients. Iron. The preparations of iron which are of importance are the sulphate and the muriate. Sulphate of Iron — Copperas or Green Vitriol — has been administered as a poison, but more frequently to procure abortion. An ounce has been taken with no other unpleasant effect than the production of violent pain, purging, and vomiting, Constant application of this substance to the body has produced vomiting, pains in the belly and limbs. These symptoms disappear on treatment. BISMUTH. 277 Chemical Analysis — 1. Hydrosulplmret of ammonia gives a black precipitate. 2. Ferrocyanide of potassium added to it, in solution, gives rise to a greenish-blue pre- cipitate, becoming dark-blue on exposure. 3. Chloride of barium will point to the nature of the acid present. Muriate of Iron, better known as the Tincture of Sesquichloride of Iron, or the Tincture Ferri Per chloridi. The tincture acts as a corrosive and irritant poison, death having followed in five weeks after an ounce and a-half had been swallowed. Eecovery has, however, taken place after three ounces had been swallowed. The symptoms present in most cases observed were those of a corrosive and irritant. Chemical Analysis — 1. The addition of nitrate of silver, causing^ a white precipitate insoluble in nitric acid, points to the presence of chlorine. 2. The peroxide of iron indicated by the forma- tion of Prussian-blue on adding a solution of the ferrocyanide of potassium. Bismuth. The preparations of this metal act as irritant poisons, death having occurred from a dose of two drachms of the subnitrate. Dr Trail (Outlines of Medical Juris- prudence, p. 116) mentions the case of a patient of his who took six drachms in three days in divided doses. The symptoms were vomiting, extreme pain in the abdomen and throat, a weak, feeble pulse, and much anxiety about the pr?scordia. Eecovery took place. Not long ago, in Scotland, a case of severe vomiting during pregnancy, ending fatally, was mistaken for arsenic poisoning. The error arose from mistaking a 278 FORENSIC MEDICINE. greyish powder on the walls of the stomach for arsenic. It turned ont on further inquiry that it was bismuth, given medicinally to prevent the vomiting. Chromium. • Two compounds of this metal are largely used in the arts for dying purposes — the neutral chromate and the bichromate. The chromate of potash is a powerful poison, and death may occur from its direct action on the nervous system, without the development of any of the signs of irritation ; in other cases, however, well- marked irritant symptoms have been present. Applied externally, it produces deep fistulous sores. Dyers not infrequently suffer severely on their arms when using it in the course of their trade. Death has resulted in four hours after its administration. Treatment. — Emetics, magnesia, chalk, and demulcent drinks. VEGETABLE IEEITAOTS. Mode of Action. — The general effects produced by the somewhat large class of vegetable irritants are — a. Severe abdominal pain, accompanied with vomit- ing and purging. b. Absence in most cases of any cerebral or nervous symptoms. c. The irritant properties appear to reside in an acrid oil or resin. In colchicum, stavesacre, and some others, the pre- sence of an alkaloid may account for their active pro- perties. d. In medicinal doses, the vegetable irritants act as safe purgatives. e. The post-mortem appearances found in the ali- SAVIN. 279 mentary canal betoken inflammation, the result of irri- tation. /. Applied externally, they produce inflammation, pustular eruptions, and sometimes unhealthy, callous sores. Savin. Juniperus Sabina. Nat. Ord. Coniferce. The leaves and tops of this plant yield an acrid volatile oil, to the presence of which the poisonous pro- perties are due. The oil is colourless or pale-yellow, with a peculiar terebinthinate odour. It is used in medicine both internally and externally, and is sup- posed to possess emmenagogue properties. The dried powder is less active than the fresh tops. Savin is seldom used as a poison, more frequently to procure abortion. Its use for this purpose is mentioned in the old ballad of Marie Hamilton : — ' The King has gane to the Abbey garden, And pu'd the savin tree, To scale the babe frae Marie's heart ; But the thing it wadna be. ' Symptoms. — Those of irritant poisoning. Violent pain in the abdomen, followed by vomiting, and in some cases salivation and strangury. Purging is not always present. When taken to procure abortion, death often takes place before the object for which it was taken is attained. Post-mortem Appearances. — The stomach, gullet, and intestines are found congested and inflamed. The stomach may in places be seen corroded, and a green powder adherent to its coats. The powder washed and dried, and then rubbed, gives off the odour of savin. Analysis. — When an infusion or decoction of the leaves has been taken, chemical analysis is of no assist- ance. The oil may be separated from the contents of the stomach by subjecting them to distillation, and 280 FORENSIC MEDICINE. then shaking the distillate with ether, when the oil is dissolved out. On the evaporation of the ether, the oil is left for examination. When the powder is taken, the contents of the stomach are not unlike green pea- soup. If a small portion of the green liquid be taken and diluted with water, the green chlorophylle, being insoluble, will sink • but if the colour be due to bile, the liquid will remain of a uniform green colour. A portion of the green matter collected, dried, and then rubbed in a mortar, the characteristic odour of savin will be given off. The microscope may detect bits of the twigs. Croton Oil. The oil expressed from the seeds of croton tiglium, Nat. Ord. Euphorbiacece. The seeds, when taken, produce violent pains in the stomach and purging. Pereira has described the case of a man who suffered severely from inhaling the dust of the seeds. The dose of the oil is from half-a-minim to a minim. Dr Trail (Outlines, p. 151) mentions the case of a delicate lady patient who took three drops for a dose without inconvenience. Dr Adam records a case (Edinburgh Medical Journal, 1856) of a man who, in mistake, drank three drachms of a liniment containing about fifty drops of croton oil. After the most alarm- ing symptoms, the patient ultimately recovered. Two drachms and a-half have caused death (Jour, de Clinic Medicate, 1839, p. 509). A medical friend informs me that in Shetland six drops in as many colocynth pills have, in cases there, only produced e a comfortable " aisement" of the bowels.' This is attributed to the dura ilia, resulting from a constant fish diet. The poisonous properties depend upon the presence of a fatty acid. Symptoms. — Pain in the abdomen, vomiting, and purging, followed by exhaustion and collapse. In some COLCHICUM. 281 cases, when the dose is large, the pain is hot and burn- ing, and may be felt from the mouth downward. Analysis. — Separate the oil from the contents of the stomach by means of ether, and then drive off the ether by means of heat. The oil then warmed with nitric acid becomes of a brown colour, and nitrous acid vapours are given off. Colchicum. Colchicum Autumnale {Meadow Saffron). Nat. Orel. Melanthacece. The poisonous properties of this plant reside in an alkaloid, colchicina, chiefly found in the corms, but also present in other parts of the plant. The seeds have caused death. In June 1875, an epidemic of gastric irritation among the inhabitants of Eione Boego was traced to the use of milk of goats accidentally eating the leaves of col- chicum. Symptoms. — Colchicum, in medicinal doses, increases the activity of the liver, and- bile is freely secreted. The action of the kidneys and of the skin is also increased. The heart is more or less affected, and its frequency diminished. In large doses, all the symp- toms of irritant poisoning are present, and in some cases have been likened to those observed in Asiatic cholera. Post-mortem Appearances. — Death may result from its use without leaving any morbid appearances. In other cases, however, the usual signs of inflammation were present. Casper describes the colour and con- dition of the blood in those poisoned by colchicum as dark cherry-red, with the consistency of treacle. A marked congestion of the vena cava may also be present. Analysis. — Colchicina, obtained by Stass' process, added to concentrated nitric acid, becomes of a violet colour, changing to blue and brown. Tincture of iodine precipitates colchicina of a kermes brown colour, 282 FORENSIC MEDICINE. platinum clichloride yellow, and tannic acid white, the precipitate being soluble in alcohol, acetic acid, and alkaline carbonates. Fatal Dose. — One ounce. Treatment. — Stimulants and opium should be given to counteract its depressing effects. Tannin is said to be an antidote. Black Hellebore. Helleborus Niger. Black Hellebore. Nat. Ord. Ranmiculacece. This plant, known as the Christmas-rose, is the Melampodium of the old Pharmacopoeias. All parts of the plants are poisonous. Symptoms. — Purging, vomiting, pain in the bowels, and cold sweats. Death is generally preceded by con- vulsions and insensibility. Post-mortem Appearances. — Those common to the action of other irritants. White Hellebore. Veratrum Album. Nat. Ord. Melanthacece. White hellebore acts very much in the same manner as the black hellebore, but is more powerful. The powder causes violent sneezing. The alkaloid veratria appears to be the active principle. The symptoms and post-mortem appearances are analogous to those produced by black hellebore. Veratria. The alkaloid veratria is obtained from the dried fruit of Asagroea officinalis. Nat. Ord. Melanthacece. The alkaloid is in the form of a white amorphous powder, bitter and acrid to the taste. It acts as a powerful errhine, causing violent sneezing. Insoluble in water, it is readily dissolved by alcohol, ether, and chloroform. When gently heated on a plate with GAMBOGE, CASTOR-OIL. 283 strong sulphuric acid, it first turns yellow, then crim- son. Yeratria is entirely dissipated by heat. Two grains of the alkaloid killed a cat in one minute ; a dog being destroyed in two hours by a dose of three grains. The Symptoms and Post-mortem Appearances in man are the same as in poisoning by hellebore. Treatment. — Stomach-pump and emetics. Astringent infusions should be given, and alcohol and opium administered if the condition of the patient seems to require them. Gamboge is the gum resin of Garcinia Morella. It is an active ingredient in certain quack * vegetable pills.' One drachm has caused death by its irritant action. Owing to the imperfect pulverisation of gamboge in quack pills, I have seen violent irritation of the bowels, straining at stool, and prolapsus uteri, due to the irri- tating action of small pieces of this substance. Jalap, the powder obtained from the tubers of Exo- gonium purga. The active properties of the drug reside in a resin. It is a drastic purgative, twelve grains hav- ing killed a dog. Scammony is obtained from the dry root of Convol- vulus scammonia. Like the last-mentioned, it is a powerful purgative, and may cause death if given in large doses to debilitated individuals. Castor-Oil. — The oil expressed, with or without the aid of heat, from the seeds of Ricinus communis. A girl eighteen years of age died in Liverpool in 1837 from eating a few of the castor-oil seeds. Arum Maculatum. — Cuckow-pint, Wake-robin, or Lords and Ladies, is one of the most acrid of indi- 284 FORENSIC MEDICINE. genous vegetables. The active property of the plant appears to be lost by drying and by distillation in water. Children have been poisoned by its leaves. Yew. — The twigs and fruit of Taxus baccata act as irritant poisons, producing also symptoms which point to cerebro-spinal mischief. A case is recorded of poison- ing by yew leaves, in which only five grains of the leaves were found in the stomach ; yet death took place within an hour from the time the symptoms commenced (Brit. Med. Jour., vol. ii., 1876, p. 392). In the above- mentioned case, vomiting and other signs of gastric irritation were absent. The chief symptoms present were, pallor of the face, faintness, an almost impercep- tible pulse, facial convulsions, foaming at the mouth, stertorous breathing, loss of consciousness, ending in death. Several children have died after eating the fruit. Post-mortem signs of irritation of the alimentary canal. Laburnum. — Cytisus laburnum, or common laburnum, the seeds of which are poisonous. They contain a nar- cotico-acrid, uncrystallisable alkaloid, producing vomit- ing, foaming at the mouth, and insensibility. Eecovery took place in two cases, mentioned by Trail, from the use of emetics and ammonia. Fool's Parsley.— JEthusa cynapium has been mis- taken for parsley. Nausea, vomiting, giddiness, and severe abdominal pains are among the most common symptoms of poisoning by this plant. Bryony. — Two plants included under this name, Bryonia dioica, white bryony, Nat Ord. Cucurbit .acece, the only indigenous cucurbitaceous plant, and the Tamus communis, black bryony, Nat. Ord. Dioscoreacem. Both the bryonia dioica and the tamus communis pos- sess active irritant properties. They are of importance ANIMAL IRRITANTS. 285 from the fact of their growing wild, and the possibility of the fruit been eaten by children. Elaterium, the inspissated juice of Ecbalium Offici- jtarum, or Squirting Cucumber. It is a powerful drastic purgative, one grain having given rise to alarming symptoms in man. ANIMAL IKBITANTS. Cantharides. Cantltaris vesicatoria. Nat. Ord. Coleoptera. Cantharides is seldom given as a poison, but is most frequently employed to procure abortion, or for its sup- posed aphrodisiac properties. Cantharides is a pure irritant. Applied externally it produces vesication ; and if absorbed, strangury. - Canfharidine, the active principle of cantharides, is insoluble in water and bisulphide of carbon. It is but slightly soluble in alcohol, but it is dissolved by chloro- form, ether, and some oils. Four parts of cantharidine have been procured from a thousand parts of the flies. Symptoms. — An acrid taste is first experienced in the mouth, followed by burning heat in the throat, stomach, and abdomen. There is constant vomiting of bloody mucus, and the stools also contain blood. The patient complains of intense thirst, pains in the loins, and an incessant desire to void urine, which is frequently mixed with blood. Salivation in some cases is a prominent symptom. Strangury may result from the external application of cantharides as a blister, etc. Priapism is often obstinate and painful, and the fatal termination is generally ushered in by violent convulsions and de- lirium. In pregnant women abortion may take place as a result of the general irritation and disturbance of the system, there being no proof that the uterus is 286 FORENSIC MEDICINE. particularly affected by the drug. The vomited matters may contain shining green particles, the presence of which indicate the nature of the poison taken. The invasion of the symptoms may in some cases be retarded. Post-mortem Appearances. — Those of powerful irrita- tion. The mucous membrane of the whole alimentary canal, from the mouth to the rectum, has been found in a state of acute inflammation. The uterus, kidneys, and internal organs of generation share also in the general irritation, ulceration of the bladder having been met with in some cases. Portions of the wings and elytra are sometimes found adhering to the coats of the stomach. Fatal Dose. — One ounce of the tincture has caused death in fourteen days. This is perhaps the smallest fatal dose on record. Six ounces have been stated to have produced no dangerous symptoms. The worth- lessness of the preparation may account for this result. Treatment. — Vomiting should be promoted, and warm mucilaginous drinks given. If vomiting be absent, emetics should be administered. Oil should not be given, as it dissolves out the active principle. Opium may be given with advantage. Analysis. — The contents of the stomach should be concentrated, and then treated with chloroform filtered, and the filtrate allowed to spontaneously evaporate. A portion of the residue should then be placed on the skin, and the presence or absence of vesication noticed. Examined under the microscope, portions of the wing cases may be detected. No change of colour is pro- duced in cantharidine by the action of sulphuric or nitric acid, thus distinguishing this substance from any of the vegetable alkaloids. Mussels. — These not infrequently produce symptoms of irritant poisoning, sometimes attributed to the pre- sence of copper, obtained from the copper coverings of the woodwork of jetties, to which they are very fond of adhering. One case which has lately come under my ANIMAL IRKITANTS. 287 notice deserves mentioning from the peculiarity of the symptoms present. A printer, to whom I was person- ally well known, was sent to me by his employer. While at work he had suddenly become giddy, with loss of vision and difficulty of speech, and feeling, as he expressed it, very strange. "When I saw him in my consulting-room, whither he had been sent, and which is about a mile from the place where he was taken ill, he was quite unconscious who I was, and asked my name, though he had seen me about an hour before. His eyes were staring, and the expression of his face, was that of a man suddenly frightened. He could only speak with difficulty, stammering considerably. I ordered him home, and went to see him about an hour afterwards, when I found him in bed much better. His wife, in the meantime, had given him a dose of castor-oil. I also then learnt that he had partaken rather freely of mussels at breakfast, of which he was particularly fond. The next day he was much better, and went to work in a day or two after, but still felt ' shaky.' He ultimately got quite well. The following, though not strictly animals, are yet animal products, and as their use has been followed by symptoms of poisoning, it may be as well in this place to draw attention to them. Cheese. — Four cases of irritant poisoning have been recorded (Lancet, 1873). Sausages. — Symptoms of narcotico-irritant poison- ing have followed the eating of sausages, and in the Medical Gazette for 1842 three deaths are attributed to the eating of sausages made from the liver of the pig. The poisonous principle has not yet been isolated, but by some it is considered to be the product of the partial decomposition of the fatty part of the sausage. The symptoms may not commence for three or four days after the sausages have been eaten. Mutton. — A boy is reported to have died within three hours from the irritation produced by eating mutton. 288 FORENSIC MEDICINE. Trichiniasis. This disease is due to the introduction of the triclinia spiralis into the human body. The encysted worm is found embedded in the fibres of all the striped muscles of the trunk and limbs, and even in the heart, where it appears in the form of white ovoid bodies or capsules, the capsules being sometimes calcareous. The worm passes the greater part of its existence in the chrysalis state in the muscular system of one animal, and only reaches its mature condition in the stomach of another. Yirchow and Zenker assert that the trichnia not only frequently presents itself in the human organism, but that this organism is most favourable for its full development. Once in the stomach, the period of incubation is about six or eight days, and then propa- gation rapidly begins, and continues so, that Dr Kellen estimates that in a few days after the ingestion of half- a-pound of meat the stomach and intestines may con- tain thirty millions of the worms. The worms when introduced into the stomach leave their capsules, be- come free, produce young, and then leave the stomach through its coats for the muscles, where they become encysted. The trichnia is most frequently found in pork, seldom in sheep, horses, or oxen, the last being the freest. Symptoms. — Intestinal irritation, loss of appetite, sickness, malaise, general weakness of the limbs, and diarrhoea. The eyelids swell as well as the joints, the skin is bathed in cold, clammy sweat, and a low form of fever sets in. Death may be due to peritonitis, paralysis of the muscles, the result of their destruction, or to irritative fever. During the perforation of the coats of the stomach and bowels by the worms, the mucous membrane becomes inflamed, pus is formed on the surface, and the stools become bloody. Treatment. — Medical treatment at present is hope- less. METHODS FOR DETECTING VEGETABLE ALKALOIDS. 289 METHODS FOE DETECTING THE VEGETABLE ALKALOIDS. There are several methods recommended for the isolation and detection of the vegetable alkaloids, and their separation from the contents of the stomach or from the membranes and tissues of the body. The process, however, most generally pursued is that of Stass, which may be briefly described as follows : — 1. The substance to be examined is mixed with twice its weight of absolute alcohol, to which from ten to thirty grains of tartaric or oxalic acid — preferably the former — have been added, and the mixture sub- jected to gentle heat in a flask, 70° to 75° C., or 155° to 167° E. 2. If the membranes or organs have to be examined, they are finely divided, treated with absolute alcohol, squeezed, and again treated with fresh alcohol, as ra\L. In either case, the mixture, when quite cold, is filtered, and the alcoholic solution' is concentrated by evaporation, either in vacuo or in a current of air not exceeding 95° F. or 35° C. The liquid residue is now passed through a moistened filter, which separates the fat and other insoluble matters. The filtrate is evaporated to dryness over sulphuric acid or in vacuo, and the acid residue of this evaporation dissolved in the smallest possible quantity of distilled water. The acid liquid is then gradually neutralised with the bicarbonate of potash or soda until effervescence ceases, and afterwards shaken in a flask with four or five times its bulk of pure ether, and allowed to settle. When the ether has become quite clear, a small portion of it is decanted into a small glass capsule, and allowed to spontaneously evaporate in a dry place. If during evaporation streaks of liquid appear on the side of the capsule, running together at the bottom, a liquid volatile alkaloid is probably present. \ t 290 FORENSIC MEDICINE. If none of these manifestations occur, the alkaloid is in all probability solid and non-volatile. THE ALKALOID IS VOLATILE. To the original mixture in a flask add a moderate quantity of a strong solution of caustic potash or soda, mixed with ether ; agitate, and allow the mixture to settle. Pour off ethereal solution, and re -shake residue with a fresh quantity of ether; decant, and mix both solutions. The ethereal solu- tion is now shaken with a mix- ture of four parts of water and one of sulphuric acid, which withdraws the alkaloid from its solution, leaving any fatty matter dissolved in the ether. The acid solution is now mixed with strong potash or soda solu- tion in excess, 1 agitated with ether, the ether poured off, and then evaporated at as low a tem- perature as possible, 2 leaving the pure alkaloid with all its characteristic chemical and phy- sical properties. THE ALKALOID IS NON- VOLATILE. To the original mixture in a flask add strong caustic potash or soda solution, and agitate with successive portions of pure ether, allowing it to completely settle each time. The ethereal solutions, being mixed, are eva- porated, leaving the alkaloid in an impure state. To purify it, the solid residue left on evapo- ration is treated with a small quantity of dilute sulphuric acid, which dissolves the alka- loid, leaving any fatty impuri- ties behind. The acid liquid is evaporated to three-quarters of its bulk over strong sulphuric acid, and then a saturated solution of carbonate of potash or soda added. Absolute alco- hol will then dissolve out the pure alkaloid, giving it, on eva- poration, in the crystalline form, and in a state to show its charcteristic reactions. If morphia has to be sought for, the liquid should be shaken with ether immediately after being neutralised with carbonate of sodium, and the ether poured off as quickly as possible ; for if the alkaloid have time to separate in the crystalline form, scarcely any of it is dissolved by the ether (Otto). The method of Stass is based upon the fact that the salts of the alkaloids, as a class, are soluble in water 1 The sulphates of the alkaloids are insoluble in ether ; hence they must be decomposed by an alkali. 2 The temperature should be low, or the greater part of the conia will be evaporated with the ether. METHODS FOR DETECTING VEGETABLE ALKALOIDS. 291 and alcohol, but are insoluble in ether ; and that these salts when in solution are readily decomposed by the mineral alkalies with the elimination of the alkaloids, which, in their free and uncombined state, are more or less readily soluble in ether. Otto's Method, Otto's modification of Stass' process is simpler, and at the same time equally accurate. Instead of the numerous treatments and evaporations which have to be gone through in the original process, Otto converts the alkaloid into a salt, such as the sulphate, by the addition of acid, and after solution in a small quantity of water, agitates with successive quantities of ether, which remove all foreign fatty matters, leaving the solution of the alkaloid comparatively pure, and from which the alkaloid may be obtained in a state of great purity, by first rendering the solution alkaline, and then using ether to dissolve the alkaloid. R. Wagner's Method; The presence of alkaloids in organic liquids — strychnia in beer, for example — may, according to E. Wagner (Zeitschr. Anal. Chem., iv. 387), be detected by mixing the liquid, diluted with two vol. water (| to one litre) with about 5 c.c. of a solution of iodine in potassium iodide (12*7 grains iodine to the litre), and a few drops of sulphuric acid. The precipi- tate separated from the supernatant liquid is dissolved in a dilute solution of sodium hyposulphite, and again precipitated by means of the iodine solution. If this new precipitate be now dissolved in aqueous sulphurous acid, the solution will leave, on evaporation, the pure sulphate of the base. 292 FORENSIC MEDICINE. * SI co -to *>> .00 CD ^ *+o CO SI §1 £V2 c3 P) f-, "3 >> o <^ >— i a *■ • °£ 2 i— I o5 OJ CD CO ^-H m b s . « co P^S CD ^ £ ° § o g a , — i * co CD Ph 0*1 cd CD 'sag CO CO , go S w o .3 pj CD CO r— ' CO CD CD CQ PJ CO 1 . «J C ?-l ?H CD CO ^ CD ^ 2 CD* 3 S« i P o Hh o o METHODS FOR DETECTING VEGETABLE ALKALOIDS. 293 i © CO • ^3 « p. a t fill CO ~C0 rd • ? a § « © CO [> p*-Ji 3 § co co g 8 » ft -ill cS a ft <^-H CO ft §'-3 ° s © ^ d . ft 3 ft^ s to CO % CO +3 ft fH g a£ ,5 TO CO «d2 o ■ d o ft^ S 5P rag r— 1 TO r* O TO o S d 68 5b-2 • TO b2 o d © • a o co 3 © 2 •a-a v d METHODS FOR DETECTING VEGETABLE ALKALOIDS. 295 P >-> O O q 5P d 5 ^ P 03 O i — i o 8 w t-> o CZ2 £P m © d 03 . aj'r 1 d (55 &0«C d &J3 c3 r/2 « 55 ' o ^ o S c3 o PQ o'd.S Ph o 00 rd Ph O C$ Ph d <3 o 3 03 5 o d o try 5=1 E O rO 03 r-~ - O Ph^~ d ^ £ 2 -Ph ft 'g O rd © . 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The poisonous properties depend upon the presence of an alkaloid — aconita — chiefly found in the root. When any part of the plant is chewed, a sensation of tingling is expe- rienced in the mouth, and burning in the throat. Many of the aconites, are, however, inert. The root, having been taken by mistake for horse-radish, has led to several cases of accidental poisoning. ACONITE. General Characteristics. — Root conical, dark-brown ex- ternally, with numerous twisted rootlets ; internally the colour is whitish. Taste, — Produces a tingling and numbing sensation in the mouth. HORSE-RADISH. General Characteristics. — Root cylindrical, of nearly the same thickness down its whole length. Externally, buff coloured ; internally, white. Taste. — Sweet and pungent. Symptoms. The patient complains, within a short time after the poison is taken, of dryness of the throat, accompanied with tingling and numb- ness of the mouth and tongue. He then com- plains of nausea, vomiting, pain in the epigas- trium, and distressing dyspnoea, of a sensation of formication or tingling, with numbness in his face and limbs, which appear to him heavy and enlarged. In attempting to walk he staggers, his limbs losing their power of sup- porting his body. He becomes giddy, and his sight and hearing imperfect, but he is seldom unconscious. His pulse irregular, gradually becomes weaker, and at last almost imperceptible, his skin cold and clammy, his features pale and bloodless, his mind clear, and then suddenly he dies, in some cases from shock, in others from asphyxia, and lastly he may die from syncope. IN ANIMALS. "Weakness of the limbs and staggering, the respiration slow and laboured, loss of sensation, paralysis, dim- ness of vision, increasing diffi- culty in breath- ing, convulsion and death by asphyxia. ACONITE. 343 Delirium is present in some cases, and dilatation of the pupil has also been noticed. In a case recorded in the Brit. Med. Jour., vol. i., 1877, p. 258, two ounces of the tincture of aconite were drunk in mistake for succus lemonis ; recovery took place, but not before alarming symptoms had taken place, and death at one time appeared imminent. Post-mortem Appearances. — General venous conges- tion. The brain and its membranes are, in most cases, found congested, and the stomach and intestines in- flamed. Fatal Period. — The symptoms may come on imme- diately, or may be delayed for an hour or two. In the case mentioned in the British Medical Journal the , patient walked about five miles after swallowing two ounces of the tincture, which he drank at eleven o'clock, returning home at 2.30 p.m. An excise officer, who died in about four hours, was able to walk from the Custom House over London Bridge. Death has taken : place in so short a time as one hour and a-quarter. Fatal Dose. — About four grains of the extract, and one drachm of the tincture. Much will depend upon the amount of the alkaloid present. One drachm of the scraped root is said to have proved fatal. Treatment. — Emetics, castor-oil, and animal charcoal should be given. Stimulants will be required; and friction down the spine, together with galvanism and artificial respiration, may be tried. Synopsis of Poisoning by Aconite. 1. Symptoms. a. In Nervous System. — Giddiness, numbness, and tingling in the limbs is a primary effect, followed by I gradually increasing paralysis of the muscles, and insen- sibility of the surface of the body to pinching and pricking. Dr Fleming asserts that it produces a power- ful sedative effect on the nervous system. I 344 FORENSIC MEDICINE. b. In Vascular System. — Extreme depression of the circulation is produced by doses large enough, to cause death. The pulse may become imperceptible at the wrist. c. In Digestive System. — Some have denied the irritant action of aconite on the alimentary canal, but Sir E. Christison states that he was deterred from the use of aconite 'by two patients being attacked with severe vomiting, griping, and diarrhoea. 1 CONIUM. Conium Maculatum. Nat. Ord. Umbelliferm. The common or spotted hemlock is indigenous. It must be distinguished from the myrrhis temulenta, another indigenous, umbelliferous plant which has also a spotted stem, but which is covered with hairs, the stem of the hemlock being smooth. Several cases of poisoning have occurred, hemlock having been mistaken for parsley, fennel, asparagus, and parsnip. The leaves of the plant have a peculiar mousy odour, which is intensified when they are rubbed in a mortar with some caustic potash. The poisonous properties reside in an alkaloid, conia^ The activity of the plant appears to depend upon the time of the year when it is gathered, being most powerful in May. The ready decomposition of the alkaloid by heat or age renders the extract of conium a very uncertain preparation, the conia being converted into an inert resinoid matter. Conia. The alkaloid is a colourless volatile oil, lighter than water, with an odour of mice. It is strongly alkaline, soluble in diluted acid, but its salts have not yet been crystallised. It is a deadly poison, killing all animals, CONIA. 345 death resulting from asphyxia. Neutralised with an acid, its activity is increased, and it becomes more soluble in water. Almost instant death in a dog resulted from injecting two grains of conia, neutralised with hydrochloric acid, into the femoral vein. The symptoms and post-mortem appearances are the same as mentioned under conium. Symptoms. IN MAN. The symptoms in some cases resemble those of poisoning with opium ; in others the patient com- plains of dryness and constriction of the throat, and drowsiness. There is dilatation of the pupil and loss of power in the muscles of the extremities. Gradual loss of power in the respiratory muscles is the cause of death. Giddiness, coma, and convulsions were the typical symptoms of two cases of accidental poisoning recorded by Dr Watson. IN ANIMALS. ' Palsy, first of the volun- tary muscles, next of the chest, lastly of the dia- phragm — asphyxia, in short, from paralysis, with- out insensibility, and with slight occasional twitches only of the limbs ; and the heart was always found contracting vigorously for a long time after death. ' — Cheistison. Post-mortem Appearances. — Congestion of the vessels of the brain and lungs. The blood is very fluid, and of a dark colour, the fluidity due probably to the mode of death — slowly induced asphyxia. There may be some redness of the mucous membrane of the alimentary canal. Fatal Period. — The symptoms may come on in from ten minutes to an hour or more after the poison has been taken. Death usually takes place in about four hours. Fatal Dose. — Uncertain. Thirty grains of the ex- tract carefully prepared killed a rabbit in five minutes. A single drop of conia dropped into the eye of a rabbit killed it in nine minutes. Treatment. — Emetics, castor-oil, followed by ammonia and other diffusible stimulants. 346 FORENSIC MEDICINE. Phyostigma Venenosum. Nat. Ord. Leguminosce. A strong emulsion of this bean is used on the Western Coast of America as a test of innocence in cases of suspected witchcraft. In 1864 some children in Liver- pool were poisoned by eating some of these beans, which had been swept out of a ship from Africa on to a heap of rubbish. Symptoms. — Vomiting, giddiness, irregular action of the heart; the mental faculties are unaffected. The eyes are bright and the pupils contracted; in which latter it differs most strikingly from atropia, liyos- cyamia, and datura, where dilatation of the pupil is the rule. Sir E. Christison considers that its primary action is on the heart, causing paralysis of that organ, and that the insensibility and coma are only secondary. Dr Harley considers that it is not a cardiac, but a respiratory poison. The motor nerves appear to be affected, the intellect being left clear. A few drops of the extract placed in the eye causes powerful contrac- tion of the pupil. Analysis. — The physiological test is the effect on the pupil. Bromine dissolved in water is stated by Dragendorff to produce a red colour with the calabar bean. EXCITOMOTORY. Nux Vomica. Strychnia. Some of the most poisonous known plants belong to the genus Strychnos. Nat. Ord. Loganiacece. The Java poison Upas Tieute is a watery extract of S. Tieute ; the basis of the poison used in Guiana, and known as Wourali, Ourari, Urari, or Curare, is the juice of S. Toxifera. S. Nux Vomica, the Koochla tree, pro- duces the Nux Vomica seeds of commerce; and the STRYCHNIA. 347 Lark of the tree has been accidentally substituted for cusparia, or angustura bark, hence it is known as false angustura bark. The substitution is attended with considerable risk, on account of the strychnia which the false bark contains. It may be known by its being quilled, externally covered with white lichenous spots ; and the internal surface becoming blood-red when touched with nitric acid. This reaction, which depends upon the presence of an alkaloid, Erucia, does not occur when true angustura bark is thus treated. Nux Vomica. The Seeds of S. Nux Vomica. The British Pharmacopoeia contains an extract and a tincture. Strychnia is also obtained from the seeds. The active principle of the seeds is the alkaloid strychnia. The symptoms and post-mortem appearances will be detailed under the head of Strychnia. The brown powder of the seeds may, in some cases, be seen adher- ing to the mucous membrane of the stomach. Treatment. — As for strychnia. Strychnia. Symptoms. — Should the poison be in solution, the patient complains of a hot and intensely bitter taste during swallowing. The effects of the poison become manifest in from a few minutes to an hour, or more, after it is taken. The earliest symptoms are a feeling of suffocation and great difficulty of breathing. These come on suddenly, without any premonitory warnings. Twitching of the muscles, rapidly passing into tetanic convulsions of nearly all the muscles of the body, which are simultaneously affected. The head after several jerks becomes stiffened ; the neck rigid; the body curved forward, quite stiff, and resting on the back of the head and heels. The face is congested, and the countenance expresses intense anxiety, the eyes staring, the mouth 348 FORENSIC MEDICINE. open, and the lips livid. The throat is dry, the thirst great \ but when an attempt is made to drink, the jaws are spasmodically closed, and a piece of the vessel may be bitten out. During the intervals of the paroxysms the intellect is usually clear, and the patient appears conscious of his danger, frequently exclaiming, 'I shall die !' and he is also conscious of the accession of the paroxysms, telling those around him of their approach, and asking to be held. In the case of J. P. Cook, poisoned by Palmer, those about him tried to raise him ; but he was so stiff that they found it impossible. He then said, ' Turn me over/ which they did, and he died in a few minutes. Intense pain is felt, due to the powerful contractions of the muscles. After the lapse of a minute or two, the spasms subside, a sudden lull takes place, during which the patient feels exhausted and his skin bathed in sweat. In poisoning by strychnia, the jaws are slightly, if at all, affected. In tetanus the result of disease, the locking of the jaws is an early and a marked symptom. As death approaches the fits become more frequent, and the patient dies from exhaustion or suffocation. The poison may fail to be detected, and this link in the scientific evidence may be wanting, as was the case in Palmer's trial ; whereas the strychnia had been admini- stered in pills, and after death the stomach had been cut open, and the contents lost ; there was little hope of discovering the poison. The non-discovery of the poison was made a strong point on the part of the defence, ignoring at the same time the fact that the stomach had been tampered with and the contents spilt. Death may be the direct result of a dose of strychnia, and yet it may not be detected in the dead body, even with the greatest care, and when the body has not been tampered with. Post-mortem Appearances. — There is no characteristic appearance found after death. The blood is fluid, the heart empty, with some congestion of the membranes of STRYCHNIA. 349 the brain. Absence of all cause for so violent and sudden a death. Rigor mortis is prolonged for some time. Fatal Period. — The rapidity in the accession of the symptoms and fatal termination will, to some extent, depend upon the form in which the poison is taken, i.e., in solution or in pill. In most cases the symptoms appear in from three or four minutes to an hour, or more, after the poison is swallowed, death following in from ten minutes to six hours. Fatal Dose. — A quarter to half-a-grain ; but large doses ha^ve been taken followed by recovery. Treatment. — Evacuation of stomach by emetics and stomach-pump, and then the administration of animal charcoal, iodide of potash, tannic acid, and tea, followed by diffusible stimulants. Analysis. — The alkaloid abstracted from the tissues or contents of the stomach by Stass' process may have the following tests applied to it : — 1. Scarcely soluble in water, but readily soluble in acidulated water. 2. Intensely bitter taste. 3. Not affected by sulphuric acid ; but when a little peroxide of lead, or peroxide of manganese, or bichro- mate of potash, or ferridcyanide or permanganate of potassium is added, a magnificent purple-blue colour, changing to crimson, and finally to a light-red tint is the result. Less than 10 oo 00 of strychnia has been stated to give this reaction. The physiological test consists in introducing a small quantity of the suspected substance under the skin of a frog, and noting whether the animal suffers from tetanic spasms or not. Strychnia may not be found in the body even after death from poisoning by it for the following reasons : — . 1. Smallness of the quantity taken. 2. On the time which has elapsed after taking the strychnia, until the symptoms commence. 3. If the careful preservation of the stomach and its contents has been overlooked. 350 FORENSIC MEDICINE. £ P3 -4 Ph jz E- !□ G w o 0 ° Ph S w o O W w goo tH O f>a j 4-3 CO CO Qj Ph © § r— I © it teg CO © 03 © c5 O © h r-i 03 TH CO © CO • J .9 S ! 2 ^ * , $ * ■ CO © r^-J 1^2 03 ^ a QJD S o3 o3 P- „ ^ Ph S o M ^ h S « S fi * s ° s 5 g ° s § 2 H P3 © ©r^ 3 so o ^ ^ 03 © co ^-i oi s © © P-I ca ^ - 2 d co 03 CD §11 © © fl o © > rcJ O • ft o 03 ' © 03 £ d ° O eg . § © rd rj O • cl © CO ' rj ffl .3 S § g &ft .2 a k «i > ft"2 ® S'fi § ft ^.a w ° O >i CO - r ft^ «H W Oj.H « s a cd ® o CO 4J pj CO Tj? o3 Ph O O p_, CO CO aj ©bo ^ +3 d R o ^ g g g- ft gs CD © • CO © i£5 *m 352 FORENSIC MEDICINE. Irrespirable Gases. Carbonic Acid. Poisoning by Carbonic Acid. 1. Circumstances which may show that it is Suicidal. — The position of the body and the presence of one or more of the methods adopted for the generation of the gas. But it must always be borne in mind, that in order to conceal a murder, the body may be placed under circumstances which point to carbonic acid poisoning. Poisoning by this gas is a favourite mode of suicide in Paris. 2. Circumstances under which it occurs Accidentally. — Death may result where several persons are sleeping in the same room, and the ' ventilation is imperfect; from the admission of the vapour of charcoal into a room from an adjoining vent ; or from incautiously sleeping in a brewery close to a vat in which fermen- tation is going on. It must also be borne in mind that death may result from the presence of this gas in an atmosphere which will permit the combustion of a candle. The burning of a candle is therefore no test of security from danger in an atmosphere where the presence of carbonic acid is suspected. Carbonic acid does not, as is generally supposed, sink to the lower portions of a room, and Dr Taylor, from his experi- ments, states 6 that in a small and close room persons are liable to be suffocated at all levels from the very equal and rapid diffusion of carbonic acid during com- bustion. ' 3. Symptoms. — The early symptoms are a feeling of weight and fulness in the head, accompanied with giddiness, throbbing of the temporal arteries, drowsi- ness, palpitation of the heart, gradually increasing insensibility, stertorous breathing, ending in death from asphyxia or apoplexy. Sometimes the victim dies convulsed, at other times a deep sleep quietly CARBONIC ACID. 353 merges into death. The symptoms will of course depend upon the quantity and purity of the gas present in the apartment. 4. Action on the Animal Economy. — The opinion of observers varies greatly, Berzelius maintaining that an atmosphere containing 5 per cent, was not injurious to life ; Allen and Pepys on the other hand stating that 10 per cent, of the gas would cause death. Bernard considers that it is not poisonous, as it can be injected into the bodies of animals without injury, and that its action is purely negative ; it is irrespirable in the same sense as pure hydrogen or nitrogen is ; simply therefore causing death by suffocation. Whatever may be the true explanation of its action, it is enough for all practical purposes to know that death follows when it is breathed, even when mixed with a normal amount of oxygen. 5. Post-mortem Appearances. — The face may be pale and composed, or swollen and livid. The vessels of the brain are frequently greatly congested, and the heart and great vessels gorged with black fluid blood. The blood in some cases is, however, of a cherry-red colour. This may be probably due to the presence of carbonic oxide, which appears to have the power of preventing the change of arterial into venous blood, the opposite effect to that of carbonic acid. The tongue may or may not be protruded beyond the teeth; in most instances the latter is the case. Animal heat is long retained after death, and the rigor mortis occurs as in other forms of death. 6. Treatment. — Bleeding from the arm, cupping : from the nape of the neck, and the employment of cold affusion to the head. The patient should be removed without delay into the open air. Artificial respiration t and galvanism have been successfully employed in some ' cases. 7. Hoiv proportion of Carbonic Acid may be estimated. — The air to be examined is drawn into a vessel cap- 354 FORENSIC MEDICINE. able of holding one-and-a-half gallons, to which is added a clear solution of lime or baryta. The vessel, after being well agitated, is allowed to remain un- touched for from eight to twenty-four hours. The carbonic acid is absorbed by the lime or baryta, and the difference in the causticity of the lime solution before and after it is placed in the vessel gives the amount of carbonic acid present in the air. A simple method of collecting the air in a mine is by lowering a bottle full of fine sand, so arranged that at any depth it may be turned upside down, and the sand allowed to run out, its place being taken by the air of the mine. The bottle may now be quickly drawn up, corked, and reserved for examination. 8. Hoio may a Well or Mine he cleared of it ? — In the case of a well, a basket of slacked lime may be let down ; but in mines, a steam fanner or a jet of steam must be blown through the mine. No one, of course, should be allowed to enter the well or mine till it has been cleared of the carbonic acid. Carbonic Oxide. This gas is formed in a variety of ways, one being the oxidation of carbon at a very high temperature in a limited supply of oxygen. It is one of the chief in- gredients of the vapour of burning charcoal. It is a very powerful gas, speedily causing death by acting chiefly on the nervous system, the symptoms being those produced by a pure narcotic. To this gas is due the suffocating quality of air in which coke or charcoal is burnt. It is inodorous, hence the dangerous in- siduousness with which it produces its fatal results. The vapours from brick kilns and 6 burnt ballast ' heaps are injurious to health, and the owners of them may be indicted for causing a nuisance. TOXICOHJEMIA. 355 Sulphuretted Hydrogen. Sulphuretted hydrogen is a gas possessing a power- ful odour of rotten eggs. It is largely used as a test for most of the metals ; and its presence may be de- tected by filtering paper, moistened with a salt of lead, becoming black. The symptoms produced when the gas is moderately diluted are giddiness, throbbing of the temples, pain and oppression of the stomach, nausea, and vomiting. Delirium and convulsions sometimes occur, together with laborious respiration and an irregular pulse. When the gas is but slightly diluted, the person becomes suddenly weak and insensible, and rapidly dies. The post-mortem appearances are fluidity and blackness of the blood, loss of muscular contractility, and a tendency to rapid putrefaction. The bronchial tubes are reddened, and the internal vascular organs may appear almost black. The treatment will consist in the immediate removal of the person into fresh air, and the administration of stimulants, together with the respiration of chlorine gas evolved from bleaching powder by the action of an acid. Toxicoilemia. Under this head may be classed all those effects produced by the sting or bite of various insects and reptiles, and also by the bite of the mad dog and wolf. No medico-legal question is likely to be raised on this subject, at least in this country, where, with the excep- tion of the common viper or adder, all our reptiles are harmless enough. MEDICAL POLICE. Man, subject to certain physical and moral influences, should be regarded rather as a species than as an individual. These influences are — A. Purely physical or natural. 1. Sex. 2. Age. 3. Locality. 4. Periods. 5. Seasons. 6. Hours of the day. B. Moral or disturbing. By the operation of this second group, man is distinguished from the lower animals. A. Purely Physical. 1. Sex. — More male children die in the earlier years of infancy than female. The male births are in excess of the female, as seen from the following tables. Several suggestions have been made to explain this law. Some have tried to show that, after the birth of a son, means are taken to prevent further increase in the family. Giron de Buzareignes is of opinion that employment has a governing influence, the more lusty male reproducing his sex. Thus more males are born in the country than in towns. Bickes considers that the excess of males depends on certain physiolo- gical peculiarities of race. Hofacker and Quetelet lean to the opinion that the relative ages of the parents are the determining causes. See Tables under Age. INFLUENCE OF SEX. 357 Table shoiving the Ratio of Boys to Girls in the folloiving Countries : — Countries. Boys. Girls. France 106-55 100 Russia 108-91 Holland and Belgium . 106*44 > > Sweden 104-62 England 103-5 Average of Europe 106-00 J 5 Table shoiving the Ratio of Legitimate and Illegitimate Boys to Girls for every 100 Girls : — Countries. Legitimate. Illegitimate. Sweden 10473 103*12 France 106*69 104-78 Austria 106-15 104-32 Bohemia 105-65 100-44 Towns. ! Paris .... 103-82 103-42 Amsterdam . 105-00 108-83 Leipzig 106-16 105-94 As already stated, more males die during infancy than females, and this effect of the sexes is well pro- nounced in all that concerns the deaths. This mor- tality does not only affect the males before birth, but even during the first ten or twelve months after birth, that is to say, during the period of nursing. The ratio of deaths before birth is as 3 to 2 ; during the first and second months after birth, as 4 to 3 j during the fourth and fifth months, 5 to 4 ; till between the eighth and ninth, the difference between the male and female deaths is almost nil. In Belgium, the ratio of 358 MEDICAL POLICE. male still-births to female is as 1*33 to 1 for the towns, and 1*70 to 1 for the country. At birth the mortality is greater in males than in females ; but at two years of age the mortality is nearly the same. At the age of puberty the female mortality is in slight excess of the male ; between 21 and 26 the male deaths are again in excess of the female; but between 26 and 30 they are- equal. During the period of child-bearing the female deaths exceed the male in country places, but this mortality again diminishes after the catamenia have ceased. Taking the whole term of life, the female has the advantage of long life ; yet, owing to the risks of child-birth, her life is not so insurable as male lives, but after that period, as an annuitant, she has an immense advantage. It is also found that congenital malformations are more common in the male than in the female, due probably to some intra-uterine forces, the exact nature of which have not yet been deter- mined, but which appear to act after birth. Males are more liable to diseases of the vascular system, calcifica- tion, and atheroma of the arteries, angina pectoris, and also to dangerous haemorrhages. 