AIDS

TO

FORENSIC MEDICINE AND TOXICOLOGY

BY

W. G. AITCHISON ROBERTSON

M. D. , D. Sc. , F. R. C. P. E. 

LECTURER ON FORENSIC MEDICINE, SCHOOL OF MEDICINE, EDINBURGH; LATEEXAMINER IN THE UNIVERSITIES OF EDINBURGH AND ST. ANDREWS; FOR THETRIPLE BOARD; DIPLOMA IN PUBLIC HEALTH, ETC. 

NINTH EDITION

TWENTIETH THOUSAND

LONDON

BAILLIÈRE, TINDALL AND COX

8, HENRIETTA STREET, COVENT GARDEN

1922

PREFACE TO NINTH EDITION

I trust that, having thoroughly revised the "Aids to Forensic Medicine, "it may prove as useful to students preparing for examination in thefuture as it has been in the past. 

 W. G. AITCHISON ROBERTSON. 

SURGEONS' HALL, EDINBURGH, _November_, 1921. 

PREFACE TO EIGHTH EDITION

This work of the late Dr. William Murrell having met with such a largemeasure of success, the publishers thought it would be well to bring outa new edition, and invited me to revise the last impression. 

This I have done, and while retaining Dr. Murrell's text closely, I havemade large additions, in order to bring the "Aids" up to presentrequirements. I have also rearranged the matter with the object ofmaking the various sections more consecutive than they were previously. 

 W. G. AITCHISON ROBERTSON. 

SURGEONS' HALL, EDINBURGH, _June_, 1914. 

CONTENTS

PART I

FORENSIC MEDICINE

 PAGE

 I. Crimes 1 II. Medical Evidence 2 III. Personal Identity 10 IV. Examination of Persons found Dead 12 V. Modes of Sudden Death 13 VI. Signs of Death 16 VII. Death from Anæsthetics, etc. 19 VIII. Presumption of Death; Survivorship 20 IX. Assaults, Murder, Manslaughter, etc. 21 X. Wounds and Mechanical Injuries 21 XI. Contused Wounds, etc. 22 XII. Incised Wounds 23 XIII. Gunshot Wounds 24 XIV. Wounds of Various Parts of the Body 26 XV. Detection of Blood-Stains, etc. 30 XVI. Death by Suffocation 34 XVII. Death by Hanging 35 XVIII. Death by Strangulation 35 XIX. Death by Drowning 36 XX. Death from Starvation 38 XXI. Death from Lightning and Electricity 38 XXII. Death from Cold or Heat 39 XXIII. Pregnancy 40 XXIV. Delivery 41 XXV. Foeticide or Criminal Abortion 42 XXVI. Infanticide 44 XXVII. Evidences of Live-Birth 46 XXVIII. Cause of Death in the Foetus 50 XXIX. Duration of Pregnancy 50 XXX. Viability of Children 51 XXXI. Legitimacy 52 XXXII. Superfoetation 53 XXXIII. Inheritance 54 XXXIV. Impotence and Sterility 54 XXXV. Rape 55 XXXVI. Unnatural Offences 59 XXXVII. Blackmailing 60XXXVIII. Marriage and Divorce 60 XXXIX. Feigned Diseases 63 XL. Mental Unsoundness 67 XLI. Idiocy, Imbecility, Cretinism 68 XLII. Dementia 70 XLIII. Mania, Lucid Intervals, Undue Influence, Responsibility, etc. 71 XLIV. Examination of Persons of Unsound Mind 76 XLV. Inebriates Acts 78

PART II

TOXICOLOGY

 I. Definition of a Poison 80 II. Scheduled Poisons 80 III. Classification of Poisons 83 IV. Evidence of Poisoning 85 V. Symptoms and Post-Mortem Appearances of Different Classes of Poisons 86 VI. Duty of Practitioner in Supposed Case of Poisoning 89 VII. Treatment of Poisoning 90 VIII. Detection of Poison 91 IX. The Mineral Acids 94 X. Sulphuric Acid 95 XI. Nitric Acid 97 XII. Hydrochloric Acid 98 XIII. Oxalic Acid 98 XIV. Carbolic Acid 100 XV. Potash, Soda, and Ammonia 101 XVI. Potassium Salts, etc. 103 XVII. Nitrate of Potassium, etc. 103 XVIII. Barium Salts 104 XIX. Iodine--Iodide of Potassium 104 XX. Phosphorus 105 XXI. Arsenic and its Preparations 107 XXII. Antimony and its Preparations 112 XXIII. Mercury and its Preparations 113 XXIV. Lead and its Preparations 116 XXV. Copper and its Preparations 117 XXVI. Zinc, Silver, Bismuth, and Chromium 118 XXVII. Gaseous Poisons 120 XXVIII. Vegetable Irritants 123 XXIX. Opium and Morphine 124 XXX. Belladonna, Hyoscyamus, and Stramonium 127 XXXI. Cocaine 128 XXXII. Camphor 129 XXXIII. Tetrachlorethane 129 XXXIV. Alcohol, Ether, and Chloroform 130 XXXV. Chloral Hydrate 134 XXXVI. Petroleum and Paraffin Oil 134 XXXVII. Antipyrine, Antefebrin, Phenacetin, and Aniline 135XXXVIII. Sulphonal, Trional, Tetronal, Veronal, Paraldehyde 137 XXXIX. Conium and Calabar Bean 138 XL. Tobacco and Lobelia 139 XLI. Hydrocyanic Acid 140 XLII. Aconite 143 XLIII. Digitalis 144 XLIV. Nux Vomica, Strychnine, and Brucine 145 XLV. Cantharides 146 XLVI. Abortifacients 147 XLVII. Poisonous Fungi and Toxic Foods 148 XLVIII. Ptomaines or Cadaveric Alkaloids 150

 Index 152

AIDS TO FORENSIC MEDICINE AND TOXICOLOGY

PART I

FORENSIC MEDICINE

I. --CRIMES

Forensic medicine is also called Medical Jurisprudence or LegalMedicine, and includes all questions which bring medical matters intorelation with the law. It deals, therefore, with (1) crimes and (2)civil injuries. 

1. A _crime_ is the voluntary act of a person of sound mind harmful toothers and also unjust. No act is a crime unless it is plainly forbiddenby law. To constitute a crime, two circumstances are necessary to beproved--(a) that the act has been committed, (b) that a guilty mind ormalice was present. The act may be one of omission or of commission. Every person who commits a crime may be punished, unless he is under theage of seven years, is insane, or has been made to commit it undercompulsion. 

Crimes are divided into _misdemeanours_ and _felonies_. The distinctionis not very definite, but, as a rule, the former are less serious formsof crime, and are punishable with a term of imprisonment, generallyunder two years; while felonies comprise the more serious charges, asmurder, manslaughter, rape, which involve the capital sentence or longterms of imprisonment. 

An _offence_ is a trivial breach of the criminal law, and is punishableon summary conviction before a magistrate or justices only, while themore serious crimes (_indictable offences_) must be tried before a jury. 

2. _Civil injuries_ differ from crimes in that the former arecompensated by damages awarded, while the latter are punished; anyperson, whether injured or not, may prosecute for a crime, while onlythe sufferer can sue for a civil injury. The Crown may remit punishmentfor a crime, but not for a civil injury. 

II. --MEDICAL EVIDENCE

On being called, the medical witness enters the witness-box and takesthe oath. This is very generally done by uplifting the right hand andrepeating the oath (Scottish form), or by kissing the Bible, or bymaking a solemn affirmation. 

1. He may be called to give _ordinary evidence_ as a _common witness_. Thus he may be asked to detail the facts of an accident which he hasobserved, and of the inferences he has deduced. This evidence is whatany lay observer might be asked. 

2. _Expert Witness. _--On the other hand, he may be examined on mattersof a technical or professional character. The medical man then givesevidence of a skilled or expert nature. He may be asked his opinion oncertain facts narrated--_e. G. _, if a certain wound would be immediatelyfatal. Again, he may be asked whether he concurs with opinions held byother medical authorities. 

In important cases specialists are often called to give evidence of askilled nature. Thus the hospital surgeon, the nerve specialist, or themental consultant may be served with a subpoena to appear at court on acertain date to give evidence. The evidence of such skilled observerswill, it is supposed, carry greater weight with the jury than would theevidence of an ordinary practitioner. 

Skilled witnesses may hear the evidence of ordinary witnesses in regardto the case in which they are to give evidence, and it is, indeed, better that they should understand the case thoroughly, but they are notusually allowed to hear the evidence of other expert witnesses. 

In civil cases the medical witness should, previous to the trial, makean agreement with the solicitor who has called him with reference to thefee he is to receive. Before consenting to appear as a witness thepractitioner should insist on having all the facts of the case putbefore him in writing. In this way only can he decide as to whether inhis opinion the plaintiff or defendant is right as regards the medicalevidence. If summoned by the side on which he thinks the medicaltestimony is correct, then it is his duty to consent to appear. If, however, he is of opinion that the medical evidence is clearly andcorrectly on the opposite side, then he ought to refuse to appear andgive evidence; and, indeed, the lawyer would not desire his presence inthe witness-box unless he could uphold the case. 

Whether an expert witness who has no personal knowledge of the facts isbound to attend on a subpoena is a moot point. It would be safer for himto do so, and to explain to the judge before taking the oath that hismemory has not been sufficiently 'refreshed. ' The solicitor, if hedesires his evidence, will probably see that the fee is forthcoming. 

A witness may be subjected to _three_ examinations: first, by the partyon whose side he is engaged, which is called the 'examination in chief, 'and in which he affords the basis for the next examination or'cross-examination' by the opposite side. The third is the're-examination' by his own side. In the first he merely gives a clearstatement of facts or of his opinions. In the next his testimony issubjected to rigid examination in order to weaken his previousstatements. In the third he is allowed to clear up any discrepancies inthe cross-examination, but he must not introduce any new matter whichwould render him liable to another cross-examination. 

The medical witness should answer questions put to him as clearly and asconcisely as possible. He should make his statements in plain and simplelanguage, avoiding as much as possible technical terms and figurativeexpressions, and should not quote authorities in support of hisopinions. 

An expert witness when giving evidence may refer to notes for thepurpose of refreshing his memory, but only if the notes were taken byhim at the time when the observations were made, or as soon after aspracticable. 

There are various _courts_ in which a medical witness may be called onto give evidence:

1. =The Coroner's Court. =--When a coroner is informed that the dead bodyof a person is lying within his jurisdiction, and that there isreasonable cause to suspect that such person died either a violent orunnatural death, or died a sudden death of which the cause is unknown, he must summon a jury of not less than twelve men to investigate thematter--in other words, hold an inquest--and if the deceased hadreceived medical treatment, the coroner may summon the medical attendantto give evidence. By the Coroners (Emergency Provisions) Act of 1917, the number of the jury has been cut down to a minimum of seven and amaximum of eleven men. By the Juries Act of 1918, the coroner has thepower of holding a court without a jury if, in his discretion, itappears to be unnecessary. In charges of murder, manslaughter, deaths ofprisoners in prison, inmates of asylums or inebriates' homes, or ofinfants in nursing homes, he must summon a jury. The coroner may besatisfied with the evidence as to the cause of a person's death, and maydispense with an inquest and grant a burial certificate. 

Cases are notified to the coroner by the police, parish officer, anymedical practitioner, registrar of deaths, or by any private individual. 

Witnesses, having been cited to appear, are examined on oath by thecoroner, who must, in criminal cases at least, take down the evidence inwriting. This is then read over to each witness, who signs it, and thisforms his _deposition_. At the end of each case the coroner sums up, andthe jury return their verdict or _inquisition_, either unanimously or bya majority. 

If this charges any person with murder or manslaughter, he is committedby the coroner to prison to await trial, or, if not present, the coronermay issue a warrant for his arrest. 

A chemical analysis of the contents of the stomach, etc. , in suspectedcases of poisoning is usually done by a special analyst named by thecoroner. If any witness disobeys the summons to attend the inquest, herenders himself liable to a fine not exceeding £2 2s. , but in additionthe coroner may commit him to prison for contempt of court. In criminalcases the witnesses are bound over to appear at the assizes to giveevidence there. The coroner may give an order for the exhumation of abody if he thinks the evidence warrants a post-mortem examination. 

Coroners' inquests are held in all cases of sudden or violent death, where the cause of death is not clear; in cases of assault, where deathhas taken place immediately or some time afterwards; in cases ofhomicide or suicide; where the medical attendant refuses to give acertificate of death; where the attendants on the deceased have beenculpably negligent; or in certain cases of uncertified deaths. 

The medical witness should be very careful in giving evidence before acoroner. Even though the inquest be held in a coach-house or barn, yetit has to be remembered it is a court of law. If the case goes on fortrial before a superior court, your deposition made to the coroner formsthe basis of your examination. Any misstatements or discrepancies inyour evidence will be carefully inquired into, and you will make a badimpression on judge and jury if you modify, retract, or explain awayyour evidence as given to the coroner. You had your opportunity ofmaking any amendments on your evidence when the coroner read over to youyour deposition before you signed it as true. 

By the Licensing Act of 1902, an inquest may not be held in any premiseslicensed for the sale of intoxicating liquor if other suitable premiseshave been provided. 

The duties of the coroner are based partly on Common Law, and are alsodefined by statute, principally by the Coroners Act of 1887 (50 and 51Vict. C. 71). They have been modified, however, by subsequentActs--_e. G. _, the Act of 1892, the Coroners (Emergency Provisions) Act, 1917, and the Juries Act of 1918. 

The fee payable to a medical witness for giving evidence at an inquestis one guinea, with an extra guinea for making a post-mortem examinationand report (in the metropolitan area these fees are doubled). Thecoroner must sign the order authorizing the payment, and should aninquest be adjourned to a later day, no further fee is payable. If thedeceased died in a hospital, infirmary, or lunatic asylum, the medicalwitness is not paid any fee. Should a medical witness neglect to makethe post-mortem examination after receiving the order to do so, he isliable to a fine of £5. 

In Scotland the Procurator Fiscal fulfils many of the duties of thecoroner, but he cannot hold a public inquiry. He interrogates thewitnesses privately, and these questions with the answers form the_precognition_. More serious cases are dealt with by the Sheriff of eachcounty, and capital charges must be dealt with by the High Court ofJusticiary. In Scotland the verdicts of the jury may be 'guilty, ' 'notguilty, ' or 'not proven. '

2. =The Magistrate's Court or Petty Sessions= is also a court ofpreliminary inquiry. The prisoner may be dealt with summarily, as, forexample, in minor assault cases, or, if the case is of sufficientgravity, and the evidence justifies such a course, may be committed fortrial. The fee for a medical witness who resides within three miles ofthe court is ten shillings and sixpence; if at a greater distance, oneguinea. 

In the Metropolis the prisoner in the first instance is brought before amagistrate, technically known as the 'beak, ' who, in addition to being aperson of great acumen, is a stipendiary, and thus occupies a superiorposition to the ordinary 'J. P. , ' who is one of the great unpaid. In theCity of London is the Mansion House Justice-Room, presided over by theLord Mayor or one of the Aldermen. The prisoner may ultimately be sentfor trial to the Central Criminal Court, known as the Old Bailey, orelsewhere. 

3. =Quarter Sessions. =--These are held every quarter by Justices of thePeace. All cases can be tried before the sessions except felonies orcases which involve difficult legal questions. In London this court isknown as the Central Criminal Court, and it also acts as the AssizeCourt. In Borough Sessions a barrister known as the _Recorder_ isappointed as sole judge. 

4. =The Assizes= deal with both criminal and civil cases. There is the_Crown Court_, where criminal cases are tried, and there is the _CivilCourt_, where civil cases are heard. Before a case sent up by a lowercourt can be tried by the judge and petty jury, it is investigated bythe _grand jury_, which is composed of superior individuals. If theyfind a 'true bill, ' the case goes on; but if they 'throw it out, ' theaccused is at liberty to take his departure. At the Court of Assize theprisoner is tried by a jury of twelve. In bringing in the verdict thejury must be unanimous. If they cannot agree, the case must be retriedbefore a new jury. At the Assize Court the medical witness gets a guineaa day, with two shillings extra to pay for his bed and board for everynight he is away from home, with his second-class railway fare, if thereis a second class on the railway by which he travels. If there is norailway, and he has to walk, he is entitled to threepence a mile forrefreshments both ways. 

5. =Court of Criminal Appeal. =--This was established in 1908, andconsists of three judges. A right of appeal may be based (1) solely on aquestion of law; (2) on certificate from the judge who tried theprisoner; (3) on mitigation of sentence. 

Speaking generally, in the Superior Courts the fees which may be claimedby medical men called on to give evidence are a guinea a day if residentin the town in which the case is tried, and from two to three guineas aday if resident at a distance from the place of trial, this to includeeverything except travelling expenses. The medical witness also receivesa reasonable allowance for hotel and travelling expenses. 

If a witness is summoned to appear before two courts at the same time, he must obey the summons of the higher court. Criminal cases takeprecedence of civil. 

A medical man has no right to claim privilege as an excuse for notdivulging professional secrets in a court of law, and the less he talksabout professional etiquette the better. Still, in a civil case, if hewere to make an emphatic protest, the matter in all probability wouldnot be pressed. In a criminal case he would promptly be reminded of thenature of his oath. 

A medical man may be required to furnish a _formal written report_. Itmay be the history of a fatal illness or the result of a post-mortemexamination. These reports must be drawn up very carefully, and notechnical terms should be employed. 

No witness on being sworn can be compelled to 'kiss the book. ' The OathsAct (51 and 52 Vict. , c. 46, § 5) declares, without any qualification, that 'if any person to whom an oath is administered desires to swearwith uplifted hand, in the form and manner in which an oath is usuallyadministered in Scotland, he shall be permitted to do so, and the oathshall be administered to him in such form and manner without furtherquestion. ' The witness takes the oath standing, with the bare right handuplifted above the head, the formula being: 'I swear by Almighty Godthat I will speak the truth, the whole truth, and nothing but thetruth. ' The presiding judge should say the words, and the witness shouldrepeat them after him. There is no kissing of the book, and the words'So help me, God, ' which occur in the English form, are not employed. Itwill be noted that the Scotch form constitutes an oath, and is not anaffirmation. The judge has no right to ask if you object on religiousgrounds, or to put any question. He is bound by the provisions of theAct, and the enactment applies not only to all forms of the witnessoath, whether in civil or criminal courts, or before coroners, but toevery oath which may be lawfully administered either in Great Britain orIreland. 

A witness engaged to give expert evidence should demand his fee beforegoing into court, or, at all events, before being sworn. 

With regard to notes, these should be made at the time, on the spot, andmay be used by the witness in court as a refresher to the memory, thoughnot altogether to supply its place. All evidence is made up oftestimony, but all testimony is not evidence. The witness must notintroduce hearsay testimony. In one case only is hearsay evidenceadmissible, and that is in the case of a _dying declaration_. This is astatement made by a dying person as to how his injuries were inflicted. These declarations are accepted because the law presumes that a dyingman is anxious to speak the truth. But the person must believe that heis _actually_ on the point of death, with _absolutely_ no hope ofrecovery. A statement was rejected because the dying person, in usingthe expression 'I have no hope of recovery, ' requested that the words'at present' should be added. If after making the statement the patientwere to say, 'I hope now I shall get better, ' it would invalidate thedeclaration. To make the declaration admissible as evidence, death mustensue. If possible, a magistrate should take the dying declaration; butif he is not available, the medical man, without any suggestions orcomments of his own, should write down the statements made by the dyingperson, and see them signed and witnessed. It must be made clear to thecourt that at the time of making his statement the witness was under thefull conviction of approaching or impending death. 

III. --PERSONAL IDENTITY

It is but seldom that medical evidence is required with regard to theidentification of the living, though it may sometimes be so, as in thecelebrated Tichborne case. The medical man may in such cases beconsulted as to family resemblance, marks on the body, nævi materni, scars and tattoo marks, or with regard to the organs of generation incases of doubtful sex. Tattoo marks may disappear during life; thebrighter colours, as vermilion, as a rule, more readily than those madewith carbon, as Indian ink; after death the colouring-matter may befound in the proximal glands. If the tattooing is superficial (merelyunderneath the cuticle) the marks may possibly be removed by aceticacid or cantharides, or even by picking out the colouring-matter with afine needle. With regard to scars and their permanence, it will beremembered that scars occasioned by actual loss of substance, or bywounds healed by granulation, never disappear. The scars of leech-bites, lancet-wounds, or cupping instruments, may disappear after a lapse oftime. It is difficult, if not impossible, to give any certain orpositive opinion as to the age of a scar; recent scars are pink incolour; old scars are white and glistening. The cicatrix resulting froma wound depends upon its situation. Of incised wounds an ellipticalcicatrix is typical, linear being chiefly found between the fingers andtoes. By way of disguise the hair may be dyed black with lead acetate ornitrate of silver; detected by allowing the hair to grow, or by steepingsome of it in dilute nitric acid, and testing with iodide of potassiumfor lead, and hydrochloric acid for silver. The hair may be bleachedwith chlorine or peroxide of hydrogen, detected by letting the hair growand by its unnatural feeling and the irregularity of the bleaching. 

Finger-print impressions are the most trustworthy of all means ofidentification. Such a print is obtained by rubbing the pulp of thefinger in lampblack, and then impressing it on a glazed card. Theimpression reveals the fine lines which exist at the tips of thefingers. The arrangement of these lines is special to each person, andcannot be changed. Hence this method is employed by the police in theidentification of prisoners. 

In the determination of cases of doubtful sex in the living, thefollowing points should be noticed: the size of the penis or clitoris, and whether perforate or not, the form of the prepuce, the presence orabsence of nymphæ and of testicles or ovaries. Openings must becarefully sounded as to their communication with bladder or uterus. After puberty, inquiry should be made as to menstrual or vicariousdischarges, the general development of the body, the growth of hair, the tone of voice, and the behaviour of the individual towards eithersex. 

With regard to the identification of the dead in cases of death byaccident or violence, the medical man's assistance may be called. Thesex of the skeleton, if that only be found, may be judged from the bonesof the female generally being smaller and more slender than those of themale, by the female thorax being deeper, the costal cartilages longer, the ilia more expanded, the sacrum flatter and broader, the coccyxmovable and turned back, the tuberosities of the ischia wider apart, thepubes shallow, and the whole pelvis shallower and with larger outlets. But of all these signs the only one of any real value is the roundnessof the pubic arch in the female, as compared with the pointed arch inthe male. Before puberty the sex cannot be determined from anexamination of the bones. 

Age may be calculated from the presence, nature and number of theerupted teeth; from the cartilages of the ribs, which gradually ossifyas age advances; from the angle formed by the ramus of the lower jawwith its body (obtuse in infancy, a right angle in the adult, and againobtuse in the aged from loss of the teeth); and in the young from thecondition of the epiphyses with regard to their attachment to theirrespective shafts. 

To determine stature, the whole skeleton should be laid out andmeasured, 1-1/2 to 2 inches being allowed for the soft parts. 

IV. --EXAMINATION OF PERSONS FOUND DEAD

When a medical man is called to a case of sudden death, he shouldcarefully note anything likely to throw any light on the cause of death. He should notice the place where the body was found, the position andattitude of the body, the soil or surface on which the body lies, theposition of surrounding objects, and the condition of the clothes. Heshould also notice if there are any signs of a struggle having takenplace, if the hands are clenched, if the face is distorted, if there hasbeen foaming at the mouth, and if urine or fæces have been passedinvoluntarily. Urine may be drawn off with a catheter and tested foralbumin and sugar. 

If required to make a post-mortem examination, every cavity andimportant organ of the body must be carefully and minutely examined, theseat of injury being inspected first. 

V. --MODES OF SUDDEN DEATH

There are three modes in which death may occur: (1) Syncope; (2)asphyxia; (3) coma. 

1. =Syncope= is death beginning at the heart--in other words, failure ofcirculation. It may arise from--(1) _Anæmia_, or deficiency of blood dueto hæmorrhage, such as occurs in injuries, or from bleeding from thelungs, stomach, uterus, or other internal organs. (2) _Asthenia_, orfailure of the heart's action, met with in starvation, in exhaustingdiseases, such as phthisis, cancer, pernicious anæmia, and Bright'sdisease, and in some cases of poisoning--for example, aconite. 

The symptoms of syncope are faintness, giddiness, pallor, slow, weak, and irregular pulse, sighing respiration, insensibility, dilated pupils, and convulsions. 

Post mortem the heart is found empty and contracted. When, however, there is sudden stoppage of the heart, the right and left cavitiescontain blood in the normal quantities, and blood is found in the venæcavæ and in the arterial trunks. There is no engorgement of either lungsor brain. 

2. =Asphyxia=, or death beginning at the lungs, may be due toobstruction of the air-passages from foreign bodies in the larynx, drowning, suffocation, strangling, and hanging; from injury to thecervical cord; effusion into the pleuræ, with consequent pressure on thelungs; embolism of the pulmonary artery; and from spasmodic contractionof the thoracic and abdominal muscles in strychnine-poisoning. 

The symptoms of this condition are fighting for breath, giddiness, relaxation of the sphincters, and convulsions. 

Post mortem, cadaveric lividity is well marked, especially in nose, lips, ears, etc. ; the right cavities of the heart and the venæ cavæ arefound gorged with dark fluid blood. The pulmonary veins, the leftcavities of the heart, and the aorta, are either empty or contain butlittle blood. The lungs are dark and engorged with blood, and the liningof the air-tubes is bright red in colour. Much bloody froth escapes oncutting into the lungs. Numerous small hæmorrhages (Tardieu's spots) arefound on the surface and in the substance of the internal organs, aswell as in the skin of the neck and face. 

3. =Coma=, or death beginning at the brain, may arise from concussion;compression; cerebral pressure from hæmorrhage and other forms ofapoplexy; blocking of a cerebral artery from embolism; dietetic anduræmic conditions; and from opium and other narcotic poisons. 

The symptoms of this condition are stupor, loss of consciousness, andstertorous breathing. 

The post-mortem signs are congestion of the substance of the brain andits membranes, with accumulation of the blood in the cavities of theheart, more on the right side than on the left. 

It must be remembered that, owing to the interdependence of all thevital functions, there is no line of demarcation between the variousmodes of death. In all cases of sudden death think of angina pectorisand the rupture of an aneurism. 

The following is a list of some of the commoner causes of sudden death:

(a) =Instantaneously Sudden Death=--

1. Syncope (by far the commonest cause). 

2. Aortic incompetence. 

3. Rupture of heart. 

4. Rupture of a valve. 

5. Rupture of aortic aneurism. 

6. Embolism of coronary artery. 

7. Angina pectoris. 

(b) =Less Sudden but Unexpected Death=--

1. Cerebral hæmorrhage or embolism. 

2. Mitral and tricuspid valvular lesions if the patient exerts himself. 

3. Rupture of a gastric or duodenal ulcer; rupture of liver, spleen, orextra-uterine gestation, or abdominal aneurism. 

4. Suffocation during an epileptic fit; vomited matter or other materialdrawn into the trachea or air-passages; croup. 

5. Arterio-sclerosis may lead to thrombosis, embolism, or aneurism. 

6. Poisoning, as by hydrocyanic acid, cyanide of potassium, inhalationof carbonic acid or coal gas, oedema of glottis following inhalation ofammonia. 

7. Rapid onset of some acute specific disease, such as pneumonia ordiphtheria; collapse from cholera. 

8. Heat-stroke, lightning, shocks of electricity of high tension. 

9. Mental or physical shock. 

10. Exertion while the stomach is overloaded. 

11. Diabetic coma; uræmia. 

12. _Status lymphaticus. _ This is a general hyperplastic condition ofthe lymphatic structures in the body, and is seen in enlargement oftonsils, thymus, spleen, as well as of Peyer's patches and mesentericglands. It is a frequent cause of death during chloroform anæsthesia forslight operations in young people. 

In addition, it may be as well to remember that death sometimes occurssuddenly in exophthalmic goitre, hypertrophy of the thymus, and inAddison's disease. 

In some cases of sudden death nothing has been found post mortem, evenwhen the autopsy has been made by skilled observers, and the brain andcord have been submitted to microscopical examination. 

VI. --SIGNS OF DEATH

(1) Cadaveric appearance; ashy white colour. (2) Cessation of thecirculation and respiration, no sound being heard by the stethoscope. Cessation of the circulation may be determined by (a) placing a ligatureround the base of a finger (Magnus' test); (b) injecting a solution offluorescin (Icard's test); (c) looking through the web of the fingers ata bright light (diaphanous test); (d) the dulling of a steel needle whenthrust into the living body; (e) the clear outline of the dead heartwhen viewed in the fluorescent screen. (3) The state of the eye; thetension is at once lost; iris insensible to light, fundus yellow incolour; cornea dull and sunken. (4) The state of the skin; pale, livid, with loss of elasticity. (5) Extinction of muscular irritability. Theabove signs afford no means of determining how long life has beenextinct. The following, however, do:

=Cooling of the Body. =--The average internal temperature of the body isfrom 98° to 100° F. The time taken in cooling is from fifteen to twentyhours, but it may be modified by the kind of death, the age of theperson, the presence or absence of clothing on the body, the surroundingtemperature, and the stillness or otherwise of the air about the body. Still, the body, other things being equal, may be said to be _quitecold_ in about _twelve hours_. 

=Hypostasis= or =post-mortem staining= is due to the settling down ofthe blood in the most dependent parts of the body while the body iscooling. It is a sure sign of death, and occurs in all forms of death, even in that due to hæmorrhage, although not so marked in degree. Post-mortem staining (_cadaveric lividity_) begins to appear in fromeight to twelve hours after death, and its position on the body willhelp to determine the length of time the body has lain in the positionin which it was found. The staining is of a dull red or slaty bluecolour. It must be distinguished from ecchymosis the result of a bruise, by making an incision into the part; in the case of hypostasis a fewsmall bloody points of divided arteries will be seen, in the case ofecchymosis the subcutaneous tissues are infiltrated with blood-clot. Internally, hypostasis must not be mistaken for congestion of the brainor lungs, or the results of inflammation of the intestines. If theintestine is pulled straight, inflammatory redness is continuous, hypostasis is disconnected. About the neck hypostasis must not bemistaken for the mark of a cord or other ligature. When the blood is ofa bright red colour after death (as happens in poisoning by CO or HCN, or in death from cold), the hypostasis is bright red also. 

=Cadaveric Rigidity--Rigor Mortis. =--For some time after death themuscles continue to contract under stimuli. When this irritabilityceases--and it seldom exceeds two hours--rigidity and hardening sets in, and in _all_ cases precedes putrefaction. It is caused by thecoagulation of the muscle plasma. It commences in the muscles of theback of the neck and lower jaw, and then passes into the muscles of theface, front of the neck, chest, upper extremities, and lastly to thelower extremities. 

It has been noticed in the new-born infant, as well as in the foetus. Itlasts from sixteen to twenty hours or more. In lingering diseases, afterviolent exertion, and in warm climates, it sets in quickly, anddisappears in two or three hours; in those who are in perfect health anddie from accident or asphyxia, it may not come on until from ten totwenty-four hours, and may last three or four days. After death fromconvulsions or strychnine-poisoning, the body may pass at once intorigor mortis. Rigor mortis must be distinguished from _cadaveric spasm_or the _death clutch_; in the former, articles in the hands are readilyremovable, in the latter this is not the case. In tetanic spasm thelimbs when bent return to their former position; not so in rigor mortis. 

