The Project Gutenberg EBook of Aids to Forensic Medicine and Toxicology, by W. G. Aitchison Robertson This eBook is for the use of anyone anywhere at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.org Title: Aids to Forensic Medicine and Toxicology Author: W. G. Aitchison Robertson Release Date: August 10, 2006 [EBook #19019] Language: English Character set encoding: ISO-8859-1 *** START OF THIS PROJECT GUTENBERG EBOOK AIDS TO FORENSIC MEDICINE *** Produced by Suzanne Lybarger, Brian Janes, Annika Feilbach and the Online Distributed Proofreading Team at http://www.pgdp.net AIDS TO FORENSIC MEDICINE AND TOXICOLOGY BY W.G. AITCHISON ROBERTSON M.D., D.Sc., F.R.C.P.E. LECTURER ON FORENSIC MEDICINE, SCHOOL OF MEDICINE, EDINBURGH; LATE EXAMINER IN THE UNIVERSITIES OF EDINBURGH AND ST. ANDREWS; FOR THE TRIPLE BOARD; DIPLOMA IN PUBLIC HEALTH, ETC. NINTH EDITION TWENTIETH THOUSAND LONDON BAILLIÈRE, TINDALL AND COX 8, H ENREITTA S TREE , T C OVEN T G ARDEN 1922 PREFACE TO NINTH EDITION Irtusttha,thavingthoroughlyrevisedthe"AidstoForensicMedicine,"itmayproveasusefultostudents preparingforexaminationinthefutureasithasbeeninthepas.t W.G. AITCHISON ROBERTSON. S URGEONS ' H ALL , E DINBURGH , November , 1921. PREFACE TO EIGHTH EDITION ThisworkofthelateD.rWliilamMurrellhavingmetwtihsuchalargemeasureofsuccess,thepublishers thoughtitwouldbewelltobringoutanewedition,andinvitedmetorevisethelastimpression. ThisIhavedone,andwhlieretainingDr.Murrel'lstextclosely,Ihavemadelargeaddiitons,inordertobring the"Aids"uptopresentrequirements.Ihavealsorearrangedthematterwiththeobjectofmakingthevairous secitonsmoreconsecuitvethantheywerepreviousl.y W.G. AITCHISON ROBERTSON. S URGEON ' S H ALL , E DINBURGH . June , 1914. CONTENTS PART I FORENSIC MEDICINE PAGE I. C ir mes 1 I .I Medical Evidence 2 II I. PersonalIdentity10 IV. Examination of Persons found Dead 12 V. Modes of Sudden Death 13 VI. Signs of Death 16 VI.I DeathfromAnæstheitcs,etc.19 V II I. Presumption of Death; Survivorship 20 IX. Assautls,Murder,Manslaughter,etc.21 X. WoundsandMechanicaIlnjuires21 XI. Contused Wounds, etc. 22 XI.I Incised Wounds 23 X .III Gunshot Wounds 24 XIV. WoundsofVairousPatrsoftheBody26 XV. Detection of Blood-Stains, etc. 30 XVI. DeathbySuffocaiton34 XV .II Death by Hanging 35 XVIII. Death by Strangulation 35 XIX. Death by Drowning 36 XX. Death from Starvation 38 XX.I DeathrfomLightningandElectirctiy38 XXII. DeathrfomColdorHeat39 XXIII. Pregnancy 40 XXIV. Delivery 41 XXV. FœitcideorCirminalAbortion42 XXV.I Infanticide 44 XXVII. EvidencesofLive-Bitrh46 XXVI.II Cause of Death in the Fœtus 50 XXIX. DuraitonofPregnancy50 XXX. ViablitiyofChildren51 XXXI. Legitimacy52 XXX.II Superfœtaiton53 XXXIII. Inhertiance54 XXXIV. ImpotenceandSterliity54 XXXV. Rape 55 XXXV.I Unnatural Offences 59 XXXVI.I Blackmailing 60 XXXVII.I Marriage and Divorce 60 XXXIX. Feigned Diseases 63 XL. Mental Unsoundness 67 XL.I Idioc,yImbecliti,yCretinism68 XLI.I Demenita70 XLIII. Mania,LucidIntervals,UndueInfluence,Responsibilti,yetc.71 XLIV. ExaminaitonofPersonsofUnsoundMind76 XLV. InebiratesActs78 PART II TOXICOLOGY I. DefintiionofaPoison80 II. Scheduled Poisons 80 II .I ClassiifcationofPoisons83 IV. Evidence of Poisoning 85 V. SymptomsandPost-MortemAppearancesofDifferentClassesofPoisons86 VI. DutyofPracititonerinSupposedCaseofPoisoning89 VII. Treatment of Poisoning 90 V .III DetecitonofPoison91 IX. The Mineral Acids 94 X. SulphuircAcid95 X .I NrtiicAcid97 XI.I HydrochloircAcid98 XII.I Oxalic Acid 98 XIV. CarboilcAcid100 XV. Potash, Soda, and Ammonia 101 XV.I NrtiateofPotassium,etc.103 XVII. PotassiumSatls,etc.103 XV II .I BariumSatls104 XIX. Iodine—Iodide of Potassium 104 XX. Phosphorus 105 XX.I Arsenic and its Preparations 107 XXI.I AntimonyandtisPreparaitons112 XX II .I MercuryandtisPreparaitons113 XXIV. LeadandtisPreparations116 