2. Age. — The fecundity of marriages appears to be in an inverse ratio to the age of the parents. The fecun- dity of marriages is greatest when the husband and the wife are about the same age, or in those in which the man is older than the woman by from 1 to 6 years. The number of births is not, however, appreciably affected when the difference in the ages does not exceed 16 years; but the minimum of fecundity is reached when this limit is exceeded, or the man is much younger than the female. Early marriages are generally sterile, or, when children are born, the ten- dency to early death is great. Fruitful marriages pro- duce the same number of births, irrespective of age or locality, provided the age of the man is at or about 33, and that of the woman 26 years. After these ages the number of births gradually diminishes. INFLUENCE OF AGE. 359 The period of greatest fecundity is, therefore, at 33 years of age for the man and 26 for the female. Other things being equal, those marriages are most productive when the age of the man is either slightly under or in excess of the female. In Great Britain the average age at which marriages take place is 25 years. The average age of the wives is forty and a-half ; of husbands, forty- three years. The age of majority in England, according to the com- mon law, is twenty-one ; all persons under that age are infants. Males at fourteen and females at twelve may consent to marry, but they cannot marry legally with- out the consent of their guardians till they are twenty- one years of age. The number of marriages very sensibly diminishes over 40 years of age. The fecundity of women ceases between the ages of 45 and 50 ; that of men is uncertain. The Effect of the Ages of the Parents on the Ratio of Boys to Girls is seen from the following Tables : — Age of the Man. Age of the Woman. Boys to 100 Girls. The man is younger than the woman 90*6 same age as ... 90*0 , , older 3 to 6 years . 103'4 >> 3 > 6 to 9 , , 1247 9 to 18 „ 143-7 5» J 5 18 „ and more 200-0 The man 24 to 36 years, the woman 16 to 27 years . 116-6 ,, 36 to 46 . 95*4 \\ 36 to 48 is young 176-9 1i 19 JJ , , middle age 114-3 over middle age 109-2 48 to 60 " middle age 190-0 i i 5 J if , , over middle age 164-3 360 MEDICAL POLICE. Difference of Age — the Husband being Younger Same age Older . From 1 to 6 years „ 6 to 11 „ „ 11 to 16 „ 16 and above Number of Mar- riages. 54 18 Births. Total 126 107 43 33 381 122 54 366 327 145 95 1109 Girls. 141 57 353 258 97 57 963 Ratio of Boys to Girls. 86-5 94-8 106-7 1267 147*4 165-2 114-8 Age exerts a powerful influence on the mortality, and this influence is universally acknowledged. Out of 100,000 males alive at 3, only 94,417 will probably be alive at 10 ; of females at the same age, 94,551. At the age of 50, 59,123 males will be alive, and 65,237 females. Nine females out of 100,000 may reach the age of 100, but none of the other sex. A large amount of the mortality among infants may be due to the ignorance of mothers as to the simplest dietetic and hygienic arrangements, and the pernicious habit of drugging the children to keep them quiet. This system is probably more often practised by those left in charge of the children, during the absence of the mothers ' at work/ than by the mothers themselves. At the age of five the mortality, which had previously been so marked, is suddenly arrested ; and it is at this age that the probability of life is greatest. At puberty the maximum of viability is reached ; after that period the mortality is greatest, especially among women, when the passions become developed, and the dangers of mater- nity are greatest. Between 60 and 65 the probability of life becomes very doubtful. INFLUENCE OF AGE. 361 The following Table gives the probable Duration of Life of Men and Women in various Countries : — Ages. France. England. Hol- land. Sw'den. Europe. Duvi lard. Depar cieux. Morgan. Milne. Kerss- booni. War- gentin. General Table. Birth. 20 8 41 51 33 38'5 5 years 46 54 41 57 47 51 53'3 10 43 52 40 53 45 49 50*3 15 " 39 48 37 49 41 45 46-0 20 „ 36 44 34 45 38 41 42-2 25 „ 33 41 31 ■ 40 35 37 38*5 30 „ 29 37 28 36 32 33 34'5 35 „ 26 33 26 33 29 29 30-5 40 „ 23 29 23 29 26 25 26-5 45 „ 20 25 20 25 23 22 23'2 50 „ 17 21 17 21 20 19 19'2 55 „ 14 18 15 18 17 15 16*0 60 „ 11 14 12 14 14 12 12*7 65 „ 8-5 11 9 11 11 9 9-5 70 „ 6-5 8 8 8 8 7 7*2 75 ,, 5 6 6 6 6 5 5*2 80 3-5 4 4 4-6 4-5 3*5 37 362 MEDICAL POLICE. Table showing probable Duration of Male and Female Life in different Countries, and at different Ages : — Ages. Sweden. Engl'nd B'lgium. Neth'k- LANDS. Bavaria General Mean. Berg. Fair. Quetelet Baum- hauer. De Her- man. Male. Female. Female. Male. Female. Male. Female. Male. Female. Male. Female. Birth. 48 55 11 46 40 43 31 36 22 32 37 43 5 years 54 59 56 53 54 51 54 53 53 53 55 10 „ 50 55 ^1 01 52 49 51 49 51 50 49 50 52 15 „ 45 50 47 48 46 47 44 47 46 45 46 47 20 41 46 43 44 42 43 40 43 41 41 41 43 25 „ 37 42 39 40 38 40 37 39 38 37 38 40 30 „ 33 37 25 36 34 36 33 34 34 33 34 35 35 „ 29 33 31 32 30 32 29 31 30 29 30 31 40 25 29 27 29 26 28 25 27 26 26 26 28 45 „ 22 25 23 25 22 25 22 24 22 22 22 24 50 „ 18 21 20 21 18 21 18 20 18 18 18 20 55 „ 15 17 16 17 15 17 15 16 15 15 15 16 60 „ 12 13 13 14 12 13 12 12 12 11 12 13 65 „ 9 10 10 11 10 10 9 9 9 9 9 10 70 „ 7 7 8 8 7 7 7 7 7 7 7 7 75 „ 5 5 6 6 5 6 5 5 5 5 5 5 80 ,, 3 4 4 4 4 4 3 3 3 4 3 4 3. Locality. — The first thing to be considered under this head is the effect of locality on fecundity; and on this subject the data are unfortunately very incomplete. The fecundity of the inhabitants of even neighbouring countries varies greatly ; thus, in England the ratio of births to the number of inhabitants is 1 to 35*0; in Trance, 1 to 31*6; Sweden, 1 to 27 ; and in Prussia, 1 to 23*3. It is stated that 'the places which produce annually the greatest number of marriages are those where the fecundity of marriages is least and also, * that the countries where marriages are most numerous LOCALITY. 363 are those where the mortality is greatest/ Quetelet states that 100 marriages in Northern Europe produced 430 births ; in Southern Europe, 457. This he attri- butes to the late period of marriage in the north, and to the precocity of the inhabitants of southern countries. The reports of births and deaths of Scotland make three divisions of the people. 1. Those living on the islands. 2. Those living in the country of the mainland. 3. Those living in the great cities. During the fourteen years reported, the proportions of deaths of children for every 100 births in each class were — UNDER ONE. UNDER EIVE. Islands . . . .8*05 15 '58 Mainland Country . .9*80 18*56 Cities .... 14-91 30'90 The death-rate also varies in different countries; thus, in England it is about 1 in 51*0 ; in France, 1 in 39*7 j in Sweden and Belgium, 1 in 47*0 and 1 in 43 '1 respectively. The number of deaths is greater in towns than in the country ; and greater also where the sanitary arrangements are incomplete. Dr Stokes says : — ' Since the introduction of sanitary measures, the death-rate of the three great capitals, and of the gaols on the continent of India, is stated to be greatly lessened. Calcutta shows better than Liverpool or Manchester, and the death-rate of Bombay is less than that of London.' Hot and cold climates materially increase the death- rate ; but this, as above shown, may be checked by the adoption of sanitary measures. The climate of the British Isles, with ' a mean range of only 20° between summer and winter, cloudy skies, and frequent rains, with a high relative humidity, so far from acting injuriously on the health of the people, conduces to the greatest activity of mind and body, to a high standard of health, and to longevity.' 364 MEDICAL POLICE. But beyond the mere questions of birth and death- rate, locality has a marked connection with certain diseases — ague in Essex, goitre in Derbyshire, etc. The soil probably has something to do with the causa- tion of certain diseases. Thus, damp, clay soils are attributed with rheumatism, catarrh, and neuralgia; alluvial, containing large quantities of organic matter, give out malaria, although not marshy; and the gravels, sandstones, chalk, etc., are considered as a rule healthy. Dr Bowditch has shown that the frequency of phthisis in certain localities is notably diminished by proper drainage, which is only another proof that the public health can be improved by keeping the soil clean through good drainage. See also Dr Buchanan's report on the same subject in the Tenth Eeport of the Medical Officer of the Privy Council. From the Fens ague has been almost entirely banished, due to improved systems of drainage adopted in those districts. But a curious fact is recorded by Denton, on the observations of Mr Marshall, of Ely. Ague has in some places recurred, but not, as formerly, during spring, but during autumn — the explanation given by Mr Marshall being that ' the drainage had been carried beyond the point of prudence, so that in the summer months, and especially towards harvest, the Fen ditches became nearly dry ; and the consequence was that we once more got an exhaling surface, and a noxious effluvium arising from decaying vegetable matter.' ' This state of things,' continues Mr Marshall, 6 is now quite altered, and the ague has again vanished, owing to the farmers making it a rule to let water in from the rivers during the summer months, so as to " keep a water " always in the Fen ditches.' It should always be borne in mind that a house having a higher temperature than the sur- rounding air acts as an exhauster of the soil beneath, and this is shown by the smell of gas present in a house not supplied with gas, the presence of the smell being the result of permeation through the soil of gas LOCALITY. 365 from a neighbouring broken gas-pipe. The effluvia from cesspools or drains may be thus drawn into a house, especially if the soil be loose or gravelly. The presence and amount of water in the soil also demands attention, and necessitates a good system of subsoil drainage. The observations of Pettenkofer on the wells of Munich suggested to Buhl the probable relationship between the height of the ground water and epidemics of fatal typhoid fever, the outbreaks occurring when the ground water was lowest, but especially when it had reached an unusual height, and had then rapidly subsided. This view, although confirmed by subse- quent observations in Germany, has not been accepted in England, where impurity in the drinking water is generally accredited with the causation of the outbreak. Pettenkofer considers the following conditions to be necessary for the production of typhoid fever : — a. Unusual height of ground water followed by a rapid sinking. b. Impurity of the soil from animal impregnation. c. Heat of the soil. d. Presence of a specific germ. On the subject of cholera, Pettenkofer holds like views ; but these have not been accepted in Germany, and the weight of evidence appears to be against them. The height of water in a well may be taken as a good guide as to the amount of the subsoil water. Deep drainage, and opening the outflow, are the only means to get rid of the excess of the subsoil water. While advocating a perfect system of subsoil drainage, Mr Denton lays great stress on the necessity for keep- ing the drainage of the soil distinct from the sewerage, ' inasmuch as the same apertures which let the water from the subsoil into the sewer will let the sewage out * of the sewer into the subsoil whenever the pressure from within is greater than that from without. And we must also remember that whenever sewage itself escapes sewer gas will escape too.' 366 MEDICAL POLICE. Air in the Soil. — The amount varies with the nature of the soil — probably from 40 to 50 per cent, in loose sands or gravel, and is being constantly changed. The amount of C0 2 probably owes its origin to organic pro- cesses going on in the soil. Owing to bad drainage and the presence of decaying animal and vegetable matter in the soil, the contained air may become impregnated with sulphuretted hydrogen, ammonium sulphide, carburetted hydrogen, etc. 6 It appears mani- fest to me that the escape of these constituents into the ground surrounding dwellings must be injurious, for the gases evolved in sewers are frequently fired by the candles of sewer men ; and in a case in my own practice, where an examination was being made of the condition of a sewer running under a large establish- ment, in which there were at the time 250 inmates, the confined gas took fire from a workman's candle, and passed through the entire length of a long basement. Little attention is at present given to matters like this, though they cannot fail to show that sewers with air- tight joints are desirable near dwellings. If they are air-tight they are necessarily water-tight, and then the sewage itself, with its 72 parts of dissolved solids in 100,000 parts, will not escape into the soil surround- ing the sewer, to render it " excrement sodden," and gravitate by soakage to the foundations and basements ' (J. B. Denton). Air in Soil — How estimated ? — In the case of rocks, first, after careful drying, determine specific gravity, and then weigh before and after submersion in water. Thus— Weight of water taken up x 100 , , . — — — ^ — — = rrf r— = percentage ot air. Weight of dry rock -r- specific gravity In the case of loose soil, dry soil at 100° C. (212° F.), reduce to coarse powder and place it in a burette, gently tapping it to expel as much air as possible. Take another burette, and connect by india-rubber tube the bottom of it to the first, taking care to have a PERIODS. 367 stop-cock between them. Into No. 2 pour some water ; then open the stop-cock, and allow some water to rise gradually through the soil in No. 1, so that the water stands just above the soil. Kead off from No. 2 the quantity passed through to No. 1, and calculate as follows : — Amount of water used x 100 - . : — — = percentage ot air. Cubic centimetres of dry soil Ground Water. — Soil partly filled with air and water is said to be damp; but when all the air is expelled by the water, the degree of humidity thus reached is called ground water. It commences at the lowest limit of the air in the soil. The ground water is due partly to rain, and partly also to the rising by capillary attraction of the water flowing on the surface of the more impermeable rocks. Two gallons of water may be contained in a cubic foot of loose sand, and one in the same bulk of ordinary sandstone. How Measured ? — By taking the depth of the water in the wells in the neighbourhood. This may be done by attaching a series of cups at equal distances along a rope, and carefully letting the rope down, the last cup filled will nearly give the depth of the water. The amount of moisture in the soil may be determined by drying a weighed quantity at a temperature of 220° F., and noting the loss of weight; or the soil may be dried, weighed, and then exposed to the air, the increase of weight will give the amount of moisture taken up. It is one of the duties of a medical officer of health to make himself acquainted with the geological and topographical characteristics of the district over which he presides. This he can readily do by a study of the ordnance maps published by the Surveyor-General. 4. Periods. — At different periods in the same country we find a marked difference between the number of marriages, births, and deaths. Thus at certain periods, when corn is cheap, and the cost of living small, there are more marriages, followed by an 368 MEDICAL POLICE. increase of births, than at those periods when corn is dear, the result of either the effect of bad harvests or war. The number of the deaths varies also at different epochs. The mortality is not as a rule increased during the period of famine, but during the years which follow, as a result of the diseases brought about by want of proper food. Quetelet observes that 'it is remarkable that epidemics, famines, and all great pestilences, exercise a marked influence not only on the mortality, but also on the number of marriages and of births.' a. Periods of Scarcity- Irish. Famine, Years. 1843 1844 Deaths. 70*499 75*055 Before the famine. 1845 86-900 ) 1846 122-889 } During the famine. 1847 249-335 ) 1848 208-252 1849 240-797 1850 164-093 After fluctuation and decrease b. Periods of War. — Two causes at work. 1. Increased mortality of adult males. 2. Decrease in marriage and birth-rate. c. Epidemics. — Rapid increase of death-rate. 5. Seasons. — The number of births and deaths is more or less affected by the seasons of the year : thus, the maximum of deaths occurs about the month of January, that of births during February ; the minimum of both being reached about July. The effects of winter having passed off, and the vital forces being most active, most conceptions take place in May, followed by an increase of births in the following February. The effect of the seasons is more marked in the .country than in the towns. Certain diseases are more marked in their prevalence and intensity at one season of the year than at another, SEASONS. 369 and this appears to have some indirect relationship to the varying states of the organism at those seasons. A rapid fall of the thermometer in winter is followed by a rapid rise in the death-rate, from chest affections in the young, the aged, and the weakly. It is a curious fact that after an intense and prolonged frost the death- rate rapidly increases on a break-up of the frost, the sudden increase in temperature being more fatal than the cold. In summer, excessive heat is also attended with an increased mortality from diarrhoea, especially among children. i. [Table of Seasons. 370 MEDICAL POLICE. H <; Minimum and Increase. Change — Adyna- mic and Dynamic. Diarrhoea, erup- tive fevers, inflam- mations. Summer. Decline and minimum. Adynamic. Diseases of digestive organs. Diarrhoea, cho- lera, plague. d i— 1 Ph Pw m Maximum and decline. Change — Dyna- mic and Adynamic. Inflammations, bronchitis, pneu- monia. Apoplexy, erup- tive fevers. Winter. Stationary maxi- mum. Dynamic. Diseases of respira- tory organs. Inflammations, bronchitis, pneu- monia, and brain diseases. Apoplexy. Vital activity, Type of disease, SEASONS. 371 The preceding table is somewhat complicated, and is scarcely so explicit as might be wished, but the subject discussed is one of no ordinary difficulty, for we are dealing with two most unstable and complex pheno- mena — the human organism on the one hand, and the varying seasons on the other. The data deduced from the death-rate — and at present we have no other source of information — can give or leave no correct idea of the prevalence of an epidemic, only of its fatality. Besides, the type of the disease is modified by the condition of the system previously existing, and also by the power of the individual to resist the debilitating effect of heat, or the invigorating power of a moderate degree of cold. This may help to explain the reason why only certain persons are attacked in winter or in summer by an epidemic, when the morbific element must be present to all. The type of disease also is modified by the state of the system preceding the attack ; thus, an individual bearing heat well does not suffer from debility to a like extent with one who is at his best in cold weather, and hence, in the former case an attack of disease in summer is not so likely to prove fatal as in the latter. In the case of children, Dr Edward Smith has arrived at the conclusion that a child ' born in the cold season has a higher probability of life than when born in the hot season.' The influence of season is more marked in the country than in the towns. [Table of Seasons. 372 MEDICAL POLICE. Table showing the influence of Season on Zymotic Diseases. WlNTER. Spring. Summer. Autumn. Cholera occa- sionally occurs as an epidemic dur- ing this season, especially if the weather be very- mild. Measles. Measles. Cholera, unieny at mis season. Small Pox. Small Pox. Scarlet Fever. "Whooping Cough. Typhus. Due probably to over- crowding in the cold seasons of the year from want of proper fuel for heating the dwellings. Typhoid. The state of civilisation to which the inhabitants of a country attain, is in a great measure due to the seasons. Agriculture flourishes in countries where the seasons are favourable ; and in no country was this more notice- able than in Egypt. The regular overflow of the Mle at a certain time of the year made Egypt the granary of the ancient world. As a nation becomes more agricul- tural, it becomes more civilised. 6. Houks of the Day. — There can be no doubt that man is more liable to be attacked by disease during certain hours of the day than at others. More deaths occur during the early hours of the morning than at any other time. On this subject Dr Einlayson remarks : — PROFESSIONS AND TRADES. 373 ' Hence we may either say that the period of minimum vital energy, which exists during the first few hours after midnight, being deepened and perhaps prolonged, coincides with the summit of the death curve, or, phras- ing it otherwise, that the time having arrived for a fresh rallying of the vital energies for a new day, the dying are found to be unable to respond to the call, and so they perish in greatest numbers at the very hours in which the living are manifesting, in every way, a renewed vigour.' There is also greater liability to attacks of epidemic diseases during the night. 'On referring to the experience of cholera in this country, it appears that the great majority of seizures were between twelve at midnight and six in the morning. ' In Hamburg the attacks were so generally in the night, that, when the epidemic was at its height, many persons were afraid to go to bed at all ; and it is remarkable that the same observation has been made with respect to plague, when it prevails as an epidemic.' Dr Laidlaw says : — 6 1 do not recollect to have been called to a fresh case of plague till between five and six in the morning.' This liability to disease during the night is probably due to the diminished activity of the function of respiration and to the lowered tone of the system. The number of births is greater during the night than during the day, the ratio being as 5 to 4. B. Moral or Disturbing. Professions and trades ; state of morality ; marriage and prostitution ; institutions, civil and religious, affect- ing the number of births and deaths. 1. Professions and Trades. — The influence of pro- fessions and trades on the birth-rate of a country is in ' general masked by other forces, the exact influence of which is not easily determined ; but their effect on the number of deaths is more easily appreciated. The clergy are proverbial for large families. A state of 374 MEDICAL POLICE. slavery appears to diminish the fecundity of marriages. With regard to the effect of professions and trades on the morality of a country, more definite data have been obtained. The state most favourable to man is that in which he leads a regular life, with sufficient for his wants, without having his passions excited by the profligacy of the towns. Certain professions and trades are more obnoxious to long life than others. Thus, the researches of the late Professor Casper, contrary to the generally received opinion, show that the medical profession is perhaps more liable to early death than any other, and that the clergy in the list of mortality occupy the opposite extreme. Idleness and affluence are fruitful sources of disease. All those professions which from their very nature enjoin a more or less sedentary life are injurious to health, and therefore to longevity. Lawyers confined to the desk, schoolmasters, clerks, literary men, and others precluded from taking exercise in the open air, or doomed to work to late hours of the night, are as a class short-lived. Literary men unfortunately lead most irregular lives, which may, more than their occupation, tend to shorten life. Merchants are generally considered long lived ; but it is not improbable that the formation of . railways, with the rapidity of transit and the uses of the electric telegraph, which diminishes the dimensions of the earth, will have at no far distant date most injurious effects on the mercantile population. The rapidity with which the news of the fall in prices of the markets is now transmitted, and the anxiety to sell at once to save loss, or to buy in the hope of future profit, is gradually leading to a train of evils for which the future must suffer. Shopmen, confined all day to close, ill-ventilated shops, going to bed late and rising early, with little out-door PROFESSIONS AND TRADES. 375 exercise, except on Sunday, when they are glad to rest, after the labours of the week, frequently fall victims to phthisis, and die early. Stone-masons, lapidaries, knife-grinders, quarry-men, coal-miners, coal-heavers, pin-pointers, button-makers, pottery-workers, flax-hacklers, etc., are subject to dis- eases of the air passages and lungs, phthisis, etc., due to the inhalation of solid particles of matter. Grinders' rot is a form of consumption well-known among knife and needle-grinders. White-lead manufacturers, plumbers, and painters are liable to paralysis and to lead-poisoning, known as \ painters' colic.' Workers in mercury and gilders often suffer from a form of paralysis and salivation called mercurialismus. Chimney sweeps are subject to cancer of the scrotum. Phosphorous workers to necrosis of the jaws. Arsenical workers and artificial flower makers to slow forms of arsenical poisoning. Bakers to skin eruptions, lichen, etc. Brassfounders, tin-plate workers, and coppersmiths, to a peculiar form of ague. Shoemakers, from their sedentary habits, suffer in most cases from piles and from the pressure of the last on the breast-bone. Soldiers and sailors, if the former are not selected at too early an age, and the latter when they escape the perils of their calling, are generally healthy and long- lived. The effect of recruiting the Trench army in the time of Napoleon with very young men was, that * they encumbered the road-sides and the hospitals.' The earliest age at which the recruit should be admitted into the army is twenty. On the whole, then, those professions and trades which admit of a due exercise of the healthy functions of the mind and body, together with a due amount of out-door exercise, are conducive to long life ; the con- trary, to early death. 376 MEDICAL POLICE. 2. Morality. — Marriage and Prostitution. a. Marriage. — Marriage in young nations becomes a necessity. In many ancient nations marriage was strictly enjoined, and in some enforced by penal statutes. In more modern times much is left to indi- vidual pleasure ; but it may be fairly questioned whether this liberty is always beneficial or for the best interests of the state. It leads too often to injudicious unions, with their train of evils, especially when two unhealthy individuals unite to produce a progeny more unhealthy than the parent stock. A large percentage of the pauperism in England is the result of unthrifty marriages, and the system of out-door parish relief is to a large extent a premium on them, for the more in family the more relief. Promiscuous intercourse of the sexes has a tendency to diminish the number of births, and to lessen the natural expectation of life. There are more still-births among illegitimate than legitimate children, and the mortality is also greater during the early months of infantile life. 6 Le funeste heritage/ says Quetelet, ' du vice n'atteint pas seulement 1' enfant avant sa naissance, il le poursuit longtemps apres qu'il a echappe a ce premier danger ; et la misere bien souvent aggrave encore le nial.' Married men live longer than the unmarried. Herbert Spencer questions the truth of the last statement by pointing out that the increased longevity of married men is not due so much to the married state, as to the fact that men who marry are those whose surroundings in life are most conducive to the prolongation of life, such, for instance, as easy cir- cumstances, a more vigorous constitution, etc. — in short, everything which renders marriage desirable and prac- ticable. There is a larger number of widows than widowers in Great Britain, and the proportion of the one to the other is greatest in our seaport towns. Mr Milne gives the following reasons for the larger propor- tion of widows to widowers : — 1 . Men are in general more intemperate than women. MORALITY. 377 2. They are exposed to greater hardships and dangers. 3. Widowers, perhaps, in general have greater oppor- tunities of getting wives than widows have of getting husbands. The cost of living appears to affect the number of marriages, and on this subject Professor de Morgan remarks : — ' When provisions are cheap, or wages high, when, in fact, it is easy to maintain a family, marriages are more frequent, and are contracted at earlier ages.' In London the average number of children to each marriage is less than in the country, but the average of the whole country is about four for each marriage ; and it is stated that when the relationship between the parents is very close, a large percentage of the children are more or less injuriously affected, insanity, blindness, dumbness, etc., being among the most frequent results. h. Prostitution. — This is one of the most difficult questions which may engage the attention of the State. That prostitution is a terrible evil no one will deny ; but few are agreed as to the measures to be adopted for its suppression. Besides the terrible diseases which promiscuous intercourse of the sexes engenders, the effect on the morals of the community is not less disas- trous. In foreign countries the State has interfered, and prostitution is to a great extent regulated by State enactments. In the years 1864, 1866, 1869, certain Acts were passed, known as the Contagious Diseases Acts; but these, unfortunately, only apply to certain towns used as naval and military stations. Much opposition has arisen with regard to these Acts among a small number of very well-meaning but misguided philanthropists, among whom may be noticed a few married and unmarried women. In no other country but England is prostitution so open and so undisguised. 6 The effect of this/ writes Dr Parkes, ' upon the virtu- ous female population is very serious. Every servant in London sees the fine clothes and hears of the idle and luxurious lives of the women of the town, and 378 MEDICAL POLICE. knows that occasionally respectable marriage ends a life of vice. What a temptation to abandon the hard work and the drudgery of service for such a career, of which she sees only the bright side ! It is a temptation from which the State should save her. She should see prostitution as a degraded calling only, with its restric- tions and its inconveniences. ' If a means of gratifying the sexual instincts is imperative, and marriage is not possible in all cases, the unfortunate women, who may as a rule be regarded as the victims of male licentious- ness, should be properly registered, domiciled, and placed under organised medical inspection. They should not be allowed to patrol the streets of our towns decked out in the most captious apparel, and enticing by their meretricious actions the young and the unwary. The following are some of the provisions of the above- mentioned Acts : — Contagious Diseases Act, 1866 (29 Vict., c. 35) ; 1869 (32 & 33 Vict,, c. 96). On information Justice may issue Notice to Woman who is a Common Prostitute. Sec. 15. — Where an information on oath is laid before a justice by a superintendent of police, charging to the effect that the informant has good cause to believe that a woman therein named is a common pros- titute, and either is resident within the limits of a place to which this Act applies, or being resident within ten miles of those limits, or having no settled place of abode, has, within fourteen days before the laying of the information, either been within those limits for the purposes of prostitution, or been outside of those limits for the purposes of prostitution, in the company of men resident within those limits, the justice may, if he thinks fit, issue a notice thereof addressed to such woman, which notice the superin- tendent of police shall cause to be served on her. CONTAGIOUS DISEASES ACT. 379 Provided that nothing in these Acts — 1866, 1869 — contained shall apply or extend, in the case of Wool- wich, to any woman who is not resident within one of the parishes of Woolwich, Plumstead, or Charlton. Power to Justice to Order Periodical Medical Examination. Sec. 16. — In either of the following cases, namely : — If the woman on whom such a notice is served appears herself, or by some person on her behalf, at the time and place appointed in the notice, or at some other time and place appointed by adjourn- ment : If she does not so appear, and it is shown (on oath) to the Justice present that the notice was served on her a reasonable time before the time appointed for her appearance, or that reasonable notice of such adjournment was given to her (as the case may be) : The Justice present, on oath being made before him substantiating the matter of the information to his satisfaction, may, if he thinks fit, order that the woman be subject to a periodical medical examination by the visiting surgeon, for any period not exceeding one year, for the purpose of ascertaining, at the time of each such examination, whether she is affected with a contagious disease ; and thereupon she shall be subject to such a periodical medical examination, and the order shall be a sufficient warrant for the visiting sur- geon to conduct such examination accordingly. The time and place at which the woman must attend must be stated on the order. The superintendent of police shall cause a copy of the order to be served on the woman. 380 MEDICAL POLICE. Voluntary Submission by Woman. Sec.' 17. Any woman, in any place to which this Act applies, may voluntarily, by a submission in writing, signed by her in the presence of and attested by the superintendent of police, subject herself to a periodical medical examination under this Act for any period not exceeding one year ; such submission shall, for all the purposes of the Contagious Diseases Acts, 1866, 1869, have the same effect as an order of a Justice subjecting the woman to examination, and she shall be liable for all the penalties for neglect and avoidance of examina- tion, etc. Power to make Regulations as to Examinations. Sec. 18. For each of the places to which this Act applies, either the Admiralty or the Secretary of State for War (but not both for any one place) may, from time to time, make regulations respecting the times and places of medical examinations under the Act at that place, etc. And a copy of all such regulations, from time to time, in force for each place shall be sent by the Admiralty or the Secretary of State for War (as the case may be) to the clerk of the peace, town-clerk (if any), clerk of the justices, visiting surgeon, and superintendent of police. Visiting Surgeon to prescribe Times, etc. Sec. 19. The visiting surgeon, having regard to the regulations aforesaid, and to the circumstances of each case, shall, at the first examination of each woman examined by him, and afterwards, from time to time, as occasion requires, prescribe the times and places at which she is required to attend again for examination ; and he shall, from time to time, give, or cause to be given, to each such woman notice in writing of the times and places so prescribed. CONTAGIOUS DISEASES ACT. 381 Detention in Hospital. Certificate of Visiting Surgeon. Sec. 20. If on any such examination the woman examined is found to be affected with a contagious disease, she shall thereupon be liable to be detained in a certified hospital, subject and according to the pro- visions of these Acts, and the visiting surgeon shall sign a certificate to the effect that she is affected with contagious disease, naming the certified hospital in which she is to be placed ; and he shall sign that certi- ficate in triplicate, and shall cause one of the originals to be delivered to the woman, and the others to the superintendent of police. Placing in Certified Hospital for Treatment. Sec. 21. The woman, on receiving such certificate, may proceed to the hospital and place herself there for medical treatment, but if she neglects or refuses to da so, the superintendent of police, or a constable acting under his orders, shall apprehend her, and convey her with all practicable speed to the hospital and place her there for medical treatment, and the certificate of the visiting surgeon shall be sufficient authority to him for so doing. The managers of the hospital where she is received shall provide for her care and treatment, lodging, clothing, and food, during her detention in the hospital. Detention in Hospital. Sec. 22. Where a woman, certified by the visiting surgeon to be affected with a contagious disease, places herself, or is placed as aforesaid, in a certified hospital for medical treatment, she shall be detained there for that purpose by the chief medical officer of the hospital until discharged by him by writing under his hand. The certificate of the visiting surgeon, one of three 382 MEDICAL POLICE. originals whereof shall be delivered by the superin- tendent of police to the chief medical officer, shall, when so delivered, be sufficient authority for such detention. Power to Transfer to another Certified Hospital. Sec. 23. A woman may be transferred from one certified hospital to another. The order must be in triplicate, and under such order the superintendent of police may remove a woman from one hospital to another. Limitation of Detention. Sec. 24. Provided always that any woman shall not be detained under any one certificate for a longer time than three months, unless the chief medical officer of the hospital in which she is detained, and the inspector of certified hospitals, or the visiting surgeon for the place whence she came or was brought, conjointly certify that her further detention for medical treatment is requisite. No woman is to be detained under one certificate for a longer time, in the whole, than nine months. Power of Woman detained to apply to Justice for Discharge. Sec 25. Any woman detained in a hospital may apply to a Justice to be discharged, who, if satisfied that she is cured, may order her release. During Conveyance to Certified Hospital, etc., Woman deemed to he in Legal Custody. Sec. 26. Every woman conveyed or transferred under this Act to a certified hospital shall, while being so conveyed or transferred thither, and also while detained there, be deemed to be legally in the custody of the person conveying, etc. CONTAGIOUS DISEASES ACT. 383 Eefusal to be Examined, etc. Punishment of Woman for refusing to he Examined. Sec. 28. In the following cases, namely : — If any woman subject to periodical medical examina- tion absents herself, or refuses or wilfully neglects to submit herself to such examination. If any woman quits the hospital without being dis- charged therefrom by the chief medical officer thereof, by writing under his hand (the proof whereof shall lie on the accused). If any woman detained for treatment in a certified hospital refuses, or wilfully neglects, while in the hospital, to conform to the regulations thereof approved under this Act. A first conviction, not exceeding one month ; for a second or any subsequent offence, for any term not exceeding three months, with or without hard labour • and if she leave the hospital without being properly discharged, she may be taken into cus- tody, without warrant, by any constable. The other clauses of the Act are of little importance to the medical man. Kef erring to the opinion of the late Dr Parkes on the Contagions Diseases Acts, the Edinburgh Medical Journal remarks : — ' We are tempted to quote, in con- clusion, the last dying testimony, so to speak, of this thoroughly informed witness in regard to the questio vexata which at present excites so many ignorant non-professional but well-meaning people : — " The prevention of syphilis and gonorrhoea by periodical inspection of prostitutes, and removal of them to lock hospitals when diseased, is only carried out in this country in certain military and naval stations, where the effect has been to lessen primary syphilis by nearly one-half, and to abate its virulence. The effect of the Contagious Diseases Acts upon the women, in respect not only of curing them, but of influencing them for 384 MEDICAL POLICE. good, and for reclaiming them, has been very remark- able. In Germany, France, and Belgium, precautions against venereal diseases have been carried out among the entire population for many years, with the effect of greatly lessening the amount and virulence of syphilis. As primary syphilis has a most pernicious effect upon the health of a large number of persons, it is most urgently to be hoped that the Legislature may before long deal thoroughly with this matter, and attempt to lessen syphilis, not merely in the army and navy, but among the population at large. " ' 9 Civilisation. — No one can doubt the beneficial °es of civilisation on the well-being of a country ; " "fluence is most marked in the diminished g children, and the greater prolongation oj I don't fear contradiction/ says the late jl. ' when I assert that the prolonga- tion of ix r ^ed advantage; because, in proportion ab '"^e old is brought to act on the passions ill the wisdom of nations accumulate, of individual means of over-indulgence, with 1. All religious excitement is injux. being of society, and the only effect religious excitement which passed over us a ! ago, known as 6 Kevivalism/ has been to increa. number of inmates of our lunatic asylums, and to lea the ignorant dupes of the movement in a deeper depth of licentiousness and hypocrisy than ever. Liberal institutions are most favourable to fecundity; and during periods of peace and plenty the number of marriages increases, with a consequent increase in the number of births. It is stated that in Catholic countries, where Lent is rigidly observed, the number of births is materially diminished. It appears also as well estab- lished, that civilisation has great power in diminishing character be increased.' . in itself, unfortunately brings '"^ough good n ses the CIVILISATION. 385 the mortality, in diffusing prosperity, and the most active means of preservation. The following table gives some important results, and is taken from the Geneva records :— qjhj Deaths in 10,000 born were — PEBIOD. UNDER 1. UNDER 3. q> cienth Century . 2*592 4-435 seventeenth 2*372 4-100 Eighteenth 2*012 3-316 1814 to 1833 „ 1-385 3-400 In the first period, one-half died before they com- pleted their ninth year ; in the last, one half survived their forty-fifth year. 1 The injurious effects of overcrowding are well known. Dr Farr remarks, in the Fifth Annual Eeport of E. G. p., 419, that the mortality is not only greater in town than in country districts, ' but that the mortality of town districts has a certain relation to their density.' The following Table ivill show the result of Overcrowding on the Annual Mortality per 1000 in the Metro- polis : — SPACE FOR EACH PERSON. 32 square yards . 102 „ . . . 202 „ MORTALITY. 277 24*4 20-0 Emigration. — This subject has become a matter of great importance, as the necessity of getting rid of our surplus population becomes more imperative. 6 From the beginning pressure of population/ remarks Herbert Spencer, ' has been the proximate cause of pro- 1 See a valuable article on * Infant Mortality,' in the Fourth Eeport of the Board of Health, Massachusetts. 2 B 386 ^OLICE. grass.' Some have s proprietors. This is i in the Quarterly Review x ' We feel the full beauty ^ "tion of small landed "ted by a writei He says : — c hey draw of the smock-frocked labourer s ^ ^ oor under his own fig-tree, looking ou and with his ten children — which he lying on the sward around him. But > of the next step, and picture each of these , needing these ten acres also, the economic im^ breaks down before the unrealisable ideal, peasants are too thick upon the ground already — that the fundamental cause of their wretchedness ; unless they emigrate, they will become thicker still, and rapidly so — and what then ? ' But may we not, in reducing our population by emigration, be parting with the better portion, leaving only the infirm and debilitated behind to still further deteriorate the race 1 c The reality of our difficulty/ remarks Dr Acland, c aboul population is told in a few words. England and Wales are increasing by about 200,000 annually. This number will, of course, increase by a small increment. Since a.d. 1810, the population, which was 10,000,000, has become 22,000,000; and at the same rate, will a.d. 1920 be over 45,000,000. The acres in England and Wales are about 37,325,000, including waste ground. There are now, therefore, nearly two acres per man; in fifty years there will not be one ; in Glasgow there are already 94 inhabitants to an acre, and in Liverpool 103.' Certain writers of late have recommended the limitation of families by the use of certain 1 checks.' These opinions have not generally been accepted, but there is much to be said on both sides of the question. 4. Intemperance. — On this subject I shall quote somewhat largely from some valuable papers in the Annual Eeport of the State Board of Health of Mas- sachusetts, kindly sent me by Dr H. L Bowditch : — 'First. — Stimulants are used everywhere, and at INTEMPERANCE. 387 times abused, by savage and by civilised man. Conse- quently, intoxication occurs all over the globe. 'Second. — This love of stimulants is one of the strongest of human instincts. 6 Third. — Climatic law governs it. ' Fourth. — Owing to this cosmic law, intemperance is rare near the equator. ' Fifth. — Intemperance causes little or no crime toward the equator. It is the almost constant cause of crime, either directly or indirectly, at the north, above 50°. 6 Sixth. — Intoxication is modified by race, as shown in the different tendencies to intoxication of different peoples. * Seventh. — Eaces are modified physically and morally by the kind of liquor they use, as proved by examina- tion of the returns from Austria and Switzerland. 6 Eighth. — Beer, native light wines, and ardent spirits, should not be classed together, for they produce very different effects on the individual and upon the race. 6 Ninth. — Light German beer and ale can be used even freely, without any apparent injury to the indivi- dual, or without causing intoxication. So also may light grape wines, unfortified by an extra amount of alcohol. ' Tenth. — Eaces may be educated to evil by bad laws, or by the introduction of bad habits. ' Eleventh. — A race, when it emigrates, carries its habits with it, and for a time at least those habits may override all climatic law. 4 Twelfth. — In this Dr Bowditch is somewhat hard upon England. ' England has thus overshadowed our whole country with its love of strong drinks, and with its habits of intoxication, as it has more recently ( covered Ceylon, parts of the east, and Australia. ' The other divisions, nineteen in number, relate chiefly to suggestions for suppressing drunkenness in America. ' The present intemperate condition of the English is 388 MEDICAL POLICE. due to several causes, among which may be noticed — bad legislation and war. The prohibitive duties on light French wines forced the English to seek in Por- tugal the strongly fortified port. This has been unfa- vourable to the moral status of England.' Macaulay states that wine was given up in 1648, and that punch took its place \ and worse than the change of brandy and lemonade for claret, was the increase of crime in 1692. 'As a warning to our people,' says the writer of the paper, ' by our present unwise and high tariff on the mild wines of Europe, the people of this country are led to use the only drinks provided for them, viz., the coarser liquors. Are we not, in so doing, following exactly in the absurd way, I do not say wicked example, set by England two centuries ago % The civilisation of monarchical Britain of the 17th century governs, in fact, republican America of the 19th.' Individual Man. Man, whether considered as an individual or as a species, is affected by the same influences. 6 Man,' says Draper, ' is the archetype of society, individual develop- ment, the model of social progress.' In the following pages man will be briefly considered as an individual, under three heads : — 1. Height. 2. Weight. 3. Strength. 1. Height. — The length of the new-born infant varies from 16 to 24 inches, the males being, as a rule, somewhat longer than the females. Towards the age of 16 to 17 the increase in the height of girls is relatively less than of boys between 18 and 19. This may be due to earlier accession of puberty in the female than in the male. It appears also that the average height up to the age of 19 of those living in the country is greater than those who live in the towns ; but that the HEIGHT. 389 average height of those who have reached the age of maturity is greater in the towns than in the country. Much will, of course, depend upon the ease with which the necessaries of life are procured, and also a freedom from those influences which in early childhood have a tendency to dwarf the stature. It is also found, that up to the age of puberty the height does not materially differ among the children of the lower classes, whether engaged in factories or not ; hut that it is after that period that the difference in favour of those who are not employed in factories is most marked. The following are the conclusions arrived at by M. Quetelet, from an extensive examination of this subject : — 6 L That the most rapid growth takes place imme- diately after birth, the infant growing in the course of one year about six inches. 6 2. That the growth of the infant diminishes in pro- portion to the increase in age, up to the fourth or fifth year, the period at which the maximum probability of life is reached. During the second year after birth the increase of growth is about half what it was during the first, and a- third during the third year. 4 3. Beckoning from the fourth to the fifth year, the increase of growth becomes nearly regular as far as the sixteenth year, that is to say, just after the age of puberty ; and this annual increase is about two inches. '4. After the age of puberty the height continues to increase but slowly. From the sixteenth to the seventeenth year the increase is about one inch ; in the two following years, about three-quart ers-of-an-inch. ' 5. The growth of man does not appear to entirely terminate at twenty-five years of age.' The following results are also taken from M. Quetelet : — 4 1. The limit of growth of the two sexes is unequal. ( a. Because the female at birth is smaller than the male. 390 MEDICAL POLICE. Because she arrives earlier at her full de- velopment. ' c. Because her annual increase is somewhat less than the male. J 2. The height of the inhabitants of towns at the age of nineteen is greater by half-an-inch to three-quarters than that of those who live in the country. '3. It does not appear that the growth of man is arrested at twenty-five. 6 4. Those individuals who live in ease and comfort generally exceed the average height ; want and misery have a contrary effect, as obstacles to development. 