=Putrefaction= appears in from one to three days after death, as agreenish-blue discoloration of the abdomen; in the drowned, over thehead and face. This increases, becomes darker and more general, a strongputrefactive odour is developed, the thorax and abdomen become distendedwith gas, and the epidermis peels off. The muscles then become pulpy, and assume a dark greenish colour, the whole body at length becomingchanged into a soft, semi-fluid mass. The organ first showing theputrefactive change is the trachea; that which resists putrefactionlongest is the uterus. These putrefactive changes are modified by thefat or lean condition of the body, the temperature (putrefaction takingplace more rapidly in summer than in winter), access of air, the period, place, mode of interment, age, etc. Bodies which remain in water putrefymore slowly than those in air. 

=Saponification. =--In bodies which are very fat and have lain in wateror moist soil for from one to three years this process takes place, thefat uniting with the ammonia given off by the decomposition to form_adipocere_. This consists of a margarate or stearate of ammonium withlime, oxide of iron, potash, certain fatty acids, and a yellowishodorous matter. It has a fatty, unctuous feel, is either pure white orpale yellow, with an odour of decayed cheese. Small portions of the bodymay show signs of this change in six weeks. 

=Post-Mortem Examination. =--Never make an autopsy in criminal caseswithout a written order from the coroner or Procurator Fiscal. Ifauthorized, however, first have the body identified, then photographedif it has not been identified. A medical man representing the accusedmay be present, but only by consent of the Crown authorities or of theSheriff. Clothing should be examined for blood-stains, cuts, etc. 

Examine external surface of body and take accurate measurements ofwounds, marks, deformities, tattooings; note degree and distribution ofpost-mortem staining, rigidity, etc. 

Examine brain by making incision from ear to ear across vertex, reflectscalp forwards and backwards, and saw off calvarium. Examine braincarefully externally and on section. 

Examine organs of chest and abdomen through an incision made fromsymphysis menti to pubis, reflecting tissues from chest wall and cuttingthrough costal cartilages. 

In cases of suspected poisoning have several clean jars into which youplace the stomach with contents, intestines with contents, piece ofliver, kidney, spleen, etc. , and seal each up carefully, attaching labelwith name of deceased, date, and contained organs, and transmit thesepersonally to the analyst. 

=Exhumation. =--A body which has been buried cannot be exhumed without anorder from a coroner, fiscal, or from the Home Secretary. There is nolegal limit in England as to when a body may be exhumed; in Scotland, however, if an interval of twenty years has elapsed, an accused personcannot be prosecuted (_prescription of crime_). 

VII. --DEATH FROM ANÆSTHETICS, ETC. 

The coroner in England and Wales and Ireland must inquire into everycase of death during the administration of an anæsthetic. Theanæsthetist has to appear at the inquest, and must answer a long seriesof questions relative to the administration of the drug. 

Before, therefore, giving an anæsthetic, and so as to furnish yourselfwith a proper defence in the event of death occurring, you ought toexamine the heart, lungs, and kidneys of the patient to see if they arehealthy. Should a fatal result follow, the anæsthetist will require toprove that it was necessary to give the anæsthetic, that the oneemployed was the most suitable, that the patient was in a fit state ofhealth to have it administered, that it was given skilfully and inmoderate amount, that he had the usual remedies at hand in case offailure of the heart or lungs, and that he employed every means in hispower to resuscitate the patient. 

The condition of the lungs is of more importance than the state of theheart. 

The chloroformist ought always to use the best chloroform. 

An anæsthetic should never be administered except in the presence of a_third person_. This applies especially to dentists who give gas tofemales. 

=Malpractice. =--In every case where a medical man attends a patient, hemust give him that amount of care, skill, knowledge, or judgment, thatthe law expects of him. If he does not, then the charge of malpracticemay be brought against him. It is most frequently alleged in connectionwith surgical affections--_e. G. _, overlooking a fracture or dislocation. Before a major operation is performed, it is well to get a writtenagreement. 

VIII. --PRESUMPTION OF DEATH; SURVIVORSHIP

=Presumption of Death. =--If a person be unheard of for seven years, thecourt may, on application by the nearest relative, presume death to havetaken place. If, however, it can be shown that in all probability deathhad occurred in a certain accident or shipwreck, the decree may be mademuch earlier. 

=Presumption of Survivorship. =--When two or more related persons perishin a common accident, it may be necessary, in order to decide questionsof succession, to determine which of them died first. It is generallyaccepted that the stronger and more vigorous will survive longest. 

IX. --ASSAULT, MURDER, MANSLAUGHTER, ETC. 

=Assault. =--This is an attempt or offer to do violence to anotherperson; it is not necessary that actual injury has been done, but evilintention must be proved. When a corporal hurt has been sustained, then_assault and battery_ has been committed. The assault may be aggravatedby the use of weapons, etc. 

=Homicide= may be _justifiable_, as in the case of judicial execution, or _excusable_, as in defence of one's family or property. 

_Felonious homicide_ is murder. This means that a human being has beenkilled by another maliciously and deliberately or with recklessdisregard of consequences. 

=Manslaughter= or =Culpable Homicide= (Scotland) is the unlawful killingof a human being without malice--as homicide after great provocation;signalman who allows a train to pass, and so collide with another infront. 

X. --WOUNDS AND MECHANICAL INJURIES

A wound may be defined as a 'breach of continuity in the structures ofthe body, whether external or internal, suddenly occasioned bymechanical violence. ' The law does not define 'a wound, ' but the _trueskin must be broken_. Wounds are dangerous from shock, hæmorrhage, fromthe supervention of crysipelas or pyæmia, and from _malum regimen_ onthe part of the patient or surgeon. _Is the wound dangerous to life?_This question can only be answered by a full consideration of all thecircumstances of the case; a guarded prognosis is wise in all cases. 

=Burns= are caused by flames, highly heated solids, or very cold solids, as solid carbonic acid; scalds, by steam or hot fluids. Burns may causedeath from shock, suffocation, oedema glottidis, inflammation of seroussurfaces, bronchitis, pneumonia, duodenal ulcer, coma, or exhaustion. Aburn of the skin inflicted during life is followed by a bleb containingserum; the edges of this blister are bright red, and the base, seenafter removing the cuticle, is red and inflamed; if sustained afterdeath, a bleb, if present, contains but little fluid, and there are nosigns of vital reaction. There are six degrees of burns: (1) Superficialinflammation; (2) formation of vesicles; (3) destruction of superficiallayer of skin; (4) destruction of cellular tissue; (5) deep partscharred; (6) carbonization of bones. 

The larger the area of skin burnt, the more grave is the prognosis. Burns of the abdomen and genital organs are especially dangerous. Youngchildren are specially liable to die after burns. 

XI. --CONTUSED WOUNDS AND INJURIES UNACCOMPANIED BY SOLUTION OFCONTINUITY

If a blow be inflicted with a blunt instrument, there is produced abruise, or _ecchymosis_, of which it is unnecessary here to describe theappearance and progress. A bruise may be distinguished from apost-mortem stain by the cuticle in the former often being abraded andraised. When an incision is made into the bruise, the whole of thesubcutaneous tissues are found to be infiltrated with blood-clot, andthere is no clear margin. In the case of a post-mortem stain the edgesare sharply defined, not raised, and, on section, mere bloody pointsare seen which are the cut ends of the divided blood vessels. 

XII. --INCISED WOUNDS AND THOSE ACCOMPANIED BY SOLUTION OF CONTINUITY

These comprise incised, punctured, and lacerated wounds. In a recentincised wound inflicted during life there is copious hæmorrhage, thecellular tissue is filled with blood, the edges of the wound gape andare everted, and the cavity of the wound is filled with coagula. 

Lacerated wounds combine the characters of incised and contused wounds. They are caused by falls, being ridden over, machinery crushes, bites, blows from blunt weapons, etc. The wounds heal by suppuration. 

_Punctured wounds_ come intermediate between incised and lacerated. Theyare greater in depth than in length, being caused by sword or rapierthrusts. They cause little hæmorrhage externally, but death may be dueto internal hæmorrhage. They may be complicated by (1) the introductionof septic material adhering to the instrument; (2) the entrance offoreign bodies which lodge in the wound, not only carrying in septicmatter, but acting as mechanical irritants; (3) injury to deeper parts, which may at the time be difficult to detect. 

An apparently _incised wound_ may be produced by a hard, blunt weaponover a bone--_e. G. _, shin or cranium. It is often difficult todistinguish between a wound of the scalp inflicted with a knife and onemade by a blow with a stick. A puncture with a sharp-edged, pointedknife leaves a fusiform or spindle-shaped wound. A wound from a blowwith a stick might be of this character, or it might present a jagged, swollen appearance at the margin, with much contusion of the surroundingtissues. If the wound is seen soon after it is inflicted, examinationwith a lens may disclose irregularities of the margins, or littlebridges of connective tissue or vessels running across the wound, andso be inconsistent with its production by a cutting instrument. _Lacerated wounds_ as a rule bleed less freely than those which areincised. Symptoms of concussion would favour the theory of the injuryhaving been inflicted by a heavy instrument. Again, it is oftendifficult to decide whether the injury which caused death was the resultof a blow or a fall. A heavy blow with a stick may at once cause fataleffusion of blood, but this might equally result from fracture of theskull resulting from a fall. The wound should be carefully examined forforeign bodies, such as grit, dirt, or sand. The distinction betweenincised wounds inflicted during life and after death is found in thefact that a wound inflicted during life presents the appearances alreadydescribed, whereas in a post-mortem incised wound only a small quantityof liquid venous blood is effused; the edges are close, yielding, inelastic; the blood is not effused into the cellular tissue, and thereare no signs of vital reaction. The presence of inflammatory reaction orpus shows that the wound must have been inflicted some time beforedeath, probably two or three days. 

_Self-inflicted wounds_ are made by the person himself in order todivert suspicion, or in order to bring accusation against another. Suchwounds are always in front, not over vital organs, and superficial incharacter. Note the condition of the clothes in such cases. 

XIII. --GUNSHOT WOUNDS

These may be punctured, contused, or lacerated. Round balls make alarger opening than those which are conical. Small shot fired at a shortdistance make one large ragged opening; while at distances greater than3 feet the shot scatter and there is no central opening. The Lee-Metfordbullet is more destructive than the Mauser. The former is the larger, but the difference in size is not great. The Martini-Henry bulletweighs 480 grains, the Lee-Metford 215, and the Mauser 173. Speakinggenerally, a gunshot wound, unlike a punctured wound, becomes larger asit increases in depth; the aperture of entrance is round, clean, withinverted edges, and that of exit larger, less regular than that ofentrance, and with everted edges. 

In the case of high-velocity bullets from smooth-bore rifles, includingthe Mauser and Lee-Metford, the aperture of entry is small; the apertureof exit is slightly larger, and tends to be more slit-like. There is butlittle tendency to carry in portions of clothing or septic material, andthe wound heals by first intention, if reasonable precautions be taken. The external cicatrices finally look very similar to those produced bybad acne pustules. 

The contents of all gunshot wounds should be preserved, as they may beuseful in evidence. A pocket revolver, as a rule, leaves the bullet inthe body. 

Wounds inflicted by firearms may be due to accident, homicide, orsuicide. Blackening of the wound, singeing of the hair, scorching of theskin and clothing, show that the weapon was fired at close quarters, whilst blackening of the hand points to suicide. Even when the weapon isfired quite close there may be no blackening of the skin, and the handis not always blackened in cases of suicide. Smokeless powder does notblacken the skin. Wounds on the back of the body are not usuallyself-inflicted, but a suicide may elect to blow off the back of hishead. A wound in the back may be met with in a sportsman who indulges inthe careless habit of dragging a loaded gun after him. If a revolver isfound tightly grasped in the hand it is probably a case of suicide, whilst if it lies lightly in the hand it may be suicide or homicide. Ifno weapon is found near the body, it is not conclusive proof that it isnot suicide, for it may have been thrown into a river or pond, or tosome distance and picked up by a passer-by. 

A bullet penetrating the skull even from a distance of 3, 000 yards mayact as an explosive, scattering the contents in all directions; but thebullet from a revolver will usually be found in the cranium. 

The prognosis depends partly on the extent of the injury and the partsinvolved, but there is also risk from secondary hæmorrhage, and fromsuch complications as pleurisy, pericarditis, and peritonitis. Death mayresult from shock, hæmorrhage, injury to brain or important nervousstructures. 

XIV. --WOUNDS OF VARIOUS PARTS OF THE BODY

1. =Of the Head. =--Wounds of the scalp are likely to be followed by (1)erysipelatous inflammation; (2) inflammation of the tendinousstructures, with or without suppuration. A severe blow on the vertex maycause fracture of the base of the skull. Injuries of the brain includeconcussion, compression, wounds, contusion, and inflammation. Concussionis a common effect of blows or violent shocks, and the symptoms followimmediately on the accident, death sometimes taking place withoutreaction. Compression may be caused by depressed bone or effused blood(rupture of middle meningeal artery) and serum. The symptoms may come onsuddenly or gradually. Wounds of the brain present very greatdifficulties, and vary greatly in their effect, very slight woundsproducing severe symptoms, and _vice versâ_. A person may receive aninjury to the head, recover from the first effects, and then die withall the symptoms of compression from internal hæmorrhage. This is due tothe fact that the primary syncope arrests the hæmorrhage, which returnsduring the subsequent reaction, or on the occurrence of any excitement. Inflammation of the meninges or brain may follow injuries, not only tothe brain itself, but to the scalp and adjacent parts, as the orbit andear. Inflammation does not usually come on at once, but after variableperiods. 

2. =Injuries to the Spinal Cord= may be due to concussion, compression(fracture-dislocation), or wounds. That the wound has penetrated themeninges is shown by the escape of cerebro-spinal fluid. The cord andnerves may be injured (1) by the puncture; (2) by extravasation of bloodand the formation of a clot; and (3) by subsequent septic inflammation. Division or complete compression of the cord at or above the level ofthe fourth cervical vertebra is immediately fatal (as happens injudicial hanging). When the injury is below the fourth, the diaphragmcontinues forcibly in action, but the lungs are imperfectly expanded, and life will not be maintained for more than a day or two. When theinjury is in the dorsal region, there is paralysis of the legs and ofthe sphincters of the bladder and rectum, but power is retained in thearms and the upper intercostal muscles act, the extent of paralysisdepending on the level of the lesion. In injuries to the lumbar regionthe legs may be partly paralysed, and the rectal and bladder sphinctersmay be involved. 

_Railway spine_, or traumatic neurasthenia, may be set up by concussionof the cord as a result of blows or falls. Passengers after railwayaccidents, or miners, often suffer from this affection. 

3. =Of the Face. =--These produce great disfigurement and inconvenience, and there is a risk of injury to the brain. The seventh nerve may beinvolved, giving rise to facial paralysis. Punctured wounds of the orbitare especially dangerous. Wounds apparently confined to the externalparts often conceal deep-seated mischief. 

4. =Of the Eye. =--The iris may be injured by sharp blows, as from thecork of a soda-water bottle. It is usually followed by hæmorrhage intothe anterior chamber, and there may be separation of the iris from itsciliary border. Wounds at the edge of the cornea are often followed byprolapse of the iris. Acute traumatic iritis or irido-cyclitis maysupervene four or five days after the injury. The lens is frequentlywounded in addition to the cornea and iris. In dislocation of the lensinto the anterior chamber as the result of a blow, the lens appears likea large drop of oil lying at the back of the cornea, the marginexhibiting a brilliant yellow reflex. Partial dislocations of the lensas the result of severe blows generally terminate in cataract. 

5. =Of the Throat. =--Very frequently inflicted by suicides. Division ofthe carotid artery is fatal, and of the internal jugular vein verydangerous on account of entrance of air. Wounds of the larynx andtrachea are not necessarily or immediately dangerous, but septicpneumonia is very apt to follow. Wounds of the throat inflicted bysuicides are commonly situated at the upper part, involving the hyoidbone and the thyroid and cricoid cartilages. The larynx is opened, butthe large vessels often escape. In most suicidal wounds of the throatthe direction is from left to right, the incision being slightlyinclined from above downwards. At the termination of a suicidalcut-throat the skin is the last structure divided, the wound beingshallower as it reaches its termination; the wounds often showparallelism. The weapon is often firmly grasped in the hand. Inquiryshould be made as to whether the patient is right or left handed, orambidextrous. 

Homicidal cut throat is usually very severe and situated low down in theneck or far to the side. 

6. =Of the Chest. =--Incised wounds of the walls are not of necessitydangerous; but severe blows, by causing fracture of the bones andinternal injuries, are often fatal. The symptoms of penetrating woundsof the chest are--(1) The passage of blood and air through the wound;(2) hæmoptysis; (3) pneumothorax; and (4) protrusion of the lung forminga tumour covered with pleura. Fracture of the ribs may be due to directviolence, as from a blow, when the ends are driven inwards, or toindirect violence, as from a squeeze in a crowd, when the ends aredriven outwards. 

7. =Of the Lungs. =--These usually cause hæmorrhage, and are frequentlyfollowed by pleurisy, either dry or with effusion, and by pneumonia. 

8. =Of the Heart. =--Penetrating wounds are fatal from hæmorrhage, of thebase more speedily than of the apex; but life may be prolonged for sometime even after a severe wound to the heart. Injury to the rightventricle is the most fatal injury and the most frequent. Rupture fromdisease usually occurs in the left ventricle; rupture from a crush isusually towards the base and on the right side. 

9. =Of the Aorta and Pulmonary Artery. =--Fatal. 

10. =Of the Diaphragm. =--Generally fatal, owing to the severe injury ofthe other abdominal organs. If the diaphragm be ruptured, hernia of theorgans may result. 

11. =Of the Abdomen. =--Of the walls, may be dangerous from division ofthe epigastric artery; ventral hernia may follow, internal hæmorrhage, etc. Blows on the abdomen are prone to cause death from cardiacinhibition. 

12. =Of the Liver. =--May divide the large vessels. Venous blood flowsprofusely from a punctured wound of the liver. Wounds of thegall-bladder cause effusion of bile and peritoneal inflammation. Laceration of the liver may result from external violence withoutleaving any outward sign of the injury; it is commonly fatal. There israpid and acute anæmia from the pouring out of blood into the abdominalcavity. This may also occur with injuries of other organs in theabdomen. 

13. =Of the Spleen. =--Fatal hæmorrhage may result from penetratingwounds or from rupture due to kicks, blows, crushes, especially if thespleen be enlarged. 

14. =Of the Stomach. =--May be fatal from shock, from hæmorrhage, fromextravasation of contents, or from inflammation. The danger ismaterially lessened by prompt surgical intervention. 

15. =Of the Intestines. =--May be fatal in the same way as those of thestomach. More dangerous in the small than in the large intestines. 

16. =Of the Kidneys. =--May prove fatal from hæmorrhage, extravasation ofurine, or inflammation. 

17. =Of the Bladder. =--Dangerous from extravasation of urine. Infracture of the pelvis the bladder is often injured, and extraperitonealinfiltration of urine occurs, with frequently a fatal issue. 

18. =Of Genital Organs. =--Incised wounds of penis may produce fatalhæmorrhage. Removal of testicles may prove fatal from shock to nervoussystem. Wounds of the spermatic cord may be dangerous from hæmorrhage. Wounds to the vulva are dangerous, owing to hæmorrhage from the largeplexus of veins without valves. 

XV. --DETECTION OF BLOOD-STAINS, ETC. 

Stains may require detection on clothing, on cutting instruments, onfloors and furniture, etc. The following are the distinctive charactersof blood-stains:

(a) =Ocular Inspection. =--Blood-stains on dark-coloured materials, whichin daylight might be easily overlooked, may be readily detected by theuse of artificial light, as that of a candle, brought near the cloth. Blood-spots when recent are of a bright red colour if arterial, of apurple hue if venous, the latter becoming brighter on exposure to theair. After a few hours blood-stains assume a reddish-brown or chocolatetint, which they maintain for years. This change is due to theconversion of hæmoglobin into methæmoglobin, and finally into hæmatin. The change of colour in warm weather usually occurs in less thantwenty-four hours. The colour is determined, not entirely by the age ofthe stain, but is influenced by the presence or absence of impuritiesin the air, such as the vapours of sulphurous, sulphuric, andhydrochloric acids. If recent, a jelly-like material may be seen by theaid of a magnifying-glass lying between the fibres. If old, acinnabar-red streak is seen on drawing a needle across the stain. 

(b) =Microscopic Demonstration. =--With the aid of the microscope, bloodmay be detected by the presence of the characteristic blood-corpuscles. The human blood-corpuscle is a non-nucleated, biconcave disc, having adiameter of about 1/3500 of an inch. All mammalian red corpuscles havethe same shape, except those of the camel, which are oval. Thecorpuscles of birds, fishes, reptiles, and amphibians, are oval andnucleated. The corpuscles of most mammals are smaller than those of man, but the size of a corpuscle is affected by various circumstances, suchas drying or moisture, so that the medical witness is rarely justifiedin going farther than stating whether the stain is that of the blood ofa mammal or not. Unfortunately, the corpuscles are usually so dried thatlittle information regarding their size can be given. 

(c) =Action of Water. =--Water has a solvent action on blood, freshstains rapidly dissolving when the material on which they occur isplaced in cold distilled water, forming a bright red solution. Thehæmatin of old stains dissolves very slowly, so employ a weak solutionof ammonia, and this will give a solution of alkaline hæmatin. Rust isnot soluble in water. 

(d) =Action of Heat. =--Blood-stains on knives may be removed by heatingthe metal, when the blood will peel off, at once distinguishing it fromrust. Should the blood-stain on the metal be long exposed to the air, rust may be mixed with the blood, when the test will fail. The solutionobtained in water is coagulated by heat, the colour entirely destroyed, and a flocculent muddy-brown precipitate formed. 

(e) =Action of Caustic Potash. =--The solution of blood obtained in wateris boiled, when a coagulum is formed soluble in hot caustic potash, thesolution formed being greenish by transmitted and red by reflectedlight. 

(f) =Action of Nitric Acid. =--Nitric acid added to a watery solutionproduces a whitish-grey precipitate. 

(g) =Action of Guaiacum. =--Tincture of guaiacum produces in the waterysolution a reddish-white precipitate of the resin, but on addition of anaqueous solution of peroxide of hydrogen, or of an ethereal solution ofthe same substance (known as _ozonic ether_), a blue or bluish-greencolour is developed. This test is delicate, and succeeds best in dilutesolutions. It is not absolutely indicative of the presence of blood, fortincture of guaiacum is coloured blue by milk, saliva, and pus. 

(h) =Hæmin Crystals (Teichman's Crystals). =--These are produced byheating a drop of blood, or a watery solution of it, with a minutecrystal of sodium chloride on a glass slide and evaporating to dryness. A cover-glass is placed over this, and a drop of glacial acetic acidallowed to run in. It is again heated until bubbles appear. Crystals ofhæmin may now be detected by the microscope. They are dark brown oryellow rhombic prisms. 

An improvement on this test is the use of formic acid alone; on slowlyevaporating it, numerous very small dark crystals are visible ifhæmoglobin has been present (Whitney's test). 

(i) =Spectroscopic Appearances. =--If a solution of a recent stain beexamined by the spectroscope, we get two absorption bands situatedbetween the lines D and E, the one nearer E being doubly as broad as theother. These bands indicate _oxyhæmoglobin_. 

If we now add a little ammonium sulphide to this solution, we get thespectrum of _reduced hæmoglobin_, which is a single broad absorptionband situated in the interval between the preceding oxyhæmoglobinbands. By shaking the solution, oxyhæmoglobin is again reproduced, andgives its special absorption bands. 

If ammonia be added to the original solution, _alkaline hæmatin_ isproduced, or if acetic acid be chosen, _acid hæmatin_ is produced, andeach gives its appropriate absorption bands. 

_Methæmoglobin_ is formed in stains which have been exposed to the airfor a few days, and _hæmatin_ is found in old stains. _Hæmochromogen_gives a very characteristic spectrum, and is obtained by reducingalkaline hæmatin by ammonium sulphide. _Carbon monoxide hæmoglobin_gives a spectrum which resembles that of oxyhæmoglobin, but it is notreduced by ammonium sulphide. 

(j) =Precipitin Test. =--This allows us to tell whether the blood is froma human being or not. A specific serum must be obtained from a rabbitwhich is sensitized as follows: 10 c. C. Of human blood is injected intoits peritoneal cavity at intervals, until from three to five injectionshave been given. The serum of this animal's blood will then give a whiteprecipitate only when brought into contact with dilute solutions ofhuman blood, but with the blood of no other animal. This is known alsoas the 'biologic, ' or Uhlenhuth's test. 

=Rust Stains. =--These are yellowish-red in colour, and do not stiffenthe cloth. The iron may be dissolved by placing the stain in a dilutesolution of hydrochloric acid, when, on adding ferrocyanide ofpotassium, Prussian blue is produced. 

=Fruit Stains= are seldom so dark as blood-stains. Solutions of these donot change colour or coagulate on boiling; ammonia changes the colour toblue or green; acid brightens the original colour, while chlorinebleaches it. 

=Hairs. =--Human hairs must be identified and distinguished from those ofthe lower mammals. If the hair has been pulled out from the root, themicroscope will show that the bulbous root has a concave surface whichfitted over the hair papilla, or that the root is encased in a fattysheath. 

=Fibres of Clothing. =--Microscopically, wool fibres are coarse, curly, and striated transversely; cotton fibres appear as flattened bandstwisted into spirals; linen fibres are round, jointed at frequentintervals, with small root-like filaments; silk fibres are solid, continuous, and highly glistening. 

XVI. --DEATH BY SUFFOCATION

_Signs and Symptoms. _--There are usually three stages:

1. Exaggerated respiratory activity; air hunger; anxiety; congestedappearance of face; ringing in ears. 

2. Loss of consciousness; convulsions; relaxation of sphincters. 

3. Respirations feeble and gasping, and soon cease; convulsions ofstretching character; heart continues to beat for three to four minutesafter breathing ceases. 

_Post-Mortem Appearances--External. _--Cadaveric lividity well marked;nose, lips, ears, finger-tips almost black in colour; appearance may beplacid or, if asphyxia has been sudden, the tongue may be protruded andeyeballs prominent, with much bloody mucus escaping from mouth and nose. 

_Internal. _--The blood is dark and remains fluid; great engorgement ofvenous system, right side of heart, great veins of thorax and abdomen, liver, spleen, etc. Lungs dark purple in colour; much bloody frothescapes on squeezing them; mucous lining of trachea and bronchicongested and bright red in colour; air-cells distended or ruptured;many small hæmorrhages on surface of lungs and other organs, as well asin their substance (_Tardieu's spots_), due to rupture of venouscapillaries from increased vascular pressure. 

XVII. --DEATH BY HANGING

In hanging, death occurs by asphyxia, as in drowning. Sensibility issoon lost, and death takes place in four or five minutes. The eyes insome cases are brilliant and staring, tongue swollen and livid, blood orbloody froth is found about the mouth and nostrils, and the hands areclenched. In other cases the countenance is placid, with an almostentire absence of the signs just given. The mark on the neck, which maybe more or less interrupted by the beard, shows the course of the cord, which in hanging is obliquely round the neck following the line of thejaw, but straight round in strangulation. In judicial hanging, death isnot due to asphyxiation, but, owing to the long drop, the cervicalvertebræ are dislocated, and the spinal cord injured so high up thatalmost instant death takes place. On dissection the muscles andligaments of the windpipe may be found stretched, bruised, or torn, andthe inner coats of the carotid arteries are sometimes found divided. Inordinary suicidal hanging there may be entire absence of injury to thesoft parts about the neck, the length of the drop modifying theseappearances. The mark of the cord is not a sign of hanging, is a purelycadaveric phenomenon, and may be produced some hours after death. 

XVIII. --DEATH BY STRANGULATION

This differs from hanging in that the body is not suspended. It may beeffected by a ligature round the neck, or by direct pressure on thewindpipe with the hand, in which case death is said to be caused by_throttling_. Strangulation is frequently suicidal, but may beaccidental. When homicidal, much injury is done to the neck, owing tothe force with which the ligature is drawn. In throttling, the marks ofthe finger-nails are found on the neck. 

XIX. --DEATH BY DROWNING

Death by drowning occurs when breathing is arrested by watery orsemi-fluid substances--blood, urine, etc. The fluid acts mechanically byentering the air-cells of the lung and preventing the due oxidation ofthe blood. The post-mortem appearances include those usually present indeath by asphyxia, together with the following, peculiar to death bydrowning: Excoriations of the fingers, with sand or mud under the nails;fragments of plants grasped in the hand; water in the stomach (this is avital act, and shows that the person fell into the water alive); finefroth at the mouth and nostrils; cutis anserina; retraction of penis andscrotum. On post-mortem examination, the lungs are found to be increasedin size ('ballooned'); on section, froth, water mud, sand, in air-tubes. The presence of this fine (often blood-stained) froth is the mostcharacteristic sign of drowning. Froth like that of soap-suds in thetrachea is an indication of a vital act, and must not be mistaken forthe tenacious mucus of bronchitis. The presence of vomited matters inthe trachea and bronchi is a valuable sign of drowning. The bloodcollects in the venous system, and is dark and fluid. Tardieu's spotsare not so frequently met with in cases of drowning as in other forms ofasphyxia. The other signs of death by asphyxia are present. Wounds maybe present on the body, due to falling on stakes, injuries from passingvessels, etc. 

The methods of performing artificial respiration in the case of theapparently drowned are the following (the best and most easily performedis Schäfer's prone pressure method):

1. _Schäfer's. _--Place the patient on his face, with a folded coat underthe lower part of the chest. Unfasten the collar and neckband. Go towork at once. Kneel over him athwart or on one side facing his head. Place your hands flat over the lower part of his back, and makepressure on his ribs on both sides, and throw the weight of your body onto them so as to squeeze out the air from his chest. Get back intoposition at once, but leave your hands as they were. Do this every fiveseconds, and get someone to time you with a watch. Keep this going forhalf an hour, and when you are tired get someone to relieve you. 

Other people may apply hot flannels to the limbs and hot water to thefeet. Hypodermic injections of 1/50 grain of atropine, suprarenal orpituitary extracts, may be found useful. 

2. _Silvester's. _--In this method the capacity of the chest is increasedby raising the arms above the head, holding them by the elbows, and thusdragging upon and elevating the ribs, the chest being emptied bylowering the arms against the sides of the chest and exerting lateralpressure on the thorax. The patient is in the supine position--but firstthe water must have been drained from the mouth and nose by keeping thebody in the prone position. The tongue must be kept forward bytransfixing with a pin. 

3. _Marshall Hall's. _--This consists in placing the patient in the proneposition, with a folded coat under the chest, and rolling the bodyalternately into the lateral and prone positions. 

4. _Howard's. _--This consists in emptying the thorax by forciblycompressing the lower part of the chest; on relaxing the pressure thechest again fills with air. Here the patient is placed in the supineposition. 

The objections to the supine position are that the tongue falls back, and not only blocks the entrance of air, but prevents the escape ofwater, mucus, and froth from the air-passages. 

5. _Laborde's Method. _--This consists in holding the tongue by means ofa handkerchief, and rhythmically drawing it out fully at the rate offifteen times per minute. This excites the respiratory centre, and thismethod may be employed along with any of the other methods. 

XX. --DEATH FROM STARVATION

The post-mortem appearances in death from starvation are as follows:There is marked general emaciation; the skin is dry, shrivelled, andcovered with a brown, bad-smelling excretion; the muscles soft, atrophied, and free from fat; the liver is small, but the gall-bladderis distended with bile. The heart, lungs, and internal organs areshrivelled and bloodless. The stomach is sometimes quite healthy; inother cases it may be collapsed, empty, and ulcerated. The intestinesare also contracted, empty, and translucent. 