XXV. CopperandtisPreparations117 XXVI. Zinc, Silver, Bismuth, and Chromium 118 XXVII. Gaseous Poisons 120 XXVIII. VegetableIrrtiants123 XXIX. Opium and Morphine 124 XXX. Belladonna,Hyoscyamus,andSrtamonium127 XXXI. Cocaine 128 XXXII. Camphor 129 XXXIII. Tetrachlorethane 129 XXXIV. Alcohol, Ether, and Chloroform 130 XXXV. Chloral Hydrate 134 XXXVI. PetroleumandParaffinOli134 XXXVII. Antipyirne,Antefebrin,Phenaceitn,andAniline135 XXXVII.I Sulphonal,Tirona,lTertona,lVerona,lParaldehyde137 XXXIX. Conium and Calabar Bean 138 XL. TobaccoandLobeila139 XL.I Hydrocyanic Acid 140 XLI.I Aconite 143 XLIII. Digitalis 144 XLIV. Nux Vomica, Strychnine, and Brucine 145 XLV. Cantharides 146 XLV.I Abofitracients147 XLVII. Poisonous Fungi and Toxic Foods 148 XLVIII. PtomainesorCadaveircAlkaloids150 Index 152 AIDS TO FORENSIC MEDICINE AND TOXICOLOGY PART I FORENSIC MEDICINE I. CRIMES — ForensicmedicineisalsocalledMedicalJuirsprudenceorLegalMedicine,andincludesallquesitonswhich birngmedicalmattersintorelaitonwtihthelaw.Itdealst,herefore,with(1)cirmesand(2)civilinjuires. 1. A c ir me isthevoluntaryactofapersonofsoundmindharmfultoothersandalsounjus.tNoactisacrime unlessitisplainlyforbiddenbylaw.Toconsittuteacirme,twocircumstancesarenecessarytobeproved— ( a )thattheacthasbeencommitted,( b )thataguitlymindormalicewaspresent.Theactmaybeoneof omissionorofcommission.Everypersonwhocommitsacirmemaybepunished,unlessheisundetrheage of seven years, is insane, or has been made to commit it under compulsion. Cirmesaredividedintomisdemeanours and felonies .Thedistincitonisnotverydefinite,but,asarule,the formerarelessseirousformsofcirme,andarepunishablewithatermofimpirsonment,generallyundertwo years;whliefeloniescompirsethemoreseriouscharges,asmurde,rmanslaughte,rrape,whichinvolvethe captialsentenceorlongtermsoifmpirsonmen.t A n offence isartivialbreachofthecriminallaw,andispunishableonsummaryconvicitonbeforea magistrateorjusticesonly,whilethemoreseriouscirmes( indictableoffences )mustbetriedbeforeajur.y 2. Civiilnjuires differfromcirmesinthattheformerarecompensatedbydamagesawarded,whliethelatter arepunished;anyperson,whetherinjuredorno,tmayprosecuteforacirme,whlieonlythesufferercansue foracivilinjury.TheCrownmayremitpunishmentforacrime,butnoftoracivliinjury. II.—MEDICAL EVIDENCE Onbeingcalled,themedicalwtinessentersthewtiness-boxandtakestheoath.Thisisverygenerallydone byupitfilngtherighthandandrepeaitngtheoath(Scotitshform),orbykissingtheBible,orbymakinga solemnaiffrmaiton. 1.Hemaybecalledtogiveordinary evidence as a commonwtiness .Thushemaybeaskedtodetalithe facts of an accident which he has observed, and of the inferences he has deduced. This evidence is what any lay observer might be asked. 2 . ExpetrWtiness. —On the other hand, he may be examined on matters of a technical or professional character.Themedicalmanthengivesevidenceofasklliedorexpertnature.Hemaybeaskedhisopinion on certain facts narrated— e.g , . fiacertainwoundwouldbeimmediatelyfatal.Again,hemaybeasked whether he concurs with opinions held by other medical authorities. Inimpotrantcasesspeciailstsareotfencalledtogiveevidenceofasklliednature.Thusthehospitalsurgeon, thenervespecialist,orthementalconsutlantmaybeservedwithasubpœnatoappearatcourtonacetrain datetogiveevidence.Theevidenceofsuchskilledobserverswill,itissupposed,carrygreaterweightwith thejurythanwouldtheevidenceofanordinarypracititoner. Skilledwitnessesmayheatrheevidenceofordinarywtinessesinregardtothecaseinwhichtheyaretogive evidence,andtiis,indeed,betterthattheyshouldunderstandthecasethoroughl,ybuttheyarenotusually allowedtoheartheevidenceofotherexpetrwtinesses. Incivlicasesthemedicalwtinessshould,previoustothetira,lmakeanagreementwtihthesoilcitorwhohas calledhimwithreferencetothefeeheistoreceive.Beforeconsenitngtoappearasawitnessthe