6 5. The increase in the growth of the infant for many months before birth, until development is complete, follows the same law, viz., that the rate of increase diminishes with the age. 6 6. Between the ages of five and six, or thereabouts, the annual increase is pretty regular, and it is a twelfth of the increase of the foetus during the month which precedes birth. ' 7. In short, reckoning from the age of fifty, the man and the woman undergo a diminution in height which is more or less marked, and which may be estimated at from two to two-and-a-half inches, till eighty years of age.' Certain external forces more or less affect the full development of man. Thus, the average height is less in very cold or very hot climates than it is in those countries where the climate is more temperate. Men are taller in the plains than in mountainous districts. The variety and ease with which food is obtained have a modifying effect. Some diseases, particularly fevers, have a marked effect in causing a rapid increase of growth. (See the article on Giants in Dictionnaire de Medecine.) Lying in bed is also favourable to growth. A man is found to be taller in the morning than at night. Dr Aitken considers that in selecting recruits for the army, age, height, and weight, should all be WEIGHT. 391 considered. The late Dr Parkes says : — 6 Probably 62 inches at eighteen years of age, and 112 lbs. to 116 lbs. weight should be a minimum when in times of greatest pressure. So also a very great height at eighteen years of age is objectionable, and anything over 67 inches at that age should be looked on with great suspicion. As a rule, also, adult men of middle size (67 to 69 inches) appear to bear hard work better than taller men. 2. Weight. — At birth the weight of the infant varies from 6 to 9 lbs. ; sometimes the latter is exceeded by a few pounds. Male children are also slightly heavier at birth than female. M. Chaussier — quoted and corroborated by Quetelet — states that the infant decreases in weight immediately after birth to the third day, and that it is not till after the first week of extra-uterine life that any increase in weight becomes appreciable. Weight up to a certain age increases with the height. After fifty years of age the height and weight gradually decrease. From birth to puberty the male is slightly heavier than the female, but at that period they are about equal, the male again having the advantage with increase of age. At the age of forty man reaches the maximum of his weight, and at eighty he has lost more than 12 lbs. of his weight. The woman attains her maximum of weight at fifty. Beckoning from about the age of nineteen, her weight does not vary much till after the catamenia have ceased. When fully developed, the male and the female weigh about twenty times what they did at birth, and are about three-and-a-quarter times the height they were at the same period. Infants a year old are three times the weight they were at birth ; at six they are twice as heavy, and at thirteen four times as heavy as they were at one year. Immediately before puberty both sexes weigh about half of their ultimate weight. Prom birth, and during the first year, the weight of the child is the cube of the height, but after this period 392 MEDICAL POLICE. to puberty the growth is less rapid ; the weight is then the square of the height. As the relative weight and height of individuals given by Quetelet apply more particularly to Belgium, I have not inserted them here ; but the following table of Dr Hutchinson, based upon 2650 observations, may be taken as a standard : — Feet. Inches. St. Lbs. A person 5 1 high should weis *h 8 8 2 9 0 5 9 7 „ 5 9 13 5 10 2 „ 5 10 5 „ 5 10 8 5 8 11 1 5 11 8 5 10 12 1 „ 5 12 6 „ 6 0 „ 12 10 3. Strength. — The strength of man is measured by an instrument contrived by M. Rignier, and called by him a ' dynamometer/ from Swol/jlls, force, vital poiver, and fjLtrpov, measure. This instrument is by no means so perfect as could be wished. The lumbar power of a man is the weight be can carry on his back. According to Rignier, a man from 25 to 30 years is in the zenith of his strength, and ought to press with both his hands with a force equal to about 100 lbs., and on the other hand he should be able to lift a weight of about 286 lbs. The strength of woman is considered as about equal to that of a boy from fifteen to sixteen years of age. VITAL STATISTICS. 393 The following Table gives the Rate of the Pulse -and the Number of Inspirations at Different Ages : — Ages. Pulsations. Inspirations. Average. Max'm. Min'm. Average. Max'm. Min'm. 0 to 1 year 136 165 104 44 70 23 0 5 years 88 100 73 26 32 23 10 „ 15 „ 78 98 60 26 32 23 15 „ 20 „ 69*5 90 57 20 24 16 20 „ 25 697 98 61 18-17 24 14 25 „ 30 „ 71-0 90 59 16-0 21 15 30 „ 50 70*0 112 56 181 23 11 VITAL STATISTICS. The study of the laws which govern the physical condition of mankind forms that branch of general statistical science to which the term vital statistics has been applied. The data on which this branch of the science is based, are individual facts or so-called • numerical units/ all of the same nature and which admit of their being compared with one another, added together and classified. Each unit must have precise, definite, and constant characters or else all classification is useless. ' In other words,' remarks Dr Parkes, ' an accurate diagnosis of the disease is essential, or statistical analysis can only produce error. If the numerical units are not precisely comparable, it is better not to use them. A great responsibility rests on those who send in inaccurate statistical tables of diseases : for it must be remembered that the statist does not attempt 394 MEDICAL POLICE. to determine if his units are correct, he simply accepts them, and it is only if the results he brings out are different from prior results that he begins to suspect inaccuracy. 1 The uses of vital statistics — 1. Information as to the health of the people. 2. Information as to the good or evil conditions affecting the people, and which enables us to take precautions against the spread of disease, etc. 3. Their application to life assurance, by which in- dividual members may relieve the State of the burden of keeping their offspring, etc. 4. The fatality of different diseases at varying ages, and the protection of individuals at these critical periods. 5. The influence of professions, trades, locality, age, on the well-being of the community, The first step is to arrange, by taking some destinc- tive feature, the isolated facts that are represented to us into groups or divisions. Having arrived at some sort of classification, we next compare each group with the total number of units taken together, and also with each other. Tor the sake of convenience we take 100, or some multiple of a 100, as our numerical constant. Thus, suppose the total number of deaths from all causes is 8212, of which 1378 are the result of zymotic disease, 3646 local, 224 violent, and so on, the per- centage of deaths in each group will be found as follows : — 8212 : 100 : : 1378 : 16 '8 per centage of zymotic deaths. 8212 : 100 : : 3646 : 44*4 „ of local 8212 : 100 : : 224 : 27 „ of violent ,, But suppose we wanted to know the relative per- centages between deaths and recoveries, we may pro- ceed as follows. Take, for instance, 362 cases of pneumonia, divide into two groups, the deaths and the VITAL STATISTICS. 395 recoveries, 19 of the former and 343 of the latter, and then proceed thus — 362 : 100 : : 19 : 5 '248 per cent, of deaths. 343 : 100 : : 19 : 5*54 per cent, of recoveries. The Arithmetical Mean or Average. — This is obained by dividing the sum of the units by the number of them. Thus, suppose the average of the deaths for any number of years is required ; add all the death rates together, and divide by the number of years. The arithmetical mean is, however, only reliable with regard to future results, when the units we use are very con- siderable. Thus, the average deduced from an examina- tion of the death rate for one hundred years would be more nearly correct than one deduced from ten years. In calculating averages, it is also advisable to take note of extreme values, that is the highest and lowest units on each side of the mean, for, as Dr Guy remarks, ' averages are numercial expressions of probabilities ; extreme values are expressions of possibilities. ' (See Professor Eadicke on Arithmetic Means, Syd. Soc, 1871). The Probable Error of the Arithmetical Mean. — The sum of departure from the average within which, on one side or the other, it is an even chance that the truth exists. This may be found by Poisson's rule, based on the 6 Theory of Probabilities.' Dr Parkes states this rule as follows : — Let u be the total number of cases recorded, m be the number in one group, n be the number in the other. So that m + n = u. The proportion of each group to the whole will be respectively f? and ~ ; but these proportions will vary within certain limits in succeeding instances. 396 MEDICAL POLICE. The exact variation will be within the proportions represented by m 7- — + V2, m. n. 11 T - — -3 and m % - ~ \/2. m. n. 11 3 — It will be obvious that the larger the value of u, the less will be the value of V 2 - n - ? and, consequently, the less will be the limits of error in the simple pro- ,. m portion — * An example will show how this rule is worked. The following is given by Gavarret (Statisque Medicale 1840, p. 284) : — Louis, in his work on Typhoid Fever, endeavours to determine the effect of remedies, and gives 140 cases, with 52 deaths and 88 recoveries. What is the mortality per cent., and how near is it to the true proportion? m — 52 = number of deaths, n = 88 = number of recoveries, u — 140 = total number of cases. i.e., 37 deaths in 100 cases, or more precisely 37,143 deaths in 100,000 cases. How near is this ratio to the truth? The possible error is as follows — the second half of the formula, viz. : — 2 J 2. m. n. will be 2 J2 x 52 x 88 a11 kk A . .4. "(HO? -0 '11550 to unity. (Or 11-550 in 100,000). The mortality being 37*143 per cent., or 37,143 VITAL STATISTICS. 397 deaths in 100,000 cases, in these cases, it may be in other 140 cases either 37,143 + 11,550 = 48-693 per cent., or 37,143-11,550 = 25*593 In other words, in successive 140 cases the mortality will range from 49 per cent, (nearly) to 26 per cent, (nearly), so that Louis' numbers are far too few to give even an approximation to the true mean. For ordinary purposes, and when the district is not large, the annual death-rate may be found by multiplying the quarterly death-rate by 100, and then by 4, and divid- ing by the estimated population. The follovring is the Method adopted by the Registrar-General : — 6 In the first place, it is scarcely necessary to say that all the rates now published by the Eegistrar-General, whether they relate to a year, a month, or a week, are annual rates to 1000 persons living — that is, these published rates represent the number of persons who would die in a year in 1000 of each population, if the proportion of deaths to population recorded in the shorter periods of a week, or a month, or a quarter, were maintained throughout a whole year. ' Let us take a rate of mortality from the Eegistrar- General' s last weekly return relating to the seven days ending July 31 as an example. We find, in Tables 1 and 2 of that return, it is stated that the estimated population of the borough of Sheffield in the middle of 1875 is 267,881 persons; that 127 deaths were re- corded within the borough during the week under notice ; and, further, that these deaths were equal to an annual rate of 24*6 per 1000 of this estimated > population. Now for the operation by which this result is arrived at. We have the deaths in a week, and the estimated population in which they occurred, it is desired to find the number of the deaths which 398 MEDICAL POLICE. Avould occur in each 1000 of this population, if the same number of deaths were recorded in each week throughout a year. If a week were the correct fifty- second part of a year, it is obvious that either the deaths must be multiplied by fifty-two, or the population be divided by fifty-two, in order to make the population and the deaths comparable. As, however, the correct number of days in a natural year is 365*24226, the number of weeks in a year is 52*17747. The Eegistrar- General, therefore, for the purpose of this weekly return, divides the estimated population of each of the towns dealt with by 52*17747, which gives what may be called the weekly population of each town. The population of Sheffield divided by 52*17747 gives a weekly population of 5134 persons; this number serves as constant throughout the year 1875, by which to divide the number of deaths. The 127 deaths in Sheffield during the week ending July 31st, divided by this so-called weekly population, gives an annual rate of 0*0247 to each person of the population; and by removing the decimal point three places to the right, or in other words multiplying by 1000, we arrive at 24*7, which is the correct annual rate of mortality per 1000 of the estimated population of the borough of Sheffield during that week. It would undoubtedly be more logical to multiply the deaths by 52*17747, than to deal with the population ; but this operation would have to be repeated each week, whereas there is a manifest convenience, and an arithmetical economy, in the reverse operation (the effect of which is, of course, identical), which supplies us with a constant that is applicable throughout the fifty-two weeks of 1875. For all practical purposes, the multiplication of the deaths in a week by fifty-two, in order to divide them by the estimated population, will afford the means of arriving at an approximately correct annual rate of mortality ; or the reverse operation, the division of the population by fifty-two may be resorted to. VITAL STATISTICS. 399 ' For the calculation of annual rates of mortality in a month or a quarter, the Eegistrar-General takes account of the number of days in each month or quarter, and it is found more convenient to deal with the population according to the method described in the calculation of the annual rate of mortality in a week. The popula- tions to be dealt with are divided by 365 "24226, and must then be multiplied by the number of days in a month or a quarter, in order to arrive at the population which may be applied to the deaths in a month or a quarter ■ by this means a scientifically correct annual death-rate in those respective periods will be obtained. Approximately correct annual rates of mortality in a month or a quarter may be calculated by using a twelfth or a quarter of the population respectively as the divisor of the number of deaths recorded in those periods ; but inasmuch as the length of a month varies from twenty-eight to thirty-one days, and of a quarter from ninety to ninety-two days, it is evident that a correct annual rate of mortality can only be calculated by taking into account this variation in the number of days in those periods, and that rates calculated without correction for these inequalities will differ from the rates published by the Eegistrar-General. 4 In conclusion, it may be noted that rates published in the quarterly returns of the Eegistrar-General for the eighteen largest English towns relate to the period of thirteen weeks most nearly corresponding with the natural quarter, and that the population employed in this calculation is thirteen times that used for the rates in each week, and differs slightly from the popula- tion that would be used if the period of observation were three entire calendar months instead of thirteen weeks. The facts published in the quarterly return for all other parts of the country, except the eighteen largest English towns, relate to the natural quarters of three calendar months, and the population used to produce the annual rates of mortality therein are 400 MEDICAL POLICE. manipulated in the manner before described ' {Sanitary Record, 1875). A knowledge of the vital statistics of his district is necessary for every medical officer of health. He may obtain a general knowledge of this subject from the quarterly and annual reports of the Eegistrar- General, and from the digest of the census of 1871 by Mr Lewis; and he may become especially informed as to his own district by referring, in addition to the above, to the books of the District Eegistrar, and also to those of the Board of Guardians. From the latter he will be enabled to extract the value of the sick-rate, and the amount of pauperism and parochial relief. A return of births and deaths is forwarded by the instructions of the Eegistrar-General to every medical officer of health from the District Eegistrar. From these returns the health officer is able to make the following weekly returns : — 1. Birth-rate. 2. Marriage-rate. 3. Total death-rate. That is, the proportion of births, marriages, and deaths to the total population of the country or district. a. Death-rate at different ages. b. Death-rate from zymotic diseases. c. Classified death-rate from other causes, vio- lence, etc. 4. Degree of healthiness or unhealthiness of his district. In preparing these returns, certain precautions have to be taken. Thus, suppose a district divided into urban and rural for sanitary purposes, both districts, however, combined in one union with the workhouse situated in the urban district ; the death-rate and sick- rate will be increased in the urban and lessened in the rural; and unless allowance is made, a false re- turn will be the result. A correction must, therefore, in all cases be made. Many of the deaths at sea-side VITAL STATISTICS. 401 places of resort are imported deaths, and should, if pos- sible, be eliminated. The < Bate of Mortality 9 and ' Expectation of Life 9 a. The number of deaths, say per thousand, within any given area, is known as the rate of mortality. b. By the term 6 expectation of life/ or rather 6 after life-time/ is meant the probability of the age any one person of a given population may attain according to the rate of mortality found to prevail within that area, regard being had to the age of the party at the time of fixing the expectation. At birth the after life-time and the life-time are the same. The following is Willich's formula for calculating the expectancy of any age x : — Expectancy of life = §(80 - x). Expectancy, 6 years of age - f (80 - 6) = § x 74 = 49*33. The ' expectation of life ' of any community is the true test of the health of the community. The hypothesis of De Moivre as to the law of mor- tality was, that of 86 persons born, one died every year until all became extinct. According to this hypothesis, it is an even risk that on the birth of a child it will live forty-three years, the chance of living or dying before that age being equal, forty-three being the half of eighty-six years. At age twenty there are sixty-six persons living; the half of sixty-six is thirty-three, which, as the deaths are equal in each year, is the expectation of life at that age. A Stationary Population. — A population in which neither increase nor decrease takes place, the deaths being no more than counterbalanced by the births. Such a population would necessarily furnish materials for a life-table, but applicable only to itself. Effective Population. — That portion of the community between the ages of twenty and seventy. Absolute and Specific Population. — The absolute population is the total number of persons in any 2 c 402 MEDICAL POLICE. country ; the specific population, the number of per- sons to each acre or square mile. The latter is the more important, as so much of the healthiness or un- healthiness of a locality depends upon the density of its population. Population, the Law of Increase. — Mai thus pro- pounded the proposition, that 'population, when un- checked, goes on doubling itself every twenty-five years, or tends to increase in a geometrical ratio] that is, in the following ratio — 1, 2, 4, 8, 16, etc. He also came to the conclusion that the increase of food due to agricultural improvements, etc., advanced in arith- metical progression, thus, 1, 2, 3, 4, 5, etc. In both of these statements he has been found correct. See- ing the result of this, Malthus became alarmed, for he overlooked the effect of free trade, by which one nation is enabled to supply its wants from another. The checks to the increase of population are — 1. Preventive (I 'obstacle privitif of Quetelet). — Late marriages. Moral restraint during celibacy. 2. Positive (V obstacle destructif of the same writer). — a. Vice. — Prostitution, violation of the mar- riage-bed, etc. b. Misery. — Over-work, unhealthy occupations, improper food, drunkenness, etc. Value to be placed on the Registration of the Causes of Death. — Mr Xeison, in a letter to the Eegistrar- General, insists on the importance of the following six items in the registration of deaths : — a. Place, b. Date. c. Age. d. Sex. e. Employ- ment. /. Cause of death. The value of life must necessarily depend much upon a variety of circumstances in various localities, such as occupation, liability to accident, habits, exposure to diseases, etc., etc. It is well known that in several towns in the United Kingdom the rate of mortality varies exceedingly, VITAL STATISTICS. 403 doubtless from some of the causes above-mentioned being more or less favourable to longevity; and Mr Neison's suggestion, therefore, points out the true way of arriving at the real value of life at different places. Specific Intensity. — This term, when applied to the value of human life, represents the number living at any given age divided by the number dying at that age. Females have a higher intensity of life than males. Mean Age at Death. — The mean or average age at death of any given population is the sum of the ages at death divided by the number of deaths. Is the mean age at death a safe measure and standard of comparison ? The mean age at death can be em- ployed with safety as a true test or measure only in those cases in which the calculation purporting to embrace an entire class is included, or in which the calculations embracing only a section of an entire class, the class in question is retained in a state of perfect uniformity during the whole time comprised in the calcu- lation. Different populations varying in their composi- tion, and the same population, may in course of time undergo considerable changes, and exhibit striking con- trasts in the number of persons living at different ages. The mean age at death in France is 34; Sweden, 31 ; England, 29. Mean Duration of Life. — The mean duration of life is found by adding the age to the expectation of life. It is in other words the expectation of life at birth. Death-Rate. 1 . What is meant by death-rate % The number of deaths occurring annually in every 1000 of the population. 2. From what data is it ascertained 1 ? From the Begistrar-General's Annual Eeport of the Mortality of the United Kingdom. This, of course, only applies to the country taken as a whole. The death-rate of a district is determined from the actual or estimated population of the district. 404 MEDICAL POLICE. 3. State (approximately) the mean death-rate of Great Britain. The average mortality in twenty-one years was 23*15 males and 21*58 females per 1000, the mean being 22*36. 4. State some of the leading causes which raise the death-rate of towns above that of rural districts. a. Overcrowding in towns. See p. 385. b. "Want of fresh air and pure water. c. Insufficient accommodation and drainage. d. Profligate and intemperate habits. e. In London and other large towns many die in the hospitals who ought to be accredited to the country. The death-rate of many watering-places is great only on account of the numbers who go for the benefit of health, but really to die. The death-rate is no criterion of the healthiness or unhealthiness of a place, and Dr Eumsey remarks, that ' a diminution in the rate of mortality will be found to co-exist generally with an augmentation of the rate of sickness. The very triumphs of advancing medical art are probably attended by an average prolongation of the helpless and infirm conditions of life.' The highest ratio of sickness is sometimes found associated with a favourable rate of mortality (Neison). The death-rate of model-dwellings for the poor is most probably fallacious, especially during the first few years of their tenancy; for, as Dr Eumsey remarks, ' the earlier inhabitants of these model-lodgings would naturally belong to a better-conditioned order of work- ing people. Their selection of such dwellings would indicate the possession of a higher taste, greater fru- gality and temperance, and more adequate means of livelihood than the average of their class. Besides, the ratio of mortality in any small and isolated population, as I have before said, is, and must always be, a falla- cious test of its ratio of unhealthiness.' 5. How is the estimated population of a district VITAL STATISTICS* 405 obtained according to the method pursued by the Eegistrar-General % a. To the population of the district, as given in the last census, add a tenth of the difference between that number and the number obtained at the previous census for each year that has elapsed since the last census. Id. The estimated population for the end of the first quarter of any given year, that being the period of the year at which the census is taken, is found by assuming that the increase during the ten years has been main- tained at a steady progressive rate. c. The death-rate is, however, calculated on the estimated population of the district at the close of the second quarter of the year, therefore a fourth-part of the annual increment, or a fortieth-part of the actual increase of population which has taken place between the two census, must also be added to represent the increment for the additional quarter. Thus, in a district in 1861 the population was found to be 36,000, and in 1871, 38,000, the difference would be 2000, and this, divided by ten, would give the annual increase of 200. In 1876, five years would have elapsed since the last census, hence the estimated population at the close of the first quarter of 1876 will be 38,000 + 200 x 5, and at the close of the second quarter it will be 38,000 + 200 x 5 + 200 * 4 =39,050, 39,050 being the estimated population of the district for the year 1876. The actual population can only be obtained from the census returns. Life Assubance. Life assurance is a contract by which a person, i termed the insurer, in consideration of a sum of money proportioned to the risk, and technically called a premium, becomes bound to pay the legal representa- r tives of the insured at his death, or to the insured 406 MEDICAL POLICE. himself on his attaining a certain age, a sum of money previously agreed upon at the time of making the con- tract. Insurance is a consensual contract, but a written instrument on stamped paper is by statute requisite to its constitution. There are three kinds of life insurance companies — the proprietary, the mixed, and the mutual. In proprietary companies a fixed sum is paid, the profits being divided only among the proprietors. In the mixed the insured participate in a portion of the profits, the rest being divided among the proprietors. In the mutual, after paying expenses of management, the whole of the profits is divided among the insured. Each of these modes of insurance has its advocates. The whole system of life assurance is based on the probable duration of human life, and the value of the contributions of the members of the society placed at compound interest. Several methods have been proposed by which the probable duration of life may be approximately deter- mined. These will now be noticed. Life Tahle. — A life table is a table showing the probable duration of life. The first life table was the Breslau Table of Mortality, constructed by Dr Halley from the registers of the town of Ereslau, in Silesia, no material being then available in this country, in con- sequence of the ages at death being unrecorded. This table was published in 1693. Among other attempts in this direction may be mentioned Simpson's London Table of Mortality. De Moivre's two Tables. The Northampton, constructed by Dr Price. The Carlisle Table, constructed by Dr Heysham. The experience of seventeen Life Offices' Tables. The law of mortality may be best illustrated by the annexed diagram. The English Life Tables of Dr Earr. 1. Eounded on a comparison of the deaths and the AIR. 407 living at each age, giving the rate of mortality and sur- vivorship. 2. Founded on the deaths alone, or with reference only to the ages at which the deaths have taken place. The former is the more correct and the more generally applicable ; the latter is applicable if the population is stationary, the births and deaths equal, and no disturb- ing migration for a century. A IE. The atmosphere consists of a mechanical mixture of two gases — oxygen and nitrogen. This is shown from the following : — 1. The amounts of oxygen and nitrogen in the atmo- sphere are not in their combining proportions. 2. When mixed in the proportion found in the air, no contraction in volume or evolution of heat is noticed. 3. Water takes up unequal portions of the two gases, according to the law of absorption of gases in liquids. The oxygen is the active agent in supporting animal life and promoting the combustion of bodies; the nitrogen acts simply as a diluent, and modifies the activity of the oxygen. The proportion of oxygen to nitrogen is as 1 to 4, and this proportion always remains the same. The air collected by Martins on the Faul- horn, at a height of 8226 French feet, had not less oxygen than the air of Paris. But owing to the escape or the products of combustion, of respiration, and the decay of animal and vegetable substances, the atmosphere becomes charged with aqueous vapour, carbonic acid, ammonia, organic matter, salts of sodium, etc. 408 MEDICAL POLICE. The amount of carbonic acid varies from *02 to '05 per cent., and is due to the respiration of animals, the interior of the earth in districts of extinct volcanoes and thermal springs, and the decomposition of the small portion of carburetted hydrogen existing in the air by the electric discharges of clouds (Humboldt). To these we may add the combustion of carbonised materials. The air collected above the ocean shows a small variation in carbonic acid between day and night, the proportion being 5*4 for the former and 3*3 for the latter in 10,000 volumes of air ; this being probably due to the increase of the co-efficients of absorption with decrease in temperature during the night. Impurities of Air. The chief source of the vitiation of the air round dwellings is most probably due to the dampness of the ground surrounding them, and the presence of liquid filth washed into the soil by rain from heaps of rubbish carelessly placed round them. The impurities of air may be classed under two heads — 1. Suspended Matters. The spores of certain plants, the germs of bacteria and other creatures, particles of carbon from factories, and portions of the materials used in certain industries, together with a host of other substances which find their way into the atmosphere and are carried from place to place by the winds. The phenomenon known as a dry fog is the result of a dry and stagnant state of the atmosphere, during which the air becomes filled with dust and smoke. In 1783 a dry fog prevailed over Europe, and lasted for more than a month. It was preceded by a remarkable eruption of the volcano Hecla, in Iceland. The sand which sometimes falls on the Cape Verd Islands, to which attention was directed IMPURITIES OF AIR. 409 by Darwin, was found by Ehrenberg to contain innumer- able silicious-shelled infusoria. If the air outside our dwellings be thus loaded with impurities, how much more impure must that air become in closed, ill-ventilated rooms, where to the above are added the exhalation from the lungs and skin, and the effluvia from discharged secretions ! In sick-rooms, and in the wards of hospitals, where the ventilation is imperfect, the air has been found to contain organic matter to such an amount that a portion collected and burnt gave out an odour of burnt horn. The discovery of a peculiar fungoid growth in a cholera ward in 1849 by Drs Britain and Swayne, and the presence of which subsequent observers have corrobo- rated, has led to a more careful examination of the air of our hospital wards, with the most valuable results to medicine and pathology. To the exhalation of diseased particles from the lungs of persons suffering from phthisis may the explanation come of those cases of apparently communicated consumption. Of course, as all persons are exposed to the like influences with regard to the purity or impurity of the air they breathe, the assumption of an individual predisposition to disease is rendered necessary ; but as we can seldom be certain beforehand of the presence of such predisposition, the necessary precautions to ensure purity of the air are the more imperative. Dr Tilbury Fox, some years ago, related to the London Medical Society the account of a discovery he had made of the presence of the mycelium of the trichopyton in the air of a ward where a number of children suffering from tenea circinata were placed. The dust was collected on glass slides, moistened with glycerine, and then examined under the microscope. The escape of particles of arsenic from the c rich green- flock ' papers still used for house-decoration has resulted in several cases of arsenical poisoning, and in one or two cases with a fatal issue. In workshops and factories, to the ill effects of, in 410 MEDICAL POLICE. most cases, bad ventilation and over-crowding, are added the emanations from the materials in varying stages of manufacture. The dust of grinding shops has been found to contain large quantities of iron in very minute particles, and which, by being constantly inhaled, pro- duces the disease well known as grinders' rot. In ' coalminers' phthisis/ the sputa is often quite black from the particles of carbon introduced into the lung during respiration. The wearing of respirators by the men engaged in trades where the production of a large amount of dust is unavoidable, has been sug- gested, but workmen are a heedless and stubborn class of men, and are little prone to do anything which requires a little trouble, or the smallest amount of fancied inconvenience. See the Coal Mines' Kegulation Act, 1872 (35 & 36 Vict., c. 76). This Act shall apply to mines of coal, mines of stratified ironstone, mines of shale, and mines of fire- clay. 2. Certain Gaseous Substances. Hydrochloric acid, from alkali works, ammonia, sulphuretted hydrogen, from ammonia and other chemical works, sewage gases, carburetted hydrogen, vapours from decaying animal and vegetable bodies from slaughter-houses, bone-boilers, glue-makers, soap- boilers, etc. Certain poisonous fumes from copper smelting works, brassfounders, etc. (The Alkali Act, 1863, 26 & 27 Vict., c. 124.) Purification of Air. Besides the purifying effect of ventilation, other methods are adopted to render air fit for human respira- tion, but these must only be considered as supplement- ing, not superseding ventilation. PURIFICATION OF AIE. 411 1. Solids, Certain substances act chemically on air ; thus, char- coal is used to purify the air issuing from drains and cesspools. Of the kinds of charcoal used animal appears to act the best ; then that made from peat. The char- coal, from whatever source, should be kept very dry to ensure its constant activity. Unslacked lime is used to absorb corbonic acid in wells, etc. 2. Liquids. A solution of nitrate of lead will remove the sulphuretted hydrogen from cesspools. Solution of chloride of zinc (Sir W. Burnett's fluid) destroys organic matter. Solution of permanganate of potash (Condy's fluid) destroys organic matter, decomposes ammoniacal compounds, and absorbs sulphuretted hydrogen. 3. Gases. Nitric Add. — Acts on organic matter, but it must be used with care, as it may in some persons cause severe irritation in the lungs. Chlorine. — Decomposes sulphide of ammonium and sulphuretted hydrogen, and destroys animal matter in the air. Sulphurous Acid. — Destroys organic matter, and according to Guyton de Morveau, it destroys miasms. Carbolic Acid. — Hides other odours, arrests putre- factive changes, and the growth of fungi, but does not appear to have the power of ultimately destroying them. The diluted acid has been found a valuable dressing for wounds. Iodine Vapour. — Arrests putrefaction, but it is in- ferior to chlorine, as it is not so diffusible, and con- denses readily. Bromine Vapour. — Should be used with care, as the vapour is very irritating. 412 MEDICAL POLICE. EucJilorine. — Prepared by heating strong hydrochloric acid and potassium chlorate in a saucer. Acts like chlorine, but is less irritating to the lungs. Ozone. — Ozone, which appears from modem re- searches to be a condensed form of oxygen, with powerful chemical activity as an oxidising agent superior to oxygen, may be developed artificially by passing electric discharges through air or oxygen, by the slow oxidation of phosphorus in air, and by the electrolysis of water acidulated with sulphuric acid. It appears to be a powerful oxidising agent, bleaching most vegetable colours. It has the property of bluing starch paper treated with iodide of potassium by setting free the iodine. This change may also be effected by any nitrous acid present in the atmosphere. A better test is the bluing of litmus paper slightly reddened and impregnated with iodide of potassium ; ammonia being the only gas which has a similar reaction. But this source of error may be obviated by noticing that reddened litmus paper, not impregnated by the iodide, is blued by ammonia, but not by ozone. Prepared by any of the above processes, it is said by Schonbein, its discoverer, to destroy organic matter floating about in the air of a room. Examination of the Air. Substances to be looked for — 1. Suspended Matters. Detected by the microscope, the air being previously drawn through an aspirator over glass slides moistened with glycerine, which collects all the solid matter sus- pended in the air. Pouchefs utErescope. — Its construction is very simple, consisting of an air-tight chamber with two openings, into one of which is fitted a small funnel, the stem of EXAMINATION OF THE AIR. 413 which is drawn into a fine point; into the other, a glass tube connected to the aspirator by india-rubber con- nections. A glass slide moistened with glycerine is placed in the box, so that the air drawn through the funnel may impinge upon it. The slide may be then placed under a microscope and examined. Dr Parkes objects to the use of glycerine on account of the difficulty of procuring it perfectly free from foreign particles. He recommends the following plan : — A small bent glass tube is taken, carefully washed and dried, and then heated to redness ; when cool it is inserted in a freezing mixture, and one end attached to an aspirator by a piece of india-rubber tubing. The air is then slowly drawn through, and the moisture of the air containing the suspended matter is condensed; a drop may be then placed on a slide and examined as in the former case. An aspirator may be made by procuring a box like that used by Pouchet, to contain the slide, only, in this case, filled with water. As the water is allowed to run out at one aperture, air rushes in at the other, and if this be attached to the box containing the slide, or to Parkes 1 bent tube, air will be drawn through them. In every case the air should be drawn very slowly through the aspirator. 2. Organic Matter. Determined by a solution of permanganate of potash r through which a definite quantity of air is drawn, and the amount of undecomposed potassium permanganate determined by oxalic acid. This process does not admit of satisfactory results, as it only indicates the amount of oxidisable matter present in different samples of atmospheric air, without giving any indication whence this oxidisable matter is derived, whether animal or vegetable. Mtrous, sulphurous, and other acids present in the air, produced the same reaction, thus rendering 414 MEDICAL POLICE. the test useless as to the actual presence of organic matter. In the Lancet for Nov. 2, 1872, Mr Moss, the Apothecary to the Forces, proposed the following mode of procedure : — He drew a known quantity of air through four bottles containing pure water free from ammonia ; to the contents of the first of the series 5 C.C. of pure hydrochloric acid were added. The contents of the flask were then examined on Wanklyn and Chapman's plan for free and albuminoid ammonia. 3. Carbonic Acid. Degree of milky coloration, with a standard solution of lime or baryta water. Br Angus Smith's Method. — The following is a very simple method for testing the amount of carbonic acid in a room. A clean wide-mouth stopper bottle, capable of holding seven ounces, is taken, and air drawn into it by means of a glass tube, care being taken not to breathe into the bottle. Put in half-an-ounce of clean baryta water (-08 of a gramme of baryta), close the bottle, and shake. If the air should contain less than '03 per cent, of CO 2 there will be no precipitate. Lime water may be used instead of baryta water, but in that case the bottle must be larger, owing to the greater solubility of carbonate of lime, and the consequent difficulty in recognising the beginning of opacity. In using lime water a graduated pipette is necessary to draw out the required half -ounce of lime water. The following table will best explain the process : — EXAMINATION OF THE AIR. 415 Air at 0° centigrade and 760 m.m. barometer. Size of bottle to be used with Carbonic acid in the air per cent. half-an- ounce of lime water, no precipitate produced. •03 20*63 oz. avoirdupois. *04 15*60 ,, •05 12*58 ,, •06 10*57 j, •07 9*13 •08 8*05 •09 7*21 •10 6*54 •15 4*53 •20 3*52 •25 2*92 •30 2*51 „ •50 1-71 1-00 1*10 Dr Smith proposes the following rule as a practical application of this method : — ' Let us keep our rooms so that the air gives no precipitate when a 10 J oz. bottleful is shaken with half-an-ounce of clear lime water.' Petterikofer's Method. — Take a glass vessel capable of holding from half-a-gallon to a gallon-and-a-half, and determine its exact capacity by filling it with water and measuring the contents by means of a pint measure, 1 oz. = 1*733 cubic inches. The vessel should be care- fully dried, and then filled with air, by means of a pair of bellows, taking care that the nozzle of the bellows reaches the bottom of the jar. When full, pour in rapidly 60 C.C. of clear lime, or baryta water (pure baryta, 7 grammes, water litre), cover the mouth of the jar with an india-rubber cap, shake well, so that the liquid may flow over the sides, and then set it aside for not less than six or eight hours, or more than twenty-four. By the absorption of the carbonic acid by the lime or baryta water, the causticity of these fluids 416 MEDICAL POLICE. is lessened, and on this fact the test depends, for if the causticity of the lime solution he known both hef ore and after the experiment, the amount of C0 2 can he calcu- lated. A solution of crystallised oxalic acid is used to determine the causticity of the lime, the strength of which should he 2*8636 grammes of pure crystallised oxalic acid to the litre of distilled water. Now take 30 C.C. of the contents of the jar, and carefully neutralise it hy running in from a graduated hurette the standard oxalic acid solution. The exact point of neutralisation is determined hy dropping from time to time a drop of the liquid on turmeric paper. The stain produced he- fore the addition of the oxalic acid is of a dark-hrown colour, hut as the oxalic acid is run in, the centre of the drop hecomes gradually free from colour, and only the margin appears of a delicate-hrown shade. Care must now he taken only to drop in very small quantities at a time till the coloured margin also disappears, when the point of neutralisation is reached. Having determined the causticity of the lime solu- tion in the jar, next determine the causticity of the original lime water, and then multiply the difference between the two quantities hy -790, and divide the product hy the number of cubic centimetres contained in the jar, minus 60. The result will be the ratio of carbonic acid per 1000 volumes. Care should be taken that the baryta water be absolutely free from potash or soda. A correction must be made for temperature. Wilson gives the following simple rule : — For every 5° above 62° Fahr. add 1 per cent, to the amount of C0 2 , calculated as above, and deduct the same for every 5° below 62° F. In ordinary cases, the barometric pressure may be omitted, but if it be required to examine the air at any considerable height, adopt the following : — Standard height of m observed m . capacity a barometer (30 inches) * height * * of jar The result expressed by X is substituted for the VENTILATION. 417 actual capacity of the jar in the previously mentioned calculation for CO 2 . 4. Watery Vapour, Determined by various forms of hygrometers. See page 433. 5. Ammonia. See account of the Nessler test, p. 508. To perform this test, the air must be drawn through distilled water, previously tested as to its freedom from ammonia. Ventilation. The importance of a knowledge of the principles of ventilation cannot be over-estimated, yet there is pro- bably no branch of knowledge over which so much erudition is expended, and about which so little is really understood. A knowledge of the principles of ventilation implies an intimate acquaintance with the general properties of gases and vapours, the nature and composition of atmo- spheric air, and the changes to which it is subject from the effects of the respiration of animals, the modifying influences of vegetation and climate, and the results of the combustion of certain bodies either to produce artificial heat or light. General Properties of Gases and Vapours. A gas is an aeriform body which cannot be reduced to the liquid state. Oxygen, hydrogen, etc. It has been stated of late that oxygen and hydrogen have been liquefied, but the statement is doubted by many com- petent authorities. A vapour is also an aeriform body, differing from a gas in its comparatively easy reduction to a liquid condition — the vapour of water. 2 D 418 MEDICAL POLICE. Law of Diffusion of Gases and Vapours. — Gases differ from liquids in this, that if gases of varying density be poured into a tall jar, in a short time the mixture in every , part of the jar will be the same, whereas in liquids the lighter will be found at the top, and the heavier at the bottom. And this mixture of gases will take place even through animal membranes, or considerable thicknesses of any porous material. If two jars be taken, one containing hydrogen and the other oxygen, separated by a layer of plaster of Paris, and so filled that the lighter hydrogen be placed above the heavier oxygen, an interchange of gases will take place, which may be proved by an explosive compound being formed, and which, on the application of a match, will go off with a loud report. The passage of an elec- tric current through the mixture will also cause an explosion with, as in the former case, the production of water, thus showing that the previous mixture of the gases was a purely mechanical one. The following laws should be remembered : — Charles 1 Law. — The volume of a gas is directly pro- portional to its absolute temperature, reckoned from its absolute zero. The absolute zero is that degree of cold which ceases to affect a gas, as cold usually does. Graham's Law. — The ratio of diffusion of gases is inversely proportional to the square roots of their rela- tive weights. From the experiments of Feddersen of Leipzig it appears that when a porous substance acts as a diaph- ragm between the same gases, the pressure on each being the same, the passage of the gas takes place from the cold to the warm side. The effect of winds is treated in another place. Having acquired an insight into the laws which thus govern atmospheric changes, we are now in a position to apply them, so as to enable us to supply a due and appropriate quantity of pure air to any apartment, passage, or other cavity to which the VENTILATION. 419 external air has not free and unlimited access. A due allowance must also be made for peculiarities of archi- tectural construction, and for the varying number of the occupants, and the requirements of climate. In a pre- vious section we spoke of the vitiation of air generally ; it now remains to consider the effects of respiration, and the combustion of bodies employed for artificial heat and light, as these more especially affect the ques- tion of ventilation. Air Vitiated by Respiration. The effect of respiration is to increase the amount of carbonic acid and watery vapour in the air of a room, and also to add to it a varying quantity of certain undefined organic substances, at the same time that the oxygen previously present is rapidly decreased in volume. Dr de Chaumont, quoted by Denton, states that 6 an assemblage of 2000 persons will give off in two hours (in vapour) seventeen gallons of water, and nearly as much carbon as would be extracted from a hundred- weight of coals.' The organic matter blackens sul- phuric acid, and decolorises permanganate of potash in solution. According to Dr Parkes, an adult man in ordinary work gives off in twenty-four hours from twelve to sixteen cubic feet of carbonic acid gas from his lungs, besides a certain undetermined quantity from his skin. The same authority also states that, on an average, an adult man, not doing excessive work, may be considered to give to the atmosphere every hour •6 cubic feet of C0 2 . It is found that when this gas reaches *7 per 1000 volumes, the organic matter is in most cases perceptible to the sense of smell, and that the odour is more pronounced when the C0 2 amounts to 1 per 1000. The amount of C0 2 present in a room may be taken as an index of the organic impurity of the air, vitiated by respiration alone ; for it is found that the organic matter increases as the C0 2 is in- 420 MEDICAL POLICE. creased, especially if the heat of the room be not excessive. Air Vitiated by Fires and Light-producers. The products of combustion from fires for the most part escape up the chimney, and by this means into the open air j but this is not, as a rule, the case with the products formed by gas, oil-lamps, or candles used for the production of artificial light. One cubic foot of gas in combustion destroys eight cubic feet of oxygen, with the production of about two cubic feet of carbonic acid gas. An ordinary burner burns from three to four cubic feet of gas per hour, and as it has been calculated that for every cubic foot of gas burnt at least 1800 cubic feet of air should be introduced, we are able to calculate the amount of air required per burner and per hour. An ordinary moderator lamp takes from the air of a room 3*2 cubic feet of oxygen, with the production of about half a cubic foot of C0 2 per hour. One pound of oil for its complete combustion will require from 138 to 160 cubic feet of air; and as much air must be introduced for one pound of oil as for 10 feet of gas. Dr Odling states that, for equal illuminating power, candles yield a larger amount of impurity to the air than gas, and that two candles have the same effect on the air as one man. The combustion of three cubic feet of gas per hour renders 3600 cubic feet of air impure. A burner of this description vitiates more air than three adult persons. In considering the question of ventilation, there are three important points to be borne in mind. a. The capacity of the room — that is, the amount of cubic space which it contains. b. The number of individuals normally present in it. An allowance must also be made for the number of gas jets, lamps, candles, and fire-places, etc. c. The efficiency of the means for introducing pure air, and allowing the vitiated to escape. VENTILATION. 