In the absence of any disease productive of extreme emaciation (_e. G. _, tuberculosis, stricture of oesophagus, diabetes, Addison's disease), such a state of body will furnish a strong presumption of death bystarvation. 

In the case of children there is not always absolute deprivation offood, but what is supplied is insufficient in quantity or of improperquality. The defence commonly set up is that the child died either ofmarasmus or of tuberculosis. 

In cases where it is alleged that a child has been starved and ill-used, one must examine the body for signs of neglect--_e. G. _, dirtiness ofskin and hair, presence of vermin, bruises or skin eruptions. Compareits weight with a normal child of the same age and sex. If thedisproportion be great and signs of neglect present, then theprobability is great (provided there be no actual disease present) thatthe child has been starved. 

XXI. --DEATH FROM LIGHTNING AND ELECTRICITY

The signs of death from lightning vary greatly. In some cases there areno signs; in others the body may be most curiously marked. Wounds ofvarious characters--contused, lacerated, and punctured--may beproduced. There may be burns, vesications, and ecchymoses; arborescentmarkings are not uncommon. The hair may be singed or burnt and theclothing damaged. Rigor mortis is very rapid in its onset and transient. Post mortem there are no characteristic signs, but the blood may be darkin colour and fluid. The presence or absence of a storm may assist thediagnosis. 

Injuries by electrical currents of high pressure are not uncommon;speaking generally, 1, 000 to 2, 000 volts will kill. In America, whereelectricity is adopted as the official means of destroying criminals, 1, 500 volts is regarded as the lethal dose, but there are many instancesof persons having been exposed to higher voltages without bad effects. The alternating current is supposed to be more fatal than thecontinuous. Much depends on whether the contact is good (perspiringhands or damp clothes). Death has been attributed in these cases torespiratory arrest or sudden cessation of the heart's action. The besttreatment is artificial respiration, but the inhalation of nitrite ofamyl may prove useful. Rescuers must be careful that they, also, do notreceive a shock. The patient should be handled with india-rubber glovesor through a blanket thrown over him. 

XXII. --DEATH FROM COLD OR HEAT

=Cold. =--The weak, aged, or infants, readily succumb to lowtemperatures. The symptoms are increasing lassitude, drowsiness, coma, with sometimes illusions of sight. Post mortem, bright red patches arefound on the skin surface, and the blood remains fluid for long. 

=Heat. =--Death may result from syncope, the result of exposure to greatheat. 

=Sunstroke. =--The person loses consciousness and falls down insensible;the body temperature may be 112° F. , the pulse is full, and a peculiarpungent odour is given off from the skin. Coma, convulsions with(rarely) delirium, may precede death. _Treatment_ consists in loweringthe body temperature by application of cold cloths, stimulants, strychnine or digitalin hypodermically. 

XXIII. --PREGNANCY

The signs of the existence of pregnancy are of two kinds, uncertain andcertain, or maternal and foetal. Amongst the former class areincluded--Cessation of menstruation (which may occur without pregnancy);morning vomiting; salivation; enlargement of the breasts and of theabdomen; quickening. It must be borne in mind that every woman with abig abdomen is not necessarily pregnant. The tests which affordconclusive evidence of the existence of a foetus in the uterusare--Ballottement, the uterine souffle, intermittent uterinecontractions, foetal movements, and, above all, the pulsation of thefoetal heart. The uterine souffle is synchronous with the maternalpulse; the foetal heart is not, being about 120 beats per minute. 

Evidence of pregnancy may also be afforded by the discharge from theuterus of an early ovum, of moles, hydatids, etc. Disease of the uterusand ovarian dropsy may be mistaken for pregnancy. Careful examination isnecessary to determine the nature of the condition present. Pregnancymay be pleaded in bar of immediate capital punishment, in which case thewoman must be shown to be 'quick with child. ' A woman may also pleadpregnancy to delay her trial in Scotland, and both in England andScotland, in civil cases, to produce a successor to estates, to increasedamages for seduction, in compensation cases where a husband has beenkilled, to obtain increased damages, etc. A woman may become pregnantwithin a month of her last delivery. 

In cases of rape and suspected pregnancy, it must be borne in mind thata medical man who examines a woman under any circumstances against herwill renders himself liable to heavy damages, and that the law will notsupport him in so doing. If, on being requested to permit anexamination, the woman refuse, such refusal may go against her, but ofthis she is the best judge. The duty of the medical man ends on makingthe suggestion. 

XXIV. --DELIVERY

The signs of recent delivery are as follows: The face is pale, with darkcircles round the eyes; the pulse quickened; the skin soft, warm, andcovered with a peculiar sweat; the breasts full, tense, and knotty; theabdomen distended, its integuments relaxed, with irregular light pinkstreaks on the lower part. The labia and vagina show signs of distensionand injury. For the first three or four days there is a discharge fromthe uterus more or less sanguineous in character, consisting of blood, mucus, epithelium, and shreds of membrane. During the next four or fivedays it becomes of a dirty green colour, and in a few days more of ayellowish, milky, mucous character, continuing for two to three weeks. The change in character of the lochial discharge is due to the quantityof blood decreasing and its place being taken by fatty granules andleucocytes. The os uteri is soft, patulous, and its edges are torn. Theuterus may be felt for two or three hours above the pubis as a hardround ball, regaining its normal size in about eight weeks afterdelivery. Most of these signs disappear about the tenth day, after whichit becomes impossible to fix the date of delivery. 

In the dead the external parts have the same appearance as given above. The uterus will vary in appearance according to the time elapsed sincedelivery. If death occurred immediately after delivery, the uterus willbe wide open, about 9 or 10 inches long, with clots of blood inside, andthe inner surface lined by decidua. 

The signs of a previous delivery consist in silvery streaks in the skinof the abdomen, which, however, may be due to distension from othercauses; similar marks on the breast; circular and jagged condition ofthe os uteri (the virgin os being oval and smooth); marks of rupture ofthe perineum or fourchette; absence of the vaginal rugæ; dark-colouredareola round the nipples, etc. The difference between the virgin _corpusluteum_ and that of recent pregnancy is not so marked as to justify aconfident use of it for medico-legal purposes. 

XXV. --FOETICIDE, OR CRIMINAL ABORTION

This consists in giving to any woman, or causing to be taken by her, with intent to procure her miscarriage, any poison or other noxiousthing, or using for the same purpose any instruments or other meanswhatsoever. It is a felony to procure or attempt to procure themiscarriage of a woman, whether she be pregnant or not, and it is afelony for the woman, if pregnant, to attempt to procure her ownmiscarriage. It is a misdemeanour for any person or persons to procuredrugs or instruments for a like purpose. It is not necessary that thewoman be _quick_ with child. The offence is the intent to procure themiscarriage of any woman, _whether she be or be not with child_. Whenfrom any causes it is necessary to procure abortion, a medical manshould do so only after consultation with a brother practitioner. Evenin these cases there is no exemption legally. Any medical man who giveseven the most harmless medicine where he suspects the possibility ofpregnancy may render himself liable to grave suspicion should the womanabort. 

In medicine, an _abortion_ is said to occur when the foetus is expelledbefore the sixth month; after that it is _premature birth_. In law, however, any expulsion of the contents of the uterus before the fulltime is an _abortion_ or _miscarriage_. 

In deciding whether any substance expelled from the uterus is really afoetus or a mole, and therefore the result of conception, or the coat ofthe uterus, and unconnected with pregnancy, the examination of thesubstances expelled must be carefully made. Moles are blighted foetuses. An examination of the woman will be necessary, though it is not easyduring the early months of pregnancy, and especially in those who haveborne children, to say whether abortion has taken place or not. Thehistory must be inquired into; the regular or exceptional use of drugsto promote menstruation is important, for in the former case no criminalintent may exist, although pregnancy be present. The state of thebreasts, the hymen, and the os uteri, should all be carefully examined. Putting a few apparently unimportant questions as to the frequent use ofpurgatives, the presence or absence of constipation, will often assistthe diagnosis as showing that the woman has acted in an unusual manner. Abortion may be procured by the introduction of instruments, by falls, violent exercise, blows on the abdomen, etc. In the hands of ignorantpersons the use of instruments (sounds, bougies, skewers, etc. ) isattended with great danger. Perforation of the vaginal walls, bladder, cervix, or uterus, may follow their use. Septic pelvic peritonitis mayensue, and the woman may lose her life. The person who has employed suchmeans for inducing abortion is liable to be charged with the crime ofmurder. There is no evidence to show that ergot, savin, bitter-apple, pennyroyal, or any other drug administered internally, will cause awoman to abort, except when taken in such large doses that actualpoisoning results, with inflammation of the contents of the truepelvis. In such cases reflex uterine contractions may be set up, andabortion may follow. Diachylon pills are largely employed to induceabortion, and very often the woman taking them suffers severely fromlead-poisoning. 

XXVI. --INFANTICIDE

Infanticide, or the murder of a new-born child, is not treated as aspecific crime, but is tried by the same rules as in cases of felonioushomicide. The term is applied technically to those cases in which themother kills her child at, or soon after, its birth. She is often insuch a condition of mental anxiety as not to be responsible for heractions. It is usually committed with the object of concealing delivery, and to hide the fact that the girl has, in popular language, 'strayedfrom the paths of virtue. ' The child must have had a separate existence. To constitute 'live birth, ' the child must have been alive after itsbody was entirely born--that is, entirely outside the maternalpassages--and it must have had an independent circulation, though thisdoes not imply the severance of the umbilical cord. Every child is heldin law to be born dead until it has been shown to have been born alive. Killing a child in the act of birth and before it is fully born is notinfanticide, but if before birth injuries are inflicted which result indeath after birth, it is murder. Medical evidence will be called to showthat the child was born alive. 

The methods of death usually employed are--(1) Suffocation by the handor a cloth. (2) Strangulation with the hands, by a tape or ribbon, or bythe umbilical cord itself. (3) Blows on the head, or dashing the childagainst the wall. (4) Drowning by putting it in the privy or in a bucketof water. (5) Omission: by neglecting to do what is absolutely necessaryfor the newly-born child--_e. G. _, not separating the cord; allowing itto lie under the bed-clothes and be suffocated. 

With regard to the question of the maturity of a child, the differencesbetween a child of six or seven months and one at full term may bestated as follows:

Between the sixth and seventh month, length of child 10 to 14inches--that is, the length of the child after the fifth month is aboutdouble the lunar months--weight 1 to 3 pounds; skin, dusky red, coveredwith downy hair (lanugo) and sebaceous matter; membrana pupillarisdisappearing; nails not reaching to ends of fingers; meconium at upperpart of large intestine; testes near kidneys; no appearance ofconvolutions in brain; points of ossification in four divisions ofsternum. 

At nine months, length of child 18 to 22 inches; weight, 7 to 8 pounds;skin rosy; lanugo only about shoulders; sebaceous matter on the body;hair on head about an inch long; testes past inguinal ring; clitoriscovered by the labia; membrana pupillaris disappeared; nails reach toends of fingers; meconium at termination of large intestine; points ofossification in centre of cartilage at lower end of femur, about 1-1/2to 2-1/2 lines in diameter; umbilicus midway between the ensiformcartilage and pubis. 

Owing to the difficulty of proving that the crime of infanticide hasbeen committed, the woman may in England be tried for _concealment ofbirth_, and in Scotland for _concealment of pregnancy_, if she concealher pregnancy during the whole time and fail to call for assistance inthe birth. Either of these charges would only be brought against a womanwho had obviously been pregnant, and now the child is missing or itsdead body has been found. It is expected that every pregnant womanshould make provision for the child about to be born, and so should havetalked about it or have made clothes, etc. , for it. The punishment forconcealment is imprisonment for any term not exceeding two years. Thecharge of concealment is very often alternative to infanticide. Tosubstantiate the charge, however, it must be proved that there had beena _secret disposition of the dead body_ of the infant, as well as anendeavour to conceal its birth. 

A woman may be delivered of a child unconsciously, for the contractilepower of the womb is independent of volition. Under an anæsthetic theuterus acts as energetically as if the patient were in the fullpossession of her senses. 

Nowadays a woman is rarely hanged for infanticide, and it is a meretravesty of justice to pass on her the death sentence, well knowing thatit will never be executed. 

XXVII. --EVIDENCES OF LIVE BIRTH

The signs of live birth prior to respiration are negative and positive. A negative opinion may be formed when evidence is found of the childhaving undergone intra-uterine maceration. In this case the body will beflaccid and flattened; the ilia prominent; the head soft and yielding;the cuticle more or less detached, and raised into large bullæ; the skinof a red or brownish-red colour; the cavities filled with abundantbloody serum; the umbilical cord straight and flaccid. 

A positive opinion is justified when such injuries are found on the bodyas could not have been inflicted during birth, and are attended withsuch hæmorrhage as could only have occurred while the blood wascirculating. Fractures of the cranium from accidental falls (precipitatelabour) are as a rule stellate, and are situated on the vertex or in theparietal protuberance. The fractures from violence are more extensive, usually depressed, and accompanied by laceration of the scalp. 

The evidences of live birth after respiration has taken place areusually deduced from the condition of the lungs, though indications arealso found in other organs. The diaphragm is more arched before thanafter respiration, and rises higher in the thorax in the former casethan in the latter. The lungs before respiration are situated in theback of the thorax, and do not fill that cavity; they are of a dark, red-brown colour and of the consistence of liver, without mottling. After respiration they expand and occupy the whole thorax, and closelysurround the heart and thymus gland. The portions containing air are ofa light brick-red colour, and crepitate under the finger. The lungs aremottled from the presence of islands of aerated tissue, surrounded byarteries and veins. The weight of the lungs before respiration is about550 grains, after an hour's respiration 900 grains; but this test is oflittle value. The ratio of the weight of the lungs to that of the body(Ploucquet's test), which is also unreliable, is, before respiration, about 1 to 70; after, 1 to 35. Lungs in which respiration has takenplace float in water; those in which it has not, sink. There areexceptions to this rule, on which, however, is founded the _hydrostatictest_. As originally performed, this test consisted merely in placingthe lungs, with or without the heart, in water, and noticing whetherthey sank or floated. The test is now modified by squeezing, and bycutting the lungs up into pieces. 

The objections to the test as originally performed are--(1) That thelungs may sink as the result of disease--_e. G. _, double pneumonia. (2)That respiration may have been so limited in extent that the lungs maysink, owing to large portions of lung tissue remaining unexpanded(_atelectasis_). (3) Putrefaction may cause the lungs to float whenrespiration has not taken place. (4) The lungs may have been inflatedartificially. Few of these objections apply, however, when thehydrostatic test, modified by pressure, is employed. To take theseobjections in detail, it may be stated: (1) If the lungs sink fromdisease, the question of live birth is answered. (2) This objection istoo refined for practical use. The lungs sink, there is an absence ofany of the signs of suffocation, and the matter ends. The examiner hasonly to describe the conditions which he finds, and is not required toindulge in conjectures as to the amount of respiration which may or maynot have taken place. (3) Gas due to putrefaction collects under thepleural membrane, and can be expelled by pressure, and is not found inthe air cells. The lungs decompose late, hence in a fresh bodyputrefaction of the lungs is absent; in a putrefied child, if the lungssink, it must have been stillborn. The so-called _emphysema pulmonumneonatorum_ is simply incipient putrefaction. 

The lung test simply shows that the child has breathed, but affords noproof that the child has been born alive. The child may have breathed assoon as its head protruded, the rest of the body being in the maternalpassages. The child is not born alive until it has been completelyexpelled, although it is not necessary that the umbilical cord shouldhave been cut. 

In addition to these tests, live birth may be suspected from thefollowing conditions: The _stomach_ may contain milk or food, recognizedby the microscope and by Trommer's test for sugar; the _largeintestines_ in stillborn children are filled with meconium, in thoseborn alive they are usually empty; the _bladder_ is generally emptiedsoon after birth; the _skin_ is in a condition of exfoliation soon afterbirth. The _organs of circulation_ undergo the following changes afterbirth, and the extent to which these changes have advanced will give anidea of how long the child has lived: The _ductus arteriosus_ begins tocontract within a few seconds of birth; at the end of a week it is aboutthe size of a crow quill, and about the tenth day is obliterated. The_umbilical arteries and vein_: the arteries are remarkably diminished incalibre at the end of twenty-four hours, and obliterated almost up tothe iliacs in three days; the umbilical vein and the ductus venosus aregenerally completely contracted by the fifth day. The _foramen ovale_becomes obliterated at extremely variable periods, and may continue openeven in the adult. 

Importance of late has been attached to the _stomach-bowel test_. If thestomach and duodenum contain air, and consequently float in water, thechances are that the child did not die immediately after birth; this isknown as Breslau's second life test, and the lower the air in theintestinal canal, the greater is the probability that the child survivedbirth. 

The umbilical cord in a new-born child is fresh, firm, round, and bluishin colour; blood is contained in its vessels. The cord may be rupturedby the child falling from the maternal parts in a precipitate labour, and the ruptured parts present ragged ends. It is seldom that a childbleeds to death from an untied or cut umbilical cord, and the chances ina torn cord are still more remote. The changes in the cord are asfollows: First it shrinks from the ligature towards the navel; thischange may begin early, and is rarely delayed beyond thirty hours; thecord becomes flabby, and there is a distinct inflammatory circle roundits insertion. The next change is that of desiccation or mummification;the cord becomes reddish-brown, then flattened and shrivelled, thentranslucent and of the colour of parchment, and falls off about thefifth day. The third stage, that of cicatrization, then ensues about thetenth to the twelfth day. The bright red rim round the insertion of thecord, with inflammatory thickening and slight purulent secretion, may beconsidered as evidence of live birth, and the stage at which theseparation of the cord by ulcerative process has arrived will point tothe probable duration of time the child has existed after birth. 

There are many fallacies in the application of any of these tests, andthe whole subject bristles with difficulties. The medical witness woulddo well to exhibit a cautious reserve, for if the child dies immediatelyafter birth it is almost impossible to prove that it was born alive. 

XXVIII. --CAUSE OF DEATH IN THE FOETUS

The death of the foetus may be due to--(1) Immaturity or intra-uterinemalnutrition, or simply from deficient vitality; (2) complicationsoccurring during or immediately after birth, which may either beunavoidable or inherent in the process of parturition, or may be inducedwith criminal intent. 

In the latter category come such accidents as the pressure of tumours inthe pelvic passages, or disease of the bones in the mother, or pressureon the cord from malposition of the child during labour, asphyxiationfrom the funis being twisted tightly round the neck or limbs, or frominjuries due to falls on the floor in sudden labours. Where the death ofthe foetus has been induced with criminal intent, it may be due topunctured wounds of the fontanelles, orbits, heart, or spinal marrow;dislocation of the neck; separation of the head from the body; fractureof the bones of the head and face; strangulation; suffocation; drowningin the closet pan or privy, or from being thrown into water. 

Under the head of infanticide by _commission_, we have injuries of allkinds; under infanticide by _omission_, neglecting to tie the cord, allowing it to be suffocated by discharges in the bed, neglect toprovide food, clothes, and warmth, for the new-born child. 

XXIX. --DURATION OF PREGNANCY

The natural period of gestation is considered as forty weeks, ten lunarmonths, or 280 days. A medical witness would have to admit thepossibility of gestation being prolonged to 300 days, and if this timewere not very materially exceeded it would be well to give the womanthe benefit of the doubt. It may be mentioned that 300 days is theextreme limit fixed by the French and Scottish law. No fixed period isassigned in English or American law to the duration of pregnancy, thoughit is allowed that utero-gestation may be greatly prolonged. In a recentcase decided, the Lord Chancellor accepted a case where it was allegedpregnancy had extended to 331 days. A child only five months old maylive, for a short time at all events. There is considerable difficultyin many cases in fixing the date of conception. The data from which itis calculated are the following: (1) _Peculiar sensations attendingconception_, which are not sufficiently defined to be recognized bythose conceiving for the first time. (2) _Cessation of the catamenia. _Other causes may, however, cause this; and, on the other hand, a womanmay menstruate during the whole period of her pregnancy. This datum alsogives a variable period, and may involve an error of several days or amonth, for the menses may be arrested by cold, etc. , at one monthlyperiod, and the woman become pregnant before the next. (3) _The periodof quickening. _ This, when perceived (which is not always the case), also occurs at variable periods from the tenth to the twenty-sixth week. (4) _A single coitus. _ This does not, however, correspond to the time offertilization. Several days may elapse before the spermatozoa meet withan ovum and fertilize it. 

In Scotland a child born six months after marriage is legitimate, whichis allowing an ample margin. 

XXX. --VIABILITY OF CHILDREN

A child may be born alive, but may not be viable, by which is meant thatit is not endowed with a capacity of maintaining its life. Speakinggenerally, 180 days represents the lowest limit at which a child isviable, but prolonged survival under these circumstances is theexception. Many cases, however, have been recorded in which childrenborn at six months have been reared. The signs of immaturity andmaturity may be thus tabulated:

 IMMATURITY. MATURITY. 

Centre of body high; head Strong movements and cries as soondisproportionate in size; membrana as born; body clear, red colour, pupillaris present; testicles coated with sebaceous matter; mouth, undescended; deep red colour of nostrils, eyelids, and ears, open;parts of generation; intense red skull somewhat firm, and fontanellescolour, mottled appearance, and not far apart; hair, eyebrows, anddowny covering, of skin; nails not nails, perfectly developed;formed; feeble movements; testicles descended; free dischargeinability to suck; necessity for of urine and meconium; power ofartificial heat; almost unbroken suction, indicated by seizure on thesleep; rare and imperfect nipple or a finger placed in thedischarges of urine and meconium; mouth. Closed state of mouth, eyelids, and nostrils. 

XXXI. --LEGITIMACY

A child born in wedlock is presumed to have the mother's husband for itsfather. This may, however, be open to question upon the followinggrounds: Absence or death of the reputed father; impotence or disease inthe husband preventing matrimonial intercourse; premature delivery in anewly-married woman; want of access; and the marriage of the woman againimmediately on the death of her husband. In the last case, where eitherhusband might have been the father, the child at the age of twenty-oneis at liberty to select its father from the possible pair. 

A child born of parents before marriage is in Scotland renderedlegitimate by their subsequent marriage, but in England the offspringremains illegitimate whether the parents marry or not after its birth. The offspring of voidable or invalid marriages may be made legitimateby application to the courts. 

There is a difference between being legitimate and lawfully begotten. Achild born in wedlock is legitimate, but if the parents were marriedonly a week previously it could not have been lawfully begotten. 

The Acts and rulings relating to Marriage and Legitimacy are extremelycomplicated. It is not putting it too strongly to say that a very largenumber of people in this country who believe themselves to be legallymarried are not married at all, and that thousands of children who havenot the slightest doubt as to their legitimacy are in the eyes of thelaw bastards. 

XXXII. --SUPERFOETATION

By superfoetation is meant the conception, by a woman already pregnant, of a second embryo, resulting in the birth of two children at the sametime, differing much in their degree of maturity, or in two separatebirths, with a considerable interval between. The possibility of theoccurrence of superfoetation has been doubted, but there arewell-authenticated cases which countenance the theory of a doubleconception. It has been shown that the os uteri is not closed, as wasonce supposed, immediately _on conception_. Should an ovum escape intothe uterus, it may become impregnated a month or so after a previousconception. The most probable explanation is that the case has been oneof twins, one being born prematurely; or, on the other hand, the uterusmay have been double, and conception may have taken place in one cornuat a later period than in the other cornu. 

XXXIII. --INHERITANCE

In order to inherit, the child must be born alive, must be born duringthe lifetime of the mother, and must be born capable of inheriting--thatis to say, monsters are incapable of inheriting. There is a mode ofinheritance called 'tenancy by courtesy. ' When a man marries a womanpossessed of an estate or inheritance, and has, by her, issue born alivein her lifetime capable of inheriting her estate, in this case he shall, on the death of his wife, hold the lands for his life as tenant by thecourtesy of England. The meaning of the words 'born alive' in thisinstance is not the same as in cases of infanticide. In Civil law anymotion of the child's body, however slight, or the fact of it havingbeen heard to cry by witnesses, is held to be sufficient proof of thechild having been born alive. It may die immediately afterwards, and itis not necessary that the child be viable. 

XXXIV. --IMPOTENCE AND STERILITY

In the male, impotence may arise from physical or mental causes. Thephysical causes may be--too great or too tender an age; malformation ofthe genital organs; _crypsorchides_, defect or disease in the testicles;constitutional disease (diabetes, neurasthenia, etc. ); or debility fromacute disease, as mumps. Masturbation, and early and excessive sexualindulgence, are also causes. The mental causes include--passion, timidity, apprehension, aversion, and disgust. The case will beremembered of the man who was impotent unless the lady were attired in ablack silk dress and high-heeled French kid boots. 

If a man is impotent when he marries, the marriage may be set aside onthe ground that it had never been consummated. The law requires that theimpotency should have existed _ab initio_--that is, beforemarriage--and should be of a permanent or incurable nature; marriage, as far as the law goes, being regarded as a contract in which it ispresupposed that both the contracting parties are capable of fulfillingall the objects of marriage. In the case of the Earl of Essex thedefendant admitted the charge as regards the Countess, but pleaded thathe was not impotent with others, as many of her waiting-maids couldtestify. When a man becomes impotent _after_ marriage, his wife mustaccept the situation, and has no redress. A man may be _sterile_ withoutbeing impotent, but the law will not take cognizance of that. The wifemay be practically impotent, but the law will not assist the husband. Hemust continue to do his best under difficult circumstances. In formertimes in case of doubt a husband was permitted to demonstrate hiscompetency in open court, but this custom is no longer regarded withfavour by the judges. 

The removal of the testicles does not of necessity render a manimpotent, although it deprives him of his procreative power. Eunuchs arecapable of affording illicit pleasure, whilst the male sopranos, or_castrati_, are often utilized for that purpose. 

In the female, impotence may be caused by the narrowness of the vagina, adhesion of the vulva, absence of vagina, imperforate hymen, and tumoursof the vagina. 

Sterility in women may occur from the above-named causes of impotence, together with absence of the uterus and ovaries, or from great debility, syphilis, constant amenorrhoea, dysmenorrhoea, or menorrhagia. 

XXXV. --RAPE

Rape is the carnal knowledge of a woman by force and against her will. The resistance of the woman _must be_ to the utmost of her power, but ifshe yield through fear or duress it is still rape. The woman is acompetent witness, but her statements may be impugned on the ground ofher previous bad character, and evidence may be called to substantiatethe charge. The perpetrator must be above the age of fourteen years. 

The definition of rape which we have given is not altogethersatisfactory. Take, for example, the case of a woman who goes to bedexpecting her husband to return at a certain hour. The lodger, let ussay, takes advantage of this fact, and, getting into bed, has connectionwith her, she not resisting, assuming all the while that it is herhusband. This is rape, but it is not 'by force, ' and it is not 'againsther will, ' but it is 'without her consent, ' as she has not been fullyinformed as to all the circumstances of the case. 

In all cases of rape in which there is no actual resistance orobjection, consent may be assumed. It is not essential that the womanshould state in so many words that she does not object. The force usedmay be moral and not physical--_e. G. _, threats, fear, horror, syncope. 

By 48 and 49 Vict. , c. 49, the carnal knowledge of a girl under thirteenis technically rape. The consent of the girl makes no difference, sinceshe is not of an age to become a consenting party. 

An attempt at carnal knowledge of a girl under thirteen is amisdemeanour. Her consent makes no difference, and even the solicitationof the act on the part of the child will not exonerate the accused. 

Intercourse with a girl between thirteen and sixteen, even with herconsent, is a misdemeanour. 

This Act is a favourite with the blackmailer. The child is sent out tosolicit, dressed like a woman, but appears in the witness-box in a muchmore juvenile costume. 

To constitute rape there must be _penetration_, but this may be of theslightest. There may be a sufficient degree of penetration to constituterape without rupturing the hymen. Proof of actual emission is nowunnecessary. 

The subject of carnal knowledge (C. K. ) or its attempt may be summed upas follows:

Under thirteen C. K. Felony. Under thirteen Attempt Misdemeanour. 

Consent no defence. 

From thirteen to sixteen C. K. Misdemeanour. From thirteen to sixteen Attempt Misdemeanour. 

Consent and even solicitation no defence. Reasonable cause to believe the girl over sixteen is a good defence. Charge must be brought within three months. 

Over sixteen C. K. With consent Nil. 

Subject to civil action for loss of girl's services by father. 

Idiot or imbecile C. K. With violence Rape. Idiot or imbecile C. K. Without violence Misdemeanour. Personation of husband Rape. 

Tacit consent no defence, for obtained by fraud. 

Married woman C. K. With consent Adultery. Mother, sister, daughter, C. K. Consent immaterial; Incest. Grand-daughter born in wedlock or notFemales Indecent assaults Misdemeanour. 

It is a misdemeanour to give to a woman any drug so as to stupefy her, and so enable any person to have unlawful connection with her. 

False charges of rape are very often made. The motive may be to extortblackmail, revenge, or mere delusion. On examining such cases bruisesare seldom found, but scratches which the woman has made on the front ofher body may be discovered, and the local injuries to the generativeorgans are slight, if present at all. 

_Physical Signs. _--In the adult the hymen may be ruptured, thefourchette lacerated, and blood found on the parts, together withscratches and other marks and signs of a struggle. In the child theremay be no hæmorrhage, but there will be indications of bruising on theexternal organs, with probably considerable laceration of the hymen, thelaceration in some cases extending into the rectum. Severe hæmorrhage, and even death, may follow the rape of a young child. The patient willhave difficulty in walking, and in passing water and fæces. After somehours the parts are very tender and swollen, and a stickygreenish-yellow discharge is present. These signs last longer inchildren than in adults; but as a rule--in the adult, at least--allsigns of rape disappear in three or four days. Young and delicatechildren may suffer from a vaginal discharge, with swelling of theexternal genitals, simulating an attempt at rape. Infantile leucorrhoeais common, and many innocent people have been exposed to danger fromfalse charges of rape on children, instituted as a means of levyingblackmail. A knowledge of these facts suggests the necessity of giving aguarded opinion when children are brought for examination in suspectedcases. Pregnancy may follow rape. 

_Seminal stains_ render the clothing stiff and greyish-yellow in colour, with translucent edges. On being moistened they give the characteristicseminal odour. 

Semen may be found on the linen of the woman and man, and will berecognized under the microscope by the presence in it of spermatozoa, minute filamentary bodies with a pear-shaped head; but it must not beforgotten that the non-detection of spermatozoa is no proof of absenceof sexual intercourse, for these bodies are not always present in thesemen of even healthy adult young men. Spermatozoa must not be mistakenfor the _Trichomonas vaginæ_ found in the vaginæ of some women. Thelatter have cilia surrounding the head, which is globular. 

_Florence's Micro-Chemical Test for Spermatic Fluid. _--If a drop of thefluid obtained by wetting a supposed spermatic stain be mixed with adrop of the following solution (KI, parts 1. 65; pure iodine, 2. 54;distilled water, 30) in a watch-glass, brownish-red pointed crystalsresembling hæmin crystals are obtained. 

_Barberio's Test. _--Mix a drop of the spermatic stain with a drop of asaturated solution of picric acid, when needle-shaped yellow rhombiccrystals are formed. 

_Gonorrhoeal Stains. _--A cover-glass preparation stained with methyleneblue reveals the gonococci lying in pairs within the leucocytes. 