pracititonershouldinsistonhavingallthefactsofthecaseputbeforehiminwtiring.Inthiswayonlycanhe decideastowhetherinhisopiniontheplaintiffordefendantisirghtasregardsthemedicalevidence.If summonedbythesideonwhichhethinksthemedicaltestimonyiscorrec,tthenitishisdutytoconsentto appea.rI,fhoweve,rheisofopinionthatthemedicalevidenceisclearlyandcorrectlyontheoppositeside, then he ought to refuse to appear and give evidence; and, indeed, the lawyer would not desire his presence inthewtiness-boxunlesshecouldupholdthecase. Whetheranexpetrwtinesswhohasnopersonalknowledgeotfhefactsisboundtoattendonasubpœnaisa moot point. It would be safer for him to do so, and to explain to the judge before taking the oath that his memoryhasnotbeensufifcienltyr'erfeshed.'Thesolictior,fihedesireshisevidence,willprobablyseethat thefeeisfotrhcoming. Awtinessmaybesubjectedtothree examinaitons:ifrs,tbythepatryonwhosesideheisengaged,whichis calledthe'examinaitoninchie,f'andinwhichheaffordsthebasisforthenextexaminaitonor'cross-examinaiton'bytheoppositeside.Thethirdisther'e-examinaiton'byhisownsideI.ntheifrsthemerelygives aclearstatementoffactsorofhisopinions.Inthenexthistestimonyissubjectedtoirgidexaminationin order to weaken his previous statements. In the third he is allowed to clear up any discrepancies in the cross-examinaiton,buthemustnotinrtoduceanynewmatterwhichwouldrenderhimilabletoanothercross-examinaiton. Themedicalwitnessshouldanswerquesitonsputtohimasclealryandasconciselyaspossible.Heshould make his statements in plain and simple language, avoiding as much as possible technical terms and figurativeexpressions,andshouldnotquoteauthoiritesinsuppotrofhisopinions. Anexpertwitnesswhengivingevidencemayrefertonotesforthepurposeofrerfeshinghismemory,butonly fithenotesweretakenbyhimattheitmewhentheobservaitonsweremade,orassoonatferaspracticable. Therearevairouscourts inwhichamedicalwtinessmaybecalledontogiveevidence: 1. The Coroner's Court. —When a coroner is informed that the dead body of a person is lying within his jurisdiciton,andthatthereisreasonablecausetosuspectthatsuchpersondiedetiheraviolentorunnatural death,ordiedasuddendeathofwhichthecauseisunknown,hemustsummonajuryofnoltessthantwelve mentoinvesitgatethematter—inotherwords,holdaninquest—andifthedeceasedhadreceivedmedical treatment,thecoronermaysummonthemedicalattendanttogiveevidence.BytheCoroners(Emergency Provisions) Act of 1917, the number of the jury has been cut down to a minimum of seven and a maximum of elevenmen.BytheJuiresActof1918,thecoronerhasthepowerofholdingacourtwtihoutajuryi,finhis discretion,itappearstobeunnecessar.yInchargesofmurder,manslaughte,rdeathsofprisonersinprison, inmatesofasylumsorinebirates'homes,orofinfantsinnursinghomes,hemustsummonajury.Thecoroner may be satisfied with the evidence as to the cause of a person's death, and may dispense with an inquest andgrantabuiralcetrfiicate. Casesarenoifitedtothecoronerbythepoilce,pairshofficer,anymedicalpractiitoner,registrarofdeaths,or by any private individual. Witnesses,havingbeencitedtoappear,areexaminedonoathbythecoroner,whomus,tincirminalcasesat least,takedowntheevidenceinwrtiing.Thisisthenreadovertoeachwtiness,whosigns,tiandthisforms his deposition . At the end of each case the coroner sums up, and the jury return their verdict or inquisition , either unanimously or by a majority. Ifthischargesanypersonwithmurderormanslaughter,heiscommtitedbythecoronertopirsontoawaitirtal, or,ifnotpresen,tthecoronermayissueawarrantforhisarrest. Achemicalanalysisofthecontentsofthestomach,etc.,insuspectedcasesofpoisoningisusuallydonebya specialanalystnamedbythecorone.rIfanywtinessdisobeysthesummonstoattendtheinquest,herenders himselfliabletoaifnenotexceeding£22s.,butinadditionthecoronermaycommithimtopirsonfor contemptofcoutr.Incirminalcasesthewitnessesareboundovertoappearattheassizestogiveevidence