421 a. The Capacity of the Room, etc. In calculating the cubic space of any given apart- ment, the height, length, and breadth must be multi- plied together, allowance being made for any recesses, cupboards, and also for the bodies of the occupants, an average of three cubic feet being allowed for each indi- vidual. The space occupied by articles of furniture must also be considered. If the room be irregular in shape, it must be divided into several imaginary triangles or squares, the sum of which will give the size of the room. After these various corrections, the remaining number of cubic feet divided by the number of individuals will give the cubic space per head. Dr Parkes gives the following measurements : — Measure in feet and decimals of a foot. Convert square inches into square feet by multiplying by '007. The area of a triangle = Base x J height, or Height x \ base The area of a circle = D 2 x 7854, or C 2 x -08. Area of rectangle = Multiply two sides. Area of parallelogram = Multiply a side by its width on the square. Area of trapezium = Multiply \ sum of the two perpendi- culars by the diagonal on which they fall, or divide into any num- ber of convenient triangles, and take the sum. Area of trapezoid == Take half the sum of the parallel sides, and multiply by the dis- tance between them. Cubic Contents. Cubic contents of a cone = Area of base x J height. cylinder == x height. , , , , a dome = § area of base x height, a sphere = D 3 x "5236. 422 MEDICAL POLICE. The cubical capacity of a marquee, used as a pro- visional hospital, may be found by dividing it into — 1. Eody. 2. Koof. 1. Body, — A solid rectangle, with a half cylinder at each end. 2. Roof. — Solid triangle and two half cones. The minimum amount of space allowed by the Poor Law (Local Government) Board in dormitories is 300 cubic feet, which, to allow 3000 cubic feet of air for each person, necessitates that the air be changed at least ten times during the hour. b. The Number of Individuals Normally Present. When the number of persons occupying a room sought to be ventilated is always the same, there can be- little difficulty in supplying the proper amount of pure air per head; but when the numbers are constantly sub- ject to change, considerable difficulty may be experienced in making the necessary arrangements to supply the varying demand. This was one of the difficulties with which Dr Eeid had to contend in his proposal for ven- tilating the Houses of Parliament. Putting aside this difficulty, it may be stated in general terms that sufficient air should be supplied to each individual, so that the amount of carbonic acid present in the air of the room should not exceed *6 per 1000 volumes, the amount of carbonic acid present being taken as the index of the organic impurity, allow- ance being made for '4.C0 2 naturally existing in the- atmosphere. c. The Efficiency of the Means for introducing Pure Air, and allowing the Vitiated to Escape. 1. The entering air must be pure, of a proper tem- perature, and supplied at the rate of 3000 cubic- feet per head per hour. VENTILATION. 423 2. There should be no draught. The rate at which air moves through a room depends on the differences of temperature be- tween the internal and external air, and the efficiency of the mechanical means adopted for drawing the air through the room. A velocity of from 1 to 2 feet per second, at a temperature of 60° F., will not cause a draught, and will yet answer the purpose of ventilation. The velocity should not be more than 9 feet per second ; it is better to enlarge the channels. A draught is produced if the air be changed oftener than six times an hour. 3. The air must be diffused through the room ; in no part ought it to remain stagnant. 4. There must be means provided for the escape of the foul air, and entrance of the pure. It may be as well to note here the results of Petten- kof er on the permeability of brick-walls, and the passage of air through them. The room had brick-walls, and contained 2650 cubic feet. With a difference of temperature of 34° F. (66° in and 32° outside), the air in the room was changed once. "With the same difference, but with a good fire and a free vent up the chimney, the change of air rose 3320 cubic feet, or about 25 per cent. more. With all the openings and crevices pasted up there was still a change of 1600 cubic feet, or a fall of 28 per cent. With a difference of temperature of 7° F. (71° in and 64° out- side), the change amounted to only 780 cubic feet per hour. With a window open of 8 square feet, the change was 1000 cubic feet per hour. Thus, a difference of temperature of 34°, with carefully shut windows and crevices, is of greater influence than large communica- tions with the outer air at a small difference of temperature. Marker and Schultze have found that the spontaneous ventilation through one square yard of the following 424 MEDICAL POLICE. substances, with a difference of 4° F., amounted per hour : — Sandstone Quarried Limestone Brick Turfaceous Limestone Mud . Direction and Movement of Air. Direction or movement of the air in a room may be determined by burning brown paper and noticing the direction taken by the smoke, or the direction taken by small particles of light substances, or the effect produced on the flame of a candle. First determine the direction, and then proceed to measure the discharge, which is, of course, equal to the amount entering. The velocity may then be determined by an anemometer, by the manometer, or by calculation. The cubic quantity flowing through the channels in a certain time, may be found by multiplying the known transverse section of the inlets and outlets by the velocity of air. The velocity of the air in the channels is obtained by dividing the known required quantity of air by the transverse section of the channels. The following is a description of Casella's air meter for measuring the velocity of air through public build- ings, etc. : — The indications are shown by means of the large dial and hand, and five smaller ones. The whole circum- ference of the large dial is divided into 100 parts, and represents the number of feet up to 100 traversed by the current of air. The five smaller dials are each divided into ten parts only, one revolution of each being equal to ten of the preceding dial, and represent- ing 1000, 10,000, 100,000, 1,000,000, and 10,000,000 respectively. By means of the large dial the low velocity of fifty feet per minute may be measured, and to 4*7 cubic feet ? ) 6-5 >> J) 7*9 »> J5 10-1 >> >> 14-4 >> VENTILATION. 425 by the smaller ones continuous registration is extended up to 10,000,000 feet, or equal to 1893 miles, being practically beyond what the most extended observations can require. By moving the small catch backwards or forwards the works are put in or out of gear without affecting the action of the fans; this prevents the injurious effect of stopping them suddenly, and enables the observer to begin or end his observations to a second. A small handle, with universal joint, accompanies the 'instru- ment, and may be screwed in at the base ; by putting a stick through this it may be raised or lowered to any required height, and used in any position. To use the air meter, write down the position of all the hands. For this purpose place the instrument before you, with the 0 on the outer circle facing you. The first circle on the left hand indicates hundreds -of feet, the next thousands, the third tens of thousands, the fourth hundreds of thousands, and the last circle to the right of the 0 marks millions. Begin to write down the position of the hands with the million circle, and then go round from right to left, always writing down the lowest of the two numbers if the hand is between two. Let us say that the hand on the million dial is at 0, the one-hundred-thousand hand between 2 and 3, the ten thousand between 7 and 8, the thousand between 1 and 2, the hundred at 5, and the large hand which marks units and tens at 73. The million hand would be omitted as it has not reached 1, and the remaining numbers would run 271,573. The instrument is then put in the current to be measured, and when removed after a given time is read in the same way ; the first being deducted from second reading gives the velocity (uncorrected) in feet during the time. The time when the sails begin to move should be carefully noted. Ventilation may be either natural or artificial. 426 MEDICAL POLICE. Natural Ventilation. Under natural ventilation may be classed all those naturally operating causes by which foul air is removed, and pure air introduced, without the aid of any mechani- cal means, the efficient causes here at work being the expansion of air by heat, the diffusion of gases, and the force of the wind. The air of the room heated by respiration and by contact with the human body, at the same time becoming vitiated by the products of respira- tion, rises to the upper part of the room, and then escapes by any outlet which it may find. A vacuum occurs, cold air rushes in from any orifice situated near the ground, such, for instance, as the chinks of doors and windows, and thus by natural means ventilation is established. Fires in open grates act in a similar way : a strong upward current is caused by the warm air rushing up the chimney, and cold air from below sup- plying its place. Modern fire-places only ventilate as high as the opening into the chimney, the air above the mantelpiece remaining for the most part stagnant. Chimneys without fires act as useful ventilators ; for the wind blowing over their tops creates a partial vacuum, which is being constantly filled with air from the house. This is due to the aspirating power of the wind. It is found that, practically, the natural modes of ventilation are not sufficient for the requirements of thorough ventilation ; for in some climates the air may be as hot outside as inside the house, and when this is the case there may be also a dead calm ; besides, a greater velocity in the air, and a more rapid interchange, is required in rooms where men or animals are congre- gated together, than can be obtained by the unassisted powers of nature. ' A top window-sash, lowered a little, instead of serving, as many people believe it does, like such an opening into the chimney flue, becomes generally, in obedience to the chimney draught, merely an inlet of cold air, which first falls as a cascade to the VENTILATION. 427 floor, and then glides towards the chimney, and gradu- ally passes away by this, leaving the hotter, impure air of the room nearly untouched.' Another great mistake is also sometimes made in large dormitories — In the morning the custom is to open the windows, and to let them remain open all day long, to be closed only just before bed-time. If there is not sufficient differ- ence of temperature between outside and inside a partial opening of the windows during a winter night is just as necessary as during a summer night. The watery vapour exhaled by the sleepers condenses against the walls, and obstructs the pores. A part is evapo- rated during the day, but it will be only a part, and hence the not infrequent breaking out of damp spots in such dormitories during the winter. Artificial Ventilation. Artificial ventilation, on the other hand, includes all those appliances which maybe strictly termed mechanical. All the so-called mechanical appliances, however, owe their efficiency to the utilisation of already existing natural agencies, and of these appliances it will be necessary to mention a few of the more important. Sylvester's Method. — This was in use more than fifty- years ago, but its application dates from very ancient times. By this plan the agency of the wind is utilised by the aid of a cowl, which is constantly directed to that quarter from which the wind blows. The cowl is connected to pipes distributed throughout the house, and through which the fresh air enters the various rooms ; another system of pipes is also connected to another cowl turned from the wind, by which the hot vitiated air is removed. This plan has been largely adopted on sailing vessels where the ordinary 6 wind- sail ? for carrying the fresh air in is the only part of the system used, the impure air being allowed to find the best way out for itself. The great drawbacks to this 428 MEDICAL POLICE. system are, that during periods of calm the cowls are next to useless, whilst, when the wind is high, the amount of air admitted can neither be regulated to prevent draughts nor a suitable temperature main- tained. Dr Neill Amott's Method, — Ventilation by means of a hole cut in the chimney as close to the ceiling as possible was suggested in 1849 byDr Arnott. Several forms of valves for placing in holes near the ceiling have been invented; but a description of their indi- vidual merits is not necessary here. One objection to Arnott's hole in the chimney is, that sometimes a down draught forces soot into the room. He also proposed a modification of Sylvester's plan, with which he ventilated the Field Lane Eagged School. Pott's Method. — This consists in placing behind the cornice of a room a tube divided into a lower and an upper compartment. Each compartment is pierced with small holes. The lower is connected by pipes with the external air, the upper with the chimney or other hot air shaft. The pure air is supposed to enter by the lower and sink gradually to the floor, and the products of respiration escape by the other. M'KennelVs Method. — This consists of two tubes, one encircling the other, the inner tube being always longer than the outer, and protected by a cowl. The tubes are so constructed that the transverse area between them is equal to the sectional area of the smaller. The inner is the outlet tube, and has a flange attached to its lower end, which helps to turn the in-coming air to- wards the ceiling, and thus enable it to diffuse equally about the room. Both tubes become inlets if there is a fire in the room ; if the doors and windows are open both become outlets. The tubes should be placed in the centre of the room, and are best adapted to the ven- tilation of square or round rooms, chapels, or churches, and the diameters of the tubes adjusted to meet the re- quirements of the case. VENTILATION. 429 Tobin's Method, Ventilation by Vertical Pipes. — The origination of this plan is also claimed by Messrs Shillto and Shoreland. The air is brought into the room by tubes placed vertically in the walls, with openings in the room about six feet from the floor. The advantages claimed are, that by admitting air into a room above the heads of the occupants, all draught is avoided, and a perfect renovation of the air produced, free from the necessity of constant watching. The great failing of this system appears to consist in the smallness of the tubes used, and the difficulty experienced in ensuring the proper action of the inlet tubes, their intended action being liable to be reversed. The size of the inlet should be about 24 square inches per head, and the same for outlet. Ventilation by Extraction. — It was by this method that Dr Eeid ventilated the Houses of Parliament. It consists in connecting the apartment to be ventilated by means of tubes with a ventilating shaft, at the bottom of which a fire is kept burning. An upward current is produced, fed by the air from the tubes. Pure air, carefully warmed, is admitted into the room as fast as the vitiated air is removed. The air in the Houses of Parliament was admitted through minute perforations in the floor. It is on this principle that mines are ventilated by what is known as an upcast and doivncast shaft. The downcast shaft, through which the air enters the mine, is so connected with the galleries that the air shall first circulate through the mine, and then pass out by the upcast shaft, at the bottom of which a fire is kept burning. Steam-ships are ventilated by this method, simply by connecting the several parts of the ship with a tube above the furnace fires. There are many modifications of this system, but the principle involved is the same. Several objections have been raised, of which the following alone demand attention : — 1. The inequality of the draught, due to the diffi- 430 MEDICAL POLICE. culty of always maintaining the fire at the proper height. 2. The inequality of the movement of the air in the several rooms, those nearest the shaft being more rapidly exhausted than those at greater distances. 3. Kegurgitation of smoke from the shaft into the rooms. 4. Difficulty in controlling the supply of fresh air at a proper temperature. Ventilation by Propulsion, — This was proposed by Dr Desaguliers in 1734, and consisted in forcing in the air by means of a fan- wheel enclosed in a box. By reversing the action of the wheel, the air could be drawn out of the apartment. As an example of the strictly mechanical means by which ventilation may be effected, the case of the Senate House in America may be mentioned. In this, a large fan, worked by a steam-engine, draws in the fresh air, which, after being warmed by passing over hot pipes, is distributed throughout the house — the amount of air supplied being regulated by calculating the quantity required for each individual present. Having now given a short outline of the various plans which have been suggested for the ventilation of houses and other buildings, it is well to bear in mind the remarks of Mr Tomlinson, that ' in the rooms of private houses the ventilation must also be spontaneous ; for if the slightest trouble be entailed on the inmates, even to the opening of a window, it will be neglected. The means for ventilation must be cheap, easily pro- curable, always in place, self-acting, not liable to get out of order, requiring no adjustment, no care whatever on the part of the inmates/ Law on the Subject of Ventilation. — JSTo provision is made by law for the enforcement of proper ventilation in dwelling-houses, but in the case of factories the following has been enacted : — VENTILATION. 431 Factory Acts Extension Act, 1867 (27 & 28 Vict., c. 48). This Act also applies to Scotland. Ventilation in Factories. Sec. 4. — Every factory to which this Act applies shall be kept in a cleanly state, and ventilated in such a manner as to render harmless, so far as is practicable, any gases, clust, or other impurities, generated in the process of manufacture that may be injurious to health. Penalty for neglecting this rule, not exceeding ten pounds, nor less than three pounds. By another Factory Act— 1867 (30 & 31 Vict., c. 103) — greater provision is made for every factory where grinding, glazing, or polishing on a wheel, or any other process carried on by which dust is generated and inhaled by the workmen to an injurious extent, etc. Occupier must provide fan, or other mechanical means, to remove nuisance. Penalty as above. Warming. In England this is effected at great waste and cost by open fire-places — the English prejudice against stoves being apparently unconquerable. Of late several venti- lating and warming fire-places and stoves have been introduced. Among these may be mentioned the Calorigen stove, invented by Mr George, Pierce's Pyro- pneumatic stove grate, the Goldsworthy Gurney stove, etc. Every information about them may be obtained from the advertising columns of the sanitary journals, or from the companies whose business it is to push their sale. 432 MEDICAL POLICE. METEOROLOGY. Climate. Climate [KXl^a — slope, inclination) may be said to embrace all those physical influences connected with the soil, heat of the atmosphere, or the water of a place, which, acting and reacting upon man, more or less materially affect him. The severity of the climate on the coasts and in islands is diminished by the absorption during the summer by the sea of the sun's rays, which penetrate deeper into it than into the land. Due to its saltness, it does not freeze so soon as fresh water ; and imparting its heat to the winds that blow over its surface, it affects the temperature of the countries situate on its margins. The large expanse of ocean in the south hemisphere, producing a warm, moist atmosphere favourable to luxuriant vegetation, is strikingly contrasted with cor- responding latitudes in the north, where, from excess of land, the air is rendered cold and dry, and the land for the most part barren. Climate is divided into continental, insular, or sea climate, and mixed. A continental climate consists in a cold winter and a hot summer. An insular climate is characterised by a cool summer and mild winter. A mixed climate is inclined to be continental in winter and insular in summer. Asia is an example of the first, Europe of the second, and North America of the third. Climate cannot be determined exclusively by mean temperature, as places often differ materially in climate, although having the same mean annual temperature. This arises from the circumstance that an extreme degree of heat in summer and cold in winter in one place, may give a mean annual temperature not materially differing CLIMATE. 433 from another place having a more equable temperature throughout the year. The climate of a place depends upon a variety of circumstances, which we may tabulate as follow : — A. Purity and hygrometric state of the atmosphere. B. Influence of trees and forests, and sandy deserts. C. Influence of marshes. D. Influence of the sea. E. Influence of hills and mountains. F. Efficient drainage and sewerage. A. Purity and Hygrometric State of the Atmosphere, etc. The normal constitution of the atmosphere consists of a mixture of oxygen, nitrogen, and aqueous vapour, with traces of carbonic acid. The amount of aqueous vapour depends upon the temperature and pressure of the atmosphere, but the proportions of the gases present are nearly the same everywhere. Humidity. — This term is held to imply the amount of vapour present in the air, and also the ratio of this to the amount which would saturate the air at the actual temperature. The amount of vapour in the air is not a measure of its humidity, for the air is for the most part drier in summer than in winter, although the amount of vapour present is much greater. Relative Humidity. — The percentage of moisture in the atmosphere, complete saturation being taken as 100. Absolute Humidity. — The actual amount of moisture in a given quantity of air. Tension of Aqueous Vapour. — Expressed in inches of mercury, being the elastic force of vapour in the atmosphere. Instruments used for finding the Humidity of the Air : — a. Hygrometers of absorption, or hygroscopes. b. Condensing hygrometers, or dew point instruments. 2 E 434 MEDICAL POLICE. c. Psychrometers, hygrometers of evaporation, or wet and dry bulb thermometers. a. Hygrometers of Absorption, or Hygroscopes. These instruments depend upon the fact that all organic substances are affected by moisture, which generally increases their dimensions. The hair hygro- meter, or rather hygroscope, of Saussure is a very imperfect instrument, as much depends on the previous preparation of the hair, and the length of time it has been in use. This instrument consists in an oblong frame, to the top of which one end of a hair is attached, the other end being fixed to an axle carrying an index. By the shortening or lengthening of the hair acting on the axle, the index is made to move along a gradu- ated arc. b. Condensing Hygrometers, or Dew Point Instruments. For noting the point at which moisture is condensed from the air upon the surface of a body cooled artificially to a known temperature. The simplest instrument of the kind is Leroy's Hygrometer, consisting in a bright tin vessel filled with water artificially cooled, and having a thermometer immersed in the water. A deposit of moisture forms on the sides of the vessel when the temperature of the water falls below the dew point of the surrounding air. The deposition of dew does not, however, begin till the point of saturation has been passed ; the indication of the thermometer is therefore slightly too low. Besides this objection, there is another of more importance : the placing of a vessel of water open to the air in the very place where the humidity of the air is required to be determined. DanieVs Hygrometer. — A straight glass-tube, sup- ported on a stand with a bulb at each end, at right angles to the straight part. One of the bulbs contains pure ether, over which a thermometer is suspended, the CLIMATE. 435 other bulb contains the vapour of the ether, and is covered by a piece of thin muslin. To use the instru- ment, the muslin is wetted with ether ; this causes a condensation of the ether vapour, giving rise to an increase of evaporation of ether from the other bulb, producing a commensurate decrease of temperature. The temperature at the moment of the deposit of moisture on the ether bulb is noticed, and is found to be a little lower than the dew point. If, however, the instrument be then left alone, and the temperature noted at the moment of the disappearance of the dew, the mean of the two readings will give the correct dew point. A thermometer is , generally attached to the stand, and gives the temperature of the adjacent air. On account of the boiling point of ether being 36° C. (97° F.), this hygrometer cannot be used in very hot climates. RegnauWs Hygrometer, — A modification of the fore- going, in which alcohol instead of ether may be used. c. Psychrometers, Hygrometers of Evaporation, etc. This instrument consists of two identical thermo- meters placed at a short distance from each other on a stand, the bulb of one being free, whilst the bulb of the other is covered with a piece of muslin, kept moistened with water by means of a cotton wick lead- ing from a vessel containing water. Precautions to be observed in using this instrument — L Free circulation of air round the wet bulb must be maintained. 2. The vessel containing the water should be small, and placed some inches from both bulbs. 3. The muslin must be kept thoroughly moist, but not allowing a collection of water at the bottom of the bulb. 4. When the wick is frozen in winter, the bulb must be dipped in water, and time allowed for the 436 MEDICAL POLICE. water on the bulb to freeze before an observa- tion is made. 5. Both thermometers must be exactly alike. To use this instrument, take the difference between the dry and wet bulb, and multiply it by the factor given in Glaisher's tables, standing oppo- site the dry bulb temperature, deduct the pro- duct from the dry bulb temperature ; the result is dew point. The following incomplete table will show how the above is calculated out : — Glaisher's, Factors. Dry Bulb Therm. Factor. Dry Bulb Therm. Factor. Dry Bulb Therm. Factor. 10 8-78 21 7*88 32 3'32 11 8-78 22 7*60 33 3-01 12 8-78 23 7*28 34 2-77 13 877 24 6*92 35 2*60 14 8-76 25 6'53 36 2-50 15 875 26 6-08 37 2-42 16 8*70 27 5*61 38 2*36 17 8-62 28 5*12 39 2-32 18 8-50 29 4-63 40 2'29 19 8-34 30 4*15 41 2-21 20 8*14 31 3*70 42 2*23 Example — Dry Bulb = 40°. Wet Bulb = 36°. 40° -36° = 4° x 2-29 = 9-16. 40° -9-16° = 30-84°. Dew. — Dr Wells first gave a correct explanation as to the cause of dew. He showed that when, as the result of radiation, objects near the earth's surface became cooled down to a certain point, a deposit of moisture formed on them. This is dew. CLIMATE. 437 Circumstances favourable to the Formation of Dew. 1. A cloudless night, and free exposure to the sky. Clouds, by reflecting back the heat radiated from the earth, prevent the deposition of dew. 2. A nearly tranquil atmosphere. Wind, by pro- ducing an interchange of air of varying tem- peratures, prevents sufficient depression of temperature, and therefore arrests the forma- tion of dew. 3. An atmosphere charged with moisture. 4. Good radiators and bad conductors. Good radi- ators and bad conductors — Wool, hare-skin, glass, etc. — Dew freely formed. Good con- ductors and bad radiators — Metals, etc. — Dew formed with difficulty. Dew is not formed on the surface of large bodies of deep water, for the cold particles of water sink, to be replaced by warmer particles from below, thus preventing a sufficient depression of tem- perature to allow of the deposit of dew. It is also not formed in the midst of sandy deserts, the atmosphere being too dry. The dew 'point is the temperature when the air is just saturated with moisture, so that the least further fall would cause a deposit of dew, rain, snow, or hoar-frost, according to circumstances. An early determination of the dew point may often be the means of foretelling a coming frost, and thus permit means to be taken to prevent the destruction of tender plants. Other things being favourable, a dew point at or about 29° indicates frost. Hoar-Frost. — A lower temperature is required for the formation of hoar-frost than for dew, which, how- ever, is not frozen dew, but the moisture of the air deposited in a solid form. The crystals of hoar-frost are hexagonal prisms with angles of 120°. Formation of Clouds. — Clouds are formed by the 438 MEDICAL POLICE. condensation of vapour in a stratum of air at a low temperature, and at a considerable height — one to four miles — above the surface of the earth. There are three varieties of clouds usually recognised by meteorologists as follow : — 1. Cirrus. 2. Cumulus. 3. Stratus. 1. Cirrus, or the Mare's Tail of sailors, occupies the highest region of the atmosphere. It is higher than any point yet reached by balloons, and is probably composed of small particles of ice. 2. Cumulus consists of rounded masses resting on straight bands, and having the appearance of hills or mountains. Sometimes they present the form of balls of cotton or wool packs, by which names they are known to sailors. They are most common in summer and during the day. 3. Stratus consists of horizontal sheets, which form at sunset and disappear at sunrise. The strati are the lowest clouds. Beside these, which are the primary forms, there are several combinations of the above described, viz., cirro-stratus, cumulo -stratus, cirro- cumulus, and the cumulo-cirro-stratus. The cirro-cumulus forms the well-known mackerel sky. The cumulo-cirro-stratus also known as the rain-cloud. The above classification of clouds is that of Howard. Any cloud discharging rain has had the term nimbus applied to it. Suspension of Clouds. — Clouds appear to be sus- pended in the air, because they are being continually formed. The heated air rises, is condensed, forms a cloud, and begins to fall, but, coming in contact with warm air rising from the surface of the earth, is vaporised, again ascends, and is again condensed, to form a cloud. Clouds are constantly disappearing to be re-formed. From this we may explain the curious phenomenon of a cloud clinging to a high mountain, CLIMATE. 439 even with a strong wind blowing. The fact is, the cloud is as quickly formed as blown away. Estimation of Cloudiness. — The figures usually adopted are from 1 to 10. 1, Perfect freedom from cloud; 10, The maximum of cloud; any intermediate stage is marked 3, 4, 5, etc., as the case may require. A mist is a cloud near the ground. A fog occurs when the surface of the ground is warmer than the air in contact with it. The hot air rises to be condensed into fog. The fogs off Newfound- land are due to the excess of heat of the Gulf Stream above the cold moist air on its surface and over the banks. The London fogs are due to the artificially heated smoky air over the city, and the close proximity of the river Thames. Fogs seldom occur over deserts, and are not common in tropical countries, except round the tops of high mountains. Main.— As the clouds consist of particles of water, they are constantly raining; but between the clouds and the earth there is usually a non- saturated belt or region where these particles of water, when small, are usually evaporated before they reach the earth. When this belt becomes saturated, the particles coalesce, and rain is the result. Causes that influence the Rainfall. 1. Latitude. — The greatest rainfall is near the equator, diminishing towards the poles. But the number of rainy days at the equator and at latitude 60° are very nearly the same. 2. Elevation above the Sea. — Mountains increase the rainfall. 3. Proximity to the Ocean. — It is almost always raining on the west coast of Ireland and Britain. The Gulf Stream has much to do with this rainfall. 4. Trees. 5. Winds. 6. Deserts. — Almost entire absence of rain. 440 MEDICAL POLICE. Rain may occur without clouds. A rainy day, T ^ of an inch (Symons). Mode of Estimating the Rainfall. — There are several forms of rain gauges. The simplest consists of a funnel opening into a receiver in which the rain is collected, and from which it may be drawn and measured. The funnel should have a truly horizontal rim, else the gauge will catch too much or too little, according to the direction and force of the wind. The rain gauge should be placed at least six indies from the ground, to avoid splashing, and in the centre of a level, open plot. The best location for a rain gauge is to bury it in the earth, making its top just even with the surface of the ground (Loomis). From some unexplained cause, the higher the gauge is placed above the surface of the earth the less rain it catches. The best time for measuring the rainfall is 9 a.m. According to Mr Symons, the mean annual rainfall at London and Edinburgh is 24 inches ; Liverpool and Manchester, 35 to 36; Dublin, 30; Glasgow, 40; Dart- moor, 86 ; and on Ben Lomond, 91. Electrical State of the Atmosphere. — The atmosphere is always more or less charged with positive electricity, especially during fine weather. During stormy or un- broken weather, negative electricity is as frequently met with as positive, and it is at such times that the indications of the presence of electricity are most marked. Sources of Electricity. — 1. Vegetation. 2. Evapora- tion from salt or saline water. 3. Condensation of vapour during storms. 4. Unequal distribution of heat. 5. Atmospheric friction. 6. Combustion at earth's surface. If moisture be in the form of pure vapour, electricity is not generated. Diurnal and Annual Manges. 1. The electricity of the air, estimated always at the same height, undergoes a diurnal variation, CLIMATE. 441 which generally presents two maxima and two minima. 2. The maxima and minima vary according to the seasons of the year. 3. The first maximum occurs in summer before 8 a.m., in winter towards 10 a.m. ; the second maximum occurs in summer after 9 p.m., in winter towards 6 p.m. The evening maximum is the greatest. 4. The minima of the day are towards 4 a.m. and 4 P.M. 5. The mean is probably about 11 a.m. Of the Annual Bange, the winter is greater than the summer; the greatest intensity is in January, and the least in June. Forms of Lightning. — Zig-zag, sometimes forked, ball, sheet, and heat lightning. Duration of Lightning. — About the thousandth part of a second. Ball lightning is somewhat longer. Cause of Thunder. — The in-rush of air into a vacuum produced by the lightning. The duration of a thunderclap varies from 20 to about 56 seconds. Lightning Conductors or Rods. — Electricity travels along the best conductors, which are the metals. Light- ning rods are, therefore, made of iron, pointed with copper or platinum, carefully insulated, and having one end buried in the ground. Care must be taken that the connection with the ground be continuous, that the diameter of the rod be about of an inch, and that in no part of its course must it come near any of the metal pipes connected with the house. In the ground it may be connected with the iron, gas, and water pipes, or be attached to branching rods buried in the ground and surrounded with coke. Lightning conductors probably act in two ways : by affording a means by which the electricity may travel to the ground, and also by lessening the severity of the shock by enabling, by their pointed extremities, the 442 MEDICAL POLICE. exchange of the opposite electricities of the clouds and earth. A sharp point connected with the earth modifies the sparks from the conductor of a machine. Return Shock. — Bodies within the influence of a cloud charged with electricity become charged with the opposite to that of the cloud. As soon as the cloud has discharged its electricity into the earth, the return of the electrified bodies to the neutral state causes the return shock. Electrical Condition of the Air — How Determined ? — An arrow may be shot into the air connected to an electroscope by a fine wire. It is found that as the arrow ascends the gold leaves of the electrometers diverge along an ivory scale, graduated to twentieths of an inch. Two straws may be used in the place of the gold leaves. An insulated thin copper tube, six- teen feet high, tipped with platinum points, is used at Kew. The tube passes through the dome at the top of the Observatory, and is supported on a glass cylinder. It may be connected at pleasure with the electrometers. Captive balloons, attached to conducting wires connecting them with electrometers, are some- times used to estimate the intensity of the electricity at varying heights. Temperature. The temperature of the atmosphere is measured by a thermometer. Of this instrument there are two modifications, one being used to register the greatest heat, and known as the maximum thermometer; the other the greatest cold, and known as the minimum thermometer. It is unnecessary to describe these instruments, but it may be as well here to mention the manner in which they are read. The minimum thermometer is read by noting the degree on the scale at which the end of the index farthest from the bulb is lying. To read it at the end nearest the spirit is to TEMPERATURE. 443 give the temperature at trie time of observation, not the lowest. In Eutherf Orel's maximum thermometer, read the scale at the end of the index next the bulb. In the other maximum thermometers, read as for the minimum. In the use of the thermometer certain precautions are necessary. In spirit thermometers, a small portion of the spirit may evarjorate and condense in the top of the tube, producing an error of from 3° to 8°. In the mercurial, even with the greatest care, a small quantity of air is not infrequently found at the top of the mercury, which, when heated, expands, and causes the thermometer to register a few degrees lower than the actual temperature. Solar Radiation Thermometer. — A thermometer with a blackened bulb, enclosed in a glass case deprived of air. The thermometer is exposed to the sun, and placed near the ground. It is made self -registering. Terrestrial Radiation Thermometer. — A thermometer protected by a glass shield, placed a few inches above the ground. It is also made self-registering, and regis- ters the degree of cooling by radiation from the ground. Directions for taking Observations with the Thermo- meters when 'Stevenson's Louvre Boarded Box' is used: — 1. Let down the lid of the thermometer-box, and on no account touch the thermometers. 2. Eead the dry and wet bulb thermometers first. 3. Eead the mininum thermometer by noting the degree on the scale corresponding to the farthest end of the index from the bulb. 4. Eead the maximum thermometer by noting the degree on the scale corresponding to the nearer end of the index to the bulb in Eutherford's thermometer. 5. In Negretti and Zambra's, or Phillips', read the scale at the end of the mercury farthest from the bulb. 6. Eeset the thermometers, and close the box. 444 MEDICAL POLICE. In estimating the range of temperature, certain pre- cautions are necessary : — a. Height of thermometers ahove the ground. — In all cases it would be as well to decide on a standard height for placing the thermometers, as the reading of two observers may differ from this cause alone. The nearer the ground the higher the temperature marked. b. Degree of direct or indirect radiation. c. Position of the Box. — The nature of the soil, the covering of the ground — grass, sand, etc. Higher over long than short grass, higher over sand than grass, etc. d. Circulation of air through the Box. — Greater or lesser, according to the ventilation. Causes of Interchange and Variation of Temperature. By conduction, convection, and radiation, an inter- change of temperature among bodies heated to different degrees takes place, by which they undergo modifica- tions of opposite kinds. The hottest grow cooler and the coldest grow warmer till a state of equilibrium is reached. At this point they are said to be of the same temperature. If they are again heated the temperature is said to rise ; if they become colder, to fall. When no heat passes between two bodies placed in contact they are said to have the same temperature. Conduction. — The communication of heat from par- ticle to particle in the same body. It differs from radiation in — a. Being gradual and not instantaneous. b. It does not follow the law of rectilinear transmis- sion, as the propagation of heat is as rapid along a twisted as through a straight bar. The best conductors are therefore the metals, solids better than liquids, and liquids better than gases. The practical inference from the above considerations TEMPEKATUEE. is that dense soils are better conductors of heat than porous soils, the latter holding large quantities of air between the particles. Thus loose soils are — a. Subject to higher temperatures. b. A greater degree of frost near the surface. c. The frost does not penetrate as deeply as in com- pact soils. The knowledge of these facts would determine the depth for the laying of water pipes, etc. The following table, compiled from Buchan, the result of nine years' observation in Scotland, is impor- tant : — Temperature three Temperature twelve inches below surface. inches below surface. Loose sandy soil . 26'5° 32° seldom reached. * Stiff clay soil 28° 32° frequently Schubler, taking 100 as a standard, has arranged the absorbing power of certain soils for heat thus : — Sand mixed with lime, 100; pure sand, 95*6; light clay, 79*9 ; heavy clay, 71*11 ; pure clay, 66*7 ; pure chalk, 61*8, etc. Air charged with vapour, although it mitigates the heat of the solar rays, and retards the cooling of the earth by radiation at night, is a better absorber and better radiator than dry air. This accounts for the greater apparent coldness of the air at the breaking up of a frost than during the frost, the heat from our bodies being first absorbed and then radiated into space. Snow containing a large amount of air in the interstices of the flakes protects the ground from the invasion of the frost, and prevents the radiation of heat from the earth, thus helping to preserve the roots and bulbs of plants. Convection. — The mode by winch heat is transmitted through a fluid depending on the alteration in the 446 MEDICAL POLICE. density of the particles which causes them to rise from the bottom to the surface, or vice versa. To convection is due the constant movement in the atmosphere to which we apply the term wind, and also the currents of the ocean. The heated particles of air at the surface of the earth rapidly rise, leaving a space into which the colder air from the poles flows, and wind is the result. Ocean currents are due to the same process. Land and Sea Breezes. — When two neighbouring re- gions are at different temperatures, a current of air flows from the warmer to the colder in the upper strata of the atmosphere; and in the lower strata a current flows from the colder to the warmer. Land and sea breezes are the result of this law, and may be thus explained : The land during the day becomes warmer than the ocean, and imparting its heat by radiation to the super- incumbent air, the warmed air rises to allow the colder air from the surface of the sea to take its place. During the night the land and sea both grow colder, but the former more rapidly than the latter, owing to the high specific heat of water, and the relative temperatures of the two elements being now reversed, a breeze blowing from the land towards the sea is the result. Trade Winds. — Due to the law just explained, the atmosphere at the equator being at a higher temperature than at the poles, there is a constant tendency for the colder air to flow into the space left by the ascending current of heated air, and thus to cause a wind blowing from the north southwards to the equator, and from the south northwards, or rather towards the equator. This is just what would occur if the earth were stationary ; but as the earth moves round from west to east with varying velocity from the equator to the poles, the air flowing from the north is forced into an oblique direction from north-east to south-west. On the south side of the equator, due to like causes, the direction of the wind would be from south-east to north-west. Radiation. — The propagation of heat from one body TEMPERATURE. 447 to another across an intervening space is known as radiation. In meteorology we have to consider radia- tion under two heads — solar radiation and terrestrial radiation. Solar Radiation. — The heat-rays from the sun falling on the land are arrested at the surface, the amount of absorption depending upon the conducting power of the soil, but on water the rays penetrate to a considerable depth below the surface. Terrestrial Radiation. 1. Land. 2. Water. 1. Land. — The heat received by the earth is again radiated from it, and as a result of this alternate absorption and radiation the mean temperature of the earth seldom varies. As soon as the sun disappears below the horizon the earth begins to radiate heat into space, and thus to become chilled. This chilling pro- ceeds slowly at first, but as the earth radiates more heat than it receives from the strata of air nearest to it, the chilling process becomes more rapid. This chilling is, however, soon arrested either by the return of the sun or by the action of the following causes : — a. The surface of the earth receives a certain amount of heat from the air in contact with it, and also by radiation downwards from the air above. b. The deposition of dew, by which a large amount of latent heat is set free. c. Clouds radiate back the heat to the earth. The loss of heat from the earth is therefore less on cloudy nights, especially if the clouds hang low. d. The amount of vapour in the air also obstructs radiation, hence the drier the air the colder the night. e. During calm nights the earth is more rapidly cooled that when there is any wind. This may 1 448 MEDICAL POLICE. be accounted for by the fact that the earth comes in contact with the air of the upper as well as of the lower strata of the atmosphere owing to the agitation caused by the wind. /. The degree to which the temperature of an object is reduced by radiation is proportioned to the amount of sky exposed to the free view of the object. Mr Glaisher found that a cloud passing over raw wool greatly cooled by radiation raised the temperature of the wool 1° per minute. 2. Water. — The radiation of heat from water is modified by the following causes : — a. Its great specific heat. It therefore cools more slowly than the land. b. The particles of water as they cool sink, allowing warmer portions to rise to the surface. This process of the sinking of the cold water and rising of the warm is very slow. Thus, the temperature of the surface of water can only be lowered by the temperature of the whole mass falling, which will of course require a longer or shorter time, depending on the depth of the water. As a result of the above, the temperature of the air on the surface of the water is not so quickly lowered as on land. The temperature of the sea near the surface only varies on the average about 0*6° in the day, while on the land in Scotland the air varies 12° on the average (Buchan). Hourly Variations of Temperature. — Due to the distance of the sun from the horizon the temperature of a place varies from hour to hour. Twice in the day the temperature is at the mean, that is between 9 and 10 a.m. and 9 and 10 p.m. The daily minimum occurs about an hour before sunrise, and the daily maximum about two hours after noon. The mean temperature of a day is absolutely deter- mined at Greenwich by marking the height of the thermometer at every moment of the day by the aid of TEMPEK AT U KE. 449 photography. This may also be roughly estimated in several ways — L By taking the mean of the readings of the thermometer for every hour of the day. 2. By taking the mean of the maximum and minimum readings on the same day of the thermometer placed in the shade. The mean found by this plan is however a little greater than the true mean. 3. From two hours of the same name. — Thus the means of two observations at 8 a.m. and 8 p.m., 9 a.m. and 9 p.m., do not differ much from the true mean. 4. From three daily observations. — The best hours for observation are 6 a.m., 2 p.m., and 9 p.m. The highest temperature of a day is about an hour or two after noon, that is, at a time when the heat lost each instant by radiation is just equal to the amount of heat received from the sun. The mean temperature of a month is found by dividing the sum of the daily means by the number of days. The mean temperature of a year is found by adding together the monthly ranges, and dividing them by twelve. The mean temperature of a place is determined by adding together the mean temperature for several months, and then dividing by the number of the months during which the observations have been taken. Temperature of a place modified by — 1. Geographical position. Temperature diminishes from the equator to the poles. On the eastern side of the Atlantic the mean temperature is greater than on the western side. 2. Land and water. Forests and deserts. 3. Elevation above sea-level. When the sky is clear, the fall in temperature, up to about 5000 feet, is 1° in 239, with a cloudy sky, 1° in 271 feet. 2 F 450 MEDICAL POLICE. 4. Mountains and valleys. Isothermal lines are lines drawn on a globe or map through places having the same mean annual tem- perature. Temperature increases •with height during cold weather — WJiy ? — From the experiments of Mr Glaisher and others it is found that the temperature in cold weather at night is higher at some feet above the ground than it is on the surface. The mean tempera- ture marked by the thermometer at 4 feet was 7° higher than the mean of the thermometer placed on long grass. This apparent contradiction to the well- known law that the temperature decreases with the height is found to depend largely on the physical configuration of the land, and is only marked in dry, clear, calm weather during winter. In windy, stormy weather, the ordinary law takes effect. Take, for instance, an undulating country of hill and dale, with here and there portions of table-land. Terrestrial radiation, although present over the whole surface, will however, in some parts, be modified in degree and intensity. Cold air, being denser than warm air, will tend to gravitate towards the valleys. The hot air from above coming in contact with the chilled surface of the hill side, will become chilled by contact with the cold surface and glide down the mountain side. Thus, habitations situated on the slopes of hills have a higher mean temperature than those situate in the valleys. We also learn from this why fogs are more frequent in low-lying districts than over the higher ground. Plains and table-lands are not affected by the foregoing con- siderations. Of course, the lower we descend the colder will be the downward current of air, because it will be cooled in proportion to the extent of surface along which it has flowed. The valleys, from this cause, act as reservoirs for the cold air gliding down the hill sides. The currents of cold air will, like all other fluids, flow down the gorges and ravines where there is least PRESSURE OF THE ATMOSPHERE. 