XXXVI. --UNNATURAL OFFENCES

Trials for =sodomy= and =bestiality= are common at the assizes, but, asthey are rarely reported, they fail to attract attention. Sodomy is acrime both in the active and passive agent, unless the latter is anon-consenting party. The evidence of either associated may be receivedas against his colleague. If the crime is committed on a boy underfourteen, it is a felony in the active agent only. As in cases of rape, emission is not essential, and penetration, however slight, answers allpractical purposes. 

There can be no doubt that in the majority of these cases there exists acongenitally abnormal condition of the sexual instinct, theseindividuals from their childhood manifesting a perverted sexualinstinct. The man is physically a man, but psychically a woman, and_vice versâ_. The tendency nowadays is not to charge these people withthe more serious offence, but to deal with them under Section 11 of theCriminal Law Amendment Act, 1885 (48 and 49 Vict. , c. 69). This section, which is sufficiently comprehensive, runs as follows: 'Any male personwho in public or private commits or is a party to the commission, orattempts to procure the commission by any male person, of any act ofgross indecency with another male person, shall be guilty of amisdemeanour. ' The penalty is imprisonment for two years, with orwithout hard labour. It is provided by Section 4 of the same Act that aboy under sixteen may be whipped. 

=Incest. =--This crime is dealt with under the Punishment of Incest Act, 1908 (8 Edward VII. , c. 45). Carnal knowledge with mother, sister, daughter, or grand-daughter, is a misdemeanour, provided therelationship is known. It also applies to the half-brother andhalf-sister. It is equally an offence whether the relationship can orcannot be traced through lawful wedlock. Consent is no defence. A womanmay be charged under the Act if she, being above the age of sixteen, with consent permits her grandfather, father, brother, or son, to havecarnal knowledge of her. 

XXXVII. --BLACKMAILING

There are in London and every large city scores of men and women wholive by blackmailing or chantage. There are many different forms of thisindustry. There is the man who knows something about your past life, which he threatens to reveal to your friends or colleagues unless youbuy him off. There is the breach-of-promise blackmailer, and there isthe female patient, who threatens to charge you with improper conduct orindecent assault. Medical men from their position are often selected asvictims. The introduction of corridor carriages on many of our railwayshas done much to stamp out one particular form of blackmailing, butpublic urinals are still a source of danger. 

It is the worst possible policy to temporize with a blackmailer. If yougive him a single penny, you are his for life. It is as well to rememberthat it is just as criminal to attempt to extract money from a guilty asfrom an innocent person. It is of no use attempting to deal with thesecases single-handed. You must not only deny the allegation, but 'spurnthe allegator. ' Put the matter into the hands of a good sharp criminalsolicitor, and instruct him to rid you of the nuisance by takingcriminal proceedings. 

XXXVIII. --MARRIAGE AND DIVORCE

Marriage may be accomplished in many ways: (1) By the publication ofbanns; (2) by an ordinary licence; (3) by a special licence; (4) by theSuperintendent-Registrar's licence; (5) by a special licence granted bythe Archbishop of Canterbury in consideration of the payment of the sumof £25. Then, for persons having a domicile in Scotland, there is themarriage by repute. The consent of the parties, which is the essence ofthe contract, may be expressed before witnesses, and it is not requisitethat a clergyman should assist, but it is essential that the expressionsof consent must be for a matrimonial intent. 'Habit and repute'constitute good evidence, but the repute must be the general, constant, and unvarying belief of friends and neighbours. The cohabitation must bein Scotland. 

Any irregularity in the marriage ceremony or the non-observance of anyformality will not invalidate the marriage, unless it were known to boththe contracting parties. If a man were married in a wrong name thecontract would still be valid if the wife were unacquainted with thedeception at the time. If the person who officiated were a bogusclergyman, the marriage would hold good if the contracting partiessupposed him to be a properly ordained priest. In a case in which amarriage was solemnized in a building near the church at a time when thechurch was undergoing repairs, and where during such alterations Divineservice had been performed, it was held that the ceremony was good. Toall intents and purposes marriage comes under the 'Law of Contract' (seeAnson, W. R. , Bart. ), and the law looks to the _intention_ rather than tothe actual details. All marriages between persons within the prohibiteddegrees of consanguinity or affinity are null and void. This prohibitionextends both to the illegitimate as well as the legitimate children ofthe late wife's or husband's parents. A marriage with a deceased wife'ssister is now legal in Great Britain and the Colonies, and is recognizedin most foreign countries. A common device with people within theprohibited degrees is to get married abroad, but such marriage isstrictly speaking inoperative, and the children of such union areillegitimate. Practically, however, it is a matter of no importance, forwhen people live together and say they are married, they are accepted attheir own estimate. 

A man can obtain a divorce from his wife if he can prove that she hasbeen guilty of adultery since her marriage. This may be established byinference. Obviously, it is difficult in the majority of cases toestablish by ocular demonstration that adultery has been committed. Butgiven evidence of familiarity and affection with opportunity andsuspicious conduct, a jury will commonly infer it. 

A woman cannot obtain a divorce from her husband for adultery alone. Shemust prove adultery plus cruelty, or adultery plus desertion withoutreasonable cause. Failing this, she may be able to prove either bigamyor incestuous adultery. Legal cruelty is a very comprehensive term, anddoes not of necessity mean physical violence. If the husband as theresult of his infidelity were to give his wife a contagious disease, that would constitute cruelty. Taking a more extreme case, if a husbandwere to have connection in her house with his wife's maid, that wouldprobably be held to constitute cruelty, as it would tend to lower her inthe eyes of her servants. 

A wife can obtain a judicial separation if she can prove (1) adultery, (2) cruelty, or (3) desertion without reasonable cause for two years. Ifa husband is away on his business, as, for example, the case of anofficer ordered abroad, that is not desertion. For a woman to get ajudicial separation, it is sufficient if she can prove one variety ofmatrimonial offence, but for a divorce she requires more than one. 

The jury may find that Mrs. A. Has committed adultery with Mr. B. , butthat Mr. B. Has not committed adultery with Mrs. A. The explanation is, that a wife's confession is evidence against herself, but not againstanother person. You can confess your own sins, but not another's. 

The Divorce Law of Scotland differs materially from that of England. InScotland there is no decree nisi, no decree absolute, and nointervention by the King's Proctor. Instead there is a single and finaljudgment, and when a decree of divorce is pronounced the successfullitigant at once succeeds to all rights, legal and conventional, thatwould have come to him or her on the death of the losing party. If thehusband is the offender, the wife in such circumstances may claim herright to one-third of his real estate; and if there are children, toone-third of his personal property, and to one-half if there are none. 

=Voidable Marriages. =--If a man and woman go through the marriageceremony, such a contract is null and void under the followingcircumstances: (1) Where bigamy has been committed; (2) if one of theparties were insane at the time of marriage; (3) where the plaintiff isunder sixteen years of age; (4) when the marriage has not beenconsummated or followed by cohabitation; (5) when one of the parties wasincapable of performing the marital act (impotent, and such not known bythe other at the time); (6) when drunkenness had been induced so as toobtain consent; (7) concealment of pregnancy at the time of marriage. 

XXXIX. --FEIGNED DISEASES

Malingering in its various forms is by no means uncommon, and by many isregarded as a disease in itself. It is necessary, however, todistinguish between those cases in which it is feigned for some definitepurpose--for example, to escape punishment or avoid public service--andthose in which there is adequate motive, and the patient shams simplywith the view of exciting sympathy, or from the mere delight of givingtrouble. It is not uncommon for individuals summoned on a jury, or togive evidence in the law courts, to apply to their doctor for acertificate, assigning as a cause of exemption neuralgia, or somesimilar complaint unattended with objective symptoms. In such cases itis well to remind the patient that in most courts such certificates arereceived with suspicion, and are often rejected, and that the personalattendance of the medical man is required to endorse his certificate onoath. 

Malingering has become much more common since the National HealthInsurance Act has been passed. The possibility of obtaining a fair sumeach week without the necessity of working for it induces many personseither to feign disease or to make recovery from actual disease oraccident much more tedious than it ought really to be. 

The feasibility of successfully malingering is greatly enhanced by thepossession of some chronic organic disease. An old mitral regurgitantmurmur is useful for this purpose. 

It is not flattering to one's vanity to overlook a case of malingering, but should this occur little harm is done. It is a much more seriousmatter to accuse a person of malingering when in reality he may besuffering from an organic disease. 

Here are some of the diseases which are most frequently feigned:

=Nervous Diseases=, as headache, vertigo, paralysis of limbs, vomiting, sciatica, or incontinence or suppression of urine, spitting of blood;others, again, simulate hysteria, epilepsy, or insanity. 

On the other hand, the malingerer may actually produce injuries on hisperson either to excite commiseration or to escape from work. Thus, thebeggar produces ulcers on his legs by binding a penny-piece tightly onfor some days; the hospital patient, in order to escape discharge, produces factitious skin diseases by the application of irritants orcaustics. 

It is much more difficult to decide whether certain symptoms are due toa real disease which is present, or whether they are merelyexaggerations of slight symptoms or simulations of past ones. The miner, after an injury to his back, recovers very slowly, if at all. He issuffering from 'traumatic neurasthenia'--a condition only too oftensimulated, and a disease very difficult to diagnose accurately. Theminer takes advantage of our ignorance, and continues to draw hiscompensation. A workman during his work receives a fracture; instead ofbeing able to resume work in six weeks, he asserts that the pain andstiffness prevent him, and this disability may persist for months. Suchcases as these frequently come before the courts when the employer hasdiscontinued to pay the weekly compensation for the injury. Medical menare called to give evidence for or against the injured workman. 

=Epilepsy= is often simulated. The foaming at the mouth is produced by apiece of soap between the gums and the cheek. The true epileptic, especially if he suspects that a fit is imminent, takes his walks abroadin some secluded spot, whilst the impostor selects a crowded localityfor his exertions. The epileptic often injures himself in falling, hisimitator never; one bites his tongue, but the other carefully refrainsfrom doing so. The skin of an epileptic during an attack is cold andpallid, but that of the exhibitor is covered with sweat as the result ofhis exertions. In epilepsy the urine and fæces are passed involuntarily, but his colleague rarely considers it necessary to carry his deceptionto this extent. In true epilepsy the eyes are partly open, with theeyeballs rolling and distorted, whilst the pupils are dilated and do notcontract to light; the impostor keeps his eyes closed, and he cannotprevent the iris from contracting when a bicycle-lamp is flashed acrosshis face. A useful test is to give the impostor a pinch of snuff, whichpromptly brings the entertainment to an end. 

=Lumbago= is often feigned, and the imposture should be suspected whenthere is a motive, and when physical signs, such as nodes and tenderspots, are absent. A simple test is to inadvertently drop a shilling infront of him, when he will promptly stoop and pick it up. The sameprinciples apply to spurious sciatica. 

=Hæmorrhages= purporting to come from the lungs, stomach, or bowels, rarely present much difficulty. The microscope is of use in all cases ofbleeding. Possibly the gums or the inside of the cheeks may have beenscratched or abraded with a pin. 

=Skin Diseases= are excited artificially, especially those which may beproduced by mechanical and chemical irritants. The most commonlyemployed are vinegar, acetic acid, carbolic acid, nitric acid, andcarbonate of sodium; but tramps frequently use sorrel and variousspecies of ranunculus. The lesions simulated are usually inflammatory incharacter, such as erythema, vesicular and bullous eruptions, andulceration of the skin. They may be complicated by the presence ofpediculi and other animal and vegetable parasites. Chromidrosis of thelower eyelids in young women often owes its origin to a box of paints. Factitious skin diseases are seen most commonly on the face andextremities, especially on the left side--in other words, on the mostaccessible parts of the body. 

Feigned menstruation, pregnancy, abortion, and recent delivery arecommon, and should give rise to no difficulty. The same may be said offeigned insanity, aphonia, deaf-mutism, and loss of memory. 

The following hints may be useful to a medical man when called to asupposed case of malingering: Do not be satisfied with one visit, but goagain and unexpectedly; see that the patient is watched between thevisits; make an objective examination, compare the indications with thestatements of the patient, noting especially any discrepancies betweenhis account of his symptoms and the real symptoms of disease; askquestions the reverse of the patient's statements, or take them forgranted, and he will often be found to contradict himself; have alldressings and bandages removed; suggest, in the hearing of the patient, some heroic methods of treatment--the actual cautery, or severe surgicaloperation, for example; finally, chloroform will be found of great usein the detection of many sham diseases. 

XL. --MENTAL UNSOUNDNESS

The presumption in law is in favour of a person's sanity, even though hemay be deaf, dumb, or blind. 

The terms 'insanity, ' 'lunacy, ' 'unsoundness of mind, ' 'mentalderangement, ' 'madness, ' and 'mental alienation or aberration, ' areindifferently applied to those states of disordered mind in which theperson loses the power of regulating his actions and conduct accordingto the ordinary rules of society. The reasoning power is lost orperverted, and he is no longer fitted to discharge those duties whichhis social position demands. In some cases of insanity, as in confirmedidiocy, there is no evidence of the exercise of the intellectualfaculties. It is probable that no standard of sanity as fixed by naturecan be said to exist. The medical witness should decline to commithimself to any definition of insanity. There is no practical advantagein attempting to classify the different forms of insanity. 

According to English law, madness absolves from all guilt, but in orderto excuse from punishment on this ground it must be proved that theindividual was not capable of distinguishing right from wrong inrelation to the particular act of which he is accused, and that he didnot know at the time of committing the crime that the offence wasagainst the laws of _God_ and _nature_. 

Lunatics are competent witnesses in relation to testimony, as inrelation to crime, if they understand the nature of an oath and thecharacter of the proceedings in which they are engaged. The judge, as inthe case of children, examines the lunatic tendered as a witness as tohis knowledge of the nature and obligation of an oath, and, ifsatisfied, he allows him to be sworn. 

A person, if suffering from such a state of mental unsoundness as to beunable to take care of his property, may be placed under the care of theCourt of Chancery. The Court then administers his property, andotherwise allows him entire freedom of action. 

With regard to the care of lunatics, no person is allowed to receivemore than one lunatic into his house unless such house is licensed andthe proper certificates have been signed. One patient may be takenwithout the house being licensed, but the usual certificates must in allcases be signed, and the Lunacy Commissioners communicated with. If aperson receives another not of unsound mind into his house, and suchperson becomes subsequently insane, the person so keeping him rendershimself liable to heavy penalties, unless the legal certificates are atonce procured and the Commissioners of Lunacy communicated with. 

At common law it appears that a lunatic cannot be placed in an asylumunless dangerous to himself or to others, but under the Lunacy Acts theplacing of a madman in an asylum is considered as a part of thetreatment with a view to the cure of the patient. 

XLI. --IDIOCY, IMBECILITY, CRETINISM

=Idiocy= is not a disease, but a congenital condition in which theintellectual faculties are either never manifested or have not beensufficiently developed to enable the idiot to acquire an amount ofknowledge equal to that acquired by other persons of his own age and insimilar circumstances with himself. Idiots, as a rule, are deformed inbody as well as deficient in mind. Their heads are generally small andbadly-shaped, and their features ill-formed and distorted. The teeth arefew in number and very irregular. The hard palate has a very deep arch, or may even be cleft. The complexion is sallow and unhealthy, the limbsimperfectly developed, and the gait is awkward, shambling, and unsteady. In his legal relations an absolute idiot is civilly disabled andirresponsible, but in regard to crime, or as a witness, see remarks madeabove. 

=Imbecility= is a form of mental defect not usually congenital, butcommencing in infancy or in early life. The line of demarcation betweenthe imbecile and the idiot may be found in the possession by the formerof the faculty of speech, in distinction from the mere parrot-likeutterance of a few words which can be taught the idiot. Imbecility maybe intellectual, moral, or general. Questions frequently arise as totheir responsibility for actions done by them, or as to their ability tomanage their own affairs. 

=Cretinism= is a form of amentia, which is endemic in certain districts, especially in some of the valleys of Switzerland, Savoy, and France. Themalady is not congenital, but its symptoms usually appear within a fewmonths of birth. The characteristics of this form of idiocy are anenlarged thyroid gland constituting a goitre or bronchocele, ahigh-arched palate, dwarfed stature, squinting eyes, sallow complexion, small legs, conical head, large mouth, and indistinct speech. 

=Feeble-Minded. =--These are persons who are capable of earning a livingunder favourable circumstances, but are incapable, from mental defectwhich has existed from birth or from an early age, of (a) competing onequal terms with their normal fellows, or (b) of managing themselvesand their affairs with ordinary prudence. Feeble-mindedness may affectthe moral nature only, rendering the person selfish, untruthful, obscene, or unemployable. The Act of 1899 controls feeble-mindedchildren; many such become paupers, criminals, prostitutes, etc. 

=Mental Deficiency and Lunacy Act, 1913. =--Those included under this Actare idiots, imbeciles, feeble-minded persons, and moral imbeciles. Theparents or guardians of such children between the ages of five andsixteen years must provide for them education and proper care. If theyare unable to do so, the School Boards or Parish Councils must do so. 

XLII. --DEMENTIA: ACUTE, CHRONIC, SENILE, AND PARALYTIC

In dementia the mental aberration does not occur until the mind hasbecome fully developed, thus differing from amentia, which is congenitalor comes on very early in life. 

=Acute Dementia. =--This is a condition of profound melancholy or stupor, which arises from sudden mental shock, the mind being, as it were, arrested and fixed in abstraction on the event. 

=Chronic Dementia= is generally caused by the gradual action on the mindof grief or anxiety, by severe pain, mania, apoplexy, paralysis, orrepeated attacks of epilepsy. 

=Senile Dementia= is a form which is incidental to aged persons, andcommences gradually with such symptoms as loss of memory for recentevents, dulness of perception, and inability to fix the attention. Lateron the reasoning powers begin to fail, and finally, memory, reason, andpower of attention, are quite lost, the muscular power and forceremaining intact. In the last stage there is simply bare physicalexistence. 

=General Paralysis of the Insane, Paralytic Dementia. =--This is a mostinteresting form of dementia. It is closely allied to, if not identicalwith, locomotor ataxy. Its most prominent and characteristic symptomconsists in delusions of great power, exalted position, and unlimitedwealth--megalomania. The exaltation is universal, and the patient maymaintain at one and the same time that he is running a theatricalcompany, that he is the Prince of Wales, and that he is the Almighty. Moral perversion is a common symptom, and the patient is often guilty ofcriminal assaults, indecent exposures, bigamous marriages, and the like. It is accompanied with progressive bodily and mental decay. Women arecomparatively rarely affected by it, and it generally commences in menabout middle age, and its duration is from a few months to three years. It is commonly parasyphilitic in origin. Paralytic symptoms first appearin the tongue, lips, and face; the speech becomes thick and hesitating. The paralytic symptoms gradually go on increasing, the sphincters refuseto act, and death may occur from suffocation and choking. Sometimes, during the earlier stages especially, there may be maniacal paroxysms orepileptic fits. The delusions remain the same throughout, the patientalways expresses himself as being happy, and his last words willprobably have reference to money and other absurd delusions. 

When a person of hitherto blameless life is charged with an act ofindecency, he should be examined for G. P. I. The condition of hisprostate should also be investigated. He may be suffering from eithermental or physical disease, or both (see p. 59). 

XLIII. --MANIA

Under the term 'mania' are included all those forms of mentalunsoundness in which there is undue excitement. It is divided intogeneral, intellectual, and moral, and each of the two latter classesagain into general and partial. 

=General Mania= affects the intellect as well as the passions andemotions. Mania is usually preceded by an incubative period in which thepatient's general health is affected. The duration of this period mayvary from a few days to fifteen or twenty years. When the disease isestablished, the patient has paroxysms of violence directed againsthimself as well as others. He tears his clothes to pieces, eitherabstains from food and drink or eats voraciously, and sustains immensemuscular exertion without apparent fatigue. The face becomes flushed, the eye wild and sparkling; there is pain, weight, and giddiness in thehead, with restlessness. 

=General Intellectual Mania=, attacking the intellect alone, is rare;but some one emotion or passion, as pride, vanity, or love of gain, mayobtain ascendancy, and fill the mind with intellectual delusions. 

A _delusion_ may be defined as a perversion of the judgment, achimerical thought; an _illusion_, an incorrect impression of thesenses, counterfeit appearances; hence we speak of a delusion of themind, an illusion of the senses. Lawyers lay great stress on thepresence of delusions as indicative of insanity. An _hallucination_ is asensation which is supposed by the patient to be produced by externalimpressions, although no material object acts upon his senses at thetime. 

=Partial Intellectual Mania=, or =Monomania=, also called =Melancholia=, is a form of the disease in which the patient becomes possessed of somesingle notion, contradictory alike to common-sense and his ownexperience. 

=General Moral Mania. =--This is a morbid perversion of the naturalfeelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of theintellect, or knowing and reasoning faculties, and particularly withoutany insane illusion or hallucination. It is often difficult todistinguish this form of mania from the moral depravity which weassociate with the criminal classes. 

=Partial Moral Mania--Paranoia--Delusional Insanity. =--In this form oneor two only of the moral powers are perverted. Delusions are alwayspresent, and very frequently are those of persecution. The patient'sconduct is dominated by his delusion; thus murder and suicide may becommitted. There are several forms:

_Kleptomania_, a propensity to theft; common in women in easycircumstances. _Dipsomania_, or _Oinomania_, an insatiable desire fordrink. _Morphinomania_, a craving for morphine or its preparations. _Erotomania_, or amorous madness. When occurring in women this is alsocalled _Nymphomania_, and in men _Satyriasis_. It consists in anuncontrollable desire for sexual intercourse. _Pyromania_, an insaneimpulse to set fire to everything. _Homicidal mania_, a propensity tomurder. _Suicidal mania_, a propensity to self-destruction. Someconsider suicide as always a manifestation of insanity. 

=Insanity of Pregnancy. =--This may show itself after the third month ofpregnancy in the form of melancholia. It is not recovered from untilafter delivery. 

=Puerperal Mania. =--This form of mania attacks women soon afterchildbirth. There is in many cases a strong homicidal tendency againstthe child. 

=Insanity of Lactation= comes on four to eight months after parturition, either as mania or melancholia. The mother may repeatedly attemptsuicide. 

=Mania with Lucid Intervals. =--In many cases mania is intermittent orrecurrent in its nature, the patient in the interval being in his rightmind. The question of the presence or absence of a lucid intervalfrequently occurs where attempts are made to set aside wills made bypersons having property. In these cases the law, from the reasonablenessof the provisions of the will, may assume the existence of the lucidinterval. A will made during a lucid interval is valid. When an attemptis made to set aside the provisions of a will on the ground of insanityin a person not previously judged insane, the plaintiff must show thatthe testator was mad; when the provisions of the will of a lunatic areattempted to be upheld, the plaintiff must show that the will was madeduring a lucid interval. 

A testator is capable of making a valid will when he has (1) a knowledgeof his property and of his kindred; (2) memory sufficient to recognizehis proper relations to those about him; (3) freedom from delusionsaffecting his property and his friends; and (4) sufficient physical andmental power to resist undue influence. The fact of a man being subjectto delusions may not affect his testamentary capacity. He may believehimself to be a tea-kettle, and yet be sufficiently sound mentally tomake a valid will. 

=Undue Influence. =--Persons of weak mind or those suffering from seniledementia are often said to have been unduly influenced in making theirwills, and subsequently their dispositions are disputed in court. Beforewitnessing the will made by such a person, the medical man shouldsatisfy himself that the testator is of a 'sound disposing mind. ' Thishe will do by questioning, and his knowledge of the home-life of thepatient will either confirm or set aside the idea of influence. 

A person who is aphasic may be competent to make a will. He may not beable to speak, but may understand what is said to him, and may be ableto indicate his wishes by nods and shakes of the head. Ask him if hewishes to make a will, then inquire if he has £10, 000 to leave, then ifhe has £100, and in this way arrive approximately at the sum. Then askhim if he wishes to leave it all to one person. If he nods assent, askif it be to his wife or some other likely person. If he wishes to divideit, ascertain his intention by definite questions, and, havingascertained his views, commit them to writing, read the document over tohim, and ask if it expresses his intentions. That being settled, a markwhich he acknowledges in the presence of two witnesses, preferably menof standing, will constitute a valid document. 

In certain forms of neurasthenia, the 'phobias' are common, but must notbe regarded as evidence of insanity. 'Agoraphobia' is the fear ofcrossing an open space, 'batophobia' is the fear that high things willfall, 'siderophobia' is the fear of thunder and lightning, 'pathophobia'is the fear of disease, whilst 'pantophobia' is the fear of everythingand everybody. 

=Epilepsy in Relation to Insanity. =--The subjects of this disease areoften subject to sudden fits of uncontrollable passion; their conduct issometimes brutal, ferocious, and often very immoral. As the fitsincrease in number, the intellect deteriorates and chronic dementia ordelusional insanity may supervene. (1) Before a fit the patient maydevelop paroxysms of rage with brutal impulses (_preparoxysmalinsanity_), and may commit crimes such as rape or murder. (2) Instead ofthe usual epileptic fit, the patient may have a violent maniacal attack(_masked epilepsy_, _epileptic equivalent_, _psychic form of epilepsy_). (3) After the fit the patient may perform various automatic actions(_post-epileptic automatism_) of which he has no subsequentrecollection. Thus the patient may urinate or undress in a public place, and may be arrested for indecent exposure. Epileptics who suffer fromboth petit and grand mal attacks are specially liable to maniacalattacks. Such insanity differs from ordinary insanity in its suddenonset, intensity of symptoms, short duration and abrupt ending. Toestablish a plea of epilepsy in cases of crime, one must show that theindividual really did suffer from true epilepsy, and that the crime wascommitted at a period having a definite relation to the epilepticseizure. 

=Alcoholic Insanity. =--This may occur in three forms:

1. _Acute Alcoholic Delirium_ (_mania a potu_), due to excessive amountof alcohol consumed. 

2. _Delirium Tremens_, due to long-continued over-drinking. The patientsuffers from horrible dreams, illusions, and suspicions, which may leadhim to attack people or commit suicide. 

3. _Chronic Alcoholic Insanity. _ Loss of memory is the chief symptom, with paralysis of motion, hallucinations and delusions of persecution. 

=Responsibility for Criminal Acts. =--To establish a defence on theground of insanity, it must be proved that the prisoner at the time whenthe crime was committed did not know the nature and quality of the acthe was committing, and did not know that it was wrong. At the presenttime, however, the _power of controlling his actions_ is usually madethe test. 

The plea of insanity is brought forward, as a rule, only in capitalcharges, so that the prisoner, if found guilty, will escape hanging. Ifproved 'guilty, but insane, ' the person is sentenced to be kept in acriminal lunatic asylum 'during His Majesty's pleasure. '

XLIV. --EXAMINATION OF PERSONS OF UNSOUND MIND

The following hints with regard to the examination of patients supposedto be insane will be useful: The general appearance and shape of head, complexion, and expression of countenance, gait, movements, and speech, should be noted; the state of the general health, appetite, bowels, tongue, skin, and pulse, should be inquired into; and in women the stateof the menstrual function should be ascertained. The family history mustbe traced out, and the personal history taken with care, especially asto whether the unsoundness came on late in life or followed any physicalcause. Ascertain whether it is a first attack, whether the patient hassuffered from epilepsy, has squandered his money, grown restless, hasabsurd delusions, etc. In order to ascertain the capacity of the mind, questions should be asked with regard to age, birthplace, profession, number of family, and common events, such as the day of week, month, andyear. The power of performing simple arithmetical operations may betested. It may be necessary to pay more than one visit. The examinershould be careful to ask questions adapted to the station of life of thesupposed lunatic; a man is not necessarily mad because he cannot performsimple arithmetical operations, or does not know about things with whichhis questioner is well acquainted. The opinion of a supposed lunaticthat his examiner's feet _were large_ was not considered by theCommissioners among the facts indicating insanity, yet statements quiteas absurd are made by medical men as 'facts of insanity' observed bythemselves. 'Reads his Bible and is anxious about the salvation of hissoul' is another example of a bad certificate. Some well-marked delusionshould be recorded. 

For a lunacy certificate (_Reception Order on Petition_ or _JudicialReception Order_), except in the case of a pauper patient, there arerequired the signatures of two independent medical men and of a relationor friend. The medical men must not be in partnership or in any wayinterested in the patient; they must make separate visits at differenttimes, and write on the proper forms the facts observed by themselvesand those observed by others, giving the name of the informer. Acertificate is valid only for seven days. In very urgent non-paupercases the signature of one medical man is sufficient, but suchcertificate (_Emergency Certificate_ or _Urgency Order_) is only validfor two days, and, as the patient can only be detained in the asylumunder this order for seven days in England or three in Scotland, it mustbe supplemented by another signed as above directed. The medicalcertificate must contain a statement that it is expedient for thealleged lunatic to be placed forthwith under care, with reasons formaking such statement. The certifying medical practitioner must havepersonally examined the patient not more than two clear days before hisreception. In London and other large towns, where an expert opinion isreadily obtainable, it is not expedient to resort to such urgencyorders. Medical men should be careful how they sign certificates ofinsanity. No medical man is bound to certify, but if he does so he mustbe prepared to take the responsibility of his acts. There must be noreasonable ground for alleging want of 'good faith' or 'reasonablecare. ' The practitioner must exercise that amount of care and skillwhich he may reasonably be expected to possess. 

XLV. --THE INEBRIATES ACTS

It is somewhat difficult to define an inebriate, but for the moment thefollowing will suffice, and will ultimately, in all probability, beofficially adopted:

An inebriate is a person who habitually takes or uses any intoxicatingthing or things, and while under the influence of such thing or things, or in consequence of the effects thereof, is--(a) dangerous to himselfor others; or (b) a cause of harm or serious annoyance to his family orothers; or (c) incapable of managing himself or his affairs, or ofordinary proper conduct. 

Under the provisions of the Habitual Drunkards Acts (42 and 43 Vict. , c. 19, and 51 and 52 Vict. , c. 19), any habitual drunkard may voluntarilyplace himself under restraint. He must make an application to the ownerof a licensed retreat, stating the time during which he undertakes toremain. His application must be accompanied by a statutory declarationof two persons stating that they knew the applicant to be a confirmeddrunkard. Without this testimony as to moral character his applicationcannot be entertained. His signature must also be attested by twojustices, who must state that he understands the effect of hisapplication, and that it has been explained to him. The limit to theterm of restraint is twelve months, after which he must resume hisformer habits if he wishes to qualify for another period. The Act worksautomatically, and, when it has been set for a certain time, the patientcannot release himself until the period has expired. The Inebriates'Retreat must be duly licensed, and the licensee incurs distinctobligation in return for the powers entrusted to him. It is an offenceagainst the Act to assist any habitual drunkard to escape from hisretreat, and should he succeed in effecting his escape he may bearrested on a warrant. A drunkard who does not obey orders and conformto the rules of the establishment may be sent to prison for seven days. It may be as well to mention that it is an offence to supply anydrunkard under the Act with any intoxicating drink or sedative orstimulant drug without authority, and that the penalty is a fine of £20or three months' imprisonment. The Act is a good one, but might becarried farther with advantage. It has been ruled that a crime committedduring drunkenness is as much a crime as if committed during sobriety. Aperson is supposed to know the effect of drink, and if he takes away hissenses by drink it is no excuse. He is held answerable both for beingunder the influence of alcohol or of any other drug, and for the actssuch influence induces. 

=Inebriates Act= (1898-1900). --If an habitual drunkard be sentenced toimprisonment or penal servitude for an offence committed duringdrunkenness, or if he has been convicted four times in one year, thecourt may order him to be detained for a term not exceeding three yearsin an inebriate reformatory. 