there.Thecoronermaygiveanorderfortheexhumaitonofabodyifhethinkstheevidencewarrantsapos-t mortem examination. Coroners' inquests are held in all cases of sudden or violent death, where the cause of death is not clear; in casesofassaul,twheredeathhastakenplaceimmediatelyorsometimeatferwards;incasesofhomicideor suicide;wherethemedicalattendantrefusestogiveaceritficateofdeath;wheretheattendantsonthe deceasedhavebeenculpablynegligen;torincetraincasesofuncetrifieddeaths. Themedicalwtinessshouldbeverycarefulingivingevidencebeforeacoroner.Eventhoughtheinquestbe heldinacoach-houseorbarn,yetithastoberemembereditisacoutroflaw.fIthecasegoesonfortrial beforeasupeirorcourt,yourdepostiionmadetothecoronerformsthebasisofyourexamination.Any misstatementsordiscrepanciesinyourevidencewlilbecarefullyinquiredinto,andyouwllimakeabad impressiononjudgeandjuryifyoumodify,rertac,torexplainawayyourevidenceasgiventothecoroner.You hadyouroppotrunityofmakinganyamendmentsonyourevidencewhenthecoronerreadovertoyouyour deposiitonbeforeyousignedtiasrtue. BytheLicensingActof1902,aninquestmaynotbeheldinanypremisesilcensedforthesaleofintoxicaitng liquorifothersutiablepremiseshavebeenprovided. TheduitesofthecoronerarebasedparltyonCommonLaw,andarealsodefinedbystatute,principallyby theCoronersActof1887(50and51Vict.c.71).Theyhavebeenmodfiied,howeve,rbysubsequentActs — e.g , . the Act of 1892, the Coroners (Emergency Provisions) Act, 1917, and the Juries Act of 1918. Thefeepayabletoamedicalwitnessforgivingevidenceataninquesitsoneguinea,withanextraguineafor makingapos-tmotremexaminaitonandrepotr(inthemetropoiltanareathesefeesaredoubled.)The coroner must sign the order authorizing the payment, and should an inquest be adjourned to a later day, no futrherfeeispayable.Ifthedeceaseddiedinahosptia,linifrmary,orlunaitcasylum,themedicalwitnessis notpaidanyfee.Shouldamedicalwitnessneglecttomakethepost-mortemexaminationatferreceivingthe order to do so, he is liable to a fine of £5.
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InScoltandtheProcuratorFiscalfufllismanyofthedutiesofthecorone,rbuthecannotholdapubilcinquir.y Heinterrogatesthewitnessesprivatel,yandthesequestionswtihtheanswersformtheprecognition . More seriouscasesaredealtwtihbytheSherffiofeachcounty,andcaptialchargesmustbedeatlwithbytheHigh CoutrofJusitciar.yInScotlandtheverdictsotfhejurymaybe'guilt,y''notgulit',yor'notproven.' 2. The Magistrate's Court or Petty Sessions isalsoacoutrofpreliminaryinquir.yThepirsonermaybe deatlwtihsummairl,yas,forexample,inminorassautlcases,o,rfithecaseisofsufficientgravti,yandthe evidencejustifiessuchacourse,maybecommittedfotriral.Thefeeforamedicalwtinesswhoresideswithin threemliesotfhecoutristenshillingsandsixpence;fiatagreaterdistance,oneguinea. IntheMertopolistheprisonerinthefirstinstanceisbroughtbeforeamagistrate,technicallyknownasthe 'beak,'who,inaddtiiontobeingapersonofgreatacumen,isasitpendiary,andthusoccupiesasupeiror posiitontotheordinary'J.P.',whoisoneofthegreatunpaid.IntheCityofLondonistheMansionHouse Jusitce-Room,presidedoverbytheLordMayororoneoftheAldermen.Theprisonermayulitmatelybesent fortiratlotheCentralCriminalCour,tknownastheOldBaile,yorelsewhere. 3. Quarter Sessions. —TheseareheldeveryquatrerbyJusticesofthePeace.Allcasescanbetriedbefore thesessionsexceptfeloniesorcaseswhichinvolvedffiicutllegalquestions.InLondonthiscoutrisknownas theCenrtalCriminalCoutr,anditalsoactsastheAssizeCoutr.InBoroughSessionsabarirsterknownas the Recorder is appointed as sole judge. 