451 resistance to their course. The foregoing statements will explain why Swiss villages, generally built on eminences rising out of the hill sides, and bounded on both sides by gorges and ravines, are admirably pro- tected from the cold of winter. In choosing a health resort for invalids during the winter, the best places are those situated on gentle acclivities having a southern aspect, and well supplied with terraces, to enable the enjoyment of out -door exercise without the exertion of climbing up steep ascents. A flanking of trees above the station has also a beneficial effect. Pressure of the Atmosphere. The Barometer. — This instrument is founded on the well-known law, that every surface exposed to the atmosphere sustains a normal pressure equal, on an average, to the weight of a column of mercury, whose base is the surface, and whose height is 30 inches. Mercury is thus taken as a standard, for it is found that, other things being equal, the heights of columns of different liquids vary according to their densities • thus, taking the density of water as 1, and mercury 13*59, the column of water sustained would be 13*59 times as much; that is 30 x 13*59 inches, or about 34 feet. A barometer 34 feet high would be most inconvenient. A mercurial barometer is therefore more portable ; besides, the water barometer labours under another important disadvantage. The space in the tube above the water is not a true vacuum, as it very nearly is in the mercurial barometer. The pressure on the water at the top of the tube, due to aqueous vapour, varies with the temperature from half-an-inch at 32° to a foot at 75°. Mercury also gives off vapour, but the pressure is so slight that it need not be considered. The space between the mercury and the top of the tube is known as the Torricillian vacuum. A barometer, in its simplest form, consists in a glass I 452 MEDICAL POLICE. tube 33 inches long, closed at one end, and open at the other, filled with pure mercury, and then inverted with its open end downwards in a vessel containing mercury, care being taken that no air be allowed to enter the tube. The tube thus filled, fixed in a vertical position to a graduated scale, forms the barometer in ordinary use. The following are the precautions to be adopted in filling the barometer : — 1. Purity of the Mercury. Purified by washing in dilute acid, and subse- quent distillation. Impurity affects the density of the mercury, and also causes it to adhere to the sides of the tube. 2. Perfect Dryness of the Tube. Any moisture rises as vapour to the top of the tube, forms an atmosphere, and depresses the mercury. 3. The Mercury should be Boiled to Expel Air and Moisture. The mercury should be boiled in the tube in successive portions till full. 4. The Tube should be thirty-three inches long, and of equal calibre. To test the barometer, gently incline the tube, so that the mercury may strike against the closed end. A sharp metallic click will be heard if air be absent, a dull sound if it be present. The foregoing is a description of the barometer in its simplest form ; but for practical purposes, where great nicety is required, certain modifications are necessary. Kinds of Mercurial Barometers. The Cistern and the Siphon. The Cistern Barometer. — The tube as before described filled and inverted in a vessel containing mercury, the whole fixed to a scale. The Siphon Barometer. — A tube of equal calibre PRESSURE OF THE ATMOSPHERE. 453 filled and bent in the form of a siphon, so that one leg is longer than the other. The Cistern Barometer. — Sources of error : — a. Capillarity, b. Capacity. a. Capillarity. The effect is to depress the column of mercury. This depression varies with the internal diameter of the tube. J inch, the error is *003 inch. i >, „ -012 „ 1 „ » -070 „ To rectify this, an addition has to be made to the observed height, and special tables have been prepared for this purpose. The capillarity error is always additive. This error is only half as great when the mercury has been boiled in the tube, as when this precaution has been neglected. The error increases with the diminished diameter of the tube. b. Capacity. This error is the result of the rising and falling of the mercury in the tube, and the consequent ever- varying level of the mercury in the cistern. The correction for this error is only necessary when no provision has been made for adjusting the mercury in the cistern to the zero point of the scale. In barometers without the proper adjustment there is a certain point on the scale at which the mercurial column stands when the mercury in the cistern is at the correct level. This is known as the neutral point. If any mercury be lost or added, the neutral point is altered. Siphon Barometer. — In the siphon barometer the errors of capillarity and capacity do not exist, but it labours under the following disadvantages : that the height of the mercury in the long and in the short arm have to be observed, complicating matters by admitting a considerable error in the two readings, and also that the mercury in the short arm is exposed to the air, and 454 MEDICAL POLICE. may thereby suffer contamination from dust and mois- ture. The ordinary weather-glass, or wheel barometer, is a siphon barometer fixed in a frame. On the mercury in the short arm a float is placed, to which a string is attached which is passed over a spindle, and kept tense by a small weight. As the mercury rises or falls the float rises or falls also, and thus a backward and forward motion is communicated to the spindle, causing the index attached to point to 'fine/ 4 wet,' 'dry,' etc., marked on the dial. The drawbacks to this instrument are connected with the amount of friction of the additional apparatus. These barometers or weather-glasses are of little use for scientific purposes ; for it is not so much the absolute height, as the actual rising and falling of the mercury which determines the kind of weather likely to follow. In this country a SW wind generally brings rain and a falling barometer, and a NE wind fine weather and a rising barometer. This falling of the barometer with wet weather is due to the moisture in the air, which is specifically lighter than dry air, even at the same temperature. Temperature, Correction for. — This becomes neces- sary, as the mercury in the tube expands with heat, as does also the brass scale. The following formula may be used to make this correction : — h = observed height of barometer in inches, t = temperatue of attached thermometer, m = expansion of mercury per degree — viz., •0001001. 1 = linear expansion of scale — viz., '0000104344, normal temperature being 62°. m(t-32°)-l(t-62°) lxm(t-32°) or the correction may be made by dividing by 9990 the difference between the observed temperature and 32°, and, as the temperature is above or below 32°, subtract- PRESSURE OF THE ATMOSPHERE. 455 ing or adding the result to the observed height of the barometer. Height, Correction for. — As the density of the atmosphere diminishes as we ascend, it becomes neces- sary to make an addition to the barometric readings for every height above the level of the sea, the tem- perature at the time of the observation being noted, and the necessary correction made. If the air had every- where the same density as at the level of the sea, the problem would be very easy, but it is found that the density diminishes very rapidly as we ascend — in fact, as the heights increase in arithmetical progression, the pressures diminish in geometrical progression. The Vernier. — This instrument is used for measuring the fractions of a unit of length on any scale. Used with the barometer, ten divisions of the vernier are equal to eleven on the barometer scale ; and as these ten are all equal to each other, it follows that each division of the vernier must be equal to 1^ division of the barometer scale, or ~~ inch. If, therefore, any division of the vernier coincide, or is in a line with a division on the scale, the lines immediately above or below those which coincide will be separated by a distance exactly equal to inch ; the next two divisions either way will have a deviation of -j-^ of an inch, and so on. To use the vernier, we first notice the height of the mercury column by the fixed scale, which we find to be more than 29*5 inches, but less than 2 9 '6; we then place the zero, or top of the vernier scale, on a level with the top of the mercury. "We may then observe, for instance, that only one of the lines of the vernier coincides with a line on the scale, and this line is that marked 6 on the vernier. Now, as from the top of the mercury to these lines which coincide there are six which do not, and as each pair deviates by of an inch more than the pair below it, the top pair must deviate by the of an inch. Hence we get the reading of the mercury, which is 29*5 inches and -^jj 456 MEDICAL POLICE. of an inch, or 29*56. The vernier is, of course, mov- able along the barometric scale. The Aneroid Barometer. 1 The principle of action of every aneroid barometer is that of measuring by pressure upon a vacuum chamber the weight of the atmosphere above the instrument at the time of making an observation. This pressure on the metal box is communicated from the box by a series of springs to an index traversing a graduated scale. For this reason, when we apply the instrument to the measurement of altitudes, we have to encounter the difficulty of a continual change that is going on in the atmosphere at any given station, by the effects of moisture and wind ; therefore, a scale of heights placed upon the aneroid can only give a scale of differences of heights for one given pressure. Nevertheless, with care very accurate results may be obtained, as follow : — Directions for Measuring Altitudes. Turn the outer rim of the instrument until the index carried thereby reads to the same point as the index hand. Eaise the magnifier until the reading comes in sharp focus. Hold the instrument as nearly horizontal as possible, and tap the case lightly with the thumb nail two or three times, so as to overcome any slight friction. This places the action of the works in equi- librium. "Write down the observation as it now reads in the pocket-book, taking thousands from the right hand (large figures), hundreds from the right hand (small figures), tens from the lines to the left of this, and units from observation of the position of the index- 1 The above instrument, made by Stanley, of Holborn, Lon- don, appears to be a very perfect instrument of the kind. It should be compared from time to time with a mercurial baro- meter reduced to 32°. THE ANEROID BAROMETER. 457 line in the space between the last and the next line." Say this observation reads 2465. Whether we ascend or descend, the instrument acts similarly. We will now presume we descend to a depth we require to ascer- tain, and we take a second reading, 1945, the difference between these numbers 2465-1945 = 520 feet, the number of feet descent. It is necessary, where exact measurement is required, to take the reverse reading, as the atmospheric pressure may have changed. We now ascend, taking the last observation, 1945, and find the reading at the first position 2463 instead of 2465, that is 2 difference, which proves that the atmospheric pressure has decreased. If we take half this difference = 1, and correct the first deduction, 520-1 = 519 will give us the correct measurement, subject only in this instance to the irregular possible fall of atmospheric pressure, which will not in many instances, if the times of observation have been nearly equal, be a quantity worthy of consideration. It is not necessary to make any correction for the height of the observer in positions above ground, as the instrument must be placed at a uniform distance from the eye to obtain the reading. In mines it will frequently be necessary to measure the heights from the ground at which the observation is made. Variations of the Barometer. — These may be divided into periodic and non-periodic or irregular. The diurnal is the most marked of the periodical variations, and is most regular in the tropics. 6 Their regularity is such, that, in the day-time especially, we may infer the hour from the height of the column of mercury, without being in error on an average more than fifteen or seventeen minutes ' (Humboldt's Cosmos). On the other hand, the barometer is almost constantly in motion in the middle latitudes, so that the periodical move- ments can only be detected by taking the mean of a long series of observations. The Monthly Oscillation. — The difference between 458 MEDICAL POLICE. the greatest and least heights of the barometer during a single month. The Mean Monthly Oscillation, — This is found by combining observations extending over a great number of years. This oscillation is least over the equator, but increases as the poles are approached. The height of the barometer is influenced by the direction of the wind, and also by the position of the moon, but this latter is very slight. The monthly means vary, being generally less in summer than in winter, due partly to the annual range in temperature, and partly to increased rainfall, especially near the equator and the parallel of 64°. Influence of Temperature and Vapour on the Baro- meter. — The barometric pressure of the atmosphere depends to a great extent upon temperature and hy- grometric condition. When air is heated it expands in volume and becomes diminished proportionally in density. When the vapour of water is added to air the effect of heat is also to expand the mixture and reduce its density. These two causes combined pro- duce certain diurnal variations of atmospheric pressure, which are indicated by two maxima and two minima of the barometric column. The maxima pressures are found to occur about 10 a.m. and 10 p.m., and the minima about 4 p.m. and 4 a.m. It is observed, how- ever, that the maximum at 10 a.m. is greater than that at 10 p.m., and that the minimum at 4 p.m. is more marked than that at 4 a.m. It is perhaps somewhat difficult to account completely for this phenomenon, but the following explanation may probably be nearly correct, and help to indicate the manner in which the sun acts more by its heat than by its attraction in heaping up two opposite and equal protuberances of the atmosphere, and thus producing atmospheric solar tides. Assuming the earth E to be surrounded by an atmo- sphere perfectly homogeneous in respeqt of moisture, and PRESSURE OF THE ATMOSPHERE. 459 uniform in temperature, then the barometric pressure would obviously be indicated by a concentric circle, 29-568 A D 29-580 dotted in the diagram, being uniform all round the earth. If now a portion of the atmosphere at A were more or less heated and charged with moisture, its volume would be increased, and it would therefore rise in height and overflow in both directions, piling up on each side of A a wave of increased pressure. The barometer would then show a minimum reading at A, and a maximum at B and C, on each side of it. The intermediate point D, though not really affected, would present itself as a minimum in relation to B and C. Now, if we suppose the earth, with its atmosphere in this condition to make its diurnal revolution, this con- dition of two maxima with two intermediate minima of pressure would recur at each successive point of the earth's surface following the apparent motion of the sun. At 4 p.m., just after the sun has been giving its greatest heat, and producing the greatest amount of evaporation, and after the column of air elevated thereby has had time to overflow, the most marked minimum, namely that at A, presents itself. This would determine the two maxima B and C to be about six 460 MEDICAL POLICE. hours before and after A respectively, that is, at 10 a.m. and 10 p.m., and between them we should find the secondary minimum D about 4 a.m. The above must simply be taken as an attempt to explain a most im- portant and difficult problem. Influence of Sea and Land. — It appears from obser- vation, that during the month of July in the northern hemisphere the lowest pressures are distributed over continents, the depression being greatest the larger the continental mass, and that it is over the ocean that the highest pressures prevail, especially over those parts which are for the most part land-locked. Lore Pressure in the Northern Hemisphere over Con- tinents. — This low pressure is the result of the more rapid heating of the land as compared with the ocean, owing to the greater specific heat of the latter. The air quickly heated by radiation from the land rises and overflows, diminishing the pressure near the surface of the land. The low pressure over Asia amounts to nearly half-an-inch. High Pressure over the Ocean in the Southern Hemisphere. — During the same season the pressure in the southern hemisphere is increased, for the hot air, rising from northern continents, flows over in the higher regions of the atmosphere southwards, and pro- portionally increases the barometric pressure there as it sinks and flows over the southern oceans. The like takes place over the oceans of the northern hemisphere ; hence we find that the increase of pressure is most marked in the north Atlantic, due to its being more or less surrounded by land supplying overflow air from both sides. In January the whole of the preceding results are reversed. Cause for this. — The land rapidly parts with its heat ; on the other hand, the sea, owing to the greater specific heat of water, slowly cools, hence there is a con- stant current of warm air continually rising from its WINDS. 461 surface in winter flowing over and becoming piled up over the land. The barometer is lowest over the land in the hemis- phere where summer prevails, and highest in that where winter prevails, this effect being due, to a great extent, to the annual range of the thermometer. Elevation above the Level of the Sea. — When a barometer is elevated above the level of the sea the column of mercury sinks, due to the diminished weight of the air, for as we rise in the atmosphere the density of the air is lessened. Due to this fact elevations above the sea-level may be calculated, a fall of one-inch in the barometer indicating an elevation of 872 feet. Areas of Equal Pressure. — These are joined together by lines called isobarometric lines, that is, lines of equal pressure. Areas of High Pressure. — Two bands passing round the earth, one north and the other south of the equator, and inclosing the tropical band of low pressure. Areas of Low Pressure. — One round each pole, besides the tropical band just mentioned. Buys Ballot Law. — * If at the same moment of time there be a difference between the barometrical readings at any two stations within a reasonable distance from each other, a wind will blow on that day in the neighbourhood of the line joining those stations which will be inclined to that line at an angle of nearly 90°, and will have the station where the reading is lowest on its left-hand side.' In other words — ' If on any day a person stand with his back to the wind, the reading of the barometer will be lower at all stations on his left hand than it is where he is at the time.' Winds. Wind is air in motion. Three causes are at work in the production of wind : — 1. Unequal atmospheric pressure. Winds blow t 462 MEDICAL POLICE. from a region of higher to a region of lower pressure. 2. Unequal specific gravity of the atmosphere. The result of temperature and humidity. 3. The rotation of the earth. The rotation of the earth would not alone produce wind, but it materially affects the currents of air flow- ing towards the equator from the north and south poles, and drives the air in a line the resultant of the two forces, the rotation of the earth and the flow of air from the poles to the equator respectively, NE on the north of the equator, and SE south of the line. The trade winds are the result of the above causes, and extend from 7° to 29° N for the KE trades, and to latitude 20° S for the SE trades. Between these, on both sides of the equator, there is a belt of from 150 to 500 miles of calm or variable winds. Surface Winds. — These may be divided into four systems — the Equatorial or trade winds, the Winds of the middle latitudes, the Polar winds, and the Variable winds. Equatorial or Trade Winds. — The causes in the production of these have just been given. Winds of the Middle Latitudes. — Over the parallel of 32° the mean pressure of the air is '558 inch greater than over the parallel of 64°, and, therefore, at the earth's surface the air tends from the parallel of 32° toward the pole. The air in latitude 32° is indeed warmer, and therefore lighter, than it is near the poles, and this creates a tendency of the surface current from the poles toward the equator ; but the effect of the increased pressure of the air near the parallel of 32° is greater than that of its diminished density, and the air actually moves towards the poles. Eut while moving northward it crosses parallels of latitude whose easterly motion is less than its own ; and, since it retains the easterly motion it had at starting, it has a relative motion from the west, which, combined with the first WINDS. 463 northerly motion, carries it toward the north-east. Thus, throughout the middle latitudes of the northern hemisphere the prevalent motion of the lower portions of the atmosphere is from the south-west ; and, for like reasons, in the southern hemisphere the lower portions of the atmosphere move from the north-west (Loomis). It is to the south-westerly winds that we owe, to a great extent, our mild and rainy winters. Polar Winds. — Due to the rush of air to the equator from the north, and from the south to the same destina- tion, combined with the rotatory motion of the earth. A north-east wind prevails in the arctic and a south- east in the antarctic regions. Variable Winds. — These depend on local causes, physical configuration, etc. ; thus, it is found that the mean direction of the wind is NE at Christiania, whilst it is SSE at Hammerfest, Christiansand, on the west of Norway. In the northern hemisphere southerly winds are warm and humid, and northerly winds dry and cold ; the opposite is the case in the southern hemisphere. In Europe easterly winds are cold and dry, westerly warm and humid. East Winds of Britain. — These blow chiefly during spring. They may be referred to the following causes : — 1. Expansion of the air in the southern hemisphere when the sun is south of the equator, and its overflow to the northern hemisphere. 2. Hence, a greater accumulation of dry air north of the equator in winter than in summer, the result of precipitation of snow, etc. 3. The high atmospheric pressure due to the low temperature over Russia in winter, as compared with the summer pressure. 4. The heating of the north of Africa and south of Europe and Asia causing the surface air to rise, with a consequent rush of air from Eussia to take its place. I 464 MEDICAL POLICE. 5. A tributary from this northerly current constitutes our east wind. The unhealthiness of these winds is due, to a great extent, to their coldness and dryness. Kadiation is much more active when the air is dry than when it is moist, and therefore our bodies radiate more heat when a dry cold air is blowing over us than when the air is more or less charged with vapour ; and we therefore feel the cold, biting east wind, which robs us as rapidly of our heat as it is generated, whilst that portion of our bodies which is exposed to the sun is almost scorched. This comparative freedom from vapour also explains the intense heat of the direct solar rays in the polar regions, where Captain Scoresby noticed that the pitch rapidly melted on the side of his vessel exposed to the sun, whilst ice was as rapidly produced on the pro- tected side. To like causes may be attributed the intense solar heat in Alpine regions, and the oppression felt in travelling over these regions. Prom the above statements the injurious effects of the east wind may be appreciated. Monsoons — Cause, Effect on Climate, etc. — These are due to the modifying influence of land on atmospheric changes before described, and which, in this case, so affects the trade winds as to change the direction of their course for certain months in the year. Thus, from April to October, the prevailing winds blow from SW ; from October to April, from NE. This is due to the fact that during summer the southern part of Asia becomes warmer than the Indian Ocean near the equator, and thus draws the air towards it, which, coming from a lower latitude, has an excess of motion towards the east, which, combined with the motion from the south, due to the influence of heat, produces a wind from the SW. During the winter the reverse takes place ; the ocean being warmer than the land, the usual NE trade is the result. The velocity of wind varies with the latitude, decreasing in velocity from the WINDS. 465 equator to the poles. This fact will help partly to explain the increased velocity of the monsoons. The effect of the SW monsoon on the climate of Southern Asia, Central and Western India, is most marked, for the vapour with which it is charged is condensed by the high mountains, producing heavy rains, and an increased buoyancy in the air by the heat liberated in the act of condensation, thus lowering the density of the lower strata and increasing the velocity of the in-rushing air. This and the before-mentioned causes explain the terrible velocity of the monsoon. The rainfall in China, from this cause, amounts to 3*34 inches in winter, and 37*70 in summer. A knowledge of the direction of these winds is also valuable as a means of inter-communication by sailing ships. Force and Direction of the Winds. — To determine the force and direction of the wind various forms of anemoscopes and anemometers are used. These are all modifications of the common vane, to which certain rack-work adjustments are added, and by the aid of which the force and direction of the wind may be registered. Those best known are Kobinson's and Osier's anemometers ; the latter registers direction, velocity, and pressure. Force of Wind, to Calculate. — Multiply the velocity for a minute by 60 ; square the result, and multiply by •005. The result will give the force of the wind in pounds, or parts of a pound, per square foot. Velocity of the Wind. — The average velocity of the wind may be taken as nine miles an hour at Plymouth, ten miles at Greenwich, and so on, varying with the locality. Several tables of comparison for the velocity of wind from just perceptible at two miles, to a hurri- cane at 84 or 100 miles an hour have been made, but the data from which they are composed appear to be arbitrarily selected. 2g 466 MEDICAL POLICE. B. Influence of Trees and Forests, and Sandy Deserts. Luxurious vegetation and dense forests act by pre- venting the heating of the ground by the direct rays of the sun, and also by the rapid absorption of solar heat by the moisture, the result of the vital organic action of the leaves. Due also to the increased radiation from the greater exposed surface of the leaves, the amount of heat accumulated on the surface of plants is less than that of the unprotected land. Thus, vegetation acts in a threefold manner by shade, evaporation, and radiation. Trees part with their heat from above downwards; those leaves are first cooled which are directed without any intervening screen towards the unclouded sky. A second stratum of leaves has its upper surface turned to the under surface of the first stratum, and will give out more heat by radiation towards that stratum than it can receive by radiation from it. The result of this unequal exchange will thus be a loss of temperature for the second stratum of leaves also. By this process ' a tree, the horizontal section of whose summit would measure, for example, 2000 square feet, would act in diminishing the temperature of the air equivalently to a space of bare or turf-covered ground several thou- sand times greater than 2000 square feet 9 (Humboldt's Aspects of Nature). Another effect of forests is the greater distribution of heat over the twenty-four hours in countries where the ground is thus protected, than in those where sandy deserts are exposed to the direct action of the sun. Trees, though following the same laws as other bodies as regards heating and cooling by solar and nocturnal radiation, do not, however, appear to reach their maximum of temperature till a short time after sunset. This in summer occurs about 9 p.m., while the maximum temperature in the air occurs between 2 and 3 p.m. (Buchan). For the reasons just stated, the change in the temperature of trees is slower than in the air ; as strata after strata of leaves have INFLUENCE OF FORESTS, ETC. 467 to part gradually with their heat. The result of this transference of the maximum daily temperature to so late in the evening is to render the nights warmer and the days cooler, thus more nearly approaching an insular climate. It is also not improbable that forests, whilst diminishing evaporation from the damp ground under them, increase the humidity of the atmosphere. The heat of summer is lowered, and the cold of winter lessened by the presence of large forests. Having a lower temperature than that of the surrounding district, forests increase the rainfall, and thus act like mountains in arresting the rain, bringing clouds and condensing their vapour into rain. Vegetation is also a source from which the atmo- sphere obtains its electricity. Oxygen, charged with negative electricity, is given off by plants during the day, and carbonic acid, charged with positive electricity, during the night; the two probably neutralise each other. From the above considerations, and from the fact that the movement of air is materially affected by forests, care should be taken to keep the growth of trees within proper limits. Stations situate in the midst of dense forests are often very unhealthy. But, on the other hand, it must be remembered that trees have a wonderful power in arresting the spread of malaria; villages separated by trees from marshes do not, as a rule, suffer from malarious diseases. Trees also pro-: tect mountain stations from descending currents of cold air. In a hygienic point of view, Parkes divides vegeta- tion into herbage, brushwood, and trees. Herbage is always healthy, cooling the ground as before noticed. Brushwood is generally unhealthy, and should be removed, as the air is almost stagnant where the underwood is very thick. The removal should be effected in the middle of the day, when the sun is 468 MEDICAL POLICE. hottest. The removal of brushwood may, however, for a time give rise to malarious diseases. Trees should he removed with care, and in most cases only when they materially affect the proper move- ment of the air, as their injudicious removal might materially affect the rainfall and the supply of water. The waters of Lake Tacarigua, which were gradually receding towards the end of the last century, are now increasing, due to the presence of large forests which have sprung up since the destruction by war of the peaceful operations of agriculture in the valley Aragua in Venezula, in which the lake is situated. Sandy Deserts, — Due to the absence of vegetation, the temperature of sandy deserts frequently rises to 120°, 140°, or even 200°. The desert of Sahara gives to the south of Europe an unduly high temperature. C. Influence of Lakes and Marshes. The presence of large masses of deep water sur- rounded by land, as is the case in North America, results in an almost insular climate in summer, and a continental one in winter ; for the frozen lakes seem to exercise the same influence as if they were solid land. The specific heat of water helps, therefore, to lower the summer temperature, but the winter ice gives the same results as an equal mass of land. Deep lakes situated at the bottom of valleys are a source of heat in winter, for the cold air coming down the mountain sides cools the surface water, which sinks deeply into the water, thus scarcely affecting the temperature at the surface of the lake. Marshes, on the other hand, by the evaporation of the thin layer of water, help to keep down the summer temperature. The severity of the winters of the coun- tries surrounding the Baltic is due to the shallowness and feeble saltness of that sea, which causes it to be so easily frozen over. INFLUENCE OF THE SEA. D. Influence of the Sea. In considering the effect produced by the sea on the climate of a place, we have to consider — 1. The great Specific Heat of Water.— Water has the greatest thermal capacity for heat of all known sub- stances. This property of water prevents the surface of the sea from being as highly heated as the land, and also retards its cooling, at the same time that it gives out more heat through a given range of temperature than the land. The amount of heat required to raise one pound of water from 0° to 100° C. would raise the same weight of iron from 0° to 900° C. ; hence, a pound of water, on cooling from boiling point to zero, gives out 900 caloric units. 2. Density. — Water follows the law that bodies ex- pand when heated, and contract on being cooled, till a temperature of 39° F. or 4° C. is reached, when it is at its greatest density, and from which it then begins to expand till the freezing point is reached. Water sinks on cooling, and this sinking of the cold and rising of the warm continues till the whole mass of water has fallen to 4° C. or 39° F., when further motion is arrested, and needles of ice are formed at the surface, while the temperature at the bottom remains at 4° C. or 39° F. ]STow, while this holds good for fresh water, certain modifications have to be considered when the water contains salt or any other saline substance. Depend- ing on the saltness of the water, the temperature of maximum density falls with and below the freezing point, and salt water then follows the law of expansion ► and contraction by heat and cold. An important fact to be deduced from these considerations is, that no ice can be formed on the surface of salt water till the temperature of the whole mass has fallen to its freezing point ; but in the case of fresh water, as we have just seen, ice is formed as soon as the temperature of the mass reaches 4° C. or 39*2° F. 470 MEDICAL POLICE. 3. Currents. — The climate of a country is more or less modified by the temperature of the sea currents which bathe its shores. The temperature of the fol- lowing countries is raised : — West of Europe, East of Africa, South Asia ; these depressed — East and West Coasts of North America, West Coast of South America, West Coast of Africa, East Coast of Asia, and South Coast of Australia. The sea currents depend on the following causes : — 1. The duration and strength of prevailing winds. 2. The propagation of the tide-wave round the globe. 3. Variations of density due to changes of tempera- ture in different latitudes, and to the relative quantity of saline contents. 4. Variations of atmospheric pressure regular in the tropics, and propagated east and west. Of ocean currents, the most important to us in Europe is the Gulf Stream. It is, in fact, a great river in the ocean, the margins of which are so well defined that Admiral Sir Alexander Milne found that the tempera- ture at the bow of his vessel was 21*5° C, at the stern 4-5° C. The practical effect on the climate of Britain of a large stream of warm water flowing along its western coast is to raise the temperature 20° higher than it would otherwise have been. E, Influence of Hills and Mountains. Mountain ranges act by precipitating the moisture from the winds which blow over them ; thus one side of a lofty mountain range may have a moist, humid climate, whilst on the other side, the air being thus previously dried, the winters are cold and the summers hot and sultry. The probable explanation of this is, that on the one side the ground is protected from excessive solar and terrestrial radiation by the moisture suspended in the air; on the other side, this protect- DRAINAGE. 471 ing envelope is awanting. The westerly winds which sweep over the Kocky Mountains deposit most of their moisture on the western slopes, and when they descend the eastern sides, are so dry and cold that ordinary agricultural products require artificial irrigation to raise them. In Peru this effect is most marked where a barren table-land, some miles in area, known as Punos, is the result of the protecting power of the Andes. Prescott states that the ancient Peruvians preserved the bodies of their dead by simply exposing them to the cold, dry air of the mountain. The great desert of Gobi is caused by the Himalaya mountains. Moun- tains collecting moisture from the clouds increase the rainfall, and thus produce the streams of water which flow down their declivities. In hot climates the plains at the foot of lofty mountains are often most unhealthy; but the cold air rolling down the sides of snow-cappecl mountains renders the valleys at their base cool and pleasant. This is most strikingly noticed on the Italian side of the Alps, and also on the Plains of Granada, where the cold air from the Sierra Nevada lessens the excessive heat of a Spanish summer. In selecting a mountain station for troops, the direction of the prevailing winds should be considered, for the reasons above given. F. Influence of Efficient Drainage and Sewerage. The health of any locality in a great measure depends upon the efficiency of the drainage. 6 Up to about the year 1815 it was penal to discharge sewage or other offensive matters into the sewers. Cesspools were regarded as the proper receptacles for house drainage, and sewers as the legitimate channels for carrying off the surface waters only. Afterwards it became permissive, and in the year 1847 the first Act was obtained making it compulsory to drain houses into sewers/ 472 MEDICAL POLICE. House Drains, — These, when inside the house, should be made of cast-iron, smooth inside, with calked lead joints, and with sufficient fall to render them self- cleansing. For outside the house, and where the soil is firm and unyielding, glazed earthenware pipes may be used, the joints being fixed with hydraulic cement, care being taken that no cement stands up inside to form an obstruction. The Stanford joints, as they are made by Messrs Doulton, have been greatly recom- mended. Clay should, on no account, be used for the joints of drains, as it has a strong tendency to shrink, crack, and become utterly useless. A good foundation of concrete, on which to lay the drain pipes, is also absolutely necessary to prevent the settling of a portion of the pipes and the opening of the joints. A recess should be cut in the bed of the drain-pipe trench for the socket of the pipe, and then cement should be used for the packing. Every pipe should be wiped out as laid. Tlie requirements of a good house drain are therefore — 1. A fall that will give a good velocity to the current. A fall of 1 foot in 92 for a four-inch drain, and 1 in 137 for a six-inch, and for a nine-inch 1 in 206 is sufficient. The velocity of the current should be about three feet per second, but to maintain this velocity they would require to run half full, so that a four-inch would require to be provided with water at the rate of 7*85 cubic feet per minute; a six-inch with 17*66 cubic feet per minute ; and a nine-inch with 39*76 cubic feet per minute (Latham). The above is the theoretical requirement, but in practice a greater fall will be found necessary. 2. The most polished internal surface possible. 3. Good joints, allowing of no obstacle to the passing current, and preventing escape of sewage and gas. 4. A four-inch drain will be sufficient for most DRAINAGE. 473 purposes. For large establishments, a six-inch is ample. Any increase in size above those mentioned is unnecessary, and increases the difficulty of cleansing by flushing. 5. Adequate means for flushing the drains periodi- cally. 6. The connections or branches should never be at right angles. All T joints must be prohibited, and Y joints substituted. 7. Good Traps. — These need not be more than are absolutely necessary to prevent admission of sewer gases into the house, for 6 every trap in the line of a waste or soil pipe is necessarily a place for sewage to be arrested temporarily, and, if the use of the pipe be not very frequent, decomposition occurs, evolving gases.' 8. A trap should be placed outside the house walls, on the main house drain, after it has collected all the branches which are tributary to it, and between this point and the sewer. To this rule Mr Latham objects. He says that 6 the inser- tion of an ordinary flat siphon trap in an ordinary inclined house drain has, in practice, unfortunately been found not to answer, and when so used they usually stop up in the course of a few years.' The rule given above is that made by the Local Government Board in their model by-laws. If the use of a trap be enforced, it is clear that the siphon is not the trap that should be employed. 9. A good firm bed of concrete on which to lay the pipes, in order to prevent the settling and breaking of the pipes, or the pipes may be bedded in concrete. 10. Good ventilation is absolutely necessary. This may be effected by making a number of small holes in the man-hole covers in the street, or a vent pipe may be carried from the drain 474 MEDICAL POLICE. outside the house to the top, or into a factory chimney which is being constantly used. The water conductor from the roof should never be used, for the compression of air in the sewer is most likely to occur during a heavy rain, when the pipes are otherwise engaged in carrying off the rain water. 11. Traps. — The best trap is the ordinary S bend or siphon trap. It may, however, become inopera- tive from the following causes : — a. The curve may not be deep enough to allow a certain depth of water to stand above the highest level of the water in the curve. b. The trap may be sucked dry if the pipe be small (2 and 4 inches) by the siphon action of the pipe beyond. This is most likely to occur if there be a sudden rush of water through the trap, and the pipes be running full. Also, if several siphons are used in the course of a drain, they may be one or all sucked dry by their united action, thus a b c are three siphon traps placed in the line of a drain. If the drain, when running full, have the supply of water suddenly cut off, the result will be that a vacuum is created between a b c ; b will therefore untrap «, and c, b, and c will itself be untrapped by the vacuum on the one side, and the force of the air on the other. To prevent this unsealing action, ventilators must be placed between the traps, and it may be broadly stated that no system of house drainage is perfect without a complete system of ventilation. c. In traps not used for some time the water may have partially evaporated, leaving the trap useless. d. If sufficient water be not used to thoroughly cleanse the trap, it may become clogged, and foul gases rise from it into the house. DRAINAGE. 475 e. Pressure of air in sewer may force it. The mid-feather trap is a siphon trap, with a projec- tion from the inner surface of the shorter curve of the siphon dipping into the water in the trap. This trap should be so made that access to it for occasional cleaning may be easy. The flap-trap is merely a hinged flap which allows the water to pass one way only. It closes by its own weight. It is used to close the mouth of drains, to prevent ingress of wind or water, and thus prevent regurgitation. Bell-traps ought in all cases to be avoided. These are the usual sink traps. 12. If possible a means of access to the drain pipes should be provided for the purpose of cleansing periodically. General Principles in House Drainage. 1. Good drains, well laid, well ventilated, and easily got at, if necessary for cleaning, repairing, etc. No house drain should be used as a sub-soil drain. 2. Good water-closets, which should be placed as much as possible out of the main dwelling, in a turret or lobby, and with plenty of light and ventilation. 3. The pipes from the scullery should not, if possible, open into the soil pipe, as the grease chills and clogs the drain. A receptacle for grease should in all cases be provided. The bath pipe, rain-water pipes, and all other pipes, may be discharged into the open air over a grating. 4. A plentiful supply of water. 5. The prevention of leakage. This is by no means easy unless good pipes are used, and great care taken in laying and jointing them. 6. Good traps. 7. Drains within the house should be of cast-iron, and be carried out the house Avails as directly as pos- 476 MEDICAL POLICE. sible. Latham recommends lead pipes, as they do not rust, but they are more likely to be gnawed through by rats and otherwise injured. If bedded in mortar the lime may act injuriously on the lead. In no case should the drain be carried for any distance under the basements or cellars, for it is most difficult to prevent sewer gases from escaping even when every precaution is taken. This rule becomes more important when we remember that every house acts as a ventilating shaft for the soil beneath, and that as the temperature of the house is higher than the external air, the tendency is to draw the gases through the smallest leak in the sewers. On the question of the ground-air under and around houses, and the necessity for keeping it pure, Petten- kofer remarks : — ' They can ' — our neighbours — ( also poison the ground-air for us, and I see more danger in this, as air is more universally present, and more mov- able than water.' 8. The soil pipe should be of cast-iron. 9. The fewer waste pipes in the house the better, and under no circumstances should they be placed in bed-rooms. Drains and Sewers. — Drains are generally earthen- ware pipes properly glazed inside ; sewers may be either of earthenware or built of brick. Drains vary in size from four to six inches in diameter for closets and sinks, increasing to fifteen inches for the larger house drains leading into the public or street sewer. Sewers built of brick should be well cemented, elliptical or egg-shaped, with the smaller end down- wards, and with provision for sub-soil drainage under them, to prevent percolation of soil water into them, and when curves are necessary, they should not be less than ten times the cross sectional diameter of the sewer, with no junctions at right angles. All sewers should be laid sufficiently deep to be .below all cellars. In Bedford, in many cases, the sewage was known to have percolated into the cellars. They should be large DRAINAGE. 477 enough to allow a man to creep along them, and be laid as straight as possible, and they should never be allowed to be more than two-thirds full. The junctions from house drains should be made so that the discharge from them is in the direction of the established current. Junctions at right angles have a tendency to cause eddies by the inflowing sewage, and thus impede the main current. The more acute the angle of entrance the better. In the construction of sewers, allowance must be made for storm waters, hence a knowledge of the rainfall is necessary. ' In Paris the main sewers are made with paths on each side, just above the stream ; a tramway runs on one side which carries a machine, which can at once clear the bottom of the sewer ; the entrance to each house drain is marked by a porcelain plate bearing a number ; the owner of the house pays a small sum — three francs — annually to have his house drain kept clean.' Fall and Velocity of the Current. — One foot in ninety-two, according to size, for house drains, for street sewers one in from fifty to three hundred feet, the fall depending somewhat on the size of the drain, and the nature of the liquid and solid refuse it is intended to remove. Care should be taken that the fall is equable and not broken by varying gradients. The velocity for house drains should be about 180 feet per minute, and for the street drains about 100 feet per minute. Sir Joseph Buzalgette recommends a velocity in large sewers of 176 feet per minute when running three-quarters full, 165 feet when running half full, and 146 when running one-third full. 6 The greatest dis- charge from a circular conduit is when it is not quite full — i.e., when rather better than fifteen-sixteenths full, and the greatest velocity occurs when it is thirteen- sixteenths full.' The bottom velocity in a drain differs from the mean velocity in the ratio of from *75 to *85 — say '80 to 1 — or four-fifths. Man-holes and Lamp-holes. — These should be placed 473 MEDICAL POLICE. at convenient distances to allow easy access for examina- tion and cleansing of sewer, and fitted with ventilating chambers filled with charcoal. Lamp-holes are small shafts, allowing of the suspension of a lamp, which may be seen from a man-hole along the sewer. Man- holes should be placed at every point of lateral de- viation in a sewer, and man-holes or lamp-holes at every vertical point of deviation. Both man-holes and lamp- holes should act as ventilators. Obstruction to Sewers. — This may be due to — a. Improper levels used. b. Too little fall. c. Too sharp curves and bad connections. cl. Imperfection in the laying and making of the sewers, causing sinking of the floor. e. Impediments at mouth of sewer from — 1. Accumulation of mud, excreta, etc. 2. Backward pressure of sewage, due to tides and wind. 3. Want of proper supply of water to flush the sewers periodically. Cleansing Sezvers. — This should be frequently done, by flushing or otherwise, for a large amount of putres- cent matter clings to the top and sides, due to the ever- varying level of the flow. The cleansing of sewers is now economically done by flushing, the old plan of breaking into the sewer and carting away the deposit being found too expensive. 'The cost of removing deposit from the tide-locked and stagnant sewers of London formerly amounted to the sum of about <£30,000 per annum ' (Buzalgette). Where flushing is required, the rainfall must not be depended upon, for it is during the summer, when the rainfall is least, that the most injurious effects of an accumulation of filth are likely to result, increased also by the high tem- perature of that season. Artificial means are therefore required. DKAINAGE. 479 The following table is given by Denton : — Feet. 30 per minute will disturb clay with sand and stones. 40 ,, will move along coarse sand. 60 fine gravel, size of peas. 20 ,, rounded pebbles, 1 in. diameter. 80 angular stones, If in. diameter. Calculation of Discharge from Sewers. V = 55 x ( JD x 2 F) x A. V = velocity in cubic feet per minute. D = hydraulic mean depth. F = fall in feet per mile. A = section area. First ascertain the hydraulic mean depth where the sewage is flowing, and the amount of fall in feet per mile. The hydraulic mean depth is one-fourth the diameter if the pipe be running full ; if the pipe be not full, it is the section area divided by the wetted perimeter. The wetted perimeter is that part of the circle of the pipe wetted by the fluid. To find the fall in feet per mile, measure a distance of 50 or 200 feet, and calculate fall 5280 feet = 1 mile. Multiply the hydraulic mean depth by twice the fall in feet per mile, and take the square' root. Multiply the square root by 55, and the result by the section area, this will give the amount in cubic feet per minute (Parkes). Water-Closets. — It appears that the use of water- closets is of very ancient date — probably of Asiatic origin ; but their application to private houses is more recent. The two forms most in use in this country are the ordinary ' pan closet/ and the 4 hopper closet/ but of these there are several modifications and improve- ments. The Pan Closet. — This, though the most common in 480 MEDICAL POLICE. use, is one of the most defective and dangerous. It consists — 1 . Of a'f unnel-shaped receptacle of earthenware, placed under the seat. 2. The copper pan containing water, and closing the smaller end of the funnel. When the pan requires emptying it is tilted obliquely down- wards by means of a lever. 3. The cast-iron box or receiver resting on the floor into which the contents of the pan are thrown. 4. A short pipe with a lead trap, put below the floor. The objections to this form of closet are the follow- ing :— 1. The filthy condition of the receiver, which, from its position, cannot be cleaned. 2. The trap below the floor, the contents of which generally emit obnoxious gases, and which are forced upwards every time the pan is tilted and its contents poured into the trap. 3. The large reservoir of foul air formed by the receiver, and which empties itself into the room when the pan is tilted. To obviate these evils several appliances have been suggested, but they are all more or less complex, and therefore liable to get out of order. The Hopper Closet. — This consists of an earthenware funnel with a lead siphon trap, or, better, with an earthenware trap in one piece, to which a ventilating pipe is attached. The advantages of this closet are — 1. That the reservoir of foul air in the pan-closet is dispensed with. 2. It can be easily cleaned. The disadvantages are — 1. The contents of the trap are directly exposed ; care is therefore required to flush it out immediately after it has been used. 2. Considerable waste of water may result from DRAINAGE. 481 carelessness. This may be obviated by having a separate tank containing enough water for each flushing. On no account ought the supply of water for these closets to come direct from the mains. The J earring's Closet, — This has the advantages of the Hopper closet without its disadvantages. These are provided against by the use of a hollow plug, which, when lifted, allows all faecal matter to be rapidly dis- charged, and, when down, retains a considerable quantity of water in the closet basin. The foul reservoir of the pan closet is removed, and a larger water trap than the Hopper provided with less waste. Public Privies. — These are generally used in poor neighbourhoods, where ordinary closets cannot be trusted to the care of the inhabitants. There is no necessity why they should continue longer in use, for trough water-closets, on the plan adopted in Liverpool, can always be kept clean by daily inspection at a small cost. TJie Ventilation of Seivers. — -The difficulties in the sewerage of a town are not ended when the sewers are completed, and the sewage turned into them. The sewers have to be ventilated. According to Parent Duchatelet, there is nothing which belongs to the con- struction of sewers so important as eye-holes. In some towns the ventilation of the sewers have been attempted by open gratings in the street communicat- ing with the sewers. This was done in Southampton, but the smell from the holes was so bad that the inhabitants stopped them up, the result being that the sewer gas forced the traps and entered the houses. Little ventilation is required if the sewers have a good fall, or are Pushed' daily, but this cannot always ' be accomplished. Man-holes may be used if a tray containing charcoal be so placed as to intercept the gases as they rise. An attempt was made in South- wark to ventilate the sewers by pipes connecting them 2h 482 MEDICAL POLICE. with the furnaces of the soap works ; the result was an explosion which blew 4 all the furnace down.' But even where explosions do not occur, it is found that this method of ventilation is uncertain, and that the draught so created is so great as to open the house traps in the neighbourhood, ' and when out of work such inlets form outlets for the gases generated in the sewers, and therefore at such times disperse the sewer gases into the air of the streets and dwellings of the in- habitants of the district ; or, in other words, such a system is violent, local, and intermittent in its applica- tion 9 (Thorburn.) The best plan appears to be to connect the sewers with pipes carried above the tops of the houses, with a charcoal filter at their bases, and an archimedean screw at their tops. The pipes should be of sufficient calibre to prevent the cold of winter con- densing the sewer vapours on their sides, and thus blocking them. At Tottenham, near London, the pipes are carried by the side of the chimneys of the houses, a very excellent plan. Public Health Act (38 & 39 Vict., c. 55). Privies, Water-Closets, etc. Sec 35. — It shall not be lawful newly to erect any house, or to rebuild any house pulled down to or below the ground floor, without a sufficient water-closet, earth- closet, or privy, and an ash-pit, furnished with proper doors and coverings. Any person who causes any house to be erected or rebuilt in contravention of this enactment shall be liable to a penalty not exceeding twenty pounds. Under sections 36, 37, 38, 39, 40, the local authority may enforce the provision of privy accommodation for houses, factories, and public necessaries, urinals, etc. They may also provide earth-closets to be supplied with DRAINAGE. 483 dry earth, and also to provide that drains, privies, etc., be properly kept. Public Health (Scotland) Act, 1867, sec. 40, deals with the above in much the same terms. Examination of Privies, etc., on Complaint. Sec. 41. — On the written application of any person to a local authority, stating that any drain, water-closet, earth-closet, privy, ash-pit, or cesspool, on or belonging to any premises within their district is a nuisance, or injurious to health 1 (but not otherwise), the local authority may, by writing, empower their surveyor or inspector of nuisances, after twenty-four hours' written notice to the occupier of such premises, or in case of emergency without notice, to enter such premises with or without assistants, and cause the ground to be opened, and examine such drain, water-closet, earth-closet, privy, ash-pit, or cesspool. If all be found in good condition, the cost of exami- nation is to be defrayed by local authority ; but if in bad condition, occupier to be served with a notice to do the necessary improvement under a penalty not exceed- ing ten shillings for every day during which he continues to make default. The local authority may execute such works and recover cost for same in a summary manner. Public Health Act (38 & 39 Vict., c. 55). Sanitary Provisions. Sewerage and Drainage. Definition of terms. ' The word " drain ; ' means any drain of, and used 1 for the drainage of, one building only, or premises 1 An individual complained that a public urinal had been erected too near his house ; but as it could not be shown to be injurious to health, it was not objectionable under this Act. i 484 MEDICAL POLICE. within the same curtilage, and made merely for the purpose of communicating therefrom with a cesspool or other like receptacle for drainage, or with a sewer into which the drainage of two or more buildings or premises occupied by different persons is conveyed. * The word "sewer" includes sewers and drains of every description, except drains to which the word " drain," interpreted as aforesaid, applies, and except drains vested in or under the control of any authority having the management of roads and not being a local authority under this Act.' Mr Eailey Denton objects to the loose way in which the word 6 drain 1 and 6 sewer ' are here used. He maintains that the word ' drain ' should be restricted to those channels for removal of water from the soil, c sewers ' to those used for the removal and discharge of filth. He also maintains that the sub-soil drainage should be distinct from the sewerage of the district. Dr Corfield pointedly and truly remarks, ' that it is certain that towns must be provided with pervious drains, and it is also, from the foregoing considerations, equally certain that they must be provided with imper- vious sewers. 1 Regulations as to Sewers and Drains. Sec. 13. — All existing and future sewers within the district of a local authority, together with all buildings, works, materials, and things belonging thereto, Except — 1. Sewers made by any person for his own profit, or by any company for the profit of the share- holders; and, 2. Sewers made and used for the purpose of draining, preserving, or improving land under any local or private Act of Parliament, or for the purpose of irrigating land ; and, 3. Sewers under the authority of any commissioners DRAINAGE. 485 of sewers appointed by trie Crown, shall vest in and be under the control of such local authority : Provided that sewers within the district of a local authority which have been, or which may here- after be, constructed by or transferred to some other local authority, or by or to a sewage board or other authority, empowered under any Act of Parliament to construct sewers, shall (subject to any agreement to the contrary) vest in and be under the control of the authority who con- structed the same, or to whom the same have been transferred. Power to Purchase Sewers. Sec. 14. — Empowers local authority to purchase or otherwise acquire sewers. But any person who, pre- viously to the purchase of a sewer by such authority, has acquired a right to use such sewer, shall be entitled to use the same, or any sewer substituted in lieu thereof, to the same extent as he would or might have done if the purchase had not been made. Maintenance and Making of Sewers. Sec. 15. — Every local authority shall keep in repair all sewers belonging to them, and shall cause to be made such sewers as may be necessary for effectually draining their district for the purpose of this Act. Powers for Making Sewers. Sec. 16. — Any local authority may carry any sewer through, across, or under any turnpike road, or any street or place laid out as, or intended for, a street, or under any cellar or vault which may be under the pave- ment or carriage-way of any street, and, after giving reasonable notice in writing to the owner or occupier (if, on the report of the surveyor, it appears neces- sary), into, through, or under any lands whatsoever within their district. They may also (subject to the 486 MEDICAL POLICE. provisions of this Act relating to sewage works without the district of the local authority) exercise all or any of the powers given by this section without their district for the purpose of out-fall or distribution of sewage. Purification of Sewage before Discharged into Streams. Sec. 17. — Nothing in this Act shall authorise any local authority to make or use any sewer, drain, or out- fall for the purpose of conveying sewage or filthy water into any natural stream or water-course, or into any canal, pond, or lake, until such sewage or filthy water is freed from all excrementitious or other foul or noxious matter, such as would affect or deteriorate the purity and quality of the water in such stream or water- course, or in such canal, pond, or lake. Alteration and Discontinuance of Servers. Sec. 18. — Any local authority may from time to time enlarge, lessen, alter the course of, cover in, or other- wise improve any sewer belonging to them, and may discontinue, close up, or destroy any such sewer that has in their opinion become unnecessary, on condition of providing a sewer as effectual for the use of any person who may be deprived, in pursuance of this sec- tion, of the lawful use of any sewer : Provided that the discontinuance, closing up, for destruction of any sewer shall be so done as not to create a nuisance. Cleansing Sewers. Sec. 19. — Every local authority shall cause the sewers belonging to them to be constructed, covered, ventilated, and kept so as not to be a nuisance or inju- rious to health, and to be properly cleansed and emptied. DRAINAGE. 487 To Provide Map of Sewage System, Sec. 20. — An urban authority may, if they think fit, provide a map exhibiting a system of sewerage for effectually draining their district, and any such map shall be kept at their office, and shall at all reasonable times be open to the inspection of the ratepayers of their district. Power to Drain into Seivers of Local Authority. Sec. 21. — The owner or occupier of any premises within the district of a local authority shall be entitled to cause his drains to empty into the sewers of that authority, on condition of his giving such notice as may be required by that authority of his intention so to do, and of complying with the regulations of that authority in respect of the mode in which the communications between such drains and sewers are to be made, and sub- ject to the control of any person who may be appointed by that authority to superintend the making of such communications. Any person causing a drain to empty into a sewer of a local authority, without complying with the provisions of this section, shall be liable to a penalty not exceed- ing twenty pounds ; and the local authority may close any communication between drain and sewer made in contravention of this section, and may recover in a summary manner from the person so offending any expenses incurred by them under this section. Use of Sewers by Persons outside District. Sec. 22. — Sewers, according to this section, may be used by owners and occupiers without district according to mutual agreement with such local authority, or at the option of the owner or occupier, by a court of summary jurisdiction, or by arbitration in manner pro- vided by this Act. 488 MEDICAL POLICE. Local Authority may enforce Drainage of Undrained Houses. Sec. 23. — Where any house within the district of a local authority is without a drain sufficient for the effectual drainage, the local authority shall, by written notice, require the owner or occupier of such house, within a reasonable time therein specified, to make a covered drain or drains emptying into any sewer which the local authority are entitled to use, and which is not more than one hundred feet from the site of such house ; but if no such means of drainage are within that dis- tance, then entering into such covered cesspool or other place, not being under any house, as the local authority direct; and the local authority may require any such drain or drains to be of such materials and size, and to be laid at such level and with such fall, as on the report of their surveyor may appear to them to be necessary. If such notice is not complied with, the local autho- rity may, after the expiration of the time specified in the notice, do the work required, and may recover in a summary manner the expenses incurred by them in so doing from the owner, or may by order declare the same to be private improvement expenses : Provided that when, in the opinion of the local authority, greater expense would be incurred in causing the drains of two or more houses to empty into an existing sewer, pur- suant to this section, than in constructing a new sewer, and causing such drains to empty therein, the local authority may construct such new sewer, and require the owners or occupiers of such houses to cause their drains to empty therein, and may apportion, as they deem just, the expenses of the construction of such sewer among the owners of the several houses, and recover in a summary manner the sums apportioned from such owners, or may by order declare the same to be private improvement expenses. DISPOSAL OP SEWERAGE. 489 Houses to be Drained into New Sewers. Sec. 24. — "Where any house within the district of a local authority has a drain communicating with any sewer, which drain, though sufficient for the effectual drainage of the house, is not adapted to the general sewerage system of the district, or is in the opinion of the local authority otherwise objectionable, local autho- rity may so adapt it, etc., etc. Penalty for Building Houses without Drains. Sec. 25. — Any person who causes any house to be erected or rebuilt, or any drain to be constructed in contravention of this section, shall be liable to a penalty not exceeding fifty pounds. Disposal op Sewerage. Proposed plans for the removal and treatment of sewerage. 1. Dry method. 2. "Wet method. 3. The pneumatic system (Capt. Liernur). 1. Dry Method. a. Moule's dry-earth closet. b. The charcoal closet. c. The Goux system. d. The ash-pit. a. Moule's earth-closet labours under the following disadvantages : — 1. The trouble of providing a sufficient quantity of dry earth — at least one pound and a-half for each dejection. 2. Difficulty of securing proper attention and removal of soil. 490 MEDICAL POLICE. 3. The trifling commercial value of product as manure. 4. The retention of excreta in the neighbourhood of houses. This objection may be raised against all the dry methods. The closets are fitted with pans containing dry earth, and may be used in sick-rooms, in the country, or for small communities, but their adoption will never be general. b. The charcoal closet labours under the same dis- advantages as Moule's closet. c. The Goux system consists in collecting the excre- ment in tubs lined with dry absorbents. The manure is almost valueless, and expense of removal great. d. The ashcloset has the same faults as the preceding. The dry method is adopted to a great extent in India, where the proper fall for the sewers cannot be obtained, and in places where there is either an insuffi- ciency of water, or the water for many months of the year is frozen. Where this system is adopted, the excreta are passed into proper receptacles, which in some cases allow of the fluid portions draining away ; in others, the solid and fluid portions are collected and emptied daily on the land. Under all other circumstances, the water-carriage system is the cheapest, the cleanest, and most con- venient, but it requires for its successful carrying out — 1. Good supply of water. 2. Good drains and sewers, with careful ventilation. 3. Sufficient fall to give the necessary velocity to the current. 4. Good subsoil drainage, apart from sewers. 5. A means of utilising the sewage. 2. The Wet Method. This may be divided under three heads — 1. The emptying of the sewage into a neighbouring DISPOSAL OF SEWERAGE. 491 river or into the sea. Ordered by the Public Health Act, 1848; prohibited by the Act of 1875. 2. The addition of disinfectants and other substances to precipitate the solid matter, and then allowing the liquid portion to pass into a river or the sea, as above. 3. The use of the sewage for the purpose of fertilisa- tion by irrigation. The means by which this is accom- plished are as follow : — «. By subterranean irrigation. b. Ey underground pipes and hose-and-jet distri- bution. c. Surface channels. d. By submersion. 4. Filtration. — Both upward and downward filtra- tion through sand, gravel, charcoal, sawdust, etc., have proved costly failures. A modified form of filtration has been advocated by Mr J. Bailey Denton, known as 6 Intermittent Downward Filtration/ and appears to offer some hopes of being successfully adopted. Of this process the Eivers Pollution Commission makes the following remarks : — ' Sewage traversing a porous and finely- divided soil undergoes a process to some extent analogous to that experienced by blood in passing through the lungs in the act of breathing. A field of porous soil, irrigated intermittently, virtually performs an act of respiration, copying on an enormous scale the lung action of a breathing animal ; for it is alternately receiving and expiring air, and thus deal- ing, as an oxidising agent, with the filthy fluid passing through it. The action of earth, as a means of filtra- tion, must not be regarded as simply mechanical ; it is chemical, for the results of filtration, properly con- ducted, are the oxidation, and thereby the transforma- tion, of the offensive organic substances, in solution in the sewage-stream, into fertilising matter which remains in the soil, and into certain harmless inorganic salts which pass off in the effluent water.' 4^2 MEDICAL POLICE. Dr Dyke mentions the following as requisites to the successful practice of this method : — 1. ' The soil of the land to be used must be porous. 2. ' A main effluent drain, which must not be less than six feet from the surface, must be pro- vided. 3. ' The surface of the soil to be so inclined as to permit the sewage-stream to flow on the whole land. 4. 4 The filtering area should be divided into four equal parts, each part to be irrigated with the sewage for six hours, and then an interval of eighteen hours to elapse before a second irriga- tion takes place ; each of the four parts would thus be used six hours out of the twenty-four. An acre of the land so prepared would purify 100,000 gallons of sewage per day.' Of the disposal of sewage by the first plan all that can be said against it is, that it is a great waste of valuable manure, and that by it we give to the sea what ought to be placed on the land. With regard to the second and third methods, much discussion has arisen. Against the second it is urged, that the solid part left after precipitation possesses little, if any, fertilising properties, and that the various precipitating processes were found only to clarify, and not purify, the sewage, the larger part of the matters — six-sevenths — valuable as manure, going off in the effluent fluids. Besides the precipitate being almost useless, it is considerably in the way. The cost of material for precipitation is also considerable. The only probably successful plan is that of sewage irrigation. Against the third the following objections have been raised : — a. That the exhalations from sewage farms may become a source of disease — enteric fevers, etc. This has not been verified by experience where proper DISPOSAL OF SEWERAGE. 493 precautions as to subsoil, drainage, etc., have been taken. b. That the vegetable growth of such farms, even when the process of irrigation is carefully conducted, is exceedingly rank, and may give rise to disease in man and animals. Dr Spencer Cobbold's theory is, that the sewage brings down the eggs of the tapeworm and disease germs, and that during the course of the sewage over the land, some of the germs adhere to the growing- plants. That when an animal eats such sewage produce, the ova of the tapeworm are developed, and cysts are formed in the flesh of the animals, which, if eaten by man in an imperfectly cooked state, the cysts then develope into mature tapeworms. His theory has, how- ever, not been corroborated, for no cysts were found in the flesh of an ox fed on sewage-grown grass for the purpose of experiment. If the sewage be allowed tq become stagnant on the grass, bad results may follow, but not when proper care is taken. c. That there is frequently a difficulty in obtaining sufficient land for the complete and effectual disposal of the sewage of large towns. The difficulty is in- creased in proportion to the size of the town, for the required land may be large, and the price considerable — one acre for every hundred and fifty persons. It must also be remembered, when irrigation is relied upon as a means of disposing of large volumes of sewage, that the supply is continuous, while the land is always in vary- ing states to receive it, being in wet weather already saturated with water. The effect of this state of things is to convert the whole area of land used for irrigation into a malarious swamp. This cannot occur if proper methods of drainage are adoped. The effluent fluid comes up to the standard purity of the Eivers Pollu- * tion Commission. In England, irrigation may proceed all the year round. Another minor objection to sewage irrigation, but one which must not, however, be over- looked, is the possible contamination of the neighbour- 1 494 MEDICAL POLICE. ing water supply by filtration of the sewage through the earth. Chemical Methods for Defecating Seivage. — Many plans have been proposed for the defecation and puri- fication of sewage, which, though successful in a sani- tary point of view, have proved commercial failures, because the effluent from them all is essentially seivage. The following are the three best known : — 1. The lime process. 2. The phosphate of alumina process of Messrs Forbes & Price. 3. The A B C process. 1. The Lime Process. — This process consists in the simple addition of a definite quantity of caustic lime, the amount added being in proportion to the strength of the sewage. This precipitates the whole of the suspended matter with a certain amount of the dis- solved constituents of the sewage. A fair degree of purification is thus obtained, and the effluent water is tolerably clear ; but if allowed to stand for forty-eight hours putrefaction takes place, which may, however, be delayed by the addition of chloride of lime. The precipitate possesses no fertilising properties, and is therefore of no value. 2. Phosphate of Alumina Process. — This process is a good one, but the materials used are too expensive to command success on a large scale. It consists in pre- cipitating the sewage by the aid of the native phosphate of alumina dissolved in sulphuric acid, and then adding caustic lime. The process was carried on at Tottenham for some time ; but, owing to the difficulty experienced in obtaining the native phosphate of alumina, the scheme has failed. 3. The ABC Process. — The precipitating agent in this scheme is a mixture of alum, blood, clay, and charcoal ; hence the name. The sewage is mixed with a given quantity of the ABC mixture and allowed to settle in precipitating tanks ; the clear liquid is drawn DISPOSAL OF SEWERAGE. 495 off, and the sediment is dried and sold as manure, which is of little value. On this process the Eivers Pollution Commission makes the following remarks : — a. The process precipitates the greater part of the solid particles of the sewage, but in no case to such an extent as to allow the superincumbent waters to run into the river. b. The process produces no clearer water than what would have resulted if the sewage were allowed to settle by itself. c. The sewage is considerably reduced in value through it. d. Bad smells are always perceptible. Composition of Sewage from Sample obtained from the Southern Outfall, Crossness. Total solid matter in solution , j ^g^nic' 13*3 | = 80*50 Total solid matter in suspension . j ^^anic' 10*2 j ^ ^"^0 Chlorine — chiefly as common salt .... 21*39 Nitrogen existing as ammonia 3*15 Organic nitrogen 0 70 Liernur's Method. — This plan consists in drawing the excreta from the closets of a town by creating a vacuum, by means of an air-pump worked in some central station in the town. From this central station pipes radiate in all directions through the town, follow- ing the principal streets. At varying distances along these pipes reservoirs are sunk below the pavement, which are filled directly from the house closets, and are then emptied by the continued action of the air-pump^ t By a system of stop-cocks, which can be turned on and off, any district may be cleared at pleasure. On reach- ing the central station the excreta are decanted in a fluid form in barrels, for immediate transport to the country, 496 MEDICAL POLICE. by means of hermetically-closed apparatus. The closets are very simple, consisting in a double funnel, the space between the two communicating by a pipe with the external air. No water is required. The excrement falls into a sort of hydraulic trap, capable of holding the faecal products of but one person, and compelling what is held before to fall into a larger trap of four times greater capacity. This latter discharges in the branch tube, which is connected with the main tube, and empties into the street reservoir. By a succession of short bends, repeated at regular intervals, all metal valves which are likely to get out of order are avoided, the faecal mass practically forming the required tem- porary closure from the main pipe. A separate system of sewers for rain water, street drainage, slops, and for the drainage of the soil, is necessary. The following are the objections against the adoption of this method : — a. The primary cost is great, especially as it provides for the removal of excrement alone. b. The escape of sewer gas from the sewers, and from the plug or trap of excrement. e. The not infrequent overflowing of the closets, by becoming clogged with coffee grounds, ashes, rags, etc. d. The necessity of frequently flushing the closets, thus diluting the sewage. e. The sewage may become frozen in winter, and therefore useless. /. The difficulty of disposing of the sewage during winter and summer at a remunerative price. The Influence of Drainage on Climate. The beneficial effects of drainage are sometimes as great as if the land had been transported 100 or 150 miles, southwards (Buchan). WATEK. 497 "Water. It is absolutely necessary that there should be a good supply of pure water in the neighbourhood of human habitations. Eivers are of use in the removal of sewage, when no other means are available, and for other pur- poses too numerous to mention. The banks of rivers, if not carefully attended to, may become the sources of disease, due to the deposit of decaying animal matter on them. In ancient Eome there were officers, ' Cura- tores Alvei et Eiparum/ whose duty it was to take care of the banks of the Tiber, and to regulate its channel. The channels of rivers, it should be remembered, are always liable to deterioration from physical causes in constant action. There can be no doubt that the emptying of the sewage of a town into a neighbouring stream is an unmitigated evil. The emptying of sewage into rivers was enforced by the Public Health Act, 1848, and pro- hibited by that of 1875, unless the sewage be 6 clarified/ The inhabitants on the banks of rivers subject to inundations are often attacked by intermittents. It may then become necessary to deepen the bed of the river, or to increase the velocity of its current by straightening its channel. Potable Water. — A good supply of water for drinking and for domestic purposes is absolutely essential where any number of persons are collected together. Char act eristics of a good Drinking Water. 1. It should be without taste or smell, and preferably without colour. 2. It should not contain an undue amount of solid constituents, especially when such constituents are salts of lime or magnesia. The amount of solids should not exceed eight grains per gallon, 1 grain of which should be alone dissipated by heat. In chalk water 498 MEDICAL POLICE. the solid excess should not be more than 14 grains (Parkes). 3. It should be practically free from nitrogenous organic matter, the albumenoid ammonia being less than •0056 grains per gallon. Quantity required for Individuals. — A sufficient quantity should be supplied daily to each individual. In 1852 thirty-two gallons were supplied in London daily per head, and this was increased in 1862 to fifty gallons. The amount of water required for the use of animals may be estimated at eleven to sixteen gallons per day for a horse, eight to ten for a cow, and so on for other animals. Public baths should be erected and freely supplied with water, which should, if possible, be kept constantly flowing in and out. A certain amount should also be passed into the sewers, which has been estimated at twenty-five gallons per head per day, at the least, in addition to the rainfall. The following table is given by Professor Eankine : — Gallons per Day per Head. LEAST GREATEST. AVERAGE. Used for domestic purposes .7 15 10 Washing streets, extinguishing fires, supplying fountains .3 3 3 Allowance for trade and waste .7 7 7 Total in non-manufacturing towns 17 25 20 Additional demand in manufac- turing towns .... 10 10 10 Total in manufacturing towns . 27 35 30 On the subject of water supply by local authority, see Public Health Act, 38 & 39 Vict., ss. 51 to 70. See also the Public Health (Scotland) Act, by George Munro, p. 42 et seq. Storage of Water. — The provisions to be made for storage will depend upon the consumption, calculated at so much per day for each individual of the estimated population of the district. In London, for instance, WATEE. 499 the water supplied by the New Eiver Company is taken from the New Eiver and the Lea, and a few ponds. The water is first collected in large brick tanks open to the air, the bottoms of which are covered with four or five feet of sand and coarse gravel. Through this bed of gravel the water has to percolate before it reaches the pumping station, where it is pumped to the reservoirs of the company, placed on the highest parts of the neighbourhoods, supplied by the New Eiver system. The rate of filtration should not exceed 700 gallons per square yard of filter bed in 24 hours. For the private storage of the inhabitants, slate, lead, iron, and zinc cisterns are used. The first are the best, but cisterns of zinc are most used, on account of the cheap- ness of the material. Lead is open to the objection of the poisonous nature of the soluble compounds some- times formed by the action of the water on the metal. All cisterns should be kept covered to prevent contami- nation, but free ventilation should be provided. Care must be taken that the waste does not communicate with the drains or closet-trap, but that it opens into the open air. A common practice in London is to carry the waste pipe into the closet trap. All cisterns should be inspected and cleaned periodically. The Eivers Pollution Commissioners remark in their report on the storage of water in houses, that 6 all storage of drinking water in houses is attended with the risk of pollution. Good water is spoiled, and bad water rendered worse by the intermittent system of supply. All drinking water ought to be drawn direct from the main. Under proper supervision the waste of water is less on the constant than it is on the intermittent system of supply. These and other advantages have led to the adoption of the constant system in a great majority of British towns.' The objections to the con- stant supply system are that it encourages waste and extravagance, and that no means can be taken to pro- vide against these. 500 MEDICAL POLICE. Various Sources of Water Supply. 1. Bain Water. — This ranks next in purity to dis- tilled water, but may become contaminated by passage through the air. As a supply to large towns it must not be trusted, for the following reasons : — a. Uncertainty of supply. b. The quantity falling in an inhabited country is small in proportion to the number of the inhabitants. c. Not very palatable to the taste. If used by small communities it should not be allowed to remain in lead, but in slate cisterns of con- siderable size, and should be collected as pure as possible. To find the amount of rain water that can be collected from any roof, reduce the area to square inches, and multiply by the rainfall. 2. Snow Water. — Not pleasant to the taste, and is said to cause gastric derangement. 3. Spring and Well Water. — "Water from these sources varies greatly in composition. a. Always much harder than lake or river water. b. Superficial wells apt to contain organic matter from churchyards, cesspools, etc., and also salts, sulphates, and carbonates — the latter kept in solution by excess of carbonic acid. By an improved system of sub-soil drainage, the waters from those wells may be rendered pure and whole- some. c. Deep wells contain much lime. d. Artesian wells may contain large quantities of the alkaline carbonates and sulphates of lime. 4. River Water may contain organic matter from sewage, etc. As a rule, river water is very pure. 5. Lake Water is also a pure water. 6. Marsh Water is most impure. WATER. 501 7. Peaty Water is not injurious, though unpleasant to the taste. The following is the classification of waters made in the Rivers Pollution Commission's sixth report : — Spring. "Wholesome . Deep well water. Upland surface water. Suspicious . Stored rained water. Surface water from cultivated land. Dangerous . i River water containing sewage. \ Shallow well water. Table showing the Relation between the General Character of a W ater, and the Geological Strata from which it is derived : — Alluvial Chalk Limestone and delemite Millstone, grit, and hard oolite Soft sandstone rock, loose sand and gravel, Lias clays . Granite, meta- morphic, trap rock, and clay slate forma- tions. Generally more or less impure, and exceedingly variable in quality and con- stituents. Clear, wholesome, and sparkling, gene- rally very pure, and chiefly characterised by the solid matter, consisting almost entirely of carbonate of lime. Wholesome and agreeable, but charac- terised by a larger amount of total solid matter than chalk water, and the presence of a greater quantity of the sulphates of lime and magnesia. Generally very pure, solid constituents small, and consisting chiefly of the sul- phates and carbonates of lime and mag- nesia, with a little iron. Very variable in quality — no average criterion can be given. Generally very pure, small quantities of solid constituents, mainly carbonate of soda and chloride of sodium, with a little lime and magnesia. Hard and Soft Water. — Natural waters contain varying properties of lime and other salts, and on the 502 MEDICAL POLICE. amount of these constituents depends the relative hardness or softness of water. The hardness of water is mainly due to the presence of the salts of lime and magnesia. When these are present in excessive quan- tity, such water is said to be ' hard/ and when heated, forms incrustations on the inside of vessels, also causing a great destruction of soap when the water is used for washing clothes and other purposes. Degree of Hardness. — By this term we mean that a given volume of water decomposes a certain number of C.C. of the standard soap test. Thus, ' fifteen degrees of hardness* means that fifteen C.C. of the soap solution have been used. Each C.C. = 1 degree of hardness. A rough means of judging of the relative degree of hardness of any sample of water consists in placing a small quantity in a test-glass, and adding to it a few drops of a standard solution of soap in alcohol, when a white turbidity will make its appearance, depending in degree on the hardness of the water. Some hard waters are softened by boiling, others are not. The hardness of such waters as admit of soften- ing by being boiled is due mainly to the presence of the carbonates of lime and magnesia; whilst those waters the hardness of which is but slightly, if at all, affected by boiling, contain sulphate of lime. Chalk waters are among those which are most influenced by boiling; in these the carbonate of lime is held in solution by the excess of carbonic acid present. When such a water is subjected to heat, the carbonic acid is expelled, and the carbonate of lime, no longer held in solution, is in a great measure precipitated. This hardness, due to carbonate of lime, is termed * tem- porary,' as it can be, in a great measure, thus removed. The hardness due to the sulphates of lime and mag- nesia is termed 6 permanent,' as it is not removable by boiling. In speaking of the 6 hardness of water/ it is always desirable to know to what it is due, as, in excessive cases, this would frequently determine WATER. 503 whether the water could be rendered fit for domestic purposes. In order to estimate the exact degree of hardness in any given sample of water, accurate standard solutions are needed. These are prepared as follow : — As a basis, a solution of lime is made by dissolving 0*2 gramme (3*088 gs.) of Iceland spar in dilute hydro- chloric acid, evaporating to get rid of the free acid, and finally dissolving the calcic chloride in distilled water, and diluting to one litre. A solution is then made by rubbing together in a mortar 150 parts of lead plaster (Emplast. Plumbi) with 40 parts of dry potassium carbonate. The mixture is then treated with methy- lated alcohol thrown into a filter, and washed several times with fresh portions of methylated spirit. The solution thus obtained is diluted with a mixture of one volume of distilled water and two volumes of methy- lated alcohol, until exactly 14*25 cubic centimetres (220 gs.) are required to form a permanent lather with 50 C.C. (772 grs.) of the standard calcic chloride solution. This soap solution is used for taking the degree of hardness in a water as follows : — 50 C.C. of the water are placed in an eight-ounce stoppered bottle, shaken briskly for a few seconds, and the air then sucked out (to remove carbonic acid). The standard soap solution is then run in by small quantities at a time, shaking the bottle after each addition, until a lather is formed permanent all over the surface of the water for five minutes. By noting how much soap solution has been used, and referring to a table, the degree of hardness is arrived at. Each ' degree ' represents a hardness equal to one grain of carbonate of lime per gallon in soap- destroying power. "When waters have a hardness of more than sixteen degrees, the water must be diluted before making an estimation. — For further information, see Wanklyn and Chapman's Water Analysis. 504 MEDICAL POLICE. Nature and Origin of Deposits in Boilers. When water containing a certain quantity of earthy salts is concentrated, not only is the carbonate of lime deposited in the way just described, but as the solution becomes more and more concentrated the other earthy constituents are more or less completely thrown down. Thus we find that extensive deposits occur in steam boilers in which ordinary water is used, and much inconvenience frequently arises from this source, espe- cially when this deposit assumes a compact form, from the slowness of the deposition and constitution of the water. Many schemes, both chemical and mechanical, have been proposed to obviate this inconvenience ; but the treatment must vary with the character of the water. If incrustation cannot by any means be pre- vented, a plan frequently adopted is to introduce some light powdered substance into the boiler with the water. This acts mechanically, by keeping up the free genera- tion of steam; and the water being thus kept in con- stant and violent motion, the earthy salts are precipi- tated in the form of a fine powder, which is periodically removed by ' blowing out,' as it is termed. The chemical scheme which appeared most likely to prove successful consisted in the addition of chloride of ammonium to the water in the boiler. A conversion of the carbonates of lime and magnesia into soluble chlorides was the result, while the carbonic acid passed off with the ammonia as carbonate in the steam. The great objection to the adoption of this method was, that the carbonate of ammonia, which passes off rapidly, acts on brass or copper ; and this circumstance has pre- cluded its extensive employment, except under special conditions. There is one process in use for the prevention of boiler deposits, and likewise for the softening of water for domestic purposes, which demands special notice — that known as Clark's Process. This is, however, only WATER. 505 adapted to the treatment of the chalk waters, and for these it is eminently useful. It is carried out in the following manner : — The water collected in large tanks is treated with a sufficiency of lime water to neutralise the free carbonic acid present. As the carbonate of lime present in the original water is only retained in solution by virtue of the solvent power of the excess of carbonic acid, it follows that if this be in any way neutralised, the carbonate of lime must be precipitated. The lime water acts, therefore, by neutralising the car- bonic acid, forming with it insoluble carbonate of lime, which is thus precipitated with the carbonate of lime previously dissolved in the water. By this means not only is the lime almost entirely removed, but a certain degree of organic purification takes place by the pre- cipitated lime carrying down with it a notable amount of the organic matter present. The above process is now in use on a large scale at several large paper mills/ and at other manufactories. The Kent Companies' water, notably the purest of our London supplies, obtained from deep wells in the chalk, was formerly entirely treated by Clark's process before it was sup- plied to the public. Origin of the Sulphuretted Hydrogen of Sulphurous Waters, This is generally conjectured to arise from the de- oxidising influence of decaying organic matter on the various sulphates present in the water ; the oxygen of the sulphuric acid uniting with the carbon of the organic matter to form carbonic acid, while the sulphur unites to the hydrogen, with the resulting formation of sulphuretted hydrogen. Action of Hard and Soft Waters on Lead. Natural waters are found to exercise very different 506 MEDICAL POLICE. and varying action on lead ; and as the drinking water with which we are supplied almost invariably meets with lead during its conveyance from the company to the con- sumer, either by passage through pipes of that metal or by being stored in leaden cisterns, and, moreover, as lead belongs to that class of poisons known as ' cumu- lative,' it becomes of the utmost importance that the conditions under which natural waters become charged with lead should be known. Putting aside minor dis- tinctions, there is one broad fact which may be taken in connection with this subject, viz., that hard waters have, as a rule, very little, if any, action on lead, while soft waters are almost invariably apt to dissolve more or less of that metal. The impunity with which hard waters can be stored in leaden cisterns without injurious conse- quences, depends on the fact that a coating of insoluble lead salts is formed on the surface of the metal, which protects it from further action. The salt having the most protective action is the sulphate ; and as ordinary hard waters almost invariably contain a varying quantity of earthy sulphates, the presence of these salts ensures our being able to use such waters with impunity. On the other hand, soft waters having no such protective properties, are almost sure to become more or less charged with lead if allowed to come in contact with that metal ; the dissolved oxygen in the water forming oxide of lead, which dissolves in the water, thus giving rise to contamination. Water containing nitrates or nitrites in solution are especially to be avoided, as such waters frequently exercise a powerfully solvent action on lead, and have been known to corrode that metal to such an extent as to eat holes in the cistern in which the water was stored. It is fortunate that lead is a metal which admits of easy detection when present in water, even when in minute quantities. If present to any extent, it can be immediately detected by taking a portion of the water in a tall glass jar and adding some sulphuretted hydro- WATER. 507 gen water, when, if lead be present, a brown colour will be observable, which is especially distinct if the jar containing the water be held over a piece of clean white paper. When present in minute quantities, and more especially if it be desired to make a quantitative estima- tion of the amount present, it is better to evaporate some of the water to a small bulk, and then to acidify with hydrochloric acid. On the addition of sulphuretted hydrogen water, the whole of the lead will be thrown down as the sulphide. Messrs Wanklyn and Chapman have recently intro- duced an excellent calorimetric process for the estima- tion of lead in water, based upon the intensity of the brown colour developed on the addition of sulphuretted hydrogen water. Different Forms under which Nitrogen is found in Water. Nitrogen is found in water under the following forms : — a. Ammonia. 1). As nitrates and nitrites. c. As nitrogenous organic matter. Nitrogen under one or other of the above forms is found in small quantities in all waters. Some of the chalk waters invariably contain nitrates and nitrites, probably due to fossil organic remains. The sources whence the nitrogen in water is derived vary. Eain water, especially when collected near towns, invariably contains small quantities of nitrogen in the form of ammonia, dissolved during the passage of the rain through the air. The sources of nitrogenous organic impurities are chiefly of animal origin, due to infiltration from cess- pools and churchyards. 508 MEDICAL POLICE. Estimation of Nitrates and Nitrites, WanTdyn and Chapman's Method. This is a modification of Schultze's aluminium pro- cess, and is an exceedingly accurate test. About a pint of the water to be tested is placed in a retort, and a definite quantity of strong caustic soda solution added, and the whole distilled till all the ammonia has been driven off. The contents of the retort are now left to cool, and a piece of thin sheet aluminium introduced, and allowed to remain for four or five hours. Hydro- gen is evolved from the metallic aluminium, which, being in the nascent state, unites with the nitrogen of the nitrates and nitrites present to form ammonia. After the action has ceased, the contents of the retort are again distilled, and the ammonia given off estimated by Nessler's test. The ammonia thus obtained is an index of the amount of the nitrates and nitrites present. The Nessler Test. This reagent is prepared by dissolving 50 grammes (772*0 grs.) of potassium iodide in a small quantity of distilled water, adding subsequently a cold saturated solution of corrosive sublimate until the precipitate of mercuric iodine ceases to be dissolved. 200 grammes (3088 grs.) of caustic potash in strong aqueous solution is then added to the above, and the whole made up by the addition of water to 1 litre. A little more of the corrosive sublimate is then added, the whole allowed to settle, the clear liquid being decanted and preserved in closely stoppered bottles in a dark, cool place until required for use. The addition of the last quantity of corrosive sublimate solution is requisite in order to impart the necessary sensitiveness to the test. The Nessler test is based on the fact, that when a saturated solution of iodide of mercury in iodide of potassium, rendered strongly alkaline by the addition WATER. 509 of caustic potash, is added to water impregnated with ammonia, various shades of a brown colour are pro- duced. By comparing these shades of colour, the presence and amount of ammonia present may he estimated. It is necessary that the ammonia solution be very dilute ; for, if too strong, the reagent will be either precipitated, or the delicate shades of colour, so necessary for the success of the test, destroyed by the intense dark colour produced. In testing ordinary water, it is necessary to concentrate the ammonia in the water by distillation ; but in the case of sewage, which is always rich in that substance, pure distilled water, free from ammonia, must be added to the dis- tillate till the proper degree of dilution is obtained. To estimate the quantity of ammonia present in any given sample of water, two glass cylinders, having a capacity of 1500 grains, are placed on a white surface. One is (1) filled with the solution to be tested, and the other (2) with an equal quantity of distilled water free from ammonia. Nessler's test solution, in measured quantity, is added to the first, and the shade of colour noted. A measured quantity of a dilute solution of ammonia, of known strength, is now poured into No. 2, and a measured quantity of Nessler's test added, and the shade of colour noted. Several trials are made, till the shade of colour in both cylinders is alike, when the amount of the standard ammonia used will give the quantity of this substance in the suspected water. The standard ammonia used in the estimations is made by dissolving 0*0315 gramme (0*48636 gs.) of ammonium chloride in a litre of water. Each cubic centimetre of this solution contains *0001 gramme of ammonia, or each grain measure equals *0001 I grain, IST.Hg. Estimations of the amount of free ammonia present in any specimen of water can seldom be made directly on the original sample without distillation as the pre- 510 MEDICAL POLICE. sence of the lime and magnesia salts causes a turbidity on the addition of the JSTessler test, which interferes with correct estimation. Qualitative Examination of Water. — In many cases a regulated qualitative examination of a specimen of water will afford sufficient criterion of its suitability for domestic purposes; in any case, however, where the character of the sample is doubtful, a quantitative examination should be made. The following table will afford the necessary infor- mation as to the method of conducting a general pre- liminary examination of any specimen of water : — [Table for Examination of Water. WATER. 511 £ .t3 r3 d +3 © O^.^ - ^ g r£ * .-S3 -g t^H *g .fl'g ^ § g E?.a S 3 5? g § * H — 1 t* ^ 2 -+J .2 i -> p. H .9^ !> oq o3 c3 ?^ m «h o3 PHC0r^ r c5 Ad o .2 b^.2 d d o 4 ^ O 83 r M *h if 2 8-g ^1 » _a *» w d ^ c3 o H ° ^ ^ 2 ^5 T3.g 43 ° % 2 « o a d o3 +3 o o £ d ■£ £ 0^.2 d , d Ph ! Mo ; d ' d © " o3 ^ & w »iH __i ro «*• »r-( __| m H a >-H 1 d 0 d d ^ w 3 5h tOO VI y< d a? d © PH ^ © O d d 1 *a^>l . S'g p!-^ cs p.-d d « os.i ct-m o3 i— i -p co+s o Ph > vt odd 512 MEDICAL POLICE. Interpretation of Results. Hardness. — An excessive amount is undesirable. Chlorine. — Good drinking water should contain very little, unless the presence of the chlorine be explained by the geological character of the formation from which the water is derived, or the proximity of the source of supply to the sea. Chlorine in abnormal quantity (except under the circumstances named) may indicate sewage contamination, and if associated with organic matter and free ammonia, the contamination is recent, and may be dangerous — if with nitrates and nitrites, the danger is less. Organic Matter. — This should not be present in any quantity, and, except where obviously of vegetable origin, as in the case of peaty waters, should be regarded with suspicion — more especially if associated with chlorine and free ammonia in abnormal quantity. Nitrates and Nitrites. — To be regarded with suspicion, except in the case of deep well waters and those derived from the chalk. In shallow well waters the presence of nitrates and nitrites is almost invariably to be regarded with distrust, as proving an existing contamination which may be liable to assume a dangerous character. In this case chlorides will also be found. Sulphates. — If unassociated with any special geolo- gical features which would account for the presence of an unusually large amount of sulphates, their presence in excessive quantity, taken in conjunction with chlorides, organic matter, ammonia, etc., is corrobora- tive evidence of sewage contamination. Ready-formed Ammonia,. — A water containing any recognisable amount of this substance is always to be regarded with suspicion. Corroborative evidence is obtained from the simultaneous presence of organic matter and chlorides. WATER. 513 Quantitative Examination of Potable Water. The ordinary quantitative examination of a water involves the estimation of the following points : — Total solid matter, hardness (temporary and permanent), chlorine, ready-formed ammonia, nitrogen existing in organic matter, and nitrogen in the form of nitrates and nitrites. Determination of Total Solid Matter. — For this pur- pose a measured quantity of the water is evaporated in a platinum basin to dryness, on the water bath, and the weight of the perfectly dry residue then ascertained. It is best to ascertain the exact weight of the perfectly clean platinum basin, to then introduce the water to be evaporated, and, after the evaporation, to transfer the basin and its contents to an air-bath heated to about 250° F., by which the water residue is thoroughly dried. The basin may then be withdrawn from the air- bath, rapidly cooled by being placed on a massive piece of iron, and weighed. The increase in weight over that originally necessary to counterpoise the platinum basin will give the solid matter. It is advis- able to replace the basin containing the water residue in the air-bath for a short time after the first weighing, and to subsequently re- weigh, in order to be perfectly sure of the absolute dryness of the residue. Any quantity of water may be taken for evaporation, but it is not advisable to employ too large a quantity, as the \ time occupied is considerably more, and there is more danger of error from the settlement of dust. About 2000 gs. is a convenient quantity, if the operator is in possession of an accurate balance, the above quantity being ^ of a gallon. If 3500 gs. be taken, the result is multiplied by 20, this quantity being ~ of a gallon. 1 After weighing the perfectly dry water residue, the con- tents of the platinum basin may be gently ignited, and any blackening noticed as an indication of the presence of organic matter ; the smell evolved at the same time 514 MEDICAL POLICE. will afford a rough criterion as to whether the organic matter is of animal or vegetable origin. The actual amount of the 1 loss on ignition ' may be noted, but is not of much distinctive value. Examination of Character of Water Residue. — The unignited residue is best employed for this purpose. A small quantity of distilled water is placed in the basin, and the reaction of the liquid to red litmus paper noticed, when an alkaline reaction will betray the presence of alkalies (potash or soda generally as car- bonate). A few drops of hydrochloric acid are then added, when any effervescence indicates the presence of carbonates. The liquid may then be tried for sulphates, for lime, and for magnesia in the usual way. Determination of Chlorine. — This is generally per- formed volumetrically by means of a standard solution of silver nitrate, using potassium chromate as indicator. The method is founded on the superior affinity which silver possesses for chlorine over that which it has for chromic acid, and on the distinctive colours of the compound formed in each case. In using the process, the silver nitrate solution is dropped into a measured quantity of the water, tinted a faint-yellow by the previous addition of a few drops of a solution of potas- sium chromate. As long as any chlorides are present in the water, white silver chloride is formed, but the moment the amount of soluble chlorides is exhausted, the liquid acquires a reddish tint from the formation of red silver chromate. The standard solution of silver nitrate is prepared by dissolving 4*79 grammes of the pure salt in one litre of distilled water. One cubic centimetre of this solution equals one milligramme of chlorine, or every grain measure equals *001 gr. chlorine. The water should be placed in a white porcelain basin during the examination, and the condition for WATER. 515 accuracy is that the water must be neutral, or faintly alkaline. Nitrogen in the Form of Ammonia, and as Nitro- genous Organic Matter. — For the purpose of estimating nitrogen in the above-mentioned forms, the method devised by Wanklyn, Chapman, and Smith is that most generally adopted, from its general convenience, and from its not necessitating the use of any compli- cated apparatus. The process is dependent on the use of the Messier test in the estimation of ammonia, and on the fact of nitrogenous organic matter yielding a definite quantity of its nitrogen, in the form of ammonia, on distillation with an alkaline solution of potassium permanganate. For the estimation of the free ammonia — 1. About a pint or quart of the water to be examined is placed in a stoppered glass retort, connected with a Liebig's condenser. A small quantity of a saturated solution of carbonate of soda is now added to the con- tents of the retort, and the whole carefully distilled. The distillation is continued until the whole of the ammonia present in the water has passed over in the distillate, known by the latter portions giving no coloration with Messier' s test. The distillate will con- tain the ready-formed ammonia present in the water, and the actual amount may be estimated by the aid of Messier' s test. 2. A certain proportion of a strongly alkaline solution of permanganate of potash, of known strength, is now added to the contents of the retort, and the process of distillation resumed. The distillation is stopped as soon as the last portions of the distillate cease to give the reactions of ammonia. The distillate contains all the ammonia, which may now be tested as before. 1 The quantity so obtained is a measure of the amount of nitrogenous organic matter present in the original water. The alkaline solution of potassium permanganate is ' made by dissolving 8 grammes (123*5 grains of the i 516 MEDICAL POLICE. permanganate and 200 grammes (3088 grains) of potash in a litre of water. The quantity of the solution used is about a tenth part of the water originally taken for analysis. The ammonia is estimated by Nessler in the manner already described. Frankland and Armstrong's Method. Frankland and Armstrong's process consists in sub- mitting to organic analysis, by combustion with oxide of copper in a combustion tube, the residue obtained by evaporating the water under examination to dryness. The gases — nitrogen and carbonic acid — liberated dur- ing the combustion are collected in a graduated tube. The carbonic acid is withdrawn by the aid of caustic potash, leaving the nitrogen, when its volume can be read off. Previous to evaporation, any nitrates or nitrites are destroyed by the addition of sulphurous acid to the water. The above process gives the amount of nitrogen present in the form of ammonia and organic nitrogenous matter. The amount of nitrogen present as nitrates and nitrites is estimated by treating the residue of another portion of the water with strong sulphuric acid in a graduated tube standing over mercury. On agitating the tube, the whole of the nitrogen present in the form of nitrates and nitrites is liberated as nitric oxide, the volume of which is read off and halved for the amount of nitrogen. As the evolution of hydrochloric acid gas, the result of the action of the sulphuric acid on any chloride present, would interfere with the result, all the chlorides are destroyed by the addition of sulphate of silver previous to the addition of the sulphuric acid. For a fuller account of this process, see Sutton's volumetric analysis. Diseases Due to Impure Water. Diarrhoea. — Due probably to the presence of organic FOOD. 517 matter, chiefly of animal origin. Suspended line mica scales have also been accredited with the production of this disease. Dyspepsia, or, more properly, certain gastric symp- toms to which the popular term dyspepsia is applied, are said to be caused by the use of hard water. Dysentery. — Several epidemics of this disease have been traced to the use of impure water, especially when impregnated with sewage. Ague and other malarious fevers, typhoid fever, and cholera have all, at one time or another, had their origin in the use of impure water ; and it is always advisable to examine the condition of the water at the commence- ment of a sudden outbreak of any of the above-men- tioned diseases. FOOD. The requirements of the economy that food has to meet are those which constitute the physiological pheno- mena of the life of animals — the development of heat, which the body requires for its maintenance, and also the production of nervous and muscular power. Food, therefore, contains the potential energy which, by pro- cesses acting within the body, is converted into actual energy, the sum of which we call life. The potential energy of meat food is greater than the energy it developes, because thorough oxidation of all the albu- men can never occur, for some of the constituents of the albumen always pass out incompletely oxidised in the form of urea. The potential and the actual energy of sugar are, however, practically the same ; for it is, as a rule, perfectly oxidised in the body, passing off as carbonic acid and water. Serious mistakes would, however, follow on the formation of a dietary based •on the potential and actual energy of different articles 518 MEDICAL POLICE. of food; for it is found that substances which differ but slightly in their potential energy cannot be substi- tuted the one for the other. The relative values of food of the same class are also a matter of opinion, and both vegetarians and meat-eaters claim advan- tages for their respective diets. But whichever diet be adopted, two conditions are absolutely necessaxy — that the food be in a fit state for digestion, and that the secretions which it meets with in the alimentary canal be in a healthy condition to digest it, and prepare it for its ready absorption. Another practical con- sideration enforced by all writers on diet is, that there must be as much care taken to provide variety in the articles used as food as that they should contain the proper dietetic proximate principles. The organic constituents of food have been divided into nitrogenous, fatty, and saccharine compounds, and the inorganic into water, and saline salts. It has also been found that it is impossible to substitute one of these constituents for another ; all are essential, and health can only be maintained by a due proportion of each in the diet. With regard, however, to vegetable and animal albuminates, it appears that these can be substituted for each other, and that nitrogenised vege- table products can replace animal products of the same nature. Animal food is more readily digested than farinaceous, and therefore supplies the wants of the system quicker; but, on the other hand, it has been asserted that the waste is greater in meat eaters than in vegetable feeders. The interchange between the fats and the hydro-carbonates does not appear possible, and with the admission that the subject is very obscure, I think we are not entitled to assert that the two groups of fats and hydro-carbonates are not so immediately and completely convertible as to permit us to place them together in a classification of diets (Parkes). According to the same writer, during labour the muscles appropri- ate nitrogen, and grow instead of becoming wasted by FOOD. 519 oxidation, and parting with their nitrogen, and that exhaustion does not so much depend on decay as upon the accumulation of the oxidised products of other kinds of food within their tissues. Some decay of muscles does, however, take place if labour be long continued, and the amount of nitrogen must therefore from time to time be given if the work continue. The experiments of Pettenkofer and Yoit go to show that nitrogenous substances have a direct or indirect influence on the oxidation of the other constituents of food, and that their participation is necessary for the manifestation of force. The nutrient value of food has been classed under two heads ; the nitrogenised or c flesh-forming/ and the carbonaceous or ' heat and fat producing. ' The nutritive value of food is generally written in grains of nitrogen and of carbon. The daily diet of an adult man, according to Dr Edward Smith, should contain at least 4300 grains of carbon and 200 of nitrogen, but this appears too low, Dr Letheby considering that an adult in active employment ought to have 6823 grains of carbon and 391 of nitrogen. These statements have been borne out by experiments made to ascertain the amount of carbon and nitrogen excreted under different conditions of diet and exercise. In the formation of a dietary, the following points have to be considered : — 1. Sex. — The dietaries of women should be one-tenth less than those of men. 2. Age. — A child at ten years of age will require half as much food as an adult woman, and at fourteen quite as much. Young men require almost as much food as adult men if engaged in the same employment. 3. Selection. — Variety, digestibility, relative propor- tions of proximate principles, number and dis- tribution of meals. The above will all require the careful attention of the medical officer of health, for Dr Wilson found that, in 520 MEDICAL POLICE. convict prisons, those engaged in hard labour lost weight on a diet of 255 grains of nitrogen and 5289 grains of carbon, and had from time to time to be shifted to light work to recruit, so those on light labour found a diet of 224 grains of nitrogen and 4651 of carbon sufficient to maintain health and bodily vigour. The following table is from Moleschott, adopted by Parkes : — Standard Diet for a Male European Adult of average height (5 ft. 6 in. to 5 ft. 10 in.), and amrage weight = 140 lbs. avoir. (66 kilogrammes) to 160 lbs. (72*7 kilogrammes) in moderate tvork. Water-free Substances given Daily. Ounces Avoir. Grammes. Albuminous substances Fatty substances .... Carbo-hydrate substances Salts 4-587 2-964 14-257 1-058 130 84 404 30 Total Water-free Food . 22-866 648 In estimating the nutritive value of food, the value should be calculated from an analysis of the raw materials. The following abridged table, taken from Dr Letheby's work on food may be of assistance to the student : — GRAINS PER POUND. Carbon. Nitrogen. Cheddar cheese 3344 306 Mutton 1900 189 Beef 1854 184 Fat pork 4113 106 Bullock's liver 934 204 Beer and porter 274 1 White fish 871 195 Skimmed milk 438 43 GRAINS PER POUND. Carbon. Nitrogen. Split peas 2699 248 Oatmeal 2831 136 Indian meal 3016 120 Seconds flour 2700 116 Potatoes 760 22 Baker's bread 1975 88 Turnips 273 13 New milk 599 44 FOOD. 521 From the above table the amounts of carbon and nitrogen in any given diet may be calculated. One other subject remains for consideration. What is the dietetic value of alcohol % On this most important subject no two opinions agree, but it appears certain that in very cold and in very hot climates the use of alcohol is positively injurious. The following are the physiological and dietetic values of alcohol as summed up by Dr T. L. Brunton : — 1. Alcohol, in small quantities, increases the secretion of the gastric juice, and the movements of the stomach, and thus aids digestion. Although unnecessary to health, it is useful in exhaustion and debility. 2. It increases the force and frequency of the pulse, by acting reflexly through the nerves of the stomach. 3. In large doses it impairs digestion by over irritat- ing the stomach. 4. After absorption into the blood, it lessens the oxidising power of the red blood cells. This property renders it useful in reducing temperature ; when con- stantly, or very frequently, present in the blood, it causes accumulation of fat and fatty degeneration of organs. 5. It undergoes combustion in the body, maintains or increases the body weight, and prolongs life on an insufficient diet. It is therefore entitled to be reckoned as a food. 6. If large doses be taken, part of it is excreted unchanged. 7. It dilates the blood vessels, increases the force and frequency of the heart by its action on the nervous centres, to which it is conveyed by the blood, imparts a feeling of comfort and facilitates bodily and mental labour. It does not give additional strength, but merely enables a man to draw upon his reserve energy. It may thus give assistance in a single effort, but not in prolonged exertions. 8. The same is the case with the heart, but in disease, 522 MEDICAL POLICE. alcohol frequently slows instead of quickening the pulsations of the organ, and thus economises instead of expending its reserve energy. 9. By dilating the vessels of the skin, alcohol warms the surface at the expense of the internal organs. It is thus injurious when taken during exposure to cold, but beneficial when taken after the exposure is over, as it tends to prevent congestion of internal organs. 10. The symptoms of intoxication are due to paralysis of the nervous system ; the cerebrum and cerebellum being first affected, and then the cord, and lastly the medulla oblongata. It is through paralysis of the medulla that alcohol usually causes death. 11. The apparent immunity which drunken men enjoy from the usual effects of serious accidents, is due to the paralysis of the nervous mechanism, through which a shock would be produced in a sober condition. Good and wholesome meat — beef or mutton — should present the following characters, which can be very readily observed : — On section good meat should present a marbled appearance, and be of a pale, slightly brownish, red colour, neither too pale a pink nor too dark a purple. If pink and moist, disease is indicated ; if purple and livid, it suggests that the animal most probably died with the blood in it, or had suffered from fever. The meat from healthy slaughtered animals should be firm and elastic, have little or no odour, and should dry on the surface if kept a day or two. Bad meat may easily be known by a moist and flabby appearance, accom- panied with a sickly odour, which may be more easily detected by chopping up portions of the meat and drenching it with warm water. The juice should be neither alkaline nor neutral, but slightly acid. Pork, not salted, should, in all respects, resemble other good meat, excepting the colour, which ought to be of a very pale-red tint when sound. When of a dark colour, the presence of the dangerous parasite Triclinia FOOD. 523 Spiralis must be suspected, and the meat most care- fully examined by means of a magnifying glass, as the unaided eye cannot be relied on. The sac of the cytiscerus or measle, which is often as large as a hemp seed, is easily seen, especially in the psoas muscles. Sausages are liable to partial decomposition, when they then become poisonous ; sound sausage meat may be known by its firmness, and freedom from any un- pleasant odour, and from a moist gelatinous or vesicular- appearance. Unsound Meat, etc. The Public Health Act, 1875 (38 & 39 Vict., c. 55). Sec. 116. Any Medical Officer of Health or Inspector of Nuisances may, at all reasonable times, inspect and examine any animal carcase, meat, poultry, game, flesh, fruit, vegetables, corn, bread, flour, or milk exposed for sale, or deposited in any place for the purpose of sale, or of preparation for sale, and intended for the food of man, the proof that the same was not exposed or deposited for any such purpose, or was not intended for the food of man, resting on the party charged ; and if any such animal carcase, meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, flour, or milk, appears to such medical officer or inspector to be diseased, or unsound, or unwholesome, or unfit for the food of man, he may seize and carry away the same himself, or by an assistant, in order to have the same dealt with by a justice. Sec. 117. Empowers justices to order destruction of unsound meat, etc. Sec. 118. Imposes a penalty of not more than five pounds on any one hindering officer from inspecting meat, etc. Sec. 119. Search warrant may be granted by Justice on complaint made on oath by a medical officer of health, or by an inspector of nuisances, or other officer of a local authority, to allow such officer to enter any 524 MEDICAL POLICE. building or part of a building in which such officer has reason for believing that there is kept or concealed any animal carcase, etc., unfit for food. Penalty for obstructing such officer not exceeding twenty pounds. Clothes. The blood of man remains nearly at the same tem- perature irrespective of the changes of temperature to which he may be subjected. By the use of clothes man adapts himself to all temperatures, and counteracts by their use the loss of heat by radiation, evaporation, and conduction. The heat of his body is radiated to the inner surface of his garments, and then passes through, and from them, by conduction and radiation. The heat is, therefore, by the use of clothes, kept longer near our bodies, the thinnest veil keeping the face warm by arresting the radiated heat. The textures most per- meable to air keep us warmest, air being one of the worst conductors of heat; uncompressed wadding is, there- fore, warmer than when compressed. The air which reaches our bodies has also been prepared for us by our clothes, and the differences of temperature between our bodies and the surrounding atmosphere equalised in the meshes of the cloth. Our clothes do not, therefore, keep us warm by excluding air from our bodies, for were this so, kid would be warmer than flannel. Tight-fitting clothes are not so warm as loose made ones. The heat of animals is maintained by the air in their fur, which never becomes cold except at the tips. India-rubber clothes prevent evaporation by limiting the change of air in the under garments, they therefore become in- convenient in damp warm weather, but may be worn in wet, cold, windy weather. "Wet clothes, the air in their meshes being displaced by water, keep us less warm than when dry, hence also the ease with which we take cold in wet linen or silk as compared to wool. The quicker the air is expelled the more likely are we DWELLING-HOUSES. 525 to take cold, as the body chills rapidly. Our bed clothes should be light, airy, and warm. There is a constant circulation of air from the bottom to the top of the bed, and as during sleep less animal heat is pro- duced, the appropriateness of the bed clothes becomes i even more important than our day clothes. Dwelling-Houses. In this country it is no easy matter in the neighbour- hood of towns to select the site one would wish, but it is open to every one to see that his future residence is well built, properly drained, and that every sanitary improvement is adopted to prevent disease, and ensure the health of the residents. The following suggestions may not, how r ever, be out of place : — 1. Careful drainage. 2. When houses are being built on the site of old brick-fields, careful drainage of all pits and hollows left should be enforced before such pits or hollows are filled up. 3. Places filled up with cinder rubbish containing more or less vegetable and organic matters should not be built upon for at least two years from the date of the last deposit. 4. Eoad scrapings should not be mixed with the cinder rubbish. 5. No wells should be sunk in such made-up ground. 6. All drains should be well laid. See p. 471. 7. The basements of all houses should have a good foundation of concrete, and a 6 damp-proof 1 course should be laid at such a height as to prevent the possibility of the wall being wetted by the splash- ing of rain from the ground in wet weather. Mower beds, etc., should not be raised against the walls. 8. Provision should be made for free ventilation under the floor. For this purpose iron gratings, 526 MEDICAL POLICE. let into the walls, with openings small enough to prevent the admission of mice, are better than perforated bricks. 9. The walls should be of the thickness required by the Metropolitan Euildings Act, 1855 (18 & 19 Vict., c. 122). The student had best procure this Act. 10. The walls may be built hollow, with tie bricks between each row of bricks. Damp Walls — Cause of. — There is a certain amount of water used in building, which may be called 'building water.' In old houses this has evaporated, and the pores in the walls then become filled with air ; but in new houses the walls still contain a large proportion of this ' building water,' and being colder than the sur- rounding air, condense the moisture from the air on their surface, hence the sudden appearance of dam}} on the walls. In old walls the moisture is, to a certain extent, immediately absorbed, and dampness only appears when the superficial surface of the walls is saturated by the continued application of moisture. Some walls which appear dry suddenly become damp. This is due to the evaporation of the c building water ' on the surface, or at least but for a short distance in the plaster, and the pores being only partially filled with air, soon become saturated, the air being displaced, and damp walls are the result. A fire in such a room, with the doors and windows closed, heats the portions of the walls nearest to it, causing the evaporation of the water in the walls, which water is condensed on the cold walls farthest from the fire. The more porous the walls are, the drier they will become. How shall ice find if a House be Dry ? — Procure specimens of mortar from different parts of the house. These ought not to contain more than 5 per cent, of Avateri Some builders try the walls by putting their mouths to them and sucking them ; if dry there is a peculiar sensation, like that experienced when a clean EPIDEMIC DISEASES. 527 clay pipe is put for the first time in the mouth. As a means of rapidly drying houses, light fires in all the rooms and allow of constant ventilation. Endemic Diseases. The action of endemic influences on the animal economy was held by Cullen to be a direct sedative, not merely lowering the vital power, but also inducing spasm of the extreme capillaries. If the vital energy of the system were not entirely overpowered, reaction supervened, and fever became developed. Some hold the opinion that marsh effluvia acts as a stimulant or irritant, and that the debility which it evidently occasions is consecutive on a state of exhaustion. These opinions do not, however, explain all the phenomena of these diseases. The sources of endemics are — a. Low marshy places. Due, however, to the antiseptic property of peat, ague is unknown in the bogs of Ireland. b. Ground subject to inundation, or saturated with moisture. c. Woods, jungles, etc. d. Presence of decaying animal and vegetable matter. Prevention. — Drainage, embankments, flooding the marshes with water — in fact, turning the marsh into a lake ; clearing the soil of wood, and cultivating it. Epidemic Diseases. Epidemic diseases are diseases which prevail occa- sionally with unusual severity, and at uncertain in- tervals, attacking large masses of the people, and lasting in most cases for some months, and obeying a certain law of periodicity. 528 MEDICAL POLICE. Sources. — Certain endemic influences just mentioned, and a condition of the atmosphere, of the exact nature of which we are utterly ignorant. Some epidemics are peculiar to certain seasons, especially when those seasons have been more than usually prolonged or otherwise exaggerated, excessive heat or cold, etc. Sydenham remarks 6 that all epidemics are referable to one of two classes. They are either vernal or autumnal. Even when they originate during some other period of the year, they must be referred to one of these divisions, spring or autumn, whichever they are nearest to, just as the case may be. For it happens occasionally that the atmospheric influences may so coincide with an epidemic as to forward its development, and to precipitate it, as it were, prematurely upon its victims.' This may be true of fevers, cholera, etc., but it will scarcely account for all epidemics. See Hecker's History of the Epi- demics of the Middle Ages. Any condition, whether acting primarily within the body, or as the result of physical influences acting without, that tends to lower the vital powers, is favour- able to the inception and spread of an epidemic. Thus, the excessive heat of summer, if prolonged beyond the usual limits, tends to lower the resisting power of the system, and favour the growth and spread of diseases most obnoxious to the state of exhaustion thus brought about. Famine and drought are fertile sources of epidemics, and to these two causes, to a great extent, was due the fearful mortality during the period from 1333 to 1351. Religious and other social conditions are all more or less instrumental in the spread or pre- vention of epidemics; and diseases occurring among the lower animals, and in those vegetables most used for food, also add their influence to the list of causes of epidemics. The failure of the potato crop led to the Irish famine, with its terrible results. A few of the diseases that have occurred as epidemics, and the means for their prevention, will now be given. EPIDEMIC DISEASES. 529 Cholera. — This disease has prevailed as an epidemic in England at various times, but notably during the years 1832, 1849, and 1854, when the mortality was very great. The disease seldom prevails as an epidemic during winter, though it has done so in certain Eussian towns. Origin and Cause. — Of the origin of cholera very little is known, but it has been shown by Pettenkofer and other observers that three factors — place, time, and individual — are necessary for its spread, these being usu- ally spoken of as the local, temporal, and individual dis- position. Although in its advance towards and through Europe the places attacked were ranged along the great traffic lines, still it was noticeable that, whilst Paris and Marseilles were almost depopulated, Lyons escaped. But, further than this, one part of a town suffered more than another. Munich, Berg, and Elaidhausen were examples of this. In these towns it was almost univer- sally noticed that the houses on the limestone gravel were those attacked, whilst those on the brick clay almost entirely escaped. This singular fact may be explained by the amount of ground air contained in loose, moist soils not saturated with water, and which is hourly drawn into the houses whenever they are warmer than the surrounding atmosphere. In clay soils there is but little of this ground air, and hence the comparative freedom from diseases which it affords. Of the individual conditions favourable to the reception of the poison a like ignorance prevails, for all are attacked, irrespective of age, sex, or position in life, the strong claiming no advantage over the feeble. Communicability. 1. By persons themselves in various stages of the disease. 2. Carriage of infection by healthy persons (?). 3. Soiled clothes. 530 MEDICAL POLICE. 4. Importation of choleraic discharges by "bad sewers into wells and other sources of water supply. 5. Certain constituents of the soil of a place (Petten- kofer). 6. Presence of the cholera poison in the air. 7. Introduction by food. Precautions, etc. — 1. Quarantine for twenty days at least. 2. House-to-house visitation. 3. Early treatment of the first symptoms of diar- rhoea. 4. Most careful disinfection of the stools or other dejections of cholera patients before allowing them to enter the sewers. 5. In small towns having only cesspools, the stools, etc., should be disinfected and buried deep in the earth, as far as possible from human habi- tations. 6. If the season permit, the treatment of cholera patients is best conducted in tents. 7. Careful disinfection of houses by the usual methods, and prevention of ground air into them. Small-Pox. — Small-pox belongs to the zymotic class of diseases. Prevails chiefly in winter and spring. The precautions to be taken against its spread are — 1. Careful vaccination. 2. Immediate removal by special means of convey- ance of those attacked to properly regulated hospitals or tents. This is the more important when small-pox attacks, as it generally does, those living in ill-ventilated and densely-popu- lated courts and alleys. 3. Pree ventilation and disinfection of the house by the use of chlorine, nitrous acid, and iodine vapour. Scarlet Fever and Measles will also require careful attention as to the sanitary condition of the neighbour- EPIDEMIC DISEASES. 531 hood, water supply, drainage, etc., as nothing definite is known as to the best means of prevention, beyond the precautions just mentioned. Typhus. — The result of a specific poison probably of animal origin, and having an intimate connection with overcrowding and deficient or unwholesome food, and propagated through the excretions from the skin and the lungs, one attack giving a certain immunity from another. Prevention. — Free ventilation, isolation of those attacked, and perfect cleanliness of everything used by the patient. Treat in tents or temporary wooden huts. Typhoid. — Propagated chiefly by the discharges from the bowels, and probably, as in typhus, the result of the admission of a poison of animal origin into the blood. The poison may be carried by the air, by water, and by food, as in the case of the out- breaks in Islington and in the west-end of London, where the carriage of the poison was traced to the milk used by those attacked. Prevention. — Complete isolation of the afflicted, and the most rigid attention to the proper disinfection of the stools with zinc chloride, ferrous sulphate, etc. ' Never empty any evacuation into a closet, sewer, or cesspool ; bury it several feet deep and mix it well with earth 7 (Parkes). The clothes and bedding should be well fumigated and exposed to a temperature of at least 240° F. The purity of the drinking water, and the most efficient drainage are absolutely necessary to pre- vent a future outbreak, and to arrest the existing one. Treat in tents as in the case of typhus. Relapsing Fever, largely dependent on a widespread insufficiency of food. The following Diseases are supposed to spread by Infection contained in the faeces of the Sick. Yellow fever, cholera, and typhoid fever, though as 532 MEDICAL POLICE. in the last disease, persons convalescent may carry the disease. Parkes suggests that this may be the result of ' badly-washed clothes.' It may also be asked, What are the diseases which nearly all physicians and surgeons admit would almost be best treated in the open air, in tents, etc. i Erysipelas, cholera, small-pox, typhus, and typhoid fever, yellow fever, hospital gangrene, etc., etc. In the case of scarlet fever and measles, patients should not be exposed to cold, but in no case is free ventilation contra- indicated. Influences under which Zymotic Diseases arise. The causes which, appear to influence the rise and spread of zymotic diseases may be tabulated thus : — 1. Those which belong more particularly to the locality. 2. Those which depend upon population. (1.) Those of locality. a. Locality. This can scarcely be considered in old-established countries, and is more important in countries where new communities are being formed ; for then it may be stated that the higher the situation above sea level the greater freedom from zymotic diseases. b. Drainage. c. Age, construction, and condition of houses and streets. The effect of these causes are notably seen in all old towns, Edinburgh, Dublin, London, etc. In the old town of Edinburgh, fever is almost endemic, and the same appears to be the case in Dublin. (See report of Dub. San. Assoc., 1873.) The narrow streets in the old town of Edinburgh, combined with the age and filthy condition of the houses, the density and EPIDEMIC DISEASES. 533 poverty of the population, all tend to localise fever in these parts. d. Season and climate. These have been mentioned before. (2.) Those of population. a. Density of population. The unhealthiness and increased death-rate due to this cause have been discussed elsewhere. b. Pauperism. c. Cleanliness. — This is almost absent in poor dis- tricts, dirt prevailing everywhere. cL Improper accommodation for the sick. The Public Health Act, 1875 (38 & 39 Vict., c. 55.) Infectious Diseases and Hospitals. Provisions against Infection. Sec. 120. Where any ]ocal authority are of opinion, on the certificate of their medical officer of health, or of any other legally qualified medical practitioner, that the cleansing and disinfecting of any house or part thereof, and of any articles therein likely to retain infection, would tend to prevent or check infectious disease, it shall be the duty of such authority to give notice in writing to the owner or occupier of such house or part thereof, requiring him to cleanse and disinfect such house or part thereof, and articles, within a time specified in such notice. If the person to whom notice is so given fail to comply therewith, he shall be liable to a penalty of not less than one shilling, and not exceeding ten shillings, for every day during which he continues to make default ; and the local authority shall i cause such house or part thereof, and articles, to be cleansed and disinfected, and may recover the expenses incurred from the owner or occupier in default in a summary manner. Where the owner or occupier of 1 534 MEDICAL POLICE. any such house or part thereof is, from poverty or otherwise, unable, in the opinion of the local authority, effectually to carry out the requirements of this section, such authority may, without enforcing such require- ments on such owner or occupier, with his consent, cleanse and disinfect such house or part thereof, and articles, and defray the expenses thereof. Destruction of Infected Clothing, etc., and Compensation for the same. Sec. 121. Any local authority may direct the de- struction of any bedding, clothing, or other articles which have been exposed to infection from any dan- gerous infectious disorder, and may give compensation for the same. Disinfection of Clothes, etc., free of Charge. Sec. 122. Any local authority may provide a proper place, with all necessary apparatus and attendance, for the disinfection of bedding, clothing, or other articles which have become infected, and may cause any articles brought for disinfection to be disinfected free of charge. For Providing Public Conveyance of Infected Persons. Sec. 123. Any local authority may provide and maintain a carriage or carriages suitable for the convey- ance of persons suffering under any infectious disorder, and may pay the expense of conveying therein any person so suffering to an hospital or other place of des- tination. Removal to Hospital of Infected Persons by Order of Justice. Sec. 124. Where any suitable hospital or place for the reception of the sick is provided within the district EPIDEMIC DISEASES. 535 of a local authority, or within a convenient distance of such district, any person who is suffering from any dangerous infectious disorder, and is without proper lodging or accommodation, or lodged in a room occu- pied by more than, one family, or is on board any ship or vessel, may, on a certificate signed by a legally qualified medical practitioner, and with the consent of the superintending body of such hospital or place, be removed, by order of any justice, to such hospital or place at the cost of the local authority; and any person so suffering, who is lodged in any common lodging-house, may, with the like consent, and on a like certificate, be so removed by order of the local authority. An order under this section may be addressed to such constable or officer of the local authority as the justice or local authority making the same may think expedient; and any person who wilfully disobeys or obstructs the execution of such order shall be liable to a penalty not exceeding ten pounds. Sec. 126. Any person who — 1. While suffering from any dangerous infectious disorder, wilfully exposes himself without pro- per precautions against spreading the said dis- order in any street, public place, shop, inn, or public conveyance, or enters any public con- veyance without previously notifying to the owner, conductor, or driver thereof that he is suffering; or, 2. Being in charge of any person so suffering, so exposes such sufferer ; or, 3. Gives, lends, sells, transmits, or exposes, without previous disinfection, any bedding, clothing, rags, or other things which have been exposed to infection from any such disorder, shall be liable to a penalty not exceeding five pounds ; and a person who, while suffering from any such disorder, enters any public conveyance 536 MEDICAL POLICE. without previously notifying to the owner or driver that he is so suffering, shall in addition be ordered by the court to pay such owner and driver the amount of any loss and expense they may incur in carrying into effect the provisions of this Act with respect to disinfection of the conveyance. Provided that no proceedings under this section shall be taken against persons transmitting with proper pre- cautions any bedding, clothing, rags, or other things, for the purpose of having the same disinfected. Owner or Driver to Provide for Disinfection of Public Conveyance, Sec. 127. Every owner or driver of a public conyey- ance shall immediately provide for the disinfection, of such conveyance after it has, to his knowledge, con- veyed any person suffering from a dangerous infectious disorder; and if he fail to do so he shall be liable to a penalty not exceeding five pounds ; but no such owner or driver shall be required to convey any person so suffering until he has been paid a sum sufficient to cover any loss or expense incurred by him in carrying into effect the provisions of this section. Letting Infected Rooms or Houses. Sec. 128. Any person who, knowingly, lets for hire any house, room, or part of a house in which any person has been suffering from any dangerous infec- tious disorder, without having such house, room, or part of a house, and all articles therein liable to retain infection, disinfected to the satisfaction of a legally qualified medical practitioner, as testified by a certifi- cate signed by him, shall be liable to a penalty not exceeding twenty pounds. For the purpose of this section, the keeper of an inn EPIDEMIC DISEASES. 537 shall be deemed to let for hire part of a house to any person admitted as a guest into such inn. 1 Letting Infected Houses. j Sec. 129. Any person letting for hire, or showing for the purpose of letting for hire, any house or part of \ a house, who, on being questioned by any person 1 negotiating for the hire of such house, or part of a house, as to the fact of there being, or within six < weeks previously having been therein, any person suffering from any dangerous infectious disorder, know- ingly makes a false answer to such question, shall be liable, at the discretion of the court, to a penalty not }. exceeding twenty pounds, or to imprisonment, with or without hard labour, for a period not exceeding one month. Mortuaries, etc. Local Authority to provide Mortuary, and bury dead if necessary. Sec. 141. Any local authority may, and if required by local government board shall, provide and fit up a proper place for the reception of dead bodies before interment (in this Act called a mortuary), and may make by-laws with respect to the management and charges for use of the same ; they may also provide for the decent and economical interment, at charges to be fixed by such by-laws, of any dead body which may be received into a mortuary. Removal of dead body to Mortuary by order of Justice. Recovery of Buried Fees by Relieving Officer. Sec. 142. Where the body of one who has died of any infectious disease is retained in a room in which persons live or sleep, or any dead body which is in 538 MEDICAL POLICE. such a state as to endanger the health of the inmates of the same house or room, is retained in such house or room, any justice may, on a certificate signed by a legally qualified medical practitioner, order the body to be removed, at the cost of the local authority, to any mortuary provided by such authority, and direct the same to be buried within a time to be limited in such order; and unless the friends and relations of the deceased undertake to bury the body within the time so limited, and do bury the same, it shall be the duty of the relieving officer, to bury such body at the expense of the poor-rate, but any expense so incurred may be recovered by the relieving officer in a summary manner from any person legally liable to pay the expense of such burial. Any person obstructing the execution of an order made by a justice under this section shall be liable to a penalty not exceeding five pounds. To provide a Post-mortem House. Sec. 143. Any local authority may provide and maintain a proper place (otherwise than at a workhouse or a mortuary) for the reception of dead bodies during the time required to conduct any post-mortem examina- tion ordered by a coroner or other constituted authority, and may make regulations with respect to the manage- ment of such place; and where any such place has been provided, a coroner or other constituted authority may order the removal of the body to and from such place for carrying out such post-mortem examination, such costs of removal to be paid in the same manner, and out of the same fund, as the costs and fees for post- mortem examinations when ordered by the coroner. Accommodation for the Sick. — This is provided for under section 131 of the Public Health Act, 1875, by CONTAGION. 539 . the local authority, who may build or lease a building for the purpose, or they may farm their sick in any hospital by paying for the reception of the same. Two or more local authorities may combine to provide a common hospital. Hospitals should be built if possible on dry porous soil, well drained, and on the pavilion plan now so much advocated. All the sanitary arrange- ments should be as perfect as possible, the water-closets being placed as far as practicable outside the wards. The unit of a hospital is the ward, and this should not contain more than thirty-two beds, the number fixed by Miss Nightingale as capable of being watched over by one head nurse. Each patient should be allowed at least 880 cubic feet of space, and a superficial area of 90 square feet for each bed. For infectious diseases these numbers may be increased. Contagion. — On this subject opinions have differed, and still continue to differ. For a full account of the present received opinions on this subject, the student is referred to the reports of the medical officer of the Privy Council. The earlier ideas that contagion con- sisted of inorganic solids, liquids, or even gaseous fluids in peculiar electrical states, which acted as ' ferments 1 in the blood, and which has given rise to a class of diseases named zymotic, have of late given place to the theory that contagion is due to the presence of small bodies either present in the air or floating about in a fluid, as, for instance, the vaccine lymph. 'It is characteristic,' says Dr Burdon Sanderson (Twelfth Eeport of the Medical Officer of the Privy Council), ( of many of the communicable diseases, that at the same period, in the course of their development, liquids exist in the diseased body, whether human or animal, which have the power of producing the original dis- order when brought into contact with the living sub- stance of a healthy individual. Such liquids are said to be virulent or infecting. Their occurrence in human pathology is familiar to us in small-pox and syphilis ; 540 MEDICAL POLICE. and lately we have learnt experimentally to recognise it in tuberculosis, and inf erentially in other allied diseases. Among the lower animals, the maladies of which the liquid contagium is known are much more numerous. In some, as in cattle plague and in anthrax, all the tissues and juices become virulent ; in others, the con- tagious property is found only in liquids derived from special seats of diseased processes similar to ordinary inflammation, as, e.g., in glanders, in pleuro-pneumonia, and in sheep-pox/ In 1868, M. Chauveau (Comptes Kendus) published two papers, in which he showed that when vaccine lymph was mixed with water in varying proportions, and allowed to settle for twenty- four hours, vaccine pustules were not produced when the upper portions of the fluid were used, and that the amount of successful results increased as the lower portions were used. It has also been found that vaccine lymph, examined under the microscope, con- tains certain small bodies, to which the infecting properties of the lymph are attributed ; but c it is not contended that all varieties of contagion are liquid, or dissolved or suspended in liquid, but only that the several contagia of diseases known to be inocuable must be contained in the liquids with which we can perform inoculation' (Braid wood, Brit. Med. Jour., 1875). Dr Parkes collects the several views on the nature of contagion under three heads, to which we will add three more. 1. That the particles are supposed to be of animal origin, born in, and only growing in the body ; they are, in fact, minute portions of bioplasm (Beale) or protoplasm. The meaning of this term c bioplasm ' is thus given by Beale : — 4 The term I propose to apply to the living germinal, self-propagating matter of living beings, and to restrict to this, is bioplasm (Bios, life ; and 7rAaoyza, plasma). Now that the word biology has come into common use, it seems desirable to employ the same CONTAGION. 541 root in speaking of the matter which it is the main purpose of biology to investigate. Bioplasm involves no theory as regards the nature or the origin of the matter ; it simply distinguishes it as living ' {Disease Germs ; their Nature and Origin, 1872). A 'germ' is, according to this writer, ' a particle of living matter which has been detached from already existing living matter, and this living matter came from matter of some sort which lived before it/ This doctrine, as Parkes points out, is the scientific dress for the old doctrine of ' f omites.' These particles are said to possess an independent life, are capable of moving about in the fluids, searching for f ood,- growing and dying. The failure of the transference of disease from one individual to another may be explained on this theory to the want of the proper supply of food in the second individual, or the recurrence of the same disease to the fact that all the necessary amount of nutriment has been used up during the first attack. Against this is the fact that living animals, when removed from the body, rapidly die ; is not the case with these particles, which appear to possess con- siderable vitality. 2. The particles are supposed to be of a fungoid nature, and to simply grow in the body after being introduced ab externo. In other words, that contagium is not merely in the sense of being part of a living body, as in the case of a blood cell, but is a distinct living organised being, living within a diseased body, and capable of propagating itself. This doctrine has been ably supported by Professor Hallier, who contends that the contagium particles of cholera, diarrhoea, small-pox, syphilis, etc., are of a fungoid nature. Of this theory Dr Parkes remarks : — ' It is clearly a view which would explain many phenomena of the contagious diseases, and has been supported by the experimental evidence of Hallier, and many others who have believed either that they have invariably identified special fungi from 542 MEDICAL POLICE. particles of contagia. At the present time, however, the evidence of true and recognisable and special fungi "being thus discovered and grown, and forming the efficient causes, is very much doubted by the best observers.' 3. The particles of contagia are thought to be like c schizomycetes,' i.e., of that class of organisms which, according to Nageli, are not fungi, but partake some- what of the character of bacteria, with which they are probably identical. These bodies have been called bacteria, vibrios, monads, microzymes zooglcea. They have been shown by Klebs and ^Recklinghausen to play an important part in the production of septicaemia, and, according to Parkes, * they have been proved to cause disease of the intestinal mucous membrane, the uterus, the kidneys, and the heart.' Dr Burdon Sanderson states that, under certain favourable conditions, ( a single bacterium will produce 16*777,220 individuals every twenty-four hours.' 4. The theory of Dr A. E. Sanson, best expressed in his own words : — ' The poisons of spreading diseases are extremely minute living organisms, having the cha- racteristic endowments of vegetable growths, analogous to the minute particles of vegetable protoplasm, whose function it is to disintegrate and convert complex organic products, owing their specific properties in the special diseases not to any botanical peculiarities, but to the characters implanted in them by the soil in which they first sprang from innocuous plants, and from which they are transmitted ; this soil (except in the case of their earliest origin) being the fluids of the animal bodies ' (The Antiseptic System). 5. The ' graft theory ' of Dr James Eoss, based on Darwin's theory of pangenesis, and applied to explain the phenomena of zymotic diseases. ' Heterologous growth' or modified portions of the individual from whom they have become detached, and which produced disease when ' grafted ' into another person. CONTAGION. 543 6. The purely physical theory' of Dr W. B. Eichardson, that certain substances exert their deleteri- ous properties, by setting at liberty the oxygen of the blood in undue quantities, the organic substances during the process becoming themselves decomposed. These organic poisons, it is also stated, are capable of forming salts with acids. It is impossible to go further here into this important subject, but the student is particularly requested to read the papers published in the British Medical Journal during 1875, 1876, 1877, on the 'Life History of Contagium,' by Dr Braid wood and Francis Vacher. How is Contagium Communicated? — Both directly and indirectly — directly as in vaccination, gonorrhoea, syphilis, etc. ; and indirectly when there is some inter- vening media, as water, air, food, etc. The following experiment was performed by Kiichenmeister : — A sheep was made to breathe for an hour air passed through a shirt worn for some hours by a small-pox patient. Five days afterwards smallpox commenced in the sheep, and on the eighth day a well-marked eruption was developed. The outbreaks of typhoid in Islington and in Marylebone were clearly traced to the milk used by those attacked. On what Conditions does the Life or Activity of Contagia Depend ? — On this subject very little is posi- tively known. Of the effect of cold, Dr Braidwoocl states that the exposure of vaccine lymph for an hour- and-a-quarter to a temperature nearly a hundred degrees below that at which mercury solidifies, not only does not destroy the activity of vaccine lymph, but does not impair or affect it at all, that is, so far as regards its specific properties. Heat also, according to the experiments of the same writer, has, contrary to the i generally-received opinion that 140° F. destroyed the potency of vaccine, no effect on vaccine, unless the temperature be raised to 149^° F. Disinfectants and Deodorants. — These terms are 544 MEDICAL POLICE. often used indiscriminately, but the latter simply act by disguising trie smell, whilst there is good reason to be- lieve that the former actually destroy the disease germs. Eau de Cologne is an example of the class deodorants ; Condy's Fluid of the class disinfectants. The following remarks are an epitome of the article on disinfectants by Dr Baxter, in the reports of the Medical Officer of the Privy Council, 1875. The term disinfectant is still employed to designate agents possessing one or more of the following properties : — 1. That of checking or preventing certain chemical changes due to the operation of azotised ferments, and seemingly independent of the presence of living organisms. The word ' catalysis' is used to specify, without in any way elucidating, the nature of such changes. Examples of them are furnished by the action of emulsion upon amygdalin, or diastase on starch, etc. 2. That of preventing or stopping decompositions, which are casually connected with the presence of organisms. Looked at from the biological rather than the chemical point of view, such changes naturally fall under at least two heads, viz., fermentations, occurring in acid media, and attended by the germination and multiplication of torula forms ; and putrefactions occur- ring in neutral or alkaline media, and associated with the presence and vital activity of schizonycetous organisms. 3. That of destroying the injurious products of any of the above processes, or of rendering them innocuous to man and the higher animals. 4. That of destroying the contagia of communicable diseases, or of depriving such contagia of their specific infective power. Dr Parkes gives the following as the best definition of the term ' disinfectants.' 'Those substances which can prevent infectious diseases from spreading, by destroying their specific poisons/ and these must be carefully distinguished from ' those agents which DISINFECTANTS. 545 merely arrest the progress or absorb the offensive pro- ducts of organic decomposition.' Dr Baxter defines a disinfectant' to be 'any agent capable of so modifying the contagium of a communicable disease, during its transit from a sick to a healthy individual, as to deprive it of its specific power of infecting the latter.' Reasons for the discordance of opinion on the meaning of the term 6 disinfectant ' : — 1. Ignorance of the nature of contagion. 2. Ignorance of the power of any agent in destroying the specific virus, due to the difficulty in carrying out the necessary precautions, and watching results. 3. Preconceived notions of individuals as to the pathological nature of contagium. Germ theory, mole- cular change in albuminoid principles, etc., etc., Dr Baxter, from the experiments performed by him, has arrived at the following conclusions : — 1. That carbonic acid, sulphur dioxide, potassic per- manganate, and chlorine, are all of them endowed with true disinfectant properties, though in various degrees. 2. It is essential to bear in mind that antiseptic is not synonymous with disinfectant power, though as regards the four agents enumerated above, the one is, in a certain limited sense, commensurate with the other. 3. The value of chlorine and potassic permanganate appears to depend more on the nature of the medium through which the particles of infective matter are distributed, than on the specific characters of the par- ticles themselves. 4. When either of these agents is used to disinfect a virulent liquid containing much organic matter, or any compounds capable of uniting with chlorine, or of de- composing the permanganate, there is no security for the effectual fulfilment of disinfection, short of the pre- sence of free chlorine or undecomposed permanganate in the liquid after all chemical action has had time to subside. 2 M 546 MEDICAL POLICE. 5. A virulent liquid cannot be regarded as certainly and completely disinfected by sulphur dioxide unless it has been rendered permanently and strongly acid. The greater solubility of this agent renders it preferable, cceteris paribus, to chlorine and carbolic acid for the disinfection of liquid media. 6. No virulent liquid can be considered disinfected by carbolic acid unless it contain at least two per cent, by weight of the pure acid. 7. When disinfectants are mixed with a liquid, it is important to be sure that they are thoroughly incorpo- rated with it, that no solid matters capable of shielding contagium from immediate contact with its destroyer be overlooked. 8. Aerial disinfection, as commonly practised in the sick-room, is either useless or positively objectionable, owing to the false sense of security it is calculated to produce. To make the air of a room smell strongly of carbolic acid, by scattering carbolic acid powder about the floor, or of chlorine, by placing a tray of chloride of lime in a corner, is, so far as the destruction of specific contagia is concerned, an utterly futile proceeding. 9. When aerial disinfection is used, chlorine and sulphur dioxide are, both of them, suitable agents, the latter being the more effectual of the two. The place should be kept saturated by the gas for at least an hour, longer if possible. 10. It is probable that all contagia disappear sooner or later under the influence of air and moisture, and that the absence of these influences may act as a pre- servative. 11. Dry heat, when it can be applied, is probably the most efficient of all disinfectants, care being taken that a sufficiently high temperature be maintained, that every portion of the article be subjected to the same temperature, and that the exposure to heat be prolonged for some time. A .temperature of about 255° F. can be borne, without scorching, by most articles of dress. CEMETERIES. 547 To these may be added the following, from the Memorandum on Disinfection, issued by the Medical Officer to the Privy Council, 1866 : — c It is to cleanli- ness, ventilation, and drainage, and the use of perfectly pure drinking water, that populations ought mainly to look for safety against nuisance and infection. Artifi- cial disinfectants cannot properly supply the place of these essentials ; for, except in a small and peculiar class of cases, they are of temporary and imperfect use- fulness/ Schools, Churches, and Theatres. In schools, churches, and theatres, a system of thorough ventilation is absolutely necessary ; and in the case of theatres, care should be taken that the means of egress in case of fire is easy of access. A proposal for ventilating the school-rooms -of Boston has been presented to the Massachusetts State Board of Health by Mr Martin, architect, by means of a ventilating shaft — the impure air being removed from the room through openings under the scholars — fresh air, properly warmed, being admitted from the roof. Mr Martin refers to the injurious effects of bad venti- lation not so much to the carbonic acid present in the air, as to ' the watery vapour and the animal matter thrown off both by lungs and skin, which seems to putrefy almost immediately after being thrown into the air.' The principles of ventilation have been dis- cussed in another section. The disposal of the dead is a matter of considerable importance to the well-being of a community. The following methods have been adopted : — Cemeteries. 1. Embalming. 3. Sea -burial. 2.. Cremation. 4. Land-burial. 548 MEDICAL POLICE. Cremation, in a sanitary point of view, is by far the best way of disposing of the dead, but public prejudice is against the proceeding. Sir Henry Thompson lately drew attention to this subject in an article on * Crema- tion ' in the Contemporary Revieiv ; but his advocacy was marred by his commercial views as to the value of the dust for agricultural purposes, at once disgusting and repulsive to most people. Sea-burial can only be adopted in towns on the coast, as the expense would be too great when the body has to be carried any distance. Embalming is never likely to be adopted by modern nations. Land-burial, which, in a sanitary point of view, is the worst of all forms of burial, will most probably last thq longest of any, till the public mind by degrees becomes tutored to an enlightened appreciation of the sanitary benefits of cremation. Burial in the ground is open to the following objec- tions : — a. That the air over churchyards and cemeteries is charged with carbonic acid, ammonia, and an offensive putrid vapour. From the churchyards of London it has been stated that 2J millions of cubic feet of car- bonic acid gas were given off yearly by 52,000 bodies buried in the yards. b. That disturbance of these grounds gives rise to disease. c. That wells and other sources of water supply are contaminated by impurities percolating through the soil. The following remedies have been suggested : — a. The removal of burying-grounds to some distance beyond the town. b. Burying the body as deeply as possible, and only one body in each grave. This rule is broken daily in the cemeteries round London : four or five bodies in the same grave is not unusual. c. The use of plants of quick growth and dense QUARANTINE ESTABLISHMENTS. 549 foliage, which purify the air by absorbing the organic substances and the carbonic acid. d. Careful selection of the soil. Bodies are found to decay more rapidly in sand and gravel than in clay. Quarantine Establishments. 1 These establishments were first appointed by the Venetians, the regulations being made about the year 1484. The term is derived from the Italian quaranta, forty ; forty days or six weeks being the time supposed to be required by those on board a ship sailing from an infected port to purify themselves and their baggage. The first regulations were instituted against the im- portation of the plague, which was generally supposed to have been introduced into Western Europe from the East. Most other countries have adopted more or less entirely the Venetian practice of detaining travellers from entering their country unless they can show a clean bill of health. The existing quarantine regula- tions are embodied in the 6 Geo. IV, c. 78, and the different Orders of the Local Government Eoard issued under its authority. All Orders of Board with regard to quarantine are published in the Gazette; and this publication is deemed sufficient notice to all concerned, and no excuse of ignorance is admitted for any infringe- ment of the regulations. All vessels are furnished with an abstract of the quarantine regulations, of which the following is an epitome, dated July, 1873 : — Definition. Art. 1. In this Order — The term 1 Ship ? includes vessel or boat. The term ' Officer of Customs 1 includes any person having authority from the Commissioners of Customs. 1 See Beckman's * History of Inventions,' vol. ii., art. Quarantine. 550 MEDICAL POLICE. The term 6 Master 9 includes the officer or person for the time "being in charge or command of a ship. The term c Cholera ' includes Choleraic Diarrhoea. The term e Sanitary Authority 1 has the same mean- ing as in 6 The Public Health Act, 1872/ The term ' Clothing and Eedding 9 includes all cloth- ing and bedding in actual use, and worn or used by the person attacked, at the time of or during the attack of cholera. For the purposes of this Order, every ship shall be deemed infected with cholera, in which there is or has been, during the voyage or during the stay of such ship in any foreign part in the course of such voyage, any case of cholera. 1. Regulations as to Customs Inspections. Art. 2. Custom House may detain ship on suspicion, at a certain place appointed. Art. 3. No one must leave ship so detained. Art. 4. Notice must be at once sent to 'Port Sanitary Authority ' or ' Sanitary Authority of District/ in which the ship is detained. 5. Detention shall cease as soon as visited by Sanitary Authority, if found free of disease; if not, must be removed to place appointed by Sanitary Authority : Provided, that if the examination be not commenced within twelve hours after notice given as afore- said, the ship shall, on the expiration of the said twelve hours, be released from detention. 2. Regulations as to Sanitary Authorities. Art. 1. Sanitary Authority, with the approval of Chief Officer of Customs, to fix place where vessel shall be detained. Art. 2. Officer appointed by Sanitary Authority shall visit and examine ship, and Master must permit same. Art. 3. Medical officer of Sanitary Authority, or QUARANTINE ESTABLISHMENTS. 551 other qualified medical practitioner appointed by Sanitary Authority, to visit ship and report. Art. 9. Master of ship must moor or anchor ship during the pleasure of Sanitary Authority, and at the place appointed by such authority. Art. 10. No person must leave ship till after ex- amination and permission. Art. 11. On report of Medical Officer or Medical Practitioner, persons may land on conditions hereinafter mentioned. Art. 1 2. Those suffering from cholera may be removed to hospital, if capable of being removed, and there detained till certified by Medical Officer or Medical Practitioner. If they cannot be removed they must remain, subject to certificate of Medical Officer, as if in hospital. Art. 13. Measures to be taken to prevent spread of disease, and Master must assist in the same. Art. 14. Any one suffering from any diarrhceal or other illness may be detained in ship or sent to hospital for any period not exceeding two days, until it is ascer- tained whether the illness is or is not cholera, If then suffering from cholera, to be detained as aforesaid. Art. 1 5. Any death on board, body must be properly weighted and committed to the deep. Art. 16. Master must disinfect clothing, etc., under the superintendence of Sanitary Authority. Art. 17. The Master must cause ship to be disinfected, and if necessary destroy articles infected, by order of Sanitary Authority or Medical Officer. The following are the regulations made by the Local Government Board, in accordance with the require- ments of the Canal Boats Act, 1877 (40 and 41 Vict., c. 60). Por fixing the number, age, and sex of the persons who may be allowed to dwell in a canal boat, having 552 MEDICAL POLICE. regard to the cubic space, ventilation, provision for the separation of the sexes, general healthiness, and convenience of accommodation of the boat. 8. For the purpose of fixing the number, age, and sex of the persons who may be allowed to dwell in a canal boat, which conforms to the conditions of regis- tration provided by these regulations, and which shall, in pursuance of the statutory provision in that behalf, have been registered as a dwelling, the following rules shall apply : — a. Subject to the conditions hereinafter prescribed with respect to the separation of the sexes, the number of persons who may be allowed to dwell in the boat shall be such that in the cabin or cabins of the boat there shall be not less than 60 cubic feet of free air space for each person above the age of twelve years, and not less than 40 cubic feet of free air space for each child under the age of 12 years : Provided that in the case of a boat built prior to the thirtieth day of June, one thousand eight hundred and seventy-eight, the free air space for each child under the age of 12 years shall be deemed sufficient if it is not less than 30 cubic feet. Provided also, that in the case of a boat regis- tered as a'fly' boat, and worked by shifts, by four persons above the age of 1 2 years, there shall be not less than 180 cubic feet of free air space in any cabin occupied as a sleeping place by any two of such persons at one and the same time. b. A cabin occupied as a sleeping place by a husband and wife shall not at any time, while in such occu- pation, be occupied as a sleeping place by any other person of the female sex above the age of 12 years, or by any other person of the male sex above the age of 14 years : LOCAL GOVERNMENT BOARD. 553 Provided that in the case of a boat built prior to the thirtieth day of June, one thousand eight hundred and seventy-eight, a cabin, occupied as a sleeping place by a husband and wife, may be occupied by one other person of the male sex above the age of 14 years, subject to the follow- ing conditions : — i. That the cabin be not occupied as a sleep- ing place by any other person than those above mentioned \ ii. That the part of the cabin which may be used as a sleeping place by the husband and wife shall, at all times while in actual use, be effectually separated from the part used as a sleeping place by the other occupant of the cabin, by means of a sliding or otherwise movable screen or partition of wood or other solid material, so constructed or placed as to provide for efficient ventilation. c. A cabin occupied as a sleeping place by a person of the male sex above the age of 14 years shall not, at any time, be occupied as a sleeping place by a person of the female sex above the age of 12 years, unless she be the wife of the male occupant, or of one of the male occupants in any case within the proviso to rule Local Government Board. The Local Government Board was constituted in 1871, and superseded the Poor Law Board. It is the central authority, and is the Court of Appeal from all local authorities, and can be addressed by memorials from all parts of the country. The Board takes charge of registration, and of all matters that appertain to the public health, such as drainage, the prevention and arrest of epidemics, the improvement of towns, etc. It 554 MEDICAL POLICE. can take the initiation in sanitation, and can appoint medical officers to visit and report on the condition of any place if necessary, and also controls the salaries of medical officers of health when any part of the salary is paid by the Crown. Most of the medical officers of health are, however, paid solely by the local autho- rities, who have then the power of controlling the salary, engagement, and dismissal of the medical officer. Local Authorities. — For sanitary purposes, the country is divided into urban and rural sanitary autho- rities. The Town Council for the one, and the Union for the other, are the local authorities of the respec- tive districts. According to the Public Health (Scot- land) Act (30 and 31 Viet., cap. 101), the following bodies shall respectively be the Local Authority to execute this Act : — In places within the jurisdiction of any Town Council, and not subject to the jurisdiction of Police Commis- sioners or Trustees, as after mentioned — the Town Council. In places within the jurisdiction of Police Commis- sioners under any General or Local Act — the Police Commissioners. In any parish or part thereof, over which the jurisdic- tion of a Town Council, or of Police Commissioners, or trustees exercising the functions of Police Commissioners does not extend — the Parochial Board of such parish. Medical Officers of Health. — These are appointed by Local Authority for a term of years. They are not prevented from private practice, unless such be agreed upon at date of appointment. Any duly qualified medical practitioner may be appointed. Duties of a Medical Officer of Health. The following shall be the duties of a medical officer of health in respect of the sanitary district for which he is appointed ; or if he shall be appointed for more LOCAL GOVERNMENT BOARD. 555 than one district, or for a part of a district, then in respect of each of such districts, or of such part : — 1. He shall inform himself, as far as practicable, respecting all influences affecting, or threatening to affect, injuriously the public health within the district. 2. He shall inquire into and ascertain, by such means as are at his disposal, the causes, origin, and distribution of diseases within the district, and ascertain to what extent the same have depended on conditions capable of removal or mitigation. 3. He shall, by inspection of the district, both syste- matically at certain periods, and at intervals as occasion may require, keep himself informed of the conditions injurious to health existing therein. 4. He shall be prepared to advise the Sanitary Authority on all matters affecting the health of the district, and on all sanitary points in- volved in the action of the Sanitary Authority or Authorities; and, in cases requiring it, he shall certify, for the guidance of the Sanitary Authority, or of the Justices, as to any matter in respect of which the certificate of a medical officer of health or a medical practitioner is required as the basis or in aid of sanitary action. 5. He shall advise the Sanitary Authority on any question relating to health involved in the framing and subsequent working of such by- laws and regulations as they may have power to make. 6. On receiving information of the outbreak of any contagious, infectious, or epidemic disease of a dangerous character within the district, he shall visit the spot, without delay, and inquire into the causes and circumstances of such outbreak, and advise the persons competent to act as to the measures which may appear to him to be 556 MEDICAL POLICE. required to prevent the extension of the disease, and, so far as he may be lawfully authorised, assist in the execution of the same. 7. On receiving information from the inspector of nuisances that his intervention is required in consequence of the existence of any nuisance injurious to health, or of any overcrowding in a house, he shall, as early as practicable, take such steps authorised by the statutes in that behalf as the circumstances of the case may justify and require. 8. In any case in which it may appear to him to be necessary or advisable, or in which he shall be so directed by the Sanitary Authority, he shall himself inspect and examine any animal, carcase, meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, or flour, exposed for sale, or deposited for the purpose of sale, or preparation for sale, and intended for the food of man, which is deemed to be diseased, or unsound, or unwholesome, or unfit for the food of man, and if he find that such animal or article is diseased, or unsound, or unwholesome, or unfit for the food of man, he shall give such directions as may be necessary for causing the same to be seized, taken and carried away, in order to be dealt with by a justice according to the provisions of the statutes applicable to the case. This regulation is confirmed by the Public Health Act, 38 & 39 Vict., c. 55, 1875. See also Public Health (Scotland) Act, 1867, Public Health (Ireland) Act, 1874, sec. 57. 9. He shall perform all the duties imposed upon him by any by-laws and regulations of the Sanitary Authority, duly confirmed, in respect of any matter affecting the public health, and touching which they are authorised to frame by-laws and regulations. LOCAL GOVERNMENT BOAED. 557 10. He shall inquire into any offensive process of trade carried on within the district, and report on the appropriate means for the prevention of any nuisance or injury to health therefrom. 11. He shall attend at the office of the Sanitary Authority, or at some other appointed place, at such stated times as they may direct. 12. He shall, from time to time, report in writing, to the Sanitary Authority his proceedings, and the measures which may require to be adopted for the improvement or protection of the public health in the district. He shall in like manner report with respect to the sickness and mortality within the district, so far as he has been enabled to ascertain the same. 13. He shall keep a book or books, to be provided by the Sanitary Authority, in which he shall make an entry of his visits, and notes of his observations and instructions thereon, and also the date and result of the action taken thereon, and of any action taken on previous reports, and shall produce such book or books, whenever required, to the Sanitary Authority. 14. He shall also prepare an annual report, to be made at the end of December in each year, comprising tabular statements of the sickness and mortality within the district, classified according to diseases, ages, and localities, and a summary of the action taken during the year for the preventing the spread of disease. The report shall also contain an account of the proceedings in which he has taken part, or advised under the Sanitary Acts, so far as such proceedings relate to conditions, dangerous or injurious to health, and also an account of the supervision exercised by him, or on his advice, for sanitary purposes, over places and houses that the Sanitary Authority has power to regulate, 558 MEDICAL POLICE. with the nature and results of any proceedings which may have been so required, and taken in respect of the same during the year. It shall also record the action taken by him, or on his advice, during the year, in regard to offensive trades, bakehouses, and workshops. 15. He shall give immediate information to the Local Government Eoard of any outbreak of dangerous epidemic disease within the district, and shall transmit to the Board, on forms to be provided by them, a quarterly return of the sickness and deaths within the district, and also a copy of each annual, and of any special, report. 16. In matters not specifically provided for in this order, he shall observe and execute the instruc- tions of the Local Government Eoard on the duties of Medical Officers of Health, and all the lawful orders and directions of the Sanitary Authority applicable to his office. 17. Whenever the Diseases Prevention Act of 1855 is in force within the district, he shall observe the directions and regulations issued under that Act by the Local Government Board, so far as the same relate to, or concern, his office. Inspector of Nuisances. — Any intelligent artisan may hold the appointment. He is seldom required to take the initiative in sanitation, but by virtue of his office can do so when cleaning is indicated. Duties of Inspector of Nuisances, The following shall be the duties of the inspector of nuisances as laid down by an order of the Local Government Board, November 11, 1872, in respect of the district for which he is appointed, or if he shall be appointed for more than one district, then in respect of each of such districts — LOCAL GOVERNMENT BOARD. 559 1. He shall perform, either under the special direc- tions of the Sanitary Authority or (so far as authorised by the Sanitary Authority) under the directions of the Medical Officer of Health, or in cases where no such directions are required, without such directions, all the duties specially imposed upon an inspector of nuisances by the Sanitary Acts, or by the orders of the Local Government Board. 2. He shall attend all meetings of the Sanitary Authority when so required. 3. He shall, by inspection of the district, both systematically at certain periods, and at inter- vals as occasion may require, keep himself informed in respect of the nuisances existing therein that require abatement under the Sani- tary Acts. 4. On receiving notice of the existence of any nuisance within the district, or of the breach of any by-laws or regulations made by the Sanitary Authority for the suppression of nuisances, he shall, as early as practicable, visit the spot, and inquire into such alleged nuisance or breach of by-laws or regulations. 5. He shall report to the Sanitary Authority any noxious or offensive business, trades, or manu- factories established within the district, and the breach or non-observance of any by-laws or regulations made in respect of the same. 6. He shall report to the Sanitary Authority any damage done to any works of water supply, or other works belonging to them, and also any case of wilful or negligent waste of water sup- plied by them, or any fouling by gas, filth or otherwise, of water used for domestic purposes. 7. He shall, from time to time, and forthwith upon complaint, visit and inspect the shops and places kept or used for the sale of butchers' meat, 560 MEDICAL POLICE. poultry, fish, fruit, vegetables, corn, bread, or flour, or as a slaughter-house, and examine any animal, carcase, meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, or flour, which may be therein, and in case any such article appear to him to be intended for the food of man, and to be unfit for such food, he shall cause the same to be seized ; and take such other proceedings as may be necessary in order to have the same dealt with by a justice : Provided that in any case of doubt arising under this clause, he shall report the matter to the Medical Officer of Health, with the view of obtaining his advice thereon. 8. He shall, when and as directed by the Sanitary Authority, procure and submit samples of food or drink, and drugs suspected to be adulterated, to be analysed by the analyst appointed under the Adulteration of Food Act, 1872 ; and upon receiving a certificate stating that the articles of food or drink, or drugs, are adulterated, cause a complaint to be made, and take the other pro- ceedings presented by that Act. 9. He shall give immediate notice to the Medical Officer of Health of the occurrence within his district of any contagious, infectious, or epidemic disease of a dangerous character ; and whenever it appears to him that the intervention of such officer is necessary in consequence of the exist- ence of any nuisance injurious to health, or of any overcrowding in a house, he shall forthwith inform the medical officer thereof. 10. He shall, subject in all respects to the directions of the Sanitary Authority, attend to the instruc- tions of the Medical Officer of Health with respect to any measures which can be lawfully taken by him under the Sanitary Acts for preventing the spread of any contagious, in- LOCAL GOVERNMENT BOAKD. 561 fectious, or epidemic disease of a dangerous character. 11. He shall enter, from day to day, in a book to be provided by the Sanitary Authority, particulars of his inspections, and the action taken by him in the execution of his duties. He shall also keep a book, or books, to be provided by the Sanitary Authority, so arranged as to form, as far as possible, a continuous record of the sani- tary condition of each of the premises in respect of which any action has been taken under the Sanitary Acts, and shall keep any other syste- matic records that the Sanitary Authority may require. 12. He shall, at all reasonable times, when applied to by the Medical Officer of Health, produce to him his books, or any of them, and render to him such information as he may be able "to furnish with respect to any matter to which the duties of inspector of nuisances relate. 13. He shall, if directed by the Sanitary Authority to do so, superintend and see to the due execu- tion of all works which may be undertaken under their direction for the suppression or removal of nuisances within the district. 1 4. In matters not specifically provided for in this order, he shall observe and execute all the lawful orders and directions of the Sanitary Authority, and the orders of the Local Govern- ment Board which may be hereafter issued, applicable to his office. 2 N INDEX. ABC sewage process - 494 Abdominal cavity, ex- amination of - 44 Abortion - - - 128 causes of- - 130 Acids, poisoning by - 211 Aconite - - - 342 Acts, Alkali - - - 410 ,, Canal Boats - - 551 ,, Contagious Diseases 378 „ Factory- - - 431 ,, Public Health 482, 533 Adipocere 36 Age, determination of 19, 40 effect of, on births - 358 ,, ,, deaths- 358 ,, ,, marriages 358 ,, mean, at death - 403 effect of, on putre- faction - - 32 ,, effect of, on sex - 358 Agnate, meaning of term 195 Air, composition of - 407 ,, effect on putrefac- tion 33 examination of - 412 impurities of - - 408 „ in soil - - - 366 ,, purification - - 410 ,, Pettenkofer's method 415 ,, Smith's - - - 414' „ vitiation by respira- tion - - - 419 vitiation by fires, etc. - - - 420 Albumenoid ammonia process for water - 508 PAGE Alcohol, poisoning by - 313 ,, dietetic value of 521 Alkalies, poisoning by - 226 Alkaloids, detection of - 289 Almonds, oil of bitter - 334 Ammonia, poisoning by 227 ,, estimation of, in water - 515 Ammonio - chloride of mercury - - - 263 Aneroid barometer - 456 Aniline, poisoning by - 323 Animal irritants - - 285 Antimony, poisoning by 255 detection of - 258 chloride of - 229 Apncea, death from - 24 Apoplexy ,, - - 25 Apoplexy and narcotic poisoning - - - 302 Arithmetical mean - 395 ,, probable error 395 Arsenic, poisoning by - 238 Arsenical vapour - - 251 Arsenite of copper - - 251 ,, potash- - 251 Arsenuretted hydrogen - 254 Arum maculatum - 283 Asphyxia, death by - 24 Assault 58 ,, pretended - - 92 Assurance, life - - 405 Atelectasis pulmonum - 139 Ballottement - - 121 Barnes' test for preg- nancy - - - 121 INDEX. 563 PAGE Barometer - - - 451 aneroid- - 456 cistern - - 453 ,, siphon - - 453 ,, correction for capacity - 453 ,, ,, capillarity - 453 ,, ,, height - 455 ,, temperature 454 Battery ... 58 Belladonna, poisoning by 305 Birth, definition of - 159 Bismuth, poisoning by - 277 Blood-stains 72 „ on cloth - 73 detection of 74 on steel - 73 Bloxam's test for arsenic 249 Body, cooling of - 22 Bogs, air of - - - 527 Boiler deposits - - 504 Brain, concussion of - 62 ,, putrefaction of - 38 Brucia, tests for - - 294 Bruises - - 81 Burns ... 79 Burning, suicidal or homicidal 81 Button-makers, diseases of - - - - 375 Bryony, poisoning by - 284 Cadaveric rigidity - - 29 Calabar bean, poisoning by - - - - 346 Calomel, poisoning by - 262 Camphor - - - 309 Canal boats, regulation of - - - - 551 Cantharides - - - 285 Capacity of room, how measured - - - 421 Capillary ecchymoses - 85 Carbolic acid, poisoning by - 222 Carbonic acid, poisoning by - - - 352 PAGE Carbonic oxide - - 354 Casella's air meter - - 424 Castor-oil, poisoning by 283 Caustic potash, effects on blood 76 Caustic salts - - - 229 Cemeteries - - - 547 Certificates, medical - 2 Certificates of lunacy - 187 Chapman, water tests - 508 Chastity, offences against 104 Cheese, poisoning by - 287 Cherry-laurel - - 336 Chloral-hydrate - - 321 Chloroform, poisoning by 319 Cholera - - - 529 Chronium, poisoning by 278 Churches, ventilation of 547 Cinnabar, poisoning by - 263 Civilisation, effect of - 384 Civil rights of lunatics - 1€4 Clark's soap test for water - - - 502 Clark's water process - 504 Climate - - - 432 ,, effect of drainage on - - - 496 Closets, earth - - 489 ,, water - - 479 Clothes - - - 524 Clouds, formation of - 437 Cocculus indicus, poison- ing by - - - 310 Colchicum, poisoning by 281 Cold, death from - - 101 Coma - - - - 25 Commission in Lunacy- 194 Concussion of the brain - 62 Conditions modifying * putrefaction - - 32 Conium - - - 344 Contagious Diseases Act 378 Contagion - - - 539 Contusions - - - 81 Copper, poisoning by - 272 ,, detection of - 275 Cord, marks of 90 564 INDEX. Corrosive sublimate - 260 Courtesy, tenancy by - 161 Cranial cavity, examina- tion of - 45 Cremation - - -547 Cretinism - - - 178 Criminal abortion - - 128 Croton oil, poisoning by 280 Cutaneous hypostasis - 31 Cyanide of mercury - 264 Damp walls - - - 526 Dead, persons found - 19 Death, apparent - - 25 Death from asphyxia - 24 cold - - 101 coma - 25 ,, drowning - 92 suicide or homicide 94 hanging - 88 suicide or homicide 91 haemorrhage 66 ,, lightning - 101 ,, signs of - 25 ,, starvation - 99 ., strangling - 88 ,, suffocation- 83 ,, syncope - 24 throttling - 88 Death of foetus - - 152 Death-rate - - - 403 , , affected by density - 385 Deliriants - - - 305 Delirium tremens - - 187 Delivery - - - 124 Delusion, definition of - 180 * ' De lunatico inquirendo" 195 Dementia - 185 Density of population - 385 Dentition - - 19 Deodorants - - - 543 Detection of blood-stains 74 Dew point - - - 436 „ determination of 434 PAGE Diaphragm, position of- 139 Dietary - - - 519 Digitalis, poisoning by - 324 Diseases, feigned - - 169 Disinfectants - - 543 Documentary evidence - 2 ,, certificates 2 ,, reports - 2 , , written opinions 2 Donovan's Solution - 251 Drains - 476 , , house - - - 472 Ductus arteriosus - - 158 ,, venosus - - 159 Dulcamara, poisoning by 308 Duncan on Superfoetation 164 Duties, public, exemp- tion from - - - 170 Duty of medical officer of health - - - 554 ,, inspector of nuisances 558 Duty, neglect of - - 168 Dyer's mixture - - 230 Dying declarations - 70 Dwelling houses - - 525 Earth closets - - 489 Ecchymoses 82 Effect on man of age - 358 ,, hours of the day 372 ,, locality - 362 ,, periods - 367 ,, seasons - - 368 ,, sex- - 356 Elaterium, poisoning by 285 Electricity in atmosphere 440 ,, return shock- 442 Embryo, development of 147 Emerald green - - 252 Emigration - - - 385 Emphysema pulmonum neonatorum - - 143 Enamel, poisoning by - 231 Endemics - - - 527 Epidemics - - - 527 INDEX. 565 PAGE Erotomania - - - 184 Essence of mirbane - 322 Ether, poisoning by - 318 Examination localities - 57 Examination of persons assaulted - - 18 Examination of persons found dead - - 19 Examination of persons found living - - 15 Examination of persons found wounded - - 78 Examination of insane persons - - - 196 Exemption from public duties - - - 170 Exhumations - - 55 Expectancy of life - 401 Experimental evidence - 15 Facts of insanity, good - 191 „ ,, bad - 191 „ irrelevant 191 Fall on the child's head at birth - - - 155 Feigned diseases - - 169 Fever, typhoid - - 531 ,, typhus - - 531 relapsing - - 531 Flax-hacklers, life of - 375 Fly-powder, poisoning by 254 Foetal heart, sounds of - 122 Foeticide - - - 128 Fcetus, age of - - 151 ,, cause of death of 152 measurement of 150 Fog, formation of - - 439 Food - - - - 517 Fool's parsley, poisoning by - - - - 284 Foramen, ovale - - 159 Fowler's solution, poi- soning by - - - 251 Frankland's water tests- 516 Fungi, poisoning by - 311 Gamboge, poisoning by 283 Gas, carbonic acid - 352 ,, ,, oxide - 354 , , sulphuretted hydro- gen - - - 355 Gestation, diagnosis of - 115 ,, duration of - 162 ,, protracted - 163 Gonorrhoea! discharge in rape - 108 Goose skin in the drowned 95 Goux system - - 490 Ground water - - 367 Guaiacum, action on blood 76 Gunshot wounds - - 67 Hsemin crystals - - 77 Haemorrhage, death by - 66 Hands, state of, in the drowned 96 Hanging, death by - 88 Hardness of water, how determined - - 502 Head, injuries to - - 62 Height of man - - 388 Hellebore, black, poison- ing by - 282 , , white, poison- ing by - 282 Hemlock, poisoning by - 344 Hills, influence on cli- mate- - - - 470 Homicide, diagnosis of - 58 Homicidal mania - - 184 Hopper closets - - 480 Hours of the day, effect of - - - - 372 House drains - - 472 Humidity - - - 433 ,, absolute - 433 ,, relative- - 433 Hydrochloric acid, poi- soning by - - - 219 Hydrocyanic acid, poi- soning by - - - 327 Hydrostatic lung test - 140 Hygrometers- - - 433 Hymen in rape - - 108 566 INDEX. Hyoscyamus - Hypostasis - PAGE 307 31 Identification, light re- quired for - - - 18 Idiocy - - - - 177 Imbecility - - - 178 Impotence - - - 165 Impurities of air - - 408 . ,, water - 497 Incised wounds - - 65 Inebriants - - - 313 Infant, changes in skin, etc. ... 158 Infanticide - - - 134 Inflation of lungs of foetus - - - 144 Injury, definition of - 60 ,, abdomen - - 64 ,, chest - - 64 ,, face 64 „ head - - 62 Injuries to foetus in utero 155 new-born child 153 throat - - 64 Insane, examination of - 196 Insanity, classification of 177 ,, legal test - 171 ,, ,, definitions 171 ,, English law on 172 Scotch „ - 172 Instructions to Medical Inspectors 41 Intemperance - - 386 Intensity of life - - 403 Introduction - - 1 Iodide of potassium - 237 Iodine, poisoning by - 236 Irrigation, sewage - 491 Iron, poisoning by - 276 Isothermal lines - - 450 Jacquemier's test of preg- nancy - - - 121 Jalap, poisoning by - 283 Jenning's closet - - 481 Kleptomania Kiesteine PAGE 183 121 Laburnum, poisoning by 284 Lead, impregnation of water by - 505 ,, poisoning by - 266 ,, detection of - 271 Legitimacy - - - 162 Life assurance - - 405 ,, duration of - - 403 ,, expectancy of - 401 . ,, intensity - - 403 ,, table - - - 460 Lime, effect on putrefac- tion 39 Lime, treatment of sew- age by 496 Linen, examination of, in rape - 110 Live Birth - - - 159 Lobelia - - - 327 Locality, effect on birth and death-rate - - 362 Lolium temulentum - 311 Lodging-houses, morta- lity in 404 Lunacy, what constitutes 174 Lunatic as witness - 194 Lunatic, civil rights of 194 Lungs, foetal - - 139 „ putrefaction in 38 ,, wounds of - 64 Macquer's salt - - 254 Madness, Polonius on - 171 Malaria - - - 527 Malpraxis - - - 168 Malthus' law of popula- tion - - - - 402 Man as an individual - 388 Man as a species - - 356 Manholes, in sewers - 477 Mania - - - - 179 ,, general intellec- tual - - 180 ,, general moral - 182 INDEX. 567 Mania, homicidal - 184 ,, partial intellec- tual - - 181 . partial moral - 183 ,, suicidal - - 185 Marriage - - -376 Marshes, effect of - - 468 Marsh's test - - - 246 Maturity of Foetus - 150 Measurements of foetus 150 Meat, unsound - - 522 Meconic acid, tests for 296 Medical evidence 2 Medical Inspectors, instructions to - - 41 Men, expectancy of life in - 362 Mental unsoundness - 170 Explanation of term - 171 Merchants, life of - 374 Mercury, poisoning by - 260 „ cyanide of - 264 ,, ,, nitrates, poi- soning by 264 ,, ,, detection of 264 Mirbane, poisoning by - 322 Moisture, effect of, on putrefaction - - 34 Mole or foetus - - 132 Monsters - - - 161 Morphia, tests for - 297 Moule's closets - - 489 Mushrooms - - - 311 Mussels, poisoning by 386 Mutton, poisoning by - 387 Navel string - - 158 Nessler's test - - - 508 Nitrates in water - - 507 Nitric acid, poisoning by 217 Nitro-benzole - - 322 Nitrous acid - - 401 Nucleus, osseous - 151 Nuisance, Inspector of - 558 (Enanthe crocata - - 309 PAGE Opium, poisoning by - 298 Oral evidence - - 8 Orpiment - - - 253 Ossification, defective of skull - - - 155 Otto's method for alka- loids - - - - 291 Oxalic acid - - - 337 Ozone - 412 Pan closet - - - 479 Partial intellectual mania - - 181 ,, moral mania - 183 Periods, effects on births and deaths - - 367 Persons receiving luna- tics, liability of - 193 Petechial ecchymoses - 141 Pettenkofer on cholera - 365 ,, ,, ground air ^366 ,, ,, ,, water 365 ,, ,, typhoid - 365 ,, ,, examina- ,, ,, tionofair 415 Pin-pointers, life of - 375 Phosphate of alumina, treatment of sewerage by - - - - 494 Phosphorous, poisoning by - - - - 231 Plouquet's lung test - 146 Poison, classification of 198 ,, definition of - 197 Poisonous snakes - - 355 Population stationary - 401 ,, density of - 385 ,, increase law of 402 , , pressure of - 385 Post-mortem examina- tion, instruc- tions for - 41 ,, stains - - 31 Potable water - - 497 Potash, poisoning by - 226 Pottery workers - - 375 Pregnancy - - - 115 568 INDEX. PAGE Pregnancy, diagnosis of 124 signs of - 117 Professions, effect of, on health - - - 373 Pseudo-pregnancy- - 123 Prostitution - - - 377 Psychrometers - - 435 Pupillary membrane - 150 Putrefaction, causes affecting 31 , , external signs 34 ,, internal signs 37 Pyromania - - - 184 Quarantine - - - 549 Rainfall - - - 439 ,, how measured - 440 Rain water - - - 500 Rape - - - - 104 adult, signs of - 114 „ child, ,, - - 114 Rate of Mortality - - 401 Realgar - - - 254 Red precipitate - - 263 Reinsch's test for arsenic 248 ,, objections to - 249 Report, form of - - 5 Respiration before birth 140 ,, of man - 393 Revivalism, injurious effects of - - - 384 Rigidity, cadaveric - 29 Salicylic acid, poisoning by 313 Salts of lemons, poison- ing by - - - 339 Saponification - - 36 Savin, poisoning by - 279 Sausages, poisoning by - 287 Scalds 79 Scammony, poisoning by 283 Scars 15 Scheele's green, poison- ing by 251 Schools, ventilation of - 547 Schweinfurt, green of - 252 Scratches - - - 67 Seasons, effect on births and deaths - 368 ,, diseases - - 370 Sea, vicinity of - - 469 Seminal spots - - 111 Sewerage and drainage - 471 Sewers, construction of 476 fall in - - 477 flushing - - 478 ,, obstruction - 478 shape of - - 477 size of - - 476 ,, velocity of cur- rent in - - 477 ,, ventilation of - 481 Sex, effect of, on births and deaths - 356 ,, diagnosis of - - 40 Silver, nitrate of - - 230 Simulation of disease - 169 Sick accommodation - 538 Snakes, poisonous - - 355 Soda, poisoning by - 226 Soil, air in - - - 366 ,, water in - - 367 Solanum dulcamara - 308 nigrum - - 308 ,, tuberosum - 308 Source of water supply 500 Spermatozoa - - - 111 Satistics, vital, - - 393 Starvation, death from - 99 Strangling, ,, - 88 Stass' tests for alkaloids 289 Stirility - - - 165 Stomach, contents in drowned - - 97 Stomach, contents in new-born child - - 146 Stramonium, poisoning by - - - - 307 Strength of man, how measured - - - 392 Strychnia, poisoning by 347 INDEX. 569 PAGE Suffocation, death from 83 Sugar of lead, poisoning by - - - - 266 Suicide - - - 102 Sulphuretted hydrogen, poisoning "by - - 355 Sulphuric acid, poison- ing by - - - 214 Superfoetation - - 164 Survivorship - - 167 Tables of births - - 357 ,, illegitimate births 359 „ of legitimate births - - 359 ,, of marriages - - 360 Tartar emetic, poisoning by - - - - 255 Tattoo marks - - 16 Teeth, eruption of 19 Theatres, ventilation of 547 Theft, morbid propen- - sityto - - - 183 Throttling, death by - 88 Tichborne case - - 16 Tobacco, poisoning by - 325 Trachea, state of, in the drowned - - 97 Trachea, in those suffo- cated 85 Trades, effect of - - 373 Trees, effect on health of 466 in cemeteries - 548 Trichiniasis - - - 288 Turbith mineral, poison- ing by 264 Typhoid - - - 531 Umbilicus, changes in - 158 Unhealthy trades - - 375 Uteri, os, state of- - 120 Uterus, state after delivery 125 ,, late putrefaction 39 Vagina, dilatation of - 109 ,, rugose condition of- - - 114 Vegetable irritants - 278 Ventilation - - - 417 ,, artificial - 427 ,, extraction by 429 ,, natural - 426 ,, propulsion by 430 Arnott's - 428 ,, M'Kennell's 428 Pott's - 428 ,, Tobin's - 429 ,, Sylvester's - 427 ,, of sewers - 481 Veratria, poisoning by - 282 Viability - - " - 160 Vicinity of hills - - 470 ,, marshes - 468 ,, sea - - 469 ,, trees - - 466 Virginity, loss of - - 114 Vulnerant poisons - 231 Wagner's tests for alka - loids - - - 291 Warming - - - 431 Wanklyn's water anatysis 508 Water, analysis of - 508 Clark's treat- ment of - - 504 ,, closets - - 479 Pan 479 ,, Hopper - - 480 ,, Jennings - 481 ,, Dangerous- - 501 , , Suspicious - - 501 ,, Wholesome - 501 ,, hard - - - 501 ,, pipes, laying of - 445 ,, sewerage, im- purity of - 507 ,, soft - - - 501 ,, tests for purity - 507 Weight of man - - 391 Wet method in sewage - 490 White lead, poisoning by 266 Widows - - - 376 Winds, east - - - 463 ,, equatorial- - 462 570 INDEX. PAGE Winds, force and direc- tion of - - 465 middle latitudes 462 ,, surface - - 462 trade - - 462 ,, polar . - 463 Witness, lunatic as - 149 Women, expectancy of . life of 362 Wounds ... 60 contused - - 67 ,, dangerous to life 61 ,, gunshot - - 67 incised - - 65 PAGE Wounds, legal definition of - - 60 ,, punctured - 66 ,, suicidal or homi- cidal - - 71 Yew berries, poisoning by 284 Zinc, poisoning by - 275 ,, chloride of - - 229 ,, sulphate of - - 275 Zymotic disease, cause of 538 ,, effect of season on 372 SL M SB