PART II

TOXICOLOGY

I. --DEFINITION OF A POISON

Though the law does not define in definite terms what a poison reallyis, it lays stress on the _malicious intention_ in giving a drug orother substance to an individual. It is a _felony_ to administer, orcause to be administered, any poison or other destructive thing withintent to murder, or with the intention of stupefying or overpowering anindividual so that any indictable offence may be committed. It is a_misdemeanour_ to administer any poison, or destructive or noxiousthing, merely to aggrieve, injure, or annoy an individual. For a working_definition_ we may state that a poison is a substance which, whenintroduced into or applied to the body, is capable of injuring health ordestroying life. A poison may therefore be swallowed, applied to theskin, injected into the tissues, or introduced into any orifice of thebody. 

II. --SALE OF POISONS; SCHEDULED POISONS

The sale of poisons is regulated by various Acts, but chiefly by thePharmacy Act, 1868, and by the Poisons and Pharmacy Act, 1908. Onlyregistered medical practitioners and legally qualified druggists arepermitted to dispense and sell scheduled poisons. They are responsiblefor any errors which may be committed in the sale of poisons. If adruggist knows that a drug in a prescription is to be used for animproper purpose, he may refuse to dispense it. The practitioner whocarelessly prescribes a drug in a poisonous dose is not heldresponsible, but the dispenser would be if he dispensed it and harmfulor fatal consequences followed on its being swallowed. When a dispenserfinds an error in a prescription, it is his duty to communicate with theprescriber privately pointing out the mistake. 

A great responsibility rests on the medical man who does his owndispensing, as there is no one to check his work. 

If a doctor prescribes a drug with the intention of curing or preventinga disease, but that, contrary to expectation and general experience, itcauses illness or even death, no responsibility can rest with theprescriber. It has to be proved that actual injury has been sustained bythe complainant before an action for damages can be commenced, and thatthe plaintiff was free from all contributory negligence. 

=Scheduled Poisons. =--By the Pharmacy Act of 1868 two groups of poisonsare scheduled. Part I. Contains a list of those which are consideredvery active poisons--_e. G. _, arsenic, alkaloids, belladonna, cantharides, coca (if containing more than 1 per cent. Alkaloids), corrosive sublimate, diachylon, cyanides, tartar emetic, ergot, nuxvomica, laudanum, opium, savin, picrotoxin, veronal and all poisonousurethanes, prussic acid, vermin killers, etc. Such poisons must not besold to strangers, but only to persons known to or introduced by someoneknown to the druggist. If sold, the latter must enter into the 'PoisonRegister' the name of the poison, the name of the person to whom it issold, the quantity and purpose for which it is to be used, and date ofsale. The entry must be signed by the purchaser and by the introducer. The word 'Poison' must be affixed to the bottle or package, and alsothe name and address of the seller. 

Part II. Contains a list of poisons supposed to be less active. Thesemay only be sold if on the bottle, box, or package there is affixed alabel with the name of the article, the word 'Poison, ' and the name andaddress of the seller. It is not necessary to enter the transaction in aregister. 

Chemists are required to keep poisons in specially distinguishablebottles, and these in a special room or locked cupboard. 

=Dangerous Drugs Act, 1920. =--The regulations restrict the manufactureand sale of opium, morphine, cocaine, and heroin so as to prevent theirabuse. Preparations containing less than 1/5 per cent. Of the first twoor less than 1/10 per cent. Of the last two are excluded. Prescriptionscontaining the above drugs must be dated and signed with the full nameand address of the prescriber, and must have also those of the patient. The total amount of the drug to be supplied must be stated, and it mustnot be dispensed more than once; the dispenser retains the prescription. Special books must be kept recording the purchase and sale of thesedrugs. 

=Proprietary Medicines Bill= (introduced in 1920, and likely soon tobecome law). --The sale of any unregistered proprietary medicinepurporting to cure certain diseases or produce abortion is made anoffence. A register of proprietary medicines, etc. , is established. Theobject is to protect the public against quack remedies. 

=Notification of Poisoning. =--Every case of poisoning which occurs inany industry (lead, arsenic, anthrax, etc. ) must be notified by themedical attendant to the Chief Inspector of Factories (Factory andWorkshops Act, 1895). 

III. --ACTION OF POISONS; CLASSIFICATION OF POISONS

=Action of Poisons. =--They may act either locally or only afterabsorption into the system. 

1. _Local Action_, as seen in (a) corrosive poisons; (b) irritantpoisons, causing congestion and inflammation of the mucousmembranes--_e. G. _, metallic and vegetable irritants; (c) stimulants orsedatives to the nerve endings, as aconite, conium, cocaine. 

2. _Remote Action. _--This may be of reflex character, as seen in theshock produced by the pain caused by corrosive poisons, or the poisonmay exert a special action on certain structures, as belladonna on thecells of the brain, strychnine on the motor nerve cells of the spinalcord. 

3. _In Both Ways. _--Certain poisons, as carbolic or oxalic acids, act inthis way. 

Age, idiosyncrasy, tolerance, and disease, all exert modifyinginfluences on the action of a poison. The form in which the poison isswallowed and the quantity also determine its action. In the gaseousform, poisons act most rapidly and fatally. When in solution andinjected hypodermically, they also act very rapidly. In the solid formthey act as a rule slowly, and may even set up vomiting, and so may beentirely ejected by vomiting. Poisons act most energetically when thestomach is empty. If taken when the stomach already contains food, solution and absorption may be greatly delayed. 

Some poisons are cumulative in their action, and thus, even ifinfinitesimal doses be swallowed each day, there is a certain amount ofstorage in the tissues (though a certain percentage of the poison isbeing constantly eliminated), and at last symptoms of poisoning showthemselves. 

=Classification of Poisons. =--As an aid to memory, the followingclassification is perhaps the best:

 I. _Inorganic. _

 1. Corrosive acids and alkalies, and caustic salts (carbolic and oxalic acids also). 2. Irritant--practically all the metals and the metalloids (I. Cl. Br. P. ). 

 II. _Organic. _

 { Animal--venomous bites, food poisoning, cantharides. 1. Irritant { Vegetable--all strong purgatives, hellebores, savin, { yew, ergot, hemlock, laburnum, bryony, etc. 

 2. Neuronic. 

 (a) Somniferous--opium and its alkaloids. (b) Deliriant--belladonna, hyoscyamus, stramonium, cannabis, cocaine, cocculus, camphor, fungi. (c) Inebriants--alcohol, ether, chloral, carbolic acid (weak), benzol, aniline, nitro-glycerine. 

 3. Sedative or depressant. 

 (a) Neural--conium, lobelia, tobacco, physostigma. (b) Cerebral--hydrocyanic acid. (c) Cardiac--aconite, digitalis, colchicum, veratrum. 

 4. Excito-motory or convulsives--nux vomica, strychnine. 

 5. Vulnerants--powdered glass. 

III. _Asphyxiants. _

 Poisonous and irrespirable gases. 

IV. --EVIDENCE OF POISONING

It may be inferred that poison has been taken from consideration of thefollowing factors: Symptoms and post-mortem appearances, experiments onanimals, chemical analysis, and the conduct of suspected persons. 

1. _Symptoms_ in poisoning usually come on suddenly, when the patient isin good health, and soon after taking a meal, drink, or medicine. Manydiseases, however, come on suddenly, and in cases of slow poisoning theinvasion of the symptoms may be gradual. 

2. _Post-Mortem Appearances. _--These in many poisons and classes ofpoisons are characteristic and unmistakable. The post-mortem appearancespeculiar to the various poisons will be described in due course. 

3. _Experiments on Animals. _--These may be of value, but are not alwaysconclusive. 

4. _Chemical Analysis. _--This is one of the most important forms ofevidence, as a demonstration of the actual presence of a poison in thebody carries immense weight. The poison may be discovered in the livingperson by testing the urine, the blood abstracted by bleeding, or theserum of a blister. In the dead body it may be found in the blood, muscles, viscera--especially the liver--and secretions. Its discovery inthese cases must be taken as conclusive evidence of administration. If, however, it be found only in substances rejected or voided from thebody, the evidence is not so conclusive, as it may be contended that thepoison was introduced into or formed in the material examined after itsrejection from the body, or if the quantity be very minute it will beargued that it is not sufficient to cause death. A poison may not bedetected in the body, owing to defective methods, smallness of the doserequired to cause death, or to its ejection by vomiting or itselimination by the excretions. 

5. _Conduct of Suspected Persons. _--A prisoner may be proved to havepurchased poison, to have made a study of the properties and effects ofpoison, to have concocted medicines or prepared food for the deceased, to have made himself the sole attendant of the deceased, to have placedobstacles in the way of obtaining proper medical assistance, or to haveremoved substances which might have been examined. 

V. --SYMPTOMS AND POST-MORTEM APPEARANCES OF DIFFERENT CLASSES OF POISONS

Whilst recognizing the fact that toxic agents cannot be accuratelyclassified, the following grouping may for descriptive purposes beadmitted with the view of saving needless repetition:

1. =Corrosives. =--Characterized by their destructive action on tissueswith which they come in contact. The principal inorganic corrosives arethe mineral acids, the caustic alkalies, and their carbonates; theorganic are carbolic acid, strong solutions of oxalic acid, and aceticacid. 

_Symptoms. _--Burning pain in mouth, throat, and gullet, strong acid, metallic or alkaline taste; retching and vomiting, the dischargedmatters containing shreds of mucus, blood, and the lining membrane ofthe passages. Inside of mouth corroded. There are also dysphagia, thirst, dyspnoea, small and frequent pulse, anxious expression, shock. Death may result from shock, destruction of the parts--_e. G. _, perforation of stomach or duodenum, suffocation; or some weekssubsequently death may be due to cicatricial contraction of the gullet, stomach, or pylorus. 

_Post-Mortem Appearances. _--Those of corrosion, with corrugation fromstrong contraction of muscular fibres, and followed by inflammation andits consequences. The mouth, gullet, and stomach, and in some cases theintestines, may be white, yellow, or brown, shrivelled and corroded. Thecorrosions may be small, or may extend over a very large surface. Sometimes considerable portions of the lining membrane of the gullet orstomach may be discharged by vomiting or by stool. Beyond the corrodedparts the textures are acutely inflamed. The stomach is filled with ayellow, brown, or black gelatinous liquid or black blood, and may inrare cases be perforated. 

2. =Irritants. =--These are substances which inflame parts to which theyare applied. The class includes mineral, animal, and vegetablesubstances, and contains a larger number of poisons than all the otherclasses together. Irritants may be divided into two groups: (1) Thosewhich destroy life by the irritation they set up in the parts to whichthey are applied; (2) those which add to local irritation peculiar orspecific remote effects. The first group includes the principalvegetable irritants, some alkaline salts, some metallic poisons, etc. ;and the second comprises the metallic irritants, the metalloids(phosphorus and iodine), and one animal substance, cantharides. 

_Symptoms. _--Burning pain and constriction in throat and gullet, painand tenderness of stomach and bowels, intense thirst, nausea, vomiting, purging and tenesmus, with bloody stools, dysuria, cold skin, and feebleand irregular pulse. The vomit consists at first of the food, then itbecomes bile-stained, and later dark coffee-grounds in appearance, dueto extravasation of blood from the over-distended vessels in the gastricmucous membrane. Death may occur from shock, convulsions, collapse, exhaustion, or from starvation on account of chronic inflammation of thegastro-intestinal mucous membrane. 

_Post-Mortem Appearances. _--Those of inflammation and its consequences. Coats of stomach, fauces, gullet, and duodenum, may be thickened, black, ulcerated, gangrenous, or sloughing. Vessels filled with darkblood ramify over the surface. Acute inflammation is often found in thesmall intestines, with ulceration and softening of mucous membrane. Therectum is frequently the seat of marked ulceration. 

3. =Poisons Acting on the Brain. =--Three classes: The opium group, producing sleep; the belladonna group, producing delirium and illusions;and the alcohol group, causing exhilaration, followed by delirium orsleep. 

_Symptoms. _--Of the opium group, giddiness, headache, dimness of sight, contraction of the pupils, noises in the ears, drowsiness and confusion, passing into insensibility. Of the belladonna group, delirium, illusionsof sight, dilated pupils, dry mouth, thirst, redness of skin, coma. Ofthe alcohol group, excitement of circulation and of cerebral functions, want of power of co-ordination and of muscular movement, double vision, mania, followed by profound sleep and coma. In the chronic form, delirium tremens. 

_Post-Mortem Appearances. _--In the opium group, fulness of the sinusesand veins of the brain, with effusion of serum into the ventricles andbeneath the membranes. In the belladonna group, nil. In the alcoholgroup, signs of inflammation, congestion of brain and membranes, fluidity of blood, long-continued rigor mortis. 

4. =Poisons Acting on the Spinal Cord. =--Strychnine, brucine, thebaïne. The leading symptom is tetanic spasm. 

5. =Poisons Affecting the Heart. =--These kill by sudden shock, syncope, or collapse. They comprise prussic acid, dilute solution of oxalic acidand oxalates, aconite, digitalis, strophanthus, convallaria, andtobacco. 

6. =Poisons Acting on the Lungs. =--These have for their type carbonicacid gas and coal gas. The fumes of ammonia are intensely irritating, and may give rise to laryngitis, bronchitis, and even pneumonia. Nitricacid fumes sometimes produce no serious symptoms for an hour or more, but there may then be coughing, difficulty of breathing, and tightnessin the lower part of the throat, followed by capillary bronchitis (seep. 120). 

VI. --DUTY OF PRACTITIONER IN SUPPOSED CASE OF POISONING

If called to a case supposed or suspected to be one of poisoning, themedical man has two duties to perform: To save the patient's life, andto place himself in a position to give evidence if called on to do so. If life is extinct, his duty is a simple one. He should make inquiriesas to symptoms, and time at which food or medicine was last taken. Heshould take possession of any food, medicine, vomited matter, urine, orfæces, in the room, and should seal them up in clean vessels forexamination. He should notice the position and temperature of the body, the condition of rigor mortis, marks of violence, appearance of lips andmouth. He should not make a post-mortem examination without an order inwriting from the coroner. In making a post-mortem examination, thealimentary canal should be removed and preserved for furtherinvestigation. A double ligature should be passed round the oesophagus, and also round the duodenum a few inches below the pylorus. The gut andthe gullet being cut across between these ligatures, the stomach may beremoved entire without spilling its contents. The intestines may beremoved in a similar way, and the whole or a portion of the liver shouldbe preserved. These should all be put in separate jars without anypreservative fluid, tied up, sealed, labelled, and initialled. Allobservations should be at once committed to writing, or they will not beadmitted by the court for the purpose of refreshing the memory whilstgiving evidence. If the medical practitioner is in doubt on any point, he should obtain technical assistance from someone who has paidattention to the subject. 

In a case of attempted suicide by poisoning, is it the duty of thedoctor to inform the police? He would be unwise to do so. He had muchbetter stick to his own business, and not act as an amateur detective. 

VII. --TREATMENT OF POISONING

The modes of treatment may be ranged under three heads: (1) To eliminatethe poison; (2) to antagonize its action; (3) to avert the tendency todeath. 

1. The first indication is met by the administration of emetics, toproduce vomiting, or by the application of the stomach-tube. The bestemetic is that which is at hand. If there is a choice, give apomorphinehypodermically. The dose for an adult is 10 minims. It may be given inthe form of the injection of the Pharmacopoeia, or preferably as atablet dissolved in water. Apomorphine is not allied in physiologicalaction to morphine, and may be given in cases of narcotic poisoning. Sulphate of zinc, salt-and-water, ipecacuanha, and mustard, are alluseful as emetics. Tickling the fauces with a feather may excitevomiting. 

In using the elastic stomach-tube, some fluid should be introduced intothe stomach before attempting to empty it, or a portion of the mucousmembrane may be sucked into the aperture. The tube should be examined tosee that it is not broken or cracked, as accidents have happened fromneglecting this precaution. The bowels and kidneys must also bestimulated to activity, to help in the elimination of the poison. 

2. The second indication is met by the administration of the appropriateantidote. Antidotes are usually given hypodermically, or, if by mouth, in the form of tablets. In the absence of a hypodermic syringe, theremedy may be given by the rectum. In the selection of the appropriateantidote, a knowledge of pharmacology is required, especially of thephysiological antagonism of drugs. Antidotes may act (1) chemically, byforming harmless compounds, as lime in oxalic acid poisoning; (2)physiologically, the drug which is administered neutralizing more orless completely the poison which has been absorbed; (3) physically, ascharcoal. Every doctor should provide himself with an antidote case. Thevarious antidotes will be mentioned under their respective poisons. 

3. To avert the tendency to death, we must endeavour to palliate thesymptoms and neutralize the effects of the poison. Pain must be relievedby the use of morphine; inflamed mucous membrane soothed by such_demulcents_ as oils, milk, starch; stimulants to overcome collapse;saline infusions in shock, etc. In the case of narcotics and depressingagents, stimulants, electricity, and cold affusions, may be founduseful. We should endeavour to promote the elimination of the poisonfrom the body by stimulating the secretions. 

VIII. --DETECTION OF POISONS

Notice the smell, colour, and general appearance, of the mattersubmitted for examination. The odour may show the presence of prussicacid, alcohol, opium, or phosphorus. The colour may indicate salts ofcopper, cantharides, etc. Seeds of plants may be found. 

This examination having been made, the contents of the alimentary canal, and any other substances to be examined, must be submitted to chemicalprocesses. 

Simple filtration will sometimes suffice to separate the requiredsubstance; in other cases dialysis will be necessary, in order thatcrystalloid substances may be separated from colloid bodies. 

In the case of volatile substances distillation will be required. Thepoisons thus sought for are alcohol, phosphorus, iodine, chloral, ether, hydrocyanic acid, carbolic acid, nitro-benzol, chloroform, andanilin. The organic matters are placed in a flask, diluted withdistilled water if necessary, and acidulated with tartaric acid. Theflask is heated in a water-bath, and the vapours condensed by a Liebig'scondenser. In the case of phosphorus the condenser should be of glass, and the process of distillation conducted in the dark, so that theluminosity of the phosphorus may be noted. 

For the separation of an alkaloid, the following is the process ofStas-Otto. This process is based upon the principle that the salts ofthe alkaloids are _soluble in alcohol and water_, and _insoluble inether_. The pure alkaloids, with the exception of morphine in itscrystalline form, are _soluble_ in ether. Make a solution of thecontents of the stomach or solid organs minced very fine by digestingthem with acidulated alcohol or water and filtering. The filtrate isshaken with ether to remove fat, etc. , the ether separated, the waterysolution neutralized with soda, and then shaken with ether, whichremoves the alkaloid in a more or less impure condition. The knowledgeof these facts will help to explain the following details, which may bemodified to suit individual cases: (1) Treat the organic matter, afterdistillation for the volatile substances just mentioned, with twice itsweight of absolute alcohol, free from fusel oil, to which from 10 to 30grains of tartaric or oxalic acid have been added, and subject to agentle heat. (2) Cool the mixture and filter; wash the residue withstrong alcohol, and mix the filtrates. _The residue may be set aside forthe detection of the metallic poisons, if suspected. _ Expel the alcoholby careful evaporation. On the evaporation of the alcohol the resinousand fatty matters separate. Filter through a filter moistened withwater. Evaporate the filtrate to a syrup, and extract with successiveportions of absolute alcohol. Filter through a filter moistened withalcohol. Evaporate filtrate to dryness, and dissolve residue in water, the solution being made distinctly acid. Now shake watery solution withether. (3) Ether from the acid solution dissolves out _colchicin_, _digitalin_, _cantharidin_, and _picrotoxin_, and traces of _veratrine_and _atropine_. Separate the ethereal solution and evaporate. Hot waterwill now dissolve out _picrotoxin_, _colchicin_, and _digitalin_, butnot cantharidin. (4) The remaining acid watery liquid, holding the otheralkaloids in solution or suspension, is made strongly alkaline withsoda, mixed with four or five times its bulk of ether, chloroform, orbenzole, briskly shaken, and left to rest. The ether floats on thesurface, holding the alkaloids, except morphine, in solution. (5) A partof this ethereal solution is poured into a watch-glass and allowed toevaporate. If the alkaloid is volatile, oily streaks appear on theglass; if not volatile, crystalline traces will be visible. If avolatile alkaloid, add a few pieces of calcium chloride to etherealsolution to absorb the water; draw off the ethereal solution with apipette, allow it to evaporate, and test the residue for the alkaloids, conine and nicotine. 

If a fixed alkaloid, treat the acid solution with soda or potash andether, evaporate ethereal solution after separation, when the solidalkaloid will be left in an impure state. To purify it, add a smallquantity of dilute sulphuric acid, and, after evaporating tothree-quarters of its bulk, add a saturated solution of carbonate ofpotash or soda. Absolute alcohol will then dissolve out the alkaloid, and leave it on evaporation in a crystalline form. 

_General Reactions for Alkaloids. _--(1) Wagner's reagent (iodinedissolved in a solution of potassium iodide) yields a reddish-brownprecipitate; (2) Mayer's reagent (potassio-mercuric iodide) gives ayellowish-white precipitate; (3) phospho-molybdic acid gives a yellowprecipitate; (4) platinic chloride, a brown precipitate; (5) tannicacid, etc. 

In order to isolate an inorganic substance from organic matter, Fresenius's method is adopted. Boil the finely divided substance withabout one-eighth its bulk of pure hydrochloric acid; add from time totime potassic chlorate until the solids are reduced to a straw-yellowfluid. Treat this with excess of bisulphate of sodium, then saturatewith sulphuretted hydrogen until metals are thrown down as sulphides. These may be collected and tested. From the acid solution, hydrogensulphide precipitates copper, lead, and mercury, _dark_; arsenic, antimony, and tin, _yellowish_. If no precipitate, add ammonia andammonium sulphide, iron, _black_, zinc, _white_, chromium, _green_, manganese, _pink_. The residue of the material after digestion withhydrochloric acid and potassium chlorate may have to be examined forsilver, lead, and barium. 

For the detection of minute quantities, the microscope must be used, andGuy's and Helwig's method of sublimation will be found advantageous. Crystalline poisons may be recognized by their characteristic forms. 

IX. --THE MINERAL ACIDS

These are sulphuric, nitric, and hydrochloric acids. 

_Symptoms of Poisoning by the Mineral Acids. _--Acid taste in the mouth, with violent burning pain extending into the oesophagus and stomach, andcommencing immediately on the poison being swallowed; eructations, constant retching, and vomiting of brown, black, or yellow mattercontaining blood, coagulated mucus, epithelium, or portions of thelining membrane of the gullet and stomach. The vomited matters arestrongly acid in reaction, and stain articles of clothing on which theymay fall. There is intense thirst and constipation, with scanty orsuppressed urine, tenesmus, and small and frequent pulse; the lips, tongue, and inside of the mouth, are shrivelled and corroded. Exhaustionsucceeds, and the patient dies either collapsed, convulsed, orsuffocated, the intellect remaining clear to the last. After recoveringfrom the acute form of poisoning, the patient may ultimately die fromstarvation, due to stricture of the oesophagus, stomach, etc. 

_Post-Mortem Appearances Common to the Mineral Acids. _--Stains andcorrosions about the mouth, chin, and fingers, or wherever the acid hascome in contact. The inside of the mouth, fauces, and oesophagus, iswhite and corroded, yellow or dark brown, and shrivelled. Epiglottiscontracted or swollen. Stomach filled with brown, yellow, or blackglutinous liquid; its lining membrane is charred or inflamed, and thevessels are injected. Pylorus contracted. Perforation, when it takesplace, is on the posterior aspect; the apertures are circular, andsurrounded by inflammation and black extravasation. The blood in thelarge vessels may be coagulated. 

Avoid mistaking gastric or duodenal ulcer, with or without perforation, for the effects of a corrosive poison. 

_Treatment. _--Calcined magnesia or the carbonate or bicarbonate ofsodium, mixed with milk or some mucilaginous liquid, are the bestantidotes. In the absence of these, chalk, whiting, milk, oil, soap-suds, etc. , will be found of service. The stomach-pump should notbe used. If the breathing is impeded, tracheotomy may be necessary. Injuries of external parts by the acid must be treated as burns. 

X. --SULPHURIC ACID

=Sulphuric Acid=, or oil of vitriol, may be concentrated or diluted. Itis frequently thrown over the person to disfigure the features ordestroy the clothes. Parts of the body touched by it are stained, firstwhite, and then dark brown or black. The presence of corrosion of themouth is as important as the chemical tests. Black woollen cloths areturned to a dirty brown, the edges of the spots becoming red in a fewdays, due to the dilution of the acid from the absorption of moisture;the stains remain damp for long, owing to the hygroscopic property ofthe acid. 

_Method of Extraction from the Stomach. _--The contents of the stomach orvomited matter should, if necessary, be diluted with pure distilledwater and filtered. The stomach should be cut up into small pieces andboiled for some time in water. The solution, filtered and concentrated, is now ready for testing. Blood, milk, etc. , may be separated bydialysis, and the fluid so obtained tested. A sulphate may be present. Take a portion of the liquid, evaporate to dryness, and incinerate; asulphate, if present, will be obtained, and may be tested. 

_Caution. _--Sulphuric acid may not be found even after large doses, dueto treatment, vomiting, or survival for several days. In all cases everyorgan should be examined. Vomited matters and contents of stomach shouldnot be mixed, but each _separately_ examined. This rule holds good forall poisons. On _cloth_ the stain may be cut out, boiled in water, thesolution filtered, and tested with blue litmus and other tests. 

_Post-Mortem Appearances. _--Where the acid has come in contact with themucous membranes there are dark brown or black patches. The stomach isgreatly contracted, the summits of the mucous membrane ridges beingcharred and the furrows greatly inflamed; the contents are black orbrown. 

_Tests. _--Concentrated acid chars organic matter; evolves heat whenadded to water, and sulphurous fumes when boiled with chips of wood, copper cuttings, or mercury. Dilute acid chars paper when the paper isheated; gives a white precipitate with nitrate or chloride of barium, and is entirely volatilized by heat. Dilute solutions give a whiteprecipitate with barium nitrate, insoluble in hydrochloric acid even onboiling. 

_Fatal Dose. _--In an adult, 1 drachm. 

_Fatal Period. _--Shortest, three-quarters of an hour; average periodfrom onset of primary effects, eighteen to twenty-four hours. 

XI. --NITRIC ACID

=Nitric Acid=, or aqua fortis, is less frequently used as a poison thansulphuric acid. The fumes from nitric acid have caused death frompneumonia in ten or twelve hours. 

_Method of Extraction from the Stomach. _--The same as for sulphuricacid. In beer, etc. , the mixture may be neutralized with carbonate ofpotassium, dialyzed, the fluid concentrated and allowed to crystallize, when crystals of nitrate of potassium may be recognized. 

_Post-Mortem Appearance. _--The mucous membranes are rendered yellow orgreenish if bile be present; they are also thickened and hardened. 

_Tests. _--Concentrated acid gives off irritating orange-coloured fumesof nitric acid gas. When poured on copper, it gives off red fumes andleaves a green solution of nitrate of copper. It gives a red colour withbrucine, turns the green sulphate of iron black, and with hydrochloricacid dissolves gold. A delicate test for the acid, free or incombination, is to dissolve in the suspected fluid some crystals offerrous sulphate, and then to gently pour down the test-tube some strongsulphuric acid. Where the two liquids meet, if nitric acid be present, areddish-brown ring will be formed. It turns the skin bright yellow, anddoes the same with woollen clothes, from the formation of _picric_ acid. 

_Fatal Dose. _--Two drachms. 

_Fatal Period. _--Shortest, one hour and three-quarters in an adult; ininfants in a few minutes, from suffocation. 

XII. --HYDROCHLORIC ACID

=Hydrochloric Acid=, muriatic acid, or spirit of salt, is not uncommonlyused for suicidal purposes, being fifth in the list. 

_Method of Extraction from the Stomach. _--The same as for sulphuricacid. As hydrochloric acid is a constituent of the gastric juice, thesigns of the acid must be looked for. 

_Post-Mortem Appearances. _--The mucous membranes are dry, white, andshrivelled, and often eroded. 

_Tests. _--The concentrated acid yields dense white fumes with ammonia. When warmed with black oxide of manganese and strong sulphuric acid itgives off chlorine, recognized by its smell and bleaching properties. Diluted it gives with nitrate of silver, a white precipitate, which isinsoluble in nitric acid and in caustic potash, but is soluble inammonia, and when dried and heated melts, and forms a horny mass. Stainson clothing are reddish-brown in colour. 

_Fatal Dose. _--Half an ounce. 

_Fatal Period. _--Shortest, two hours; average, twenty-four hours. Deathmay occur after an interval of some weeks from destruction of thegastric glands and inability to digest food. 

XIII. --OXALIC ACID

=Oxalic Acid= is used by suicides, though not often by murderers. Thecrystals closely resemble those of Epsom salts or sulphate of zinc;oxalic acid has been taken in mistake for the former. It is in commonuse for cleansing brass, in laundry work, for dyeing purposes, andespecially for bleaching straw hats. 

_Symptoms. _--If a concentrated solution be taken, it acts as acorrosive, causing a burning acid, intensely sour taste, which comes onimmediately, great pain and tenderness and burning at pit of stomach, pain and tightness in throat. Vomiting of mucus, bloody or darkcoffee-ground matters, purging and tenesmus, followed by collapse, feeble pulse, cyanosis and pallor of the skin; also swelling of tongue, with dysphagia. In some cases cramps and numbness in limbs, pain in headand back, delirium and convulsions. May be tetanus or coma. If takenfreely diluted, the nervous symptoms predominate, and may resemblenarcotic poisoning. Sometimes almost instant death. 

_Post-Mortem Appearances. _--Mucous membrane of mouth, throat, andgullet, white and softened, as if they had been boiled; there are oftenblack or brown streaks in it. Stomach contains dark, grumous matter, andis soft, pale, and brittle. Intestines slightly inflamed, stomachsometimes quite healthy. 

_Treatment. _--Warm water, then chalk, carbonate of magnesium, orlime-water, freely. Not alkalies, as the oxalates of the alkalies aresoluble and poisonous. Castor-oil. Emetics, but not stomach-pump. 

_Fatal Dose. _--One drachm is the smallest, but half an ounce is usuallyfatal. 

_Method of Extraction from the Stomach. _--Mince up the coats of thestomach and boil them in water, or boil the contents of the stomach andsubject them to dialysis. Concentrate the distilled water outside thetube containing the vomited matters, etc. , and apply tests. 

_Tests. _--White precipitate with nitrate of silver, soluble in nitricacid and ammonia. When the precipitate is dried and heated onplatinum-foil, it disperses as white vapour with slight detonation. Sulphate of lime in excess gives a white precipitate, soluble in nitricor hydrochloric acid, but insoluble in oxalic, tartaric, acetic, or anyvegetable acid. 

=Oxalate or Binoxalate of Potash= (salts of sorrel or salts of lemon) isalmost as poisonous as the acid itself. 

XIV. --CARBOLIC ACID

=Carbolic Acid, Phenic Acid, or Phenol=, is largely employed as adisinfectant, and is often supplied in ordinary beer-bottles withoutlabels. 

_Symptoms. _--An intense burning pain extending from the mouth to thestomach and intestines. Indications of collapse soon supervene. The skinis cold and clammy, and the lips, eyelids, and ears, are livid. This isfollowed by insensibility, coma, stertorous breathing, abolition ofreflex movements, hurried and shallowed respiration, and death. Thepupils are usually contracted, and the urine, if not suppressed, is darkin colour, or even black. Patients often improve for a time, and thendie suddenly from collapse. When the poison has been absorbed throughthe skin or mucous membranes, a mild form of delirium, with greatweakness and lividity, are the first signs. 

_Post-Mortem. _--If strong acid has been swallowed, the lips and mucousmembranes are hardened, whitened, and corrugated. In the stomach thetops of the folds are whitened and eroded, while the furrows areintensely inflamed. 

_Treatment. _--Soluble sulphates which form harmless sulpho-carbolates inthe blood should be administered at once. An ounce of Epsom salts or ofGlauber's salts dissolved in a pint of water will answer the purposeadmirably. After this an emetic of sulphate of zinc may be given. Whiteof egg and water or olive-oil may prove useful. Warmth should be appliedto the body. 

_Fatal Dose. _--One drachm, but recovery has taken place after muchlarger quantities, if well diluted or taken after a meal. 

_Tests_ are not necessary, as the smell of carbolic acid ischaracteristic. 

_Local action_ of carbolic acid produces anæsthesia and necrosis. Accidents sometimes happen from too strong lotions applied as surgicaldressings. 

=Lysol= is a compound of cresol and linseed-oil soap, and is much lesstoxic than carbolic acid. 

XV. --POTASH, SODA, AND AMMONIA

=Caustic Potash= occurs in cylindrical sticks, is soapy to the touch, has an acrid taste, is deliquescent, fusible by heat, soluble in water. =Liquor Potassæ= is a strong solution of caustic potash, and has asimilar reaction. =Carbonate of Potassium=, also known as potash, pearlash, salt of tartar, is a white crystalline powder, alkaline andcaustic in taste, and very deliquescent. The bicarbonate is incolourless prisms, which have a saline, feebly alkaline taste, and arenot deliquescent. 

_Symptoms. _--Acrid soapy taste in mouth, burning in throat and gullet, acute pain at pit of stomach, vomiting of bloody or brown mucus, colickypains, bloody stools, surface cold, pulse weak. These preparations arenot volatile, so that there is not much fear of lung trouble. In chroniccases death occurs from stricture of the oesophagus causing starvation. 

_Post-Mortem Appearances. _--Soapy feeling, softening, inflammation, andcorrosion of mucous membrane of mouth, pharynx, oesophagus, stomach, andintestines. Inflammation may have extended to larynx. 

_Method of Extraction from the Stomach. _--If the contents of the stomachhave a strong alkaline action, dilute with water, filter, and applytests. 

_Tests. _--The carbonates effervesce with an acid. The salts give ayellow precipitate with platinum chloride, and a white precipitate withtartaric acid. They are not dissipated by heat, and give a violet colourto the deoxidizing flame of the blowpipe. Stains on dark clothing arered or brown. 

_Treatment. _--Vinegar and water, lemon-juice and water, acidulatedstimulant drinks, oil, linseed-tea, opium to relieve pain, stimulants incollapse. Do not use the stomach-tube. The glottis may be inflamed, andif there is danger of asphyxia, tracheotomy may have to be performed. 

=Carbonate of Sodium= occurs as _soda_ and _best soda_, the former indirty crystalline masses, the latter of a purer white colour. It is alsofound as 'washing soda. '

_Symptoms, Post-Mortem Appearances, Treatment, and Extraction from theStomach. _--As for potash. 

_Tests. _--Alkaline reaction, effervesces and evolves carbonic acid whentreated with an acid; crystallizes, gives yellow tinge to blowpipeflame. No precipitate with tartaric acid, nor with bichloride ofplatinum. 

=Ammonia= may be taken as _liquor ammoniæ_ (harts-horn), as carbonate ofammonium, as 'Cleansel, ' or as 'Scrubb's Cloudy Ammonia. '

_Symptoms. _--Being volatile, it attacks the air-passages, nose, eyes andlungs, being immediately affected; profuse salivation; lips and tongueswollen, red, and glazed. The urgent symptoms are those of suffocation. 

Inhalation of the fumes of strong ammonia may lead to death fromcapillary bronchitis or broncho-pneumonia. Death may result frominflammation of the larynx and lungs. When swallowed in solution, thesymptoms are similar to those of soda and potash. 

_Post-Mortem Appearances. _--Similar to other corrosives. 

_Method of Extraction from the Stomach. _--The contents of the stomach, etc. , must be first distilled, the gas being conveyed into water freefrom ammonia. 

_Tests. _--Nessler's reagent is the most delicate, a reddish-brown colouror precipitate being produced, but ammonia may be recognized by itspungent odour, dense fumes given off with hydrochloric acid, and strongalkaline reaction. 

_Treatment. _--Vinegar and water. Other treatment according to symptoms. 

_Fatal Dose. _--One drachm of strong solution. 

_Fatal Period (Shortest). _--Four minutes. 

XVI. --INORGANIC IRRITANTS

=Nitrate of Potassium (Nitre, Saltpetre)--Bitartrate of Potassium (Creamof Tartar)--Alum (Double Sulphate of Alumina and Potassium)--Chloridesof Lime, Sodium, and Potassium. =--All these are irritant drugs, and givethe usual symptoms. 

XVII. --CHLORATE OF POTASSIUM, ETC. 

=Chlorate of Potassium= produces irritation of stomach and bowels;hæmaturia; melæna; cyanosis, weakness, delirium, and coma. 

_Post-Mortem. _--Blood is chocolate-brown in colour, and so are all theinternal organs; gastro-enteritis; nephritis. 

_Tests. _--Spectroscope shows blood contains methæmoglobin; the drugdischarges the colour of indigo in acid solution with SO_{2}. 

_Treatment. _--Transfusion of blood or saline fluid; stimulants. 

=Sulphuret of Potassium= (liver of sulphur) occurs in mass or powder ofa dirty green colour; has a strong smell of sulphuretted hydrogen. 

_Symptoms. _--Of acute irritant poisoning, with stupor or convulsions. Excreta smell of sulphuretted hydrogen. 

_Post-Mortem Appearances. _--Stomach and duodenum reddened, with depositsof sulphur. Lungs congested. 

_Treatment. _--Chloride of sodium or lime in dilute solution, andordinary treatment for irritant poisoning. 

_Fatal Period (Shortest). _--Fifteen minutes. 

XVIII. --BARIUM SALTS

=Chloride of Barium= occurs crystallized in irregular plates, likemagnesium sulphate, soluble in water and bitter in taste. =Carbonate ofBarium= is found in shops as a fine powder, tasteless and colourless, insoluble in water, but effervescing with dilute acids, and readilydecomposed by the free acids of the stomach. =Nitrate of Barium= occursin octahedral crystals, soluble in water. 

_Method of Extraction from the Stomach. _--Dialysis as for other solublepoisons. 

_Tests. _--Precipitated from its solutions by potassium carbonate orsulphuric acid. Burnt on platinum-foil, it gives a green colour to theflame. 

_Symptoms. _--Besides those of irritants generally, violent cramps andconvulsions, headache, debility, dimness of sight, double vision, noisesin the ears, and beating at the heart. The salts of barium are alsocardiac poisons. 

_Post-Mortem Appearances. _--As of irritants generally. Stomach may beperforated. 

_Treatment. _--Wash out stomach with a solution of sodium or magnesiumsulphate, or of alum, and give stimulants by the mouth andhypodermically. 

XIX. --IODINE--IODIDE OF POTASSIUM

=Iodine= occurs in scales of a dark bluish-black colour. It strikes bluewith solution of starch, and stains the skin and intestinesyellowish-brown. Liquid preparations, as the liniment or tincture, maybe taken accidentally or suicidally. 

_Symptoms. _--Acrid taste, tightness of throat, epigastric pain, and thensymptoms of irritant poisons generally. Chronic poisoning (iodism) ischaracterized by coryza, salivation, and lachrymation, frontal headache, loss of appetite, marked mental depression, acne of the face and chest, and a petechial eruption on the limbs. 

_Post-Mortem Appearances. _--Those of irritant poisoning with corrosion, and staining of a dark brown or yellow colour. 

_Treatment. _--Stomach-pump and emetics, carbonate of sodium, amylaceousfluids, gruel, arrowroot, starch, etc. 

_Analysis of Organic Mixture containing Iodine. _--Add bisulphide ofcarbon, and shake. The iodine may be obtained on evaporation as asublimate. It will be recognized by the blue colour which it gives withstarch. 

=Iodide of Potassium. =--Colourless, generally opaque, cubic crystals, soluble in less than their weight of cold water. 

_Symptoms. _--Not an active poison, but even small doses sometimesproduce the effects of a common cold, including those symptoms alreadymentioned as occurring with iodine. 

_Analysis. _--Iodide of potassium in solution gives a bright yellowprecipitate with lead salts; a bright scarlet with corrosive sublimate;and a blue colour with sulphuric or nitric acid and starch. 

XX. --PHOSPHORUS

=Phosphorus= is usually found in small, waxy-looking cylinders, whichare kept in water to prevent oxidation. It may also occur as theamorphous non-poisonous variety, a red opaque infusible substance, insoluble in carbon disulphide. Ordinary phosphorus is soluble in oil, alcohol, ether, chloroform, and carbon disulphide; insoluble in water. It is much used in rat poisons, made into a paste with flour, sugar, fat, and Prussian blue. Yellow phosphorus is not allowed to be used inthe manufacture of lucifer matches, and the importation of such isprohibited. In 'safety' matches the amorphous phosphorus is on the box. 

_Symptoms. _--At first those of an irritant poison, but days may elapsebefore any characteristic symptoms appear, and these may be mistaken forthose of acute yellow atrophy of the liver. The earliest signs are agarlicky taste in the mouth and pain in the throat and stomach. Vomitedmatter luminous in the dark, bile-stained or bloody, with garlic-likeodour. Great prostration, diarrhoea, with bloody stools. Harsh, dry, yellow skin, purpuric spots with ecchymoses under the skin and mucousmembranes, retention or suppression of urine, delirium, convulsions, coma, and death. Usually there are remissions for two to three days, then jaundice comes on, with enlargement of the liver; hæmorrhages fromthe mucous surfaces and under the skin; later, coma and convulsions. Inchronic cases there is fatty degeneration of most of the organs andtissues of the body. The inhalation of the fumes of phosphorus, as inmaking vermin-killers, etc. , gives rise to 'phossy-jaw. '

_Post-Mortem Appearances. _--Softening of the stomach, hæmorrhagic spotson all organs and under the skin, fatty degeneration of liver, kidneys, and heart, blood-stained urine, phosphorescent contents of alimentarycanal. 

_Treatment. _--Early use of stomach-pump and emetics, followed by theadministration of permanganate of potassium or peroxide of hydrogen tooxidize the phosphorus. Oil should not be given. Sulphate and carbonateof magnesium, mucilaginous drinks. Sulphate of copper is a valuableantidote, both as an emetic and as forming an insoluble compound withphosphorus. 

_Fatal Dose. _--One grain and a half. 

_Fatal Period. _--Four hours; more commonly two to four days. 

_Detection of Phosphorus in Organic Mixtures. _--Mitscherlich's method isthe best. Introduce the suspected material into a retort. Acidulate withsulphuric acid to fix any ammonia present. Distil in the dark, througha glass tube kept cool by a stream of water. As the vapour passes overand condenses, a flash of light is perceived, which is the test. 

XXI. --ARSENIC AND ITS PREPARATIONS

=Arsenic= is the most important of all the metallic poisons. It is muchused in medicine and the arts. It occurs as metallic arsenic, which isof a steel-grey colour, brittle, and gives off a garlic-like odour whenheated; as arsenious acid; in the form of two sulphides--the redsulphide, or realgar, and the yellow sulphide, or orpiment; and asarsenite of copper, or Scheele's green. It also exists as an impurity inthe ores of several metals--iron, copper, silver, tin, zinc, nickel, andcobalt. Sulphuric acid is frequently impregnated with arsenic from theiron pyrites used in preparing the acid. It is a constituent of many ratpastes, vermin or weed killers, complexion powders, sheep dips, etc. 

=Arsenious Acid= (White Arsenic, Trioxide of Arsenic). --Colourless, odourless, and almost tasteless. It occurs in commerce as a white powderor in a solid cake, which is at first translucent, but afterwardsbecomes opaque. Slightly soluble in cold water; 1 ounce of waterdissolves about 1/2 grain of arsenic. Fowler's solution is thebest-known medicinal preparation of arsenic, and contains 1 grain ofarsenious anhydride in 110 minims. 

_Symptoms. _--Commence in from half to one hour. Faintness, nausea, incessant vomiting, epigastric pain, headache, diarrhoea, tightness andheat of throat and fauces, thirst, catching in the breath, restlessness, debility, cramp in the legs, and convulsive twitchings. The skin becomescold and clammy. In some cases the symptoms are those of collapse, withbut little pain, vomiting, or diarrhoea. In others the patient fallsinto a deep sleep, while in the fourth class the symptoms resembleclosely those of English cholera. The vomited matters are often bluefrom indigo, or black from soot, or greenish from bile, mixed with thepoison. Should the patient survive some days, no trace of arsenic may befound in the body, as the poison is rapidly eliminated by the kidneys. In all suspected cases the urine should be examined. 

The symptoms of _chronic_ poisoning by arsenic are loss of appetite, silvery tongue, thirst, nausea, colicky pains, diarrhoea, headache, languor, sleeplessness, cutaneous eruptions, soreness of the edges ofthe eyelids, emaciation, falling out of the hair, cough, hæmoptysis, anæmia, great tenderness on pressure over muscles of legs and arms, dueto peripheral neuritis, and convulsions. 

Pigmentation is common; the face becomes dusky red, the rest of the bodya dark brown shade. This darkening is most marked in situations normallypigmented and in parts exposed to pressure of the clothes, such as theneck, axilla, and inner aspect of the arms, the extensor aspects beingless marked than the flexor. The pigmentation resembles the bronzing ofAddison's disease, but there are no patches on the mucous membranes, andthe normal rosy tint of the lips is not altered. The skin over the feetmay show marked hyperkeratosis. 

The nervous system is notably affected. The sensory symptoms appearfirst: numbness and tingling of the hands and feet, pain in the soles ofthe feet on walking, pain on moving the joints, and erythromelalgia. Then come the motor symptoms, with drop-wrist and drop-foot. The patientsuffers severely from neuritis, and there may be early loss of patellarreflex. The nervous symptoms come on later than the cutaneousmanifestations. 

_Post-Mortem Appearances. _--Signs of acute inflammation of stomach, duodenum, small intestines, colon, and rectum. Stomach may contain darkgrumous fluid, and its mucous coat presents the appearance of crimsonvelvet. Ulceration is rare, and cases of perforation still less common, the patient dying before it occurs. If life has been preserved for somedays, there is extensive fatty degeneration of the organs. There may beentire absence of _post-mortem_ signs. Putrefaction of the body isretarded by arsenic. 

_Treatment. _--The stomach-pump, emetics, then milk, milk and eggs, oiland lime-water. Inflammatory symptoms, collapse, coma, etc. , must betreated on ordinary principles. As an antidote, the best when the poisonis in solution is the hydrated sesquioxide of iron, formed byprecipitating tinctura ferri perchloridi with excess of ammonia, orcarbonate of soda. This is filtered off through muslin and given intablespoonful doses. It forms ferric arsenate, which is sparinglysoluble. Colloidal iron hydroxide may be used instead. Dialyzed iron inlarge quantities is efficacious. 

_Fatal Dose (Smallest). _--Two grains. Exceptionally, recovery from verylarge doses if rejected by vomiting. 

_Fatal Period (Shortest). _--Twenty minutes. Exceptionally, death as lateas the sixteenth day. The effects of arsenic are modified by tolerance, some persons being able to take considerable quantities. The peasants ofStyria are in the habit of eating it. 

_Method of Extraction from the Stomach. _--The coats of the stomachshould be examined with a lens for any white particles. These, ifpresent, may be collected, mixed with a little charcoal in a test-tube, and heated. If arsenic is present, a metallic ring will be formed in thecooler parts of the tube. If this ring be also heated, octahedralcrystals of arsenic will be deposited farther up the tube, and areeasily recognized by the microscope. The contents of the stomach, or thesolid organs minced up, should be boiled with pure hydrochloric acid andwater, then filtered. The filtrate can then be subjected to Marsh's orReinsch's process. 

_Tests. _--In _solution_, arsenic may be detected by the liquid tests. (1) Ammonio-nitrate of silver gives a yellow precipitate (arsenite ofsilver). (2) Ammonio-sulphate of copper gives a green precipitate(Scheele's green). (3) Sulphuretted hydrogen water gives a yellowprecipitate. 

_Marsh's Process. _--Put pure distilled water into a Marsh's apparatuswith metallic zinc and sulphuric acid. Hydrogen is set free, and shouldbe tested by lighting the issuing gas and depressing over it a piece ofwhite porcelain. If no mark appears, the reagents are pure, and thesuspected liquid may now be added. The hydrogen decomposes arseniousacid, and forms arseniuretted hydrogen. The gas carried off by a finetube is again ignited. A piece of glass or porcelain held to the flamewill have, if arsenic be present, a deposit on it having the followingcharacters: In the centre a deposit of metallic arsenic, round this amixture of metallic arsenic and arsenious acid, and outside this anotherring of arsenious acid in octahedral crystals. The deposit is dissolvedby a solution of chloride of lime, turned yellow by sulphide of ammoniumafter evaporation; on the addition of strong nitric acid, evaporated andneutralized with ammonia and nitrate of silver added, a brick-red colouris produced--arseniate of silver. 

_Reinsch's Process. _--Boil distilled water with one-sixth or one-eighthof hydrochloric acid, and introduce a slip of bright copper. If, after aquarter of an hour's boiling, there is no stain on the copper, add thesuspected liquid. If arsenic be present, it will form an iron-greydeposit. If this foil be dried, cut up, put in a reduction-tube, andheated, crystals of arsenious trioxide will be deposited on the coldpart of the tube. 

These tests are difficult to apply, but as arsenic is a ubiquitouspoison, and as there are many sources of fallacy, it would be well, whenpossible, to obtain the services of an expert. 

_Biological Test. _--Put the substance to be tested into a flask withsome small pieces of bread, sterilize for half an hour at 120° C. Whencold, inoculate with a culture of _Penicillium brevicaule_, and keep ata temperature of 37° C. If arsenic is present, a garlic-like odour isnoticed in twenty four hours, due to arseniuretted hydrogen or anorganic combination of arsenic. This test is delicate, and will detect1/1000 of a milligramme, but it is not quantitative. 

=Other Preparations of Arsenic. =--These are arsenite of potash (Fowler'ssolution), cacodylate of sodium, and arsenite of copper (Scheele'sgreen), the last frequently used for colouring dresses and wall-papers. Persons using these preparations may suffer from catarrhal symptoms, rashes on the neck, ears, and face, thirst, nausea, pain in stomach, vomiting, headache, perhaps peripheral neuritis and loss of patellarreflex. The cacodylates, although formerly employed in the treatment ofphthisis, should be used with the utmost caution. The arsenites give thereactions of arsenious acid. 

Arsenic is eliminated not only by the kidneys and bowels, but by theskin, and in women by the menses. It may be detected in the sweat, thesaliva, the bronchial secretion, and, during lactation, in the milk. 

The sale of arsenic and its preparations to the public is properlyhedged round with restrictions of all kinds. It is included in Part I. Of the Poisons and Pharmacy Act (8 Edward VII. , c. 55). No arsenic maybe sold to a person under age, nor may it be sold unless mixed with sootor indigo in the proportion of 1 ounce of soot or 1/2 ounce of indigo atthe least to every pound of arsenic. 

=Arseniuretted Hydrogen= (arsine, AsH_{3}) is an extremely poisonousgas, and is evolved in various chemical and manufacturing processes. When damp, _Ferro-silicon_ evolves AsH_{3} and PH_{3}, both very lethalgases. _Ferrochrome_ is used in making steel, and it also evolvesPH_{3}, and in such extreme dilution as 0. 02 per cent. May cause death. 

XXII. --ANTIMONY AND ITS PREPARATIONS

=Tartar Emetic= (tartarized antimony, potassio-tartrate of antimony)occurs as a white powder, or in yellowish-white efflorescent crystals. Vinum antimoniale contains 2 grains to a fluid ounce of the wine. 

_Symptoms. _--Metallic taste, rapidly followed by nausea, incessantvomiting, burning heat and pain in stomach, purging. Dysphagia, sense ofconstriction in throat, intense thirst, cramps, faintness, profounddepression; in fatal cases, giddiness and tetanic spasms. In _chronicpoisoning_, nausea, vomiting and purging, weak pulse, loss of appetite, debility, cold sweats, great prostration, progressive emaciation. Thesymptoms in chronic poisoning may simulate gastritis or enteritis. Externally applied, it produces an eruption not unlike that of smallpox. 

_Post-Mortem Appearances. _--Inflammation, softening, and an aphthouscondition of the throat, gullet, and stomach, the last reddened inpatches. In chronic poisoning, inflammation also of cæcum and colon. Brain and lungs may be congested. Decomposition is hindered for long. 

_Treatment. _--Promote vomiting by warm greasy water, or the stomach-tubemay be used. Cinchona bark or any preparation containing tannin, as tea, decoction of oak bark, etc. Morphine to allay pain. 

_Fatal Dose. _--In an adult 2 grains (same as arsenic). 

_Fatal Period. _--Death follows in eight to twelve hours, fromexhaustion. 

_Method of Extraction from the Stomach. _--The contents of the stomach orits coats should be finely cut up and boiled in water, acidulated withtartaric acid and subjected to dialysis, or strained and filtered. Passhydrogen sulphide through the filtered or dialyzed fluid until aprecipitate ceases to fall; collect the sulphide thus formed, wash anddry it. Boil the orange-coloured sulphide in a little hydrochloricacid. If the solution be now added to a large bulk of water, the whiteoxychloride is precipitated, which is soluble in tartaric acid andprecipitated orange yellow with hydrogen sulphide. The chloride ofbismuth is also precipitated white, but the precipitate is not solublein tartaric acid, and the precipitate with hydrogen sulphide is black. 

_Tests. _--Soluble in water, but not in alcohol. 

Heated in substance, it crepitates and chars; and if heat be increased, the metal is deposited. Treated with sulphuretted hydrogen, acharacteristic orange-red sulphide is formed. 

A drop of the solution evaporated leaves crystals, either tetrahedric, or cubes with edges bevelled off. Sulphuretted hydrogen passed throughgives the orange-red precipitate above named. Dilute nitric acid gives awhite precipitate, soluble in excess, and also in tartaric acid. Marsh'sand Reinsch's processes are applicable for the detection of antimony, but Reinsch's is the better. Reinsch's process gives a violet depositinstead of the black, lustrous one of arsenic. 

=Chloride of Antimony= (Butter of Antimony). --A light yellow or dark redcorrosive liquid. 

_Symptoms. _--Violet corrosion and irritation of the alimentary canal, with the addition of narcotic symptoms. After death the mucous membraneof the entire canal is charred, softened, and abraded. 

_Treatment. _--As for tartar emetic; magnesia in milk. 

XXIII. --MERCURY AND ITS PREPARATIONS

The most important salt of mercury, toxicologically, is corrosivesublimate. Other poisonous preparations are red precipitate, whiteprecipitate, mercuric nitrate, the cyanide and potassio-mercuric iodide. Calomel has very little toxic action. Metallic mercury is not poisonous, but its vapour is. 

=Corrosive Sublimate= (perchloride of mercury) is in heavy colourlessmasses of prismatic crystals, possessing an acrid, metallic taste. It issoluble in sixteen parts of cold and two of boiling water. Soluble inalcohol and ether, the latter also separating it from its solution inwater. 

_Symptoms_ come on rapidly. Acrid, metallic taste, constriction andburning in throat and stomach, nausea, vomiting of stringy mucus tingedwith blood, tenesmus, purging. Feeble, quick, and irregular pulse, dysuria with scanty, albuminous or bloody urine or total suppression. Cramp, twitches and convulsions of limbs, occasionally paralysis. Inpoisoning from the medicinal use of mercury, there may be salivation, acoppery taste in the mouth, peculiar foetor of breath, tenderness andswelling of mouth, inflammation, swelling and ulceration of gums(cancrum oris), a blue line on the gums, and the loosening of teeth. Mercury is less quickly eliminated from the body than arsenic. Inchronic cases 'mercurialism, ' 'hydrargyrism, ' 'ptyalism, ' or'salivation, ' including most of the symptoms enumerated above. May get_eczema mercuriale_ and periostitis. Profound anæmia often a prominentsymptom; neuritis not uncommon. If fumes of mercury inhaled, mercurialtremors develop. 

_Post-Mortem Appearances. _--Corrosion, softening, and sloughingulceration of stomach and intestines. The mucous membrane of theoesophagus and stomach is often of a bluish-grey colour. The largeintestine and rectum are often ulcerated and gangrenous. Inflamedcondition of urinary organs, with contraction of the bladder. 

_Treatment. _--Encourage or produce vomiting. Albumin, as white of egg, gluten, or wheat flour, is the best antidote. Demulcent drinks, milk, and ice. Stomach-tube to be used with care, owing to softened state ofgullet and stomach. 

_Fatal Dose. _--Three grains in a child. 

_Fatal Period. _--Half an hour the shortest. 

_Method of Extraction from the Stomach. _--A trial test may be made ofthe contents of the stomach with copper-foil. If mercury is found, thecontents of the stomach may be dialyzed, the resulting clear fluidconcentrated and shaken with ether, which has the power of takingcorrosive sublimate up, and thus separating it from arsenic and othermetallic poisons. The ether allowed to evaporate will leave thecorrosive sublimate in white silky-looking prisms. Suppose no mercury isfound in the dialyzed fluid, owing to the fact that corrosive sublimateenters into insoluble compounds with albumin, fibrin, mucous membrane, gluten, tannic acid, etc. , we must dry the insoluble matter, and heat itwith nitro-hydrochloric acid until all organic matter is destroyed andexcess of nitric acid expelled. The residue dissolved in water, filtered, and tested with copper-foil, etc. 

_Tests. _--The following table gives the action of corrosive sublimatewith reagents:

1. With iodide of potassium Bright scarlet colour. 2. With potash solution Bright yellow colour. 3. With hydrochloric acid and First a yellowish and then a black sulphuretted hydrogen colour. 4. Heated in a reduction-tube Melts, boils, is volatilized, and forms a white crystalline sublimate. 5. With ether Freely soluble; the ethereal solution, when allowed to evaporate spontaneously, deposits the salt in white prismatic crystals. 6. Heated with carbonate of Globules of metallic mercury are sodium in a reduction-tube produced. 

A very simple process for detecting corrosive sublimate is to put a dropof the suspected solution on a sovereign and touch the gold through thesolution with a key, when metallic mercury will be deposited on thegold. 

XXIV. --LEAD AND ITS PREPARATIONS

=Acetate of Lead= (Sugar of Lead). --A glistening white powder orcrystalline mass. Soluble in water, with a sweetish taste. It ispractically the only lead salt which gives rise to acute symptoms, andonly when taken in large doses. 

_Symptoms. _--Metallic taste, dryness in throat, intense thirst, vomiting, colicky pains, cramps, cold sweat, _constipation_ and scantyurine, severe headache, convulsions. 

_Chronic lead-poisoning_ is liable to occur in those who handle lead inany form--white-lead workers, paint manufacturers, plumbers, potteryworkers, etc. 

In chronic lead-poisoning the most prominent symptoms are a blue line onthe gums, anæmia, emaciation, pallor, quick pulse, persistentconstipation, colic, cramps in limbs, and paralysis of the extensormuscles, causing 'dropped hand. ' May get _saturnine encephalopathies_, of which intense headache, optic neuritis, and epileptiform convulsions, are the most common. Albumin in urine, tendency to gout, and in women toabortion. 

_Post-Mortem Appearances. _--Inflamed mucous membrane of stomach andintestines, with layers of white or whitish-yellow mucus, impregnatedwith the salt of lead. 

_Treatment. _--Sulphate of sodium or magnesium, or a mixture of dilutesulphuric acid, spirits of chloroform, and peppermint-water. Milk, ormilk and eggs. As a prophylactic among workers in lead, a drinkcontaining sulphuric acid flavoured with treacle should be given. Lavatory accommodation should be provided, and scrupulous cleanlinessshould also be enjoined in the workshops. The dry grinding of lead saltsshould be prohibited. The ionization method of Sir Thomas Oliver ismost useful both as regards cure and also prevention of chronicpoisoning by lead. 

_Fatal Dose and Fatal Period. _--Uncertain. 

_Method of Extraction from the Stomach. _--Dry the contents of thestomach or portions of the liver, etc. , and incinerate in a porcelaincrucible. Treat the ash with nitric acid, dry, and dissolve in water. The solution of nitrate of lead may now have the proper tests applied. 

_Tests. _--Sulphuretted hydrogen gives a black precipitate; liquorpotassæ, white precipitate; sulphuric acid, white precipitate, insolublein nitric acid; iodide of potassium, a bright yellow precipitate. Adelicate test for lead in water is to stir the water, concentrated ornot, with a glass rod dipped in ammonium sulphide: a brown coloration isproduced. One-tenth of a grain of lead in a gallon of water may bedetected. 

Chronic lead-poisoning is an 'industrial disease, ' and, being anoccupation risk, its victims are entitled to compensation at the handsof their employers. In case of death, compensation has been awarded evenwhen at the autopsy the patient has been found to have suffered fromacute tuberculosis of the lungs. The responsibility of apportioning themonetary value of disablement resulting from the action of the leadrests with a judge or jury, who are guided by the expert medicalevidence available. 

Diachylon, or lead-plaster, is largely used as an abortifacient. 

XXV. --COPPER AND ITS PREPARATIONS

Poisoning with copper salts is rare. The most important are thesulphate, subacetate, and arsenite. 

=Sulphate of Copper= (bluestone, blue vitriol) in half-ounce doses is apowerful irritant. Has been given to procure abortion. 

=Subacetate of Copper= (verdegris) occurs in masses, or as a greenishpowder. Powerful, astringent, metallic taste. Half-ounce doses haveproved fatal. 

_Symptoms. _--Epigastric pain, vomiting of bluish or greenish matter, diarrhoea. Dyspnoea, depression, cold extremities, headache, purple lineround the gums. Jaundice is common. A _chronic_ form of poisoning mayoccur, with symptoms closely resembling those of lead. 

_Post-Mortem Appearances. _--Inflammation of stomach and intestines, which are bluish or green in colour. 

_Treatment. _--Encourage vomiting. Give albumin or very dilute solutionof ferrocyanide of potassium. 

_Method of Extraction from the Stomach. _--Boil the contents of thestomach in water, filter, pass hydrogen sulphide, filter, collectprecipitate and boil in nitric acid, filter, dilute filtrate with waterand apply tests. In the case of the solid organs, dry, incinerate, digest ash in hydrochloric acid, evaporate nearly to dryness, dilutewith water, and test. 

_Tests. _--Polished steel put into a solution containing a copper saltreceives a coating of metallic copper. Ammonia gives a whitish-blueprecipitate, soluble in excess. Ferrocyanide of potassium gives a richred-brown precipitate. Sulphuretted hydrogen gives a deep brownprecipitate. 

XXVI. --ZINC, SILVER, BISMUTH, AND CHROMIUM

The salts of zinc requiring notice are the sulphate and chloride. 

=Sulphate of Zinc= has been taken in mistake for Epsom salts. In largedoses it causes dryness of throat, thirst, vomiting, purging, andabdominal pain. 

_Post-Mortem Appearances. _--Those of inflammation of digestive tract. 

_Treatment. _--Tea, decoction of oak-bark, carbonate of potassium orsodium as antidote. 

=Chloride of Zinc. =--A solution containing this substance (230 grains tothe ounce) constitutes 'Burnett's disinfecting fluid. ' It is a corrosivepoison. 

The symptoms are burning sensation in the mouth, throat, stomach, andabdomen, followed by vomiting, diarrhoea, with tenesmus and distensionof the abdomen. The vomited matter contains shreds of mucous membranewith blood. There is profound collapse, cold surface, clammy sweats, weak pulse, with great prostration. The _treatment_ is to wash out thestomach with large and weak solutions of carbonate of sodium. Mucilaginous drinks may be given, and hypodermic injections of morphineare useful to allay the pain. 

_Method of Extraction from the Stomach. _--Dry and incinerate the tissuesin a porcelain crucible, digest ash in water, apply tests. 

_Tests. _--Ammonia, a white precipitate soluble in excess, reprecipitatedby sulphuretted hydrogen; ferrocyanide of potassium, a whiteprecipitate; sulphuretted hydrogen, a white precipitate in pure andneutral solutions. Nitrate of baryta will show the presence of sulphuricacid, and nitrate of silver of hydrochloric acid. 

=Silver. =--Nitrate of silver is a powerful irritant. 

_Tests. _--Black precipitate with sulphuretted hydrogen; white withhydrochloric acid. 

_Treatment. _--Common salt. 

Chronic nitrate of silver poisoning is characterized by _argyria_. Thegums show a blue line, which is darker than that produced by lead, andthe skin presents a greyish hue, which is permanent. 

=Bismuth. =--The bismuth salts are not poisonous, but may contain arsenicas an impurity, although this is far less common than it was some yearsago. 

=Chromic Acid, Chromate, Bichromate of Potassium. =--These act ascorrosives when solid or in concentrated liquid forms. In dilutesolutions they act as irritants. Used as dyes; have proved fatal morethan once. Those engaged in their manufacture suffer from unhealthyulcers on the nasal septum and hands. The former may to some extent beprevented by taking snuff. Lead chromate (chrome yellow) is a powerfulirritant poison. Two drachms of the bichromate caused death in fourhours. 

_Tests. _--Yellow precipitate with salts of lead, deep red with those ofsilver. 

_Treatment. _--Emetics, magnesia, and diluents. Washing out of thestomach with weak solution of nitrate of silver. 

XXVII. --GASEOUS POISONS

=Carbon Dioxide. =--Carbon dioxide is a product of combustion andrespiration, and is generated in many ways during fermentation. It is aconstituent of _choke damp_ due to explosions in coal-mines, and isgiven off from lime-kilns, brick-kilns, and cement-works. It is oftenmet with in dangerous quantities in wells and in brewers' vats. From 10to 15 per cent. In the atmosphere would prove fatal, but even 2 percent. Inhaled for long would produce serious symptoms. The proportionusually present in air is 0. 04 per cent. 

_Symptoms. _--Inhalation of the _pure_ gas causes spasm of the glottis, insensibility, and death from asphyxia, at once; _diluted_, causes senseof weight in forehead and back of head, giddiness, vomiting, somnolence, loss of muscular power. Insensibility, stertorous breathing, lividity offace and body, and death from asphyxia. Convulsions occasionally. 

_Post-Mortem Appearances. _--Face swollen and livid, or calm and pale;lividity is most marked in eyelids, lips, ears, etc. ; limbs usuallyflaccid, abdomen distended; right side of heart, lungs, and large veins, gorged with dark-coloured blood. Brain and membranes congested. 

_Treatment. _--Pure air, cold affusion, stimulants, artificialrespiration, galvanism, inhalation of oxygen, venesection, transfusion. 

=Carbonic Oxide. =--This is one of the most poisonous of gases. It isevolved in the process of burning charcoal and coke in stoves orfurnaces. Water-gas, obtained by passing steam over heated coke, contains 40 per cent. Of the substance, the remainder being chieflyhydrogen. It forms the chief part of the deadly 'choke damp' after anexplosion in a mine. Two per cent. In the atmosphere is immediatelyfatal. 

_Symptoms. _--When in _large amount_, insensibility comes on at once;when in _very small amounts_, headache, giddiness, noises in the ears, nausea, and vomiting, with prostration, insensibility, and coma. Theremay be convulsions. Even in cases which recover, permanent impairment ofthe brain may result. 

_Post-Mortem Appearances. _--The blood is bright red in colour, due tothe interaction of carbonic oxide with hæmoglobin. A rosy hue of theskin-surface and viscera is often noticed. Bright red patches of colourare found over the surface of the body. The spectrum of the blood ischaracteristic. 

_Treatment. _--Ammonia to the nostrils, inhalation of oxygen, cold douchein moderation, artificial respiration, transfusion of blood. 

=Coal Gas. =--Coal gas contains light carburetted hydrogen or marsh gas, olefiant gas, ammonia, sulphuretted hydrogen, carbonic acid, carbonicoxide, free hydrogen, and nitrogen. Coal gas has an offensive odour, burns with a yellowish-white flame, yielding water and carbonic acid. Cases of poisoning often due to escape of gas into the room. 

_Symptoms. _--Headache and giddiness, foaming at mouth, vomiting, convulsions, tetanic spasms, stertorous breathing, dilated pupil. Thebreath smells of gas; there is profound stupor; the patient, if alive, exhales gas from the lungs when removed into a fresh room or into theair. Smell of gas in the room and in patient's breath. 

_Post-Mortem Appearances. _--Pallor of skin and internal tissues; floridcolour of neck, back, and muscles, if much CO present in the coal gas;fluid florid blood; infiltration of lungs. 

_Treatment. _--Fresh air, artificial respiration, cold affusion, diffusible stimulants; inhalation of oxygen freely. 

=Sulphuretted Hydrogen= is characterized by its odour, like that ofrotten eggs. It is extremely poisonous. 

_Symptoms. _--Giddiness, pain and oppression in stomach, nausea, loss ofpower; delirium, tetanus, and convulsions. 

_Post-Mortem Appearances. _--Fluid and black blood (sulph-hæmoglobin), smell of H_{2}S on opening the body; loss of contractility of muscles, rapid putrefaction. 

_Treatment. _--Fresh air, stimulants, inhalation of chlorine. 

_Tests. _--Acetate of lead throws down a brown or black precipitateaccording to the quantity of the gas. 

=Sewer Gas. =--Cesspool emanations usually consist of a mixture ofsulphuretted hydrogen, sulphide of ammonium, and nitrogen; but sometimesit is only deoxidized air with an excess of carbonic acid gas. 

_Symptoms. _--If poison concentrated, death may ensue at once; if gasdiluted, or exposure only short, insensibility, lividity, hurriedrespiration, weak pulse, dilated pupils, elevation of temperature to104°, tonic convulsions not unlike those of tetanus. 

_Treatment. _--Fresh air, oxygen, with artificial respiration. Stimulants, hypodermic of strychnine, and alternate hot and cold douche. 

=Irritant Gases= are--(1) Nitrous acid gas; (2) sulphurous acid gas; (3)hydrochloric acid gas; (4) chlorine; (5) bromine; (6) ammonia. They havethe common property of causing irritation and inflammation of the eyes, throat, and air-passages, and may cause spasm of the glottis, bronchitis, and pneumonia. 

=Sulphurous Acid Gas. =--One of the products of combustion of commoncoal. 

=Hydrochloric Acid Gas. =--Irrespirable when concentrated, and veryirritating when diluted. Very destructive to vegetable life. 

=Chlorine. =--Used in bleaching, and as a disinfectant. Greenish-yellowcolour, suffocating odour. In poisoning, inhalation of sulphurettedhydrogen gives relief. 

XXVIII. --VEGETABLE IRRITANTS

The chief vegetable purgatives are aloes, colocynth, gamboge, jalap, scammony, seeds of castor-oil plant, croton-oil, elaterium, thehellebores, and colchicum. All these have, either alone or combined, proved fatal. The active principle in aloes is aloin; of jalap, jalapin;of white hellebore, veratria; and of colchicum, colchicin. Morrison'spills contain aloes and colocynth; aloes is also the chief ingredient inHolloway's pills. 

_Symptoms. _--Vomiting, purging, tenesmus, etc. , followed by cold sweats, collapse, or convulsions. 

_Post-Mortem Appearances. _--Inflammation of alimentary canal;ulceration, softening, and submucous effusion of dark blood. 

_Treatment. _--Diluents, opium, stimulants, abdominal fomentations, etc. 

Certain of these irritant poisons exert a marked influence on thecentral nervous system, as the following:

=Laburnum= (_Cytisis Laburnum_). --All parts of the plant are poisonous;the seeds, which are contained in pods, are often eaten by children. Contains the alkaloid _cytisine_, which is also contained in arnica. Ithas a bitter taste, and is powerfully toxic. Symptoms are purging, vomiting, restlessness, followed by drowsiness, insensibility, andconvulsive twitchings. Death due to respiratory paralysis. Most of thecases are in children. Treatment consists of stomach-pump or emetics, stimulants freely, artificial respiration, warmth and friction to thesurface of the body. 

=Yew= (_Taxus baccata_) contains the alkaloid _taxine_. The symptoms areconvulsions, insensibility, coma, dilated pupils, pallor, labouredbreathing, collapse. Death may occur suddenly. Treatment as above. Post-mortem appearances not characteristic, but fragments of leaves orberries may be found in the stomach and intestines. 

=Arum= (_Arum Maculatum_). --This plant, commonly known as 'lords andladies, ' is common in the woods, and the berries may be eaten bychildren. It gives rise to symptoms of irritant poisoning, vomiting, purging, dilated pupils, convulsions, followed by insensibility, coma, and death. 

Many plants have an intensely irritating action on the skin, and whenabsorbed act as active poisons. 

=Rhus toxicodendron= is the poison oak or poison ivy. Poisoning by thisplant is rare in England, though not uncommon in the United States. Merecontact with the leaves or branches will in many people set up an acutedermatitis, with much oedema and hyperæmia of the skin. The inflammationspreads rapidly, and there is formation of blebs with much itching. There is often great constitutional disturbance, nausea, vomiting, diarrhoea, and pains in the abdomen. The effects may last a week, andthe skin may desquamate. 

=Primula obconica= is another plant which, when handled, gives rise toan acute dermatitis of an erysipelatous character. The face swells, andlarge blisters form on the cheeks and chin. 

XXIX. --OPIUM AND MORPHINE

=Opium. =--The inspissated juice of the unripe capsules of the _Papaversomniferum_. As a poison it is generally taken in the form of thetincture (laudanum), which contains 1 grain opium in 15 minims. Opium isfound in almost all so-called 'soothing syrups' for children, and inGodfrey's cordial, Dalby's carminative, and Collis Browne's chlorodyne. Laudanum contains 1 per cent. Morphine, and it, along with all otherpreparations (_e. G. _, paregoric) which contain 1 or more per cent. Morphine, are included in Part I. Of the Schedule of Poisons, and comeunder the Dangerous Drugs Regulations. 

The most important active principles of opium are the alkaloids morphineand codeine. 

_Symptoms_ usually commence in from twenty to thirty minutes: Giddiness, drowsiness and stupor, followed by insensibility. Patient seems asleep;may be roused by loud noise, but quickly relapses. Breathing slow andstertorous, pulse weak, countenance livid. As coma increases, pulsebecomes slower and fuller. The pupils are contracted, even to a pin'spoint; they are insensible to the action of light. In deep, naturalsleep the eyes are turned upwards and the pupils contracted. Bowelsconfined, skin cold and livid or bathed in sweat. Temperature subnormal. Nausea and vomiting are sometimes present. Remissions are notinfrequent, the patient appearing about to recover and then relapsing. Hæmorrhage into the pons may give rise to contracted pupils. Youngchildren and infants are specially susceptible to the poison. 

_Diagnosis_ is not always easy, and one has to differentiate poisoningfrom _cerebral apoplexy_. In the latter one can seldom rouse thepatient, the pupils are often unequal, and hemiplegia is present. In_compression of the brain_, fracture of the skull may be present, subconjunctival hæmorrhages may be seen, the pupils are unequal anddilated, and the paralysis increases. In _uræmic or diabetic coma_ theurine must be examined. 

The habitual use of opium is not uncommon, and opium-eaters are able totake enormous quantities of the drug. The opium-eater may be known byhis attenuated body, withered yellow countenance, stooping posture, andglassy, sunken eyes. 

_Post-Mortem Appearances. _--Not characteristic. Turgescence of cerebralvessels. There may be effusion under arachnoid, into ventricles, at baseof the brain, and around the cord. Rarely extravasation of blood. Stomach and intestines usually healthy. Lungs gorged, skin livid. 

_Fatal Period. _--Usually nine to twelve hours; but in many cases, iflife is prolonged for eight hours, recovery takes place. 

_Fatal Dose. _--Four grains of opium is the smallest fatal dose in anadult, or one drachm of laudanum; children are proportionately much moresusceptible to the action of opium than adults. 

_Treatment. _--Stomach-tube, emetics, strong coffee or tea, ammonia tonostrils. Give 10 grains of permanganate of potassium in a pint of wateracidulated with sulphuric acid, and repeat the dose every half hour. Belladonna by mouth, or atropine hypodermically. Patient must be keptroused by dashing cold water over him, flagellating with a wet towel, walking about, etc. In conditions of collapse, however, this treatmentmust not be continued, but everything should be done to preserve thestrength. Treatment must be continued as long as life remains. 

_Method of Extraction from the Stomach. _--Opium itself cannot bedirectly detected, but we test for morphine and meconic acid. These maybe separated from organic mixtures thus: Boil the organic matter withdistilled water, spirit, and acetic acid; filter, and to the fluidpassed through add acetate of lead till precipitate ceases. Filter. Acetate of morphine passes through, and meconate of lead remains. Thesolution of acetate of morphine may be freed from excess of lead byhydrogen sulphide and filtered, excess of hydrogen sulphide driven offby heat, and tests applied. Put the meconate of lead with water into abeaker and pass hydrogen sulphide; sulphide of lead is formed, andmeconic acid set free. Filter. Concentrate the solution of meconic acid, allow a portion to crystallize, and apply tests. 

_Tests. _--Morphine and its acetate give an orange-red colour with nitricacid, becoming brighter on standing; decompose iodic acid, setting freeiodine; with perchloride of iron, gives a rich indigo-blue; withbichromate of potassium, a green turning to brown. When the alkaloid isheated in a watchglass with a drop of strong sulphuric acid until theacid begins to fume, and is then allowed to get quite cold, a drop ofnitric acid produces a brilliant red colour. The iodic acid test is verydelicate, but requires great care, and may be used in the presence oforganic matter. 

Meconic acid gives a blood-red colour with perchloride of iron, notdischarged by corrosive sublimate or chloride of gold. The similarcolour produced by sulpho-cyanide of potassium and perchloride of ironis discharged by chloride of gold and corrosive sublimate. 

=Morphine Habit. =--Individuals who have acquired this habit take thedrug usually by hypodermic injection. The victim suffers from nausea andvomiting, and becomes so mentally debilitated that asylum treatment isrequired. 

XXX. --BELLADONNA, HYOSCYAMUS, AND STRAMONIUM

=Belladonna. =--The root, leaves, and berries, of the _Atropa belladonna_are poisonous from the presence of alkaloid atropine. 

_Symptoms. _--Dryness of mouth and throat, intense thirst, dysphagia anddysphonia, quick pulse, noisy delirium and stupor. Strangury andhæmaturia, and redness of the skin, especially of the face, like thatof scarlatina, have been noticed. Dilatation of the pupil occurs, whether the poison be taken internally or applied locally to the eye. 

_Post-Mortem Appearances. _--Congestion of cerebral vessels, dilatedpupils, red patches in alimentary canal. 

_Treatment. _--Wash out the stomach freely; a hypodermic injection ofapomorphine as an emetic, followed by hypodermic injections ofpilocarpine or morphine. Tea, coffee, or tannin, to precipitate thealkaloid. 

_Tests. _--Atropine may be recognized by its action on the pupil. Thechloro-iodide of potassium and mercury precipitates it from very dilutesolutions. 

=Hyoscyamus= (Henbane). --_Hyoscyamus niger. _

=Stramonium= (Thorn-Apple). --_Datura stramonium. _

_Symptoms. _--Identical with those of belladonna and hyoscyamus, the_post-mortem appearances_ and _treatment_ being also the same. 

=Cannabis Indica= (Indian Hemp). --When smoked, produces intoxication andmania. _Hashish_, used in the East as a narcotic, may cause persons torun 'amok' and commit murder. 

XXXI. --COCAINE

=Cocaine. =--Any dose above 1/2 grain applied to a mucous membrane orinjected hypodermically may give rise to alarming symptoms. These areintense pallor, faintness, giddiness, dilatation of pupils, paroxysmaldyspnoea, rapid, intermittent, and weak pulse, nausea and vomiting, intense prostration verging on collapse, and convulsions. The patientmay recover if allowed to remain in a recumbent position, but stimulantsby mouth--_e. G. _, ammonia--and the hypodermic injection of brandy orether may be necessary, with the inhalation of nitrite of amyl. 

For care in the prescribing of cocaine see under the 'Dangerous DrugsAct, 1920' (p. 82). 

The =Cocaine Habit= consists in the self-administration of the drughypodermically. It induces excitement, which is followed by prostration. In time melancholia or mania develops, with great irritation of the skin('cocaine bugs'). 

XXXII. --CAMPHOR

The liniment, oil, and spirit have been poisonous in large dose. 

_Symptoms. _--Odour of breath, languor, giddiness, faintness, dimness ofvision, difficulty of breathing, delirium, convulsions, with hot skin, flushed face, and dilated pupils. 

_Fatal Dose. _--Thirty grains. 

=Cocculus Indicus. =--The fruit of _Anamirta cocculus_. Contains apoisonous active principle, picrotoxin; used to adulterate beer, and bypoachers to stupefy fish. 

_Symptoms. _--Convulsions, followed by stupor and complete loss ofvoluntary power. 

XXXIII. --TETRACHLORETHANE, ETC. 

=Tetrachlorethane= ('Cellon'). --Acetylene tetrachloride; vapour hascaused poisoning in aeroplane ('dope') and cinema film works. 

_Symptoms. _--Gastric symptoms and marked jaundice. This may be followedin days or weeks by stupor, coma, death. 

_Post-Mortem. _--Fatty degeneration of internal organs, chiefly liver. 

=Trinitrotoluene (T. N. T. ). =--An explosive solid which stains the skin anorange colour; may be absorbed through skin or be inhaled. 

_Symptoms. _--Shortness of breath, headache, drowsiness. Later, skinirritation, gastritis, jaundice, blood degeneration. 

_Treatment. _--Remove from work, rest in bed, diuretics, purgatives, alkalies. 

XXXIV. --ALCOHOL, ETHER, AND CHLOROFORM

Alcohol, ether, and chloroform, induce general anæsthesia, oftenpreceded by delirious excitement, and followed by nausea and vomiting. When they cause death, it is by inducing a state like apoplexy or byparalyzing the heart. 

=Alcohol. =--Absolute alcohol is ethyl hydroxide (C_{2}H_{5}OH) with notmore than 1 per cent. By weight of water. Rectified spirit (spiritusrectificatus) contains 90 per cent. Of alcohol. Methylated spiritconsists of rectified spirit with 10 per cent. Of wood spirit. Proofspirit contains a little over 49 per cent. Of absolute alcohol; brandyor whisky, 53 per cent. ; port wine, 20 to 25 per cent. ; ales and stout, 4 to 6 per cent. 

_Symptoms. _--Acute poisoning; confusion, giddiness, staggering gait, headache, passing into stupor, with subnormal temperature, and coma. Vomiting may occur and recovery ensue, otherwise collapse sets in. Pupils usually dilated. 

Dipsomaniacs suffer from indigestion, vomiting and purging, jaundice, albuminuria, diabetes, cirrhosis of liver, degeneration of kidneys, congestion of brain, peripheral neuritis, alcoholic insanity, andvarious forms of paralysis. In the acute form delirium tremens is themost common manifestation. 

_Post-Mortem Appearances. _--Deep red colour of lining membranes ofstomach. Sometimes congestion of cerebral vessels and meninges. Lungscongested, blood fluid. Rigor mortis persistent. 

_Fatal Dose. _--Death from 1/2 pint of gin and from two bottles of port, but recovery from larger quantities. 

_Fatal Period. _--Average about twenty-four hours. 

_Treatment. _--Stomach-tube, cold affusion, electricity, injection of apint of hot coffee into the rectum. Give chloride of ammonium in 30grain doses to prevent delirium; strychnine or digitalinhypodermically. 

_Method of Extraction from the Stomach. _--Neutralize the contents of thestomach, if acid, with sodium carbonate; place them in a retort andcarefully distil. Collect the distillate, mix with chloride of calciumor anhydrous sulphate of copper, and again distil. Agitate distillatewith dry potassium carbonate, and draw off some of the supernatant fluidfor testing. 

_Tests. _--Odour. Dissolves camphor. With dilute sulphuric acid andbichromate of potassium turns green, and evolves aldehyde. Product ofcombustion makes lime-water white and turbid. 

=Methyl Alcohol: Wood Naphtha. =--Used to produce intoxication bypainters, furniture-polishers, etc. 

_Symptoms_ are those of alcoholic poisoning, but vomiting and deliriumare more persistent. Total or partial blindness may follow as a sequelof optic atrophy. A fatal result not infrequently follows. 

The following table gives the points of distinction between concussionof brain, alcoholic poisoning, and opium poisoning:

 CONCUSSION OF BRAIN. ALCOHOL. OPIUM. 

1. Marks of violence 1. No marks of violence, 1. As alcohol. On head. Unless person has fallen. History will be of use. 

2. Stupor, sudden. 2. Excitement precedes 2. Symptoms slow. Sudden stupor. Drowsiness, stupor, lethargy. 

3. Face pale, cold; 3. Face flushed; pupils 3. Face pale; pupils pupils sluggish, generally dilated. Contracted. Sometimes dilated. 

4. Remission rare. 4. Partial recovery may 4. Remission rare. Patient recovers occur, followed by slowly. Death. 

5. No odour of alcohol 5. Odour of alcohol 5. Odour of opium in in breath. In breath. Breath. 

=Ether= is a volatile liquid prepared from ethylic alcohol byinteraction with sulphuric acid. It contains 92 per cent. Of ethyl oxide(C_{2}H_{5})O. It was formerly called 'sulphuric ether. ' It is acolourless, inflammable liquid, having a strong and characteristicodour, specific gravity 0. 735. =Purified ether= from which the ethylicalcohol has been removed by washing with distilled water, and most ofthe water by subsequent distillation in the presence of calcium chlorideand lime. It is this preparation which is used for the production ofgeneral anæsthesia. It has a specific gravity of 0. 722 to 0. 720, and itsvapour is very inflammable. 

_Symptoms. _--When taken as a liquid, same as alcohol. When inhaled asvapour, causes slow, prolonged, and stertorous breathing; face becomespale, lips bluish, surface of body cold. Pulse first quickens, thenslows. Pupils dilated, eyes glassy and fixed, muscles become flabby andrelaxed, profound anæsthesia. Then pulse sinks and coma ensues, sensation being entirely suspended. Nausea and vomiting not uncommon. 

_Post-Mortem Appearances. _--Brain and lungs congested. Cavities of heartfull of dark, liquid blood. Vessels at upper part of spinal cordcongested. 

_Treatment. _--Exposure to pure air, cold affusion, artificialrespiration, galvanism. 

_Method of Extraction from the Contents of the Stomach. _--Same as foralcohol. During distillation pass some of the vapour into concentratedsolution of bichromate of potash, nitric and sulphuric acids, and notereaction as for alcohol. 

_Tests. _--Vapour burns with smoky flame, depositing carbon. Sparinglysoluble in water. With bichromate of potash and sulphuric acid same asalcohol. 

=Chloroform. =--A colourless liquid, specific gravity 1. 490 to 1. 495, very volatile, giving off dense vapour. Sweet taste and pleasant odour. 

_Symptoms. _--When swallowed, characteristic smell in breath, anxiouscountenance, burning pain in the throat, stomach, and region of theabdomen, staggering gait, coldness of the extremities, vomiting, insensibility, deepening into coma, with stertorous breathing, dilatedpupils, and imperceptible pulse. When inhaled, much the same as ether, but produces insensibility and muscular relaxation more rapidly. Itwould be impossible to instantly render a person insensible by holding apocket-handkerchief saturated with chloroform over the face. Statementssuch as this, which are often made in cases of robbery from the personand in cases of rape, are incredible. 

_Delayed Chloroform-Poisoning. _--Death may take place in from four toseven days after chloroform has been administered, especially in thecase of children. The internal organs are found to be fattilydegenerated, and death is thought to be due to acetonuria. 

_Post-Mortem Appearances. _--Cerebral and pulmonary congestion. Heartempty, or right side distended with dark blood. 

_Treatment. _--Stomach-tube and free lavage; cold affusion; drawingforward tongue; artificial respiration; galvanism and suspension withhead downward. Inhalation of nitrite of amyl; strychnine hypodermically. 

_Fatal Dose. _--When swallowed, from 1 to 2 ounces. 

_Method of Extraction from the Stomach. _--By distillation at 120° F. Thevapour, as it passes along a glass tube, may be decomposed by heat intochlorine, hydrochloric acid, and carbon--the first shown by setting freeiodine in iodide of starch, the second by reddening blue litmus-paper, and the last by its deposit. 

_Tests. _--Taste, colour, weight; burns with a green flame; dissolvescamphor, guttapercha, and caoutchouc. 

=Iodoform. =--Poisoning may result from its use in surgery. It producesdelirium, sleepiness, and coma. It may lead to mental weakness or opticneuritis. 

XXXV. --CHLORAL HYDRATE

It was formerly largely used as a hypnotic, and many fatal consequencesensued. It is prepared from alcohol and chlorine. 

_Symptoms. _--Deep sleep, loss of muscular power, diminished or abolishedreflex action and sensibility, followed by loss of consciousness andmarked fall of temperature. Pulse may become quick, and face flushed orlivid and bloated. Prolonged use of this drug may produce a peculiareruption on the skin. Supposed to act in the blood by being decomposedinto chloroform and sodium formate. Its effects are due chiefly todepression of the central nervous system, the medulla being the lastpart of the nervous system to be attacked. 

_Method of Extraction from the Stomach. _--By distillation in stronglyalkaline solutions, when it may be obtained as chloroform and tested assuch. 

_Treatment. _--Stomach-tube or emetic. Hypodermic injections ofstrychnine. Keep patient warm, and inject a pint of hot strong coffeeinto the rectum. Nitrite of amyl and artificial respiration. 

_Tests. _--Heated with caustic potash, it yields chloroform and potassiumformate. The chloroform is readily recognized by its odour, and, if thesolution be concentrated, by separating as a heavy layer at the bottomof the test-tube. 

XXXVI. --PETROLEUM AND PARAFFIN-OIL

Cases of poisoning by petroleum and paraffin are common, and occurchiefly in children. 

=Petroleum= is a natural product, and is a mixture of the highersaturated hydrocarbons. The crude petroleum is purified by distillation, and is then free from colour, but retains its peculiar penetratingodour. Different varieties are sold under the names of cymogene, gasolene, naphtha, petrol, and benzoline. Benzoline is highlyinflammable, and is often called mineral naphtha, petroleum naphtha, andpetroleum spirit. Benzoline is not the same as benzene or benzol, whichis one of the products of the dry distillation of coal. 

From its very general use as a fuel in motor-cars many accidents havehappened from inhaling the vapour of petrol. It gives rise to coldness, shallow respiration, syncope, and insensibility, but seldom death. 

=Paraffin=, also known as kerosene and mineral oil, is a mixture ofsaturated hydrocarbons obtained by the distillation of shale. 

By the retailer the terms 'petroleum' and 'paraffin' oil are usedindifferently, and each is sold for the other without prejudice. 

_Symptoms. _--These substances are not very active poisons, and, as arule, even children recover. The breath has the odour of paraffin, theface is pale and cyanotic, hot and dry, and there may be vomiting. Deathmay result from gastro-enteritis or from coma. 

_Fatal Dose. _--In the case of an adult, 1/2 pint should not provelethal, and patients have recovered after drinking a pint. 

_Treatment. _--Emetics, purgatives, and stimulants. 

XXXVII. --ANTIPYRINE, ANTIFEBRIN, PHENACETIN, AND ANILINE

Many of the synthetical coal-tar products now so largely employed asanalgesics are powerful toxic agents. 

=Phenazone, Antipyrine, or Analgesin=, is a complex benzene derivativeprepared from aniline, aceto-acetic ether, and methyl iodide. It is incolourless, inodorous, scaly crystals, which have a bitter taste. It issoluble in its own weight of water. 

_Tests. _--Can be extracted from an alkaline solution of chloroform. Theresidue left on the evaporation of chloroform should be employed fortesting. If heated with strong nitric acid and allowed to cool, a purplecolour is produced. Ferric chloride gives a blood-red coloration, destroyed by the addition of mineral acids. 

_Treatment. _--Stimulants freely, inhalation of oxygen, patient to bekept in the recumbent position. 

=Acetanilide, Antifebrin, Phenylacetamide= (a constituent of 'Daisy' or'headache' powders), is obtained by the interaction of acetic acid andaniline. It is in colourless, inodorous, lamellar crystals, which have aslight pungent taste. It is insoluble in water. 

_Tests. _--May be extracted from acid solutions by ether or chloroform. If heated with solution of potassium hydroxide, odour of aniline isgiven off; if liquid, when it is warmed with a few drops of chloroform, a penetrating and unpleasant odour of isocyanide. 

_Treatment. _--Emetics, stimulants, inhalation of ether, recumbentposition. 

=Phenacetin, Phenacetinum=, is produced by the interaction of glacialacetic acid and para-phenetidin. It is in white, tasteless, inodorous, glistening, scaly crystals, insoluble in water. Of all the members ofthe group, it most rarely produces toxic symptoms. 

_Treatment. _--As for the other members of this group. 

=Exalgin, Aspirin, etc. =, as well as the above, may all act as poisonsto certain persons, and even small medicinal doses may cause serious andeven fatal consequences. 

_Symptoms_ (more or less common to all). --Nausea, vomiting, hurriedrespiration, marked cyanosis, syncope. Persistent sneezing andwidespread urticaria may be present; collapse. 

=Aniline= is an oily liquid, heavier than, and not soluble in, water. Itis colourless or reddish-brown; it has a peculiar tar-like odour; it issoluble in alcohol, and forms a soluble sulphate with sulphuric acid. Asolution of bleaching-powder gives with solution of the sulphate apurple colour changing to red-brown. 

_Symptoms. _--Nausea, vomiting, giddiness, intoxication, drowsiness, gasping for breath, feeble pulse, and marked cyanosis. In its_industrial use_ it may act as a poison either by inhalation of thefumes or by absorption through the skin. The symptoms then are mainlythose of peripheral neuritis with blindness. 

_Fatal Dose. _--About 6 drachms. 

_Treatment. _--Wash out stomach; stimulants, artificial respiration, inhalation of oxygen, transfusion. 

=Nitro-benzol= (Artificial Oil of Bitter Almonds). --It is used inperfumery, but is very poisonous when swallowed, or inhaled, or absorbedthrough skin. It is used in the manufacture of aniline dyes, and may actas an industrial poison. The symptoms closely resemble those of anilinepoisoning, but there is perhaps greater mental confusion. 