4. The Assizes deal with both criminal and civil cases. There is the CrownCoutr ,wherecirminalcasesare tired,andthereistheCivil Cou , tr wherecivlicasesareheard.Beforeacasesentupbyalowercoutrcanbe triedbythejudgeandpettyjury,tiisinvesitgatedbythegrand jury ,whichiscomposedofsuperior individuals.Iftheyfinda'rtuebil,l'thecasegoeson;butifthey'throwtiout',theaccusedisailtbetrytotake hisdepatrure.AttheCourtofAssizethepirsoneristriedbyajuryoftwelve.Inbringingintheverdictthejury mustbeunanimous.Iftheycannotagree,thecasemustberetriedbeforeanewjury.AttheAssizeCoutrthe medicalwitnessgetsaguineaaday,wtihtwoshillingsextratopayforhisbedandboardforeverynightheis awayrfomhome,wtihhissecond-classraliwayfare,ifthereisasecondclassontherailwaybywhichhe rtavels.fIthereisnorailway,andhehastowalk,heisentitledtothreepenceamlieforrefreshmentsboth ways. 5. CourtofCriminalAppea.l —Thiswasestabilshedin1908,andconsistsofthreejudges.Airghtofappeal maybebased(1)solelyonaquestionoflaw;(2)oncetrificatefromthejudgewhortiedtheprisoner;(3)on mitigaitonofsentence. Speakinggenerall,yintheSuperiorCourtsthefeeswhichmaybeclaimedbymedicalmencalledontogive evidenceareaguineaadayfiresidentinthetowninwhichthecaseistried,andrfomtwotothreeguineasa dayfiresidentatadistancefromtheplaceoftiral,thistoincludeeverythingexceptrtavelilngexpenses.The medicalwitnessalsoreceivesareasonableallowanceforhotelandrtavellingexpenses. Ifawitnessissummonedtoappearbeforetwocoutrsatthesametime,hemustobeythesummonsofthe highercour.tCirminalcasestakeprecedenceofcivi.l Amedicalmanhasnorighttoclaimpirvilegeasanexcusefornotdivulgingprofessionalsecretsinacourtof law,andthelesshetalksaboutprofessionaleitquettethebetter.Stli,linacivilcase,ifheweretomakean emphaticprotest,thematterinallprobabilitywouldnotbepressed.Inacirminalcasehewouldpromptlybe reminded of the nature of his oath. A medical man may be required to furnish a formalwirttenrepotr .tImaybethehistoryofafatalillnessorthe resutlofapost-motremexamination.Theserepotrsmustbedrawnupverycarefully,andnotechnicalterms should be employed. Nowtinessonbeingsworncanbecompelledto'kissthebook'.TheOathsAct(51and52Vict.,c.46,§5) declares,withoutanyquailifcaiton,that'ifanypersontowhomanoathisadministereddesirestoswearwtih upltfiedhand,intheformandmannerinwhichanoathisusuallyadministeredinScotland,heshallbe permtitedtodoso,andtheoathshallbeadministeredtohiminsuchformandmannerwtihoutfutrher quesiton'.Thewtinesstakestheoathstanding,wtihthebarerighthanduptfiledabovethehead,theformula being:'IswearbyAlmightyGodthatIwillspeakthertuth,thewholetruth,andnothingbutthetruth'.The presidingjudgeshouldsaythewords,andthewtinessshouldrepeatthemafterhim.Thereisnokissingof thebook,andthewords'Sohelpme,God',whichoccurintheEnglishform,arenotemployed.Itwillbenoted thattheScotchformconstitutesanoath,andisnotanafifrmation.Thejudgehasnoirghttoaskifyouobject onreligiousgrounds,ortoputanyquesiton.HeisboundbytheprovisionsoftheAc,tandtheenactment appilesnotonlytoallformsofthewitnessoath,whetherincivliorcriminalcourts,orbeforecoroners,butto everyoathwhichmaybelawfullyadministeredetiheirnGreatBirtainorIreland. Awtinessengagedtogiveexpertevidenceshoulddemandhisfeebeforegoingintocoutr,or,atallevents, before being sworn. Withregardtonotes,theseshouldbemadeattheitme,onthespot,andmaybeusedbythewitnessincourt asarefreshertothememort,yhoughnotatlogethertosupplytisplace.Allevidenceismadeupoftesitmon,y butalltestimonyisnotevidence.Thewtinessmustnotinrtoducehearsaytestimony.Inonecaseonlyis hearsay evidence admissible, and that is in the case of a dyingdeclaraiton . This is a statement made by a dyingpersonastohowhisinjurieswereinlficted.Thesedeclarationsareacceptedbecausethelaw presumesthatadyingmanisanxioustospeakthertuth.Butthepersonmustbeilevethatheisactually on the point of death, with absolutely no hope of recovery. A statement was rejected because the dying person, inusingtheexpressionI'havenohopeofrecover,y'requestedthatthewords'atpresent'shouldbeadded.If aftermakingthestatementthepatientweretosa,y'IhopenowIshallgetbette,r'itwouldinvalidatethe declaration.Tomakethedeclaraitonadmissibleasevidence,deathmustensue.fIpossible,amagistrate shouldtakethedyingdeclaraiton;butifheisnotavaliable,themedicalman,withoutanysuggesitonsor comments of his own, should write down the statements made by the dying person, and see them signed and witnessed.tImustbemadecleartothecourtthatattheitmeofmakinghisstatementthewitnesswasunder thefullconvicitonofapproachingorimpendingdeath. III.