_Fatal Dose. _--Eight to ten drops have caused death. 

_Treatment. _--Emetics, stimulants, transfusion of saline or blood, pituitrin, strychnine, or digitalin hypodermically. 

=Nitroglycerine= gives rise to intense and persistent headache ('powderheadache'). Throbbing and pulsation of all the arteries in the body;flushing of the face and collapse may follow. 

=Dinitrobenzene= causes symptoms resembling nitro-benzol poisoning, andwhen acting as a chronic poison gives rise to weakness, jaundice, peripheral neuritis. 

XXXVIII. --SULPHONAL, TRIONAL, TETRONAL, VERONAL, PARALDEHYDE

These are dangerous drugs. The ordinary _symptoms_ of the group arenoises in the ears, headache, vertigo, inability to stand or to walkproperly, insensibility, and cyanosis. 

The most interesting point is the condition of the urine. In cases ofpoisoning it is dark or reddish-brown in colour, due to the presence of_hæmatoporphyrin_. It contains albumin and casts, but no red corpuscles. In cases of hæmatoporphyrinuria the prognosis is bad, and it is saidthat these cases invariably end fatally. 

_Treatment. _--In an ordinary case emetics, strong coffee, hypodermicinjections of strychnine, saline injections, and transfusion. 

Cases of chronic poisoning from the 'als' are not uncommon, and areincreasing in frequency. Hypnogen is apparently identical with veronal. 

All the above-named aniline derivatives are included in Part I. Of thescheduled poisons. 

XXXIX. --CONIUM AND CALABAR BEAN

=Conium Maculatum= (Spotted Hemlock). --All parts of the plant arepoisonous, often mistaken for parsley. Contains the poisonous principle_coniine_, a volatile liquid alkaloid with a mousy smell; insoluble inwater; soluble in alcohol, ether, and chloroform. It also containsmethyl coniine. 

_Symptoms. _--Dryness of throat, headache, dilated pupil, dysphagia, lossof muscular power, passing into complete paralysis. Delirium, coma, andconvulsions, occasionally. 

_Post-Mortem Appearances. _--Congested brain and lungs; redness of themucous membrane of the stomach. The stomach and intestines should beexamined for fragments of the leaves and fruit, recognized by theirmicroscopical appearances. 

_Treatment. _--Emetics, tannic acid or gallic acid. Diffusiblestimulants. 

_Method of Extraction from the Stomach. _--Use Stas-Otto process. 

_Tests. _--The mousy odour. Deepened colour and dense white fumes withnitric acid. Pale red, deepening, with hydrochloric acid. 

There are several other umbelliferous plants which are poisonous. Thewater hemlock (_Cicuta virosa_) produces symptoms not unlike those ofhemlock; it has been mistaken for parsnip and celery. It contains anactive principle, _cicutoxin_, which in some respects is allied tostrychnine and picrotoxin. The fool's parsley, or lesser hemlock(_Æthusa cynapium_), is another member of this group, although doubt hasbeen expressed as to whether it is really poisonous. The water dropwort(_Oenanthe crocata_) is undoubtedly poisonous, especially to cattle. Inman it produces abdominal pain with diarrhoea and vomiting; dilatedpupils, slow pulse, and cyanosis; delirium, insensibility, andconvulsions. The post-mortem appearances are not characteristic, but thestomach and intestines should be examined for portions of the plant. 

=Calabar Bean or Physostigma. =--The bean of _Physostigma venenosum_contains the alkaloid physostigmine or eserine, with the antagonisticalkaloid calabarine. 

_Symptoms. _--Vomiting, giddiness, irregular cardiac action, contractionof the pupils, paralysis of lower extremities, and death from asphyxia. 

_Treatment. _--Emetics; hypodermic injection of 1/50 grain sulphate ofatropine, repeated if necessary. 

_Method of Extraction from the Stomach. _--Use Stas-Otto process. 

_Test. _--The contraction of the pupil which it causes. 

XL. --TOBACCO AND LOBELIA

=Tobacco. =--_Nicotiana tabacum_ owes its poisonous properties to itsalkaloid nicotine, a volatile, oily, amber-coloured liquid, with anacrid taste and ethereal odour; soluble in water, alcohol, ether, andchloroform. The drug has an intense depressant action on the heart andrespiratory centre. 

_Symptoms. _--Giddiness, fainting, nausea, and vomiting, with syncope, muscular tremors, stupor, stertorous breathing, and insensible pupil. Death has occurred after seventeen or eighteen pipes at a sitting. 

_Post-Mortem Appearances. _--Not uniform or characteristic. Generalrelaxed condition of muscles; engorgement of cerebral and pulmonaryvessels. Congestion of gastric mucous membrane. 

_Treatment. _--Emetics, stimulants, hypodermic injection of 1/25 grain ofstrychnine. Warmth to the surface by hot bottles, hot blankets. 

_Method of Extraction from the Stomach. _--Digest the contents of thestomach in cold distilled water and _very dilute_ sulphuric acid;strain, filter, and press residue. Evaporate the filtrate to half itsbulk, digest with alcohol, and evaporate alcohol off in a water-bath. Dissolve residue (sulphate of nicotine) in water, and make solutionalkaline with potash; then shake with ether in a test-tube. Remove etherand allow it slowly to evaporate. Test resulting alkaloid. 

_Tests. _--No change of colour with the mineral acids. White deposit withcorrosive sublimate. Sulphuric acid and bichromate of potassium give agreen colour, oxide of chromium. Precipitate with bichloride of platinumand with carbazotic acid. 

=Lobelia Inflata= (Indian Tobacco). --Much used in America by theCoffenite practitioners, and a valuable remedy for asthma. 

_Symptoms. _--Nausea, vomiting, giddiness, cold sweats, prostration. Headache, giddiness, tremors, insensibility, and convulsions. 

XLI. --HYDROCYANIC ACID

=Prussic Acid= is the most active of poisons. The diluted hydrocyanicacid of the Pharmacopoeia contains 2 per cent. Of hydrocyanic acid, Scheele's 4 per cent. It is a colourless liquid, feebly acid, withodour of bitter almonds. 

=Cyanide of Potassium= is largely used in photography and inelectro-plating, and is also poisonous. It often contains undecomposedcarbonate of potassium, which may act as a corrosive poison and causeerosion of the mucous membranes of the lips, mouth, and stomach. 

=Oil of Bitter Almonds=, used as a flavouring agent, may contain (whenimproperly prepared) from 5 to 15 per cent. Of the anhydrous acid. 

_Symptoms. _--The symptoms usually come on in a few seconds, and are ofthe shortest possible duration. There is a sudden gasp for breath, possibly a loud cry, and the patient drops down dead. If the fataltermination is prolonged for a few minutes, the symptoms are intensegiddiness, pallor of the skin, dilatation of the pupils, laboured andirregular breathing, small and frequent pulse, followed byinsensibility. There may be convulsions or tetanic spasms, withevacuation of urine and fæces. Death results from paralysis of thecentral nervous system, but artificial respiration is useless, as thedrug promptly arrests the heart's action. It also kills the protoplasmof the red blood-corpuscles, rendering them useless as oxygen-carriers. 

_Post-Mortem Appearances. _--Skin livid, pale, or violet, with bright redpatches on the dependent parts. The gastro-intestinal mucous membrane isbright red in colour, owing to the presence of cyanmethæmoglobin. Handsclenched, nails blue, jaws fixed, froth about mouth. Eyes prominent andglistening, odour of acid from body, venous system gorged. 

_Treatment. _--Empty the stomach by the tube at once, and wash it outwith a solution of sodium thiosulphate. Strong ammonia to the nostrils. Stimulants freely--brandy, chloric ether, ammonia, sal volatile _adlibitum_. If patient cannot swallow, inject hypodermically either brandyor ether. Hypodermic injection of 1/50 grain atropine. Douche to theface, alternately hot and cold. Death commonly occurs so rapidly thatthere is no time for treatment. 

_Fatal Dose (Smallest). _--Half a drachm of the B. P. Acid, equal to 0. 6grain of the anhydrous. _Recovery_ from 1/2 ounce of the B. P. Acid. These records are fallacious, for in specimens the percentage ofanhydrous acid varies enormously. Practically, 1 grain of the anhydrousacid is fatal. 

_Fatal Period. _--From two to five minutes after a large dose, but may beless. 

_Method of Extraction from the Stomach. _--Having previously carefullyfitted a watchglass to a wide-mouthed bottle, nearly fill the bottlewith the contents of the stomach, blood, secretions, etc. Place a fewdrops of a solution of nitrate of silver on the concave surface of thewatchglass, and cover the mouth of the bottle with it. The vapour ofhydrocyanic acid, if present, will form a white precipitate which may betested. Other watchglasses, treated with sulphide of ammonium orsulphate of iron and liquor potassæ, will give the reactions of the acidwith appropriate tests. This method removes all objections as to foreignadmixture. If the acid is not at first detected, gentle warming of thebottle in a water-bath will assist the evolution of the vapour. Thevapour may be obtained by distillation, but this process is open toobjections to which the other is not. In some cases it becomes changedin the body into formic acid, which should therefore be sought for. 

_Tests. _--With nitrate of silver a white precipitate, insoluble in cold, but soluble in boiling, nitric acid. The precipitate heated, evolvescyanogen, having an odour of peach-blossoms, and burning, when lighted, with a pink flame. Liquor potassæ and sulphate of iron give abrownish-green precipitate, which turns to Prussian blue withhydrochloric acid. Liquor potassæ and sulphate of copper give agreenish-white precipitate, becoming white with hydrochloric acid. Sulphide of ammonium gives sulpho-cyanide of ammonium. This develops ablood-red colour with perchloride of iron, bleached by corrosivesublimate. 

XLII. --ACONITE

=Aconite= (_Aconitum Napellus_, monkshood). --Root and leaves. Poisonousproperty depends upon an alkaloid, aconitine. Aconite is one of theconstituents of St. Jacob's Oil. 

_Symptoms. _--Numbness and tingling in mouth, throat, and stomach, giddiness, loss of sensation, deafness, dimness of sight, paralysis, first of the lower and then of the upper extremities, vomiting, andshallow respiration. Pupils dilated. Pulse small, irregular, finallyimperceptible. The mind remains unaffected. Death often sudden. 

_Post-Mortem Appearances. _--Venous congestion, engorgement of brain andmembranes. 

_Treatment. _--Emetics, stimulants freely. Best antidote is sulphate ofatropine, 1/50 grain hypodermically, and also strychnine. Digitalis alsouseful. Warmth to whole body. Patient to make no exertion. 

_Fatal Dose. _--Of root or tincture, 1 drachm. 

_Fatal Period. _--Average, less than four hours. 

_Method of Extraction from the Stomach, etc. _--Extraction from contentsof stomach by Stas-Otto process. It may be found in the urine; givesusual alkaloidal reactions, but no distinctive chemical test known. 

_Tests. _--Chiefly physiological; tingling and numbness when applied totongue or inner surface of cheek. Effects on mice, etc. A cadavericalkaloid or ptomaine has been found in the body, possessing many of theactions of aconitine. The presence of this substance was suggested inthe Lamson trial. 

The Indian aconite, _Aconitum ferox_, the Bish poison, is much moreactive than the European variety. It contains a large proportion ofpseudaconitine, and is frequently employed in India, not only for thedestruction of wild beasts, but for criminal purposes. 

=Aconitine= varies much in activity according to its mode of preparationand the source from which it is derived. The most active kind isprobably made from _A. Ferox_. 

XLIII. --DIGITALIS

All parts of the plant _Digitalis purpurea_ (purple foxglove) arepoisonous. Contains the glucoside digitalin and other active principles. 

_Symptoms. _--Nausea, vomiting, purging, and abdominal pains. Vomitedmatter grass-green in colour. Headache, giddiness, and loss of sight;pupils dilated, insensitive; pulse weak, remarkably slow and irregular;cold sweat. Salivation occasionally, or syncope and stupor. Deathsometimes quite suddenly. 

_Post-Mortem Appearances. _--Congested condition of brain and membranes;inflammation of gastric mucous membrane. 

_Treatment. _--Emetics freely; infusions containing tannin, as coffee, tea, oak-bark, galls, etc. Stimulants. Hypodermic injection of 1/120grain of aconitine. 

_Method of Extraction from the Stomach, etc. _--Use Stas-Otto process. 

_Tests for Digitalin. _--A white substance, sparingly soluble in water, not changed by nitric acid; turns yellow, changing to green, withhydrochloric acid. The minutest trace of digitalin moistened withsulphuric and treated with bromine vapour gives a rose colour, turningto mauve. This is very delicate, but in experienced hands thephysiological test is more reliable. The chemist who has had nopractical experience in pharmacological methods would be wiser to keepto his chemical tests. 

XLIV. --NUX VOMICA, STRYCHNINE, AND BRUCINE

=Nux Vomica= consists of the seeds of the _Strychnos nux vomica_. Fromthese strychnine and brucine are obtained. The symptoms, post-mortemappearances, and treatment, of poisoning by nux vomica are the same asfor strychnine. 

=Strychnine= is a powerful poison, and forms the active ingredient ofmany 'vermin-killers. ' It occurs as a white powder or as colourlesscrystals, with a persistent bitter taste; very slightly soluble inwater; more or less soluble in benzol, ether, and alcohol. 

_Symptoms. _--Sense of suffocation, twitchings of muscles, followed bytetanic convulsions and opisthotonos, each lasting half to two minutes. Mental faculties unaffected, face congested and anxious; eyes staring, lips livid; much thirst. The period of accession of the symptoms varieswith the mode of administration of the poison. Symptoms, as a rule, comeon soon after food has been taken. Patient may die within a few hoursfrom asphyxia or from exhaustion. 

In _Tetanus_ there is usually history of a wound; the symptoms come onslowly; lockjaw is an early symptom, and only later completeconvulsions; the intervals between the fits are never entirely free fromrigidity. Death is delayed for some days. 

_Post-Mortem Appearances. _--Heart empty, blood fluid, rigor mortispersistent. Hands usually clenched; feet arched and inverted. Congestionof brain, spinal cord, and lungs. 

_Treatment. _--Emetics or stomach-pump if the patient is deeplyanæsthetized. Tannic acid and permanganate of potassium. Bromide ofpotassium 1/2 ounce with chloral 30 grains, repeated if necessary. 

_Fatal Dose (Smallest). _--Quarter of a grain. 

_Fatal Period (Shortest). _--Ten minutes; usually two to four hours. 

_Method of Extraction from the Stomach. _--The alkaloid may be separatedby the process of Stas-Otto. 

_Tests. _--Strychnine has a characteristic, very bitter taste; it impartsthis taste to even very dilute solutions; it is unaffected by sulphuricacid, but gives a purple-blue colour, changing to crimson and light red, when the edge of this solution is touched with dioxide of manganese, potassium bichromate, ferricyanide of potassium, or permanganate ofpotassium. This test is so delicate as to show the 1/25000 of a grain ofthe alkaloid. A very minute quantity (1/5000 grain) in solution placedon the skin of a frog after drying causes tetanic convulsions. 

=Brucine. =--This alkaloid, found associated with strychnine, possessesthe same properties, though in a less powerful degree. Nitric acid givesa blood-red colour, changed to purple with protochloride of tin. 

XLV. --CANTHARIDES

=Cantharides. =--Spanish fly, or blistering beetle, is the basis of mostof the blistering preparations. It is sometimes taken as anabortifacient or given as an aphrodisiac, but whether it has any suchaction is open to question. It acts as an irritant to the kidneys andbladder, and sometimes produces haæmaturia and a good deal of temporarydiscomfort. 

_Symptoms. _--Burning sensation in the throat and stomach, withsalivation, pain and difficulty in swallowing. Vomiting of mucus mixedwith blood. Tenesmus, diarrhoea, the motions containing blood and mucus. Dysuria, with passage of small amounts of albuminous and bloody urine. Peritonitis, high temperature, quick pulse, headache, loss ofsensibility, and convulsions. 

_Post-Mortem. _--Gastro-intestinal mucous membrane inflamed, withgangrenous patches. Genito-urinary tract inflamed. Acute nephritis. 

_Treatment. _--An emetic of apomorphine; demulcent drinks, such asbarley-water, white of egg and water, linseed-tea and gruel (but notoils), with a hypodermic injection of morphine to allay pain. 

_Tests. _--The vomited matter often contains shining particles of thepowder. The urine will probably be albuminous. 

XLVI. --ABORTIFACIENTS

Emmenagogues are remedies which have the property of exciting thecatamenial flow; ecbolics, or abortives, are drugs which excitecontraction of the uterus, and are supposed to have the power ofexpelling its contents. The vegetable substances commonly reputed to beabortives are ergot, savin, aloes (Hierapicra), digitalis, colocynth, pennyroyal, and nutmeg; but _there is no evidence to show that any drugpossesses this property_. Lead in some parts of the country is a popularabortifacient. A medicine may be an emmenagogue without being anecbolic. Permanganate of potassium and binoxide of manganese arevaluable remedies for amenorrhoea, but will not produce abortion. Thevegetable substances frequently used as abortives are savin and ergot. 

=Savin= (_Juniperus Sabina_). --Leaves and tops of the plant yield anacrid oil having poisonous properties, and which has even produceddeath. 

_Symptoms. _--Those of irritant poisons. Purging not always present, buttenesmus and strangury. 

_Post-Mortem Appearances. _--Acute inflammation of alimentary canal. Green powder found. This, washed and dried and then rubbed, gives odourof savin. 

_Test. _--A watery solution of savin strikes deep green with perchlorideof iron, and if an infusion of the twigs has been taken the twigs may bedetected with the microscope. The twigs obtained from the stomach, driedand rubbed between the finger and thumb, will give the odour of savin. 

=Ergot= (_Secale Cornutum_). --A parasitic fungus attacking wheat, barley, oats, and rye, which is reputed to have the power of causingcontraction of unstriped muscular fibre, especially that of the uterus. 

_Symptoms. _--Lassitude, headache, nausea, diarrhoea, anuria, convulsions, coma. Small quantities frequently repeated have in the pastproduced gangrene of the extremities, or anæsthesia of fingers and toes. 

_Tests. _--Lake-red colour with liquor potassæ; this liquid filteredgives a precipitate of same colour with nitric acid. 

XLVII. --POISONOUS FUNGI AND TOXIC FOODS

=Fungi. =--Of the poisonous mushrooms, the _Amanita phalloides_ and thefly agaric, or _Agaricus muscarius_, are the most potent. The activeprinciple of the former is _phallin_, and of the latter _muscarine_. The_Amanita phalloides_ is distinguished from the common mushroom(_Agaricus campestris_) by having permanent white gills and a hollowstem. The _Agaricus muscarius_ is bright red with yellow spots. Phallinis a toxalbumin which destroys the red blood-corpuscles, causing theserum to become red in colour and the urine blood-stained. Fibrin isliberated, and thromboses occur, especially in the liver. The symptomsmay be mistaken for phosphorus-poisoning or acute yellow atrophy of theliver. Muscarine affects the nervous system chiefly. 

_Edible fungi_ have an agreeable taste and smell, and are firm insubstance. _Poisonous fungi_ have an offensive smell and bitter taste, are often of a bright colour, and soon become pulpy. 

_Symptoms. _--These may be of the narcotic or irritant types. Usually, however, there is violent colic, with thirst, vomiting, and diarrhoea, mental excitement, followed by delirium, convulsions, coma, slow pulse, stertorous breathing, cyanosis, cold extremities, and dilated pupils. 

_Post-Mortem. _--In phallin-poisoning the blood remains fluid; numeroushæmorrhages are present, with fatty degeneration of the internal organs. 

_Treatment. _--Use the stomach-tube to give a solution of permanganate ofpotash, emetics, followed by a hypodermic injection of 1/50 grain ofatropine. Transfusion of saline fluid. A dose of castor-oil would beuseful. 

=Foods. =--The kinds of food which most frequently produce symptoms ofpoisoning are pork, veal, beef, meat-pies, potted and tinned meats, sausages, and brawn. Sausage-poisoning is common in Germany. It is notnecessary that the food should be 'high' to give rise to poisoning. Itmay arise from the use of the flesh of an animal suffering from somedisease, from inoculation with micro-organisms, or from the presence oftoxalbumoses or ptomaines. Many diseases, such as diarrhoea, entericfever, and cholera, and perhaps tuberculosis, may be caused by eatinginfected food. Trichiniasis may also be mentioned. Tinned fish oftengives rise to symptoms of poisoning, and shell-fish are not uncommonlycontaminated with pathogenic micro-organisms. Mussel-poisoning wasformerly supposed to be due to the copper in them derived from ships'bottoms, but it is more probably the result of the formation of a toxineduring life, and not after decomposition has set in. Milk, too, may giverise to gastro-intestinal irritation from the occurrence in it ofchemical changes. There have been epidemics of poisoning from eatingcheese containing _tyrotoxicon_. Ergotism from eating bread made withergotized wheat is now rare, but _pellagra_ from the consumption ofmouldy maize, and _lathyrism_, due to the admixture with flour of theseeds of certain kinds of vetch, are still common in Southern Europe. 

_Symptoms. _--The symptoms which result from the ingestion of poisonousmeat are often very severe. In some cases their appearance is delayedfrom twenty-four to forty-eight hours. They may resemble those of aninfectious disease or those of acute enteritis. Usually there areheadache, anorexia, rigors, intestinal disturbance, pains in the backand limbs, and delirium. Sometimes the symptoms resembleatropine-poisoning, a condition due to ptomatropine. 

_Treatment. _--Emetics, purgatives, stimulants, with hypodermicinjections of strychnine and atropine along with stimulants. 

XLVIII. --PTOMAINES OR CADAVERIC ALKALOIDS

Every medical man, before presenting himself to give evidence in a caseof suspected poisoning, should make himself thoroughly acquainted withrecent researches on the subject. Ptomaines are, for the most part, alkaloids generated during the process of putrefaction, and they closelyresemble many of the vegetable alkaloids--veratrine, morphine, andcodeine, for example--not only in chemical characters, but inphysiological properties. They are probably allied to neurine, analkaloid obtained from the brain and also from the bile. Some of themare analogous in action to muscarine, the active principle of the flyfungus. Some are proteids, albumins, and globulins. Ptomaines may beproduced abundantly in animal substances which, after exposure underinsanitary conditions, have been excluded from the air. Ptomaines ortoxalbumins are sometimes found in potted meats and sausages, and aredue to organisms--the _Bacillus botulinus_, the _B. Enteritidis_ ofGärtner, the _B. Proteus vulgaris_, or the _B. ærtrycke_ (which isperhaps the most common of all). The symptoms produced by the latter areusually vomiting, abdominal pain, pains in the limbs and cramps, diarrhoea, vertigo, coldness, faintness, and collapse. The symptoms of_botulism_ are dryness of skin and mucous membranes, dilatation ofpupils, paralysis of muscles, diplopia, etc. Articles of food most oftenassociated with poisoning are pork, ham, bacon, veal, baked meat-pie, milk, cheese, mussels, tinned meats. 

In a case of suspected poisoning, counsel for the defence, if he knowshis work, will probably cross-examine the medical expert on thissubject, and endeavour to elicit an admission that the reactions whichhave been attributed to a poison may possibly be accounted for on thetheory of the formation of a ptomaine. There is practically nocounter-move to this form of attack. 

INDEX

Abdomen, injuries of, 29

Abortifacients, 147

Abortion, criminal, 42

Acetanilide, 136

Acetate of lead, 116

Aconite, 143

Adipocere, 18

Adultery, 62

Age, determination of, 12

Alcohol, 130

Alcoholic insanity, 76

Alkaloids, 93

Alum, 103

Ammonia, 102

Anæsthetics, death from, 19

Aniline, 136

Antifebrin, 136

Antimony, 112

Antipyrine, 135

Aqua fortis, 97

Arsenic, 107

Arsenious acid, 107

Artificial oil of bitter almonds, 137

Arum, 124

Asphyxia, 13

Assaults, 21

Assizes, 7

Atropine, 127

Barberio's test, 58

Barium salts, 104

Belladonna, 127

Bestiality, 59

Bichromate of potassium, 119

Bismuth, 119

Blackmailing, 60

Bladder, injuries of, 30

Blood-stains, 30

Born in wedlock, 52

Botulism, 151

Brain, injuries to, 26

Breslau's life test, 49

Brucine, 146

Bruises, 22

Bullet wounds, 24

Burnett's fluid, 119

Burns, 22

Cadaveric alkaloids, 150 rigidity, 17

Calabar bean, 139

Camphor, 129

Cantharides, 146

Carbolic acid, 100

Carbonic acid gas, 120 oxide, 121

Carnal knowledge, 55

Cellon, 129

Chemical analysis, 91

Chest injuries, 28

Chloral, 134

Chlorate of potassium, 103

Chloride of zinc, 119

Chlorine, 122

Chloroform, 19, 132

Choke-damp, 121

Chromium, 119

Chronic lead-poisoning, 117

Clothing, fibres of, 34

Coal-gas, 121

Cocaine, 128

Cocculus indicus, 129

Cold, death from, 39

Coma, 14

Common witness, 2

Concealment of birth, 45 of pregnancy, 45

Conium, 138

Contused wounds, 24

Cooling, rate of, 16

Copper, 117

Coroners, 4

Coroner's court, 4

Corrosive sublimate, 113

Corrosives, 86

Cretinism, 69

Crimes, 1

Criminal abortion, 42

Criminal Appeal Court, 8 courts, 7

Cross-examination, 3

Crown Court of Assize, 7

Culpable homicide, 21

Cut throat, 28

Dangerous Drugs Bill, 82

Death in the foetus, 50 signs of, 16

Delivery, 41

Dementia, 70

Depositions, 6

Determination of sex, 11

Diachylon pills, 117

Diaphragm, wounds of, 29

Digitalis, 144

Dinitrobenzene, 137

Divorce, 60

"Dope, " 129

Drowning, 36

Duration of pregnancy, 50

Dyeing of hair, 11

Dying declarations, 10

Ecchymosis, 22

Electricity, 38

Epilepsy, 65, 75

Ergot, 148

Ether, 132

Evidence, giving of, 2

Examination-in-chief, 3

Experiments on animals, 85

Experts, 2

Eye injuries, 27

Face injuries, 27

Feeble-minded, 69

Fees for medical witness, 5, 7

Feigned diseases, 63

Felony, 1

Ferro-silicon, 111

Finger prints, 11

Florence's test, 58

Foeticide, 42

Foods, poisonous, 150

Found dead, 5

Fruit stains, 33

Fungi, 148

Gaseous poisons, 120

General paralysis, 71

Genital organs, wounds of, 30

Grand jury, 8

Gunshot wounds, 24

Hæmin crystals, 32

Hair, detection of, 33 dyeing of, 11

Hanging, 35

Head injuries, 26

Heart, injuries of, 29

Heat, death from, 39

Hemlock, 138

Henbane, 128

Homicide, 21

Hydrochloric acid, 98 gas, 122

Hydrocyanic acid, 140

Hyoscyamus, 128

Hypostasis, 16

Identification of dead, 12

Identity, personal, 10

Idiocy, 68

Imbecility, 69

Impotence, 54

Incest, 59

Incised wounds, 23

Indecent assault, 57

Indictable offences, 2

Inebriates Act, 78

Infanticide, 44

Inheritance, 54

Injuries, 21

Insanity, 67-76

Intestines, wounds of, 30

Iodide of potassium, 104

Iodine, 104

Irritants, 87 gases, 122 vegetable, 123

Judicial separation, 62

Jury, coroner's, 4

Kidney, injuries of, 30

Kleptomania, 73

Laborde's method, 37

Laburnum, 123

Lacerated wounds, 24

Lead, 116

Lee-Metford bullet, 24

Legitimacy, 52

Lightning, 38

Live-birth, 44-46

Liver, injuries of, 29

Lobelia, 140

Lucid intervals, 73

Lumbago, 66

Lunacy, 67 certification, 77

Lungs, injuries of, 29 evidences of live-birth from, 47

Magistrate's court, 7

Malingering, 63

Malpractice, 20

Malum regimen, 21

Mania, 71

Manslaughter, 21

Marriage, 60

Marsh's process, 110

Martini-Henry bullet, 25

Maturity of infant, 45

Mauser bullet, 25

Medical evidence, 2

Mentally deficients, 70

Mercury salts, 113

Methyl alcohol, 131

Mineral acids, 94

Misdemeanour, 1

Monkshood, 143

Monomania, 72

Morphine, 127

Murder, 21

Muriatic acid, 98

Naphtha, 135

Nitrate of silver, 119

Nitric acid, 95

Nitro-benzol, 137

Notes, 9

Nux vomica, 145

Oaths Act, 9

Oil of bitter almonds, 141

Opium, 124

Oxalate of potash, 99

Oxalic acid, 98

Paraffin oil, 135

Paranoia, 73

Personal identity, 10

Petroleum, 134

Petty Sessions, 7

Phenacetin, 136

Phenol, 100

Phosphorus, 105

Phossy-jaw, 106

Physostigma, 139

Picrotoxin, 129

Poison, definition of, 80

Poisonous foods, 149

Poisons acting on the brain, 88 classification of, 84 detection of, 91 evidence, 85 scheduled, 81 symptoms and post-mortem appearances, 86 treatment of, 90

Potash, 101

Precipitin test for blood, 33

Pregnancy, 40, 50 insanity of, 73

Presumption of death, 20 survivorship, 21

Primula, 124

Privilege, 8

Procurator Fiscal, 7

Prussic acid, 140

Ptomaines, 150

Puerperal mania, 73

Punctured wounds, 23

Purgatives, 123

Putrefaction, 18

Quarter Sessions, 7

Railway spine, 27

Rape, 55

Reception orders, 77

Rectified spirit, 130

Re-examination, 3

Reinsch's process, 110

Reports, medical, 9

Responsibility, 76

Resuscitation, 36

Rhus, 124

Rigor mortis, 17

Rust stains, 33

Sale of arsenic, 111

Saponification, 18

Satyriasis, 73

Savin, 147

Scars, 11

Schiller's method of resuscitation, 36

Scheduled poisons, 81

Scotch oath, 9

Secrets, professional, 8

Self-inflicted wounds, 24

Seminal stains, 58

Sewer-gas, 122

Sex, determination of, 11

Signs of death, 16

Silver, 118

Skin diseases, 66

Soda, 101

Sodomy, 59

Spanish-fly, 146

Spectroscopic examination of blood, 32

Spinal cord injuries, 27

Spleen, injuries of, 29

Staining, post-mortem, 16

Starvation, 38

Stas-Otto process, 92

Status lymphaticus, 15

Sterility, 54

Stomach, injuries of, 29

Stramonium, 128

Strangulation, 35

Strychnine, 145

Sudden death, 13, 15

Suffocation, 34

Sugar of lead, 116

Sulphonal, 137

Sulphuretted hydrogen, 122

Sulphuric acid, 95

Sulphurous acid gas, 122

Summary offences, 2

Sunstroke, 39

Superfoetation, 53

Syncope, 13

Tartar emetic, 112

Tattoo marks, 10

Teichman's crystals, 32

Tetanus, 145

Tetrachlorethane, 129

Tetronal, 137

Throat injuries, 28

Tobacco, 139

Treason, 1

Trinitrotoluene, 129

Trional, 137

True bill, 8

Undue influence, 74

Unnatural offences, 59

Unsound mind, 67

Veronal, 137

Viability, 51

Vitriol, 95

Voidable marriage, 63

Witnesses, 2

Wounds, 21

Yew, 124

Zinc, 118

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