—PERSONAL IDENTITY Itisbutseldomthatmedicalevidenceisrequiredwithregardtotheidenitifcationoftheliving,thoughitmay sometimes be so, as in the celebrated Tichborne case. The medical man may in such cases be consulted as tofamilyresemblance,marksonthebody,nævimaterni,scarsandtattoomarks,orwtihregardtotheorgans ofgeneraitonincasesofdoubftulsex.Tattoomarksmaydisappearduringilfe;thebrightercolours,as vermliion,asarule,morereadliythanthosemadewithcarbon,asIndianink;atferdeaththecolouring-matter maybefoundintheproximalglands.fIthetattooingissuperifcial(merelyunderneaththecuitcle)themarks maypossiblyberemovedbyaceitcacidorcantharides,orevenbypickingoutthecolouring-matterwitha ifneneedle.Withregardtoscarsandtheirpermanence,itwillberememberedthatscarsoccasionedby actuallossofsubstance,orbywoundshealedbygranulation,neverdisappea.rThescarsofleech-bites, lancet-wounds,orcuppinginstruments,maydisappearafteralapseofitme.tIisdiiffcutli,fnotimpossible,to giveanycertainorpostiiveopinionastotheageofascar;recentscarsarepinkincolour;oldscarsare whtieandgilstening.Thecicatirxresulitngrfomawounddependsuponitsstiuation.Ofincisedwoundsan elilpitcalcicatirxistypica,llinearbeingchielfyfoundbetweenthefingersandtoes.Bywayofdisguisethehair maybedyedblackwtihleadacetateorntirateofsilver;detectedbyallowingthehairtogrow,orbysteeping someofitindilutenirticacid,andtesitngwtihiodideofpotassiumforlead,andhydrochloricacidforslive.r Thehairmaybebleachedwithchlorineorperoxideofhydrogen,detectedbyletitngthehairgrowandbytis unnaturalfeelingandtheirregulartiyofthebleaching. Finger-pirntimpressionsarethemosttrustwotrhyofallmeansofidenitficaiton.Suchaprintisobtainedby rubbing the pulp of the finger in lampblack, and then impressing it on a glazed card. The impression reveals theifneilneswhichexistatthetipsoftheifngers.Thearrangementoftheselinesisspecialtoeachperson, andcannotbechanged.Hencethismethodisemployedbythepoliceintheidentfiicaitonofprisoners. Inthedeterminaitonofcasesofdoubftulsexintheilving,thefollowingpointsshouldbenoitced:thesizeof thepenisorctiloirs,andwhetherperforateorno,ttheformoftheprepuce,thepresenceorabsenceof nymphæandoftesticlesorovaires.Openingsmustbecarefullysoundedastotheircommunicaitonwtih bladderoruterus.Atferpubetr,yinquiryshouldbemadeastomensrtualorvicariousdischarges,thegeneral developmentofthebod,ythegrowthofhair,thetoneofvoice,andthebehaviouroftheindividualtowards etihersex. Wtihregardtotheidentificaitonofthedeadincasesofdeathbyaccidentorviolence,themedicalman's assistancemaybecalled.Thesexoftheskeleton,fithatonlybefound,maybejudgedfromthebonesofthe femalegenerallybeingsmallerandmoreslenderthanthoseofthemale,bythefemalethoraxbeingdeepe,r thecostalcaritlageslonger,theiilamoreexpanded,thesacrumlfatterandbroader,thecoccyxmovableand turnedback,thetuberositiesoftheischiawiderapar,tthepubesshallow,andthewholepelvisshallowerand wtihlargeroutlets.Butofallthesesignstheonlyoneofanyrealvalueistheroundnessofthepubicarchinthe female,ascomparedwtihthepointedarchinthemale.Beforepubertythesexcannotbedeterminedrfoman examination of the bones. Age may be calculated from the presence, nature and number of the erupted teeth; from the cartilages of the irbs,whichgraduallyossifyasageadvances;fromtheangleformedbytheramusofthelowerjawwithits body(obtuseininfanc,yarightangleintheadutl,andagainobtuseintheagedrfomlossotfheteeth);andin theyoungrfomthecondtiionoftheepiphyseswithregardtotheirattachmenttotheirrespecitveshatfs. To determine stature, the whole skeleton should be laid out and measured, 1-1/2 to 2 inches being allowed forthesotfparts. IV.—EXAMINATION OF PERSONS FOUND DEAD Whenamedicalmaniscalledtoacaseofsuddendeath,heshouldcarefullynoteanythinglikelytothrowany lightonthecauseofdeath.Heshouldnoitcetheplacewherethebodywasfound,thepositionandatittudeof thebod,ythesoilorsurfaceonwhichthebodylies,theposiitonofsurroundingobjects,andthecondtiionof theclothes.Heshouldalsonoticefithereareanysignsofastrugglehavingtakenplace,ifthehandsare clenched,ifthefaceisdistotred,fitherehasbeenfoamingatthemouth,andfiuirneorfæceshavebeen passedinvoluntairly.Urinemaybedrawnoffwtihacatheterandtestedforalbuminandsuga.r Ifrequiredtomakeapos-tmortemexamination,everycavtiyandimpotrantorganofthebodymustbe carefullyandminutelyexaminedt,heseatofinjurybeinginspectedifrs.t V.—MODES OF SUDDEN DEATH Therearethreemodesinwhichdeathmayoccu:r(1)Syncope;(2)asphyxia;(3)coma. 1 . Syncope isdeathbeginningattheheatr—inotherwords,failureofcirculaiton.Itmayairserfom—(1) Anæmia ,ordeficiencyofbloodduetohæmorrhage,suchasoccursininjuries,orfrombleedingrfomthe lungs, stomach, uterus, or other internal organs. (2) Asthenia ,orfailureofthehea'trsaction,metwithin starvation,inexhaustingdiseases,suchasphthisis,cance,rperniciousanæmia,andBrigh'tsdisease,andin somecasesofpoisoning—forexample,acontie. Thesymptomsofsyncopearefaintness,giddiness,pallo,rslow,weak,andirregularpulse,sighing respiraiton,insensibliit,ydliatedpupils,andconvulsions. Postmotremtheheatrisfoundemptyandconrtacted.When,howevert,hereissuddenstoppageotfheheart, therightandletfcaviitescontainbloodinthenormalquantities,andbloodisfoundinthevenæcavæandin thearteiraltrunks.Thereisnoengorgementofetihelrungsorbrain. 2. Asphyxia ,ordeathbeginningatthelungs,maybeduetoobsrtucitonoftheair-passagesrfomforeign bodiesinthelarynx,drowning,suffocaiton,srtangling,andhanging;frominjurytothecervicalcord;effusion intothepleuræ,wtihconsequentpressureonthelungs;embolismofthepulmonaryartery;andrfom spasmodiccontractionotfhethoracicandabdominalmusclesinsrtychnine-poisoning. Thesymptomsofthiscondtiionareifghitngforbreath,giddiness,relaxaitonofthesphincters,and convulsions. Postmortem,cadaveirclividityiswellmarked,especiallyinnose,lips,ears,etc.;theirghtcavitiesofthe heartandthevenæcavæarefoundgorgedwithdarklfuidblood.Thepulmonaryveins,theletfcavitiesofthe heart,andtheaorta,areetiheremptyorcontainbutilttleblood.Thelungsaredarkandengorgedwithblood, andtheliningoftheair-tubesisbrightredincolour.Muchbloodyfrothescapesoncuttingintothelungs. Numeroussmallhæmorrhages(Tardieu'sspots)arefoundonthesurfaceandinthesubstanceoftheinternal organs,aswellasintheskinotfheneckandface. 3. Coma ,ordeathbeginningatthebrain,mayairsefromconcussion;compression;cerebralpressurefrom hæmorrhageandotherformsofapoplexy;blockingofacerebralarteryrfomemboilsm;dieteticanduræmic condiitons;andrfomopiumandothernarcoticpoisons. Thesymptomsofthiscondiitonarestupor,lossofconsciousness,andstetrorousbreathing. Thepost-mortemsignsarecongesitonofthesubstanceofthebrainanditsmembranes,wtihaccumulationof thebloodinthecavitiesotfheheatr,moreontherightsidethanontheleft. Itmustberememberedthat,owingtotheinterdependenceofallthevitalfunctions,thereisnoilneof demarcationbetweenthevairousmodesofdeath.Inallcasesofsuddendeaththinkofanginapectorisand theruptureofananeuirsm. Thefollowingisalistofsomeotfhecommonercausesofsuddendeath: ( a ) I nstantaneously Sudden Death — 1.Syncope(byfarthecommonestcause.) 2.Aoitrcincompetence. 3.Ruptureofheatr. 4. Rupture of a valve. 5.Ruptureofaoritcaneuirsm. 6.Emboilsmofcoronaryartery. 7.Anginapectoirs. ( b ) Less Sudden but Unexpected Death — 1.Cerebralhæmorrhageoremboilsm. 2.Mtiralandtricuspidvalvularlesionsifthepatientexetrshimsefl. 3.Ruptureofagastricorduodenalulcer;ruptureoflive,rspleen,orexrta-uteirnegestation,orabdominal aneuirsm. 4.Suffocationduirnganepliepitcfit;vomitedmatterorothermateiraldrawnintothetracheaorair-passages; croup. 5.Arterio-sclerosismayleadtothrombosis,embolism,oraneuirsm. 6.Poisoning,asbyhydrocyanicacid,cyanideofpotassiumi,nhalaitonofcarbonicacidorcoalgas, œdema of glottis following inhalation of ammonia. 7.Rapidonsetofsomeacutespecificdisease,suchaspneumoniaordiphtheria;collapsefromcholera. 8.Hea-tstroke,lightning,shocksofelecirtctiyofhightension. 9. Mental or physical shock. 10.Exeitronwhilethestomachisoverloaded. 11. Diabetic coma; uræmia. 12. Statuslymphaitcus . Thisisageneralhyperplasitccondtiionofthelymphaitcsrtucturesinthebody,and isseeninenlargementoftonsilst,hymus,spleen,aswellasofPeye'rspatchesandmesenteircglands. itIsarfequentcauseofdeathduringchloroformanæsthesiaforslightoperationsinyoungpeople. Inaddiiton,timaybeaswelltorememberthatdeathsomeitmesoccurssuddenlyinexophthalmicgotire, hyperrtophyotfhethymus,andinAddison'sdisease. In some cases of sudden death nothing has been found post mortem, even when the autopsy has been made byskliledobservers,andthebrainandcordhavebeensubmttiedtomicroscopicalexaminaiton. VI.—SIGNS OF DEATH (1)Cadavericappearance;ashywhtiecolou.r(2)Cessationofthecirculationandrespiraiton,nosoundbeing heardbythestethoscope.Cessationotfhecirculaitonmaybedeterminedby( a )placingailgatureroundthe baseofaifnger(Magnus'tes)t;( b )injecitngasoluitonoffluorescinI(card'stes)t;( c l)ookingthroughtheweb oftheifngersatabrightlight(diaphanoustest;)( d )thedullingofasteelneedlewhenthrustintotheliving body; ( e ) the clear outline of the dead heart when viewed in the fluorescent screen. (3) The state of the eye; thetensionisatoncelost;irisinsensibletoilgh,tfundusyellowincolour;corneadullandsunken(.4)Thestate oftheskin;pale,livid,withlossofelasitctiy.(5)Extinctionofmuscularirirtabiilty.Theabovesignsaffordno meansofdetermininghowlongilfehasbeenextinct.Thefollowing,howeve,rdo: CooilngoftheBody. —The average internal temperature of the body is from 98° to 100° F. The time taken incooilngisrfomfitfeentotwentyhours,butitmaybemodfiiedbythekindofdeath,theageoftheperson, thepresenceorabsenceofclothingonthebody,thesurroundingtemperature,andtheslitlnessorotherwise oftheairaboutthebody.Sllit,thebod,yotherthingsbeingequal,maybesaidtobequtiecold in about twelve hours . Hypostasis or post-mortem staining isduetothesettilngdownofthebloodinthemostdependentparts ofthebodywhilethebodyiscooling.Itisasuresignofdeath,andoccursinallformsofdeath,eveninthat duetohæmorrhage,atlhoughnotsomarkedindegree.Pos-tmotremstaining( cadavericlividtiy ) begins to appearinfromeighttotwelvehoursafterdeath,andtispositiononthebodywillhelptodeterminethelength oftimethebodyhaslainintheposiitoninwhichtiwasfound.Thestainingisofadullredorslatybluecolour. Itmustbedisitnguishedfromecchymosistheresultofabruise,bymakinganincisionintothepart;inthe caseofhypostasisafewsmallbloodypointsofdividedatreireswillbeseen,inthecaseofecchymosisthe subcutaneousitssuesareinflirtatedwithblood-clot.Internall,yhypostasismustnotbemistakenforcongestion ofthebrainorlungs,ortheresultsofinlfammaitonoftheintesitnes.fItheintestineispulledstraigh,t inlfammatoryrednessiscontinuous,hypostasisisdisconnected.Abouttheneckhypostasismustnotbe mistakenforthemarkofacordorotherilgature.Whenthebloodisofabrightredcolourafterdeath(as happensinpoisoningbyCOorHCN,orindeathfromcold),thehypostasisisbirghtredalso. Cadaveric Rigidity—Rigor Mortis. —Forsometimeatferdeaththemusclescontinuetoconrtactunder stimul.iWhenthisirtirablitiyceases—anditseldomexceedstwohours—irgidityandhardeningsetsin,andin all casesprecedesputrefaciton.tIiscausedbythecoagulaitonofthemuscleplasma.tIcommencesinthe musclesofthebackotfheneckandlowerjaw,andthenpassesintothemusclesoftheface,frontoftheneck, ches,tupperextremiites,andlasltytothelowerexrtemiites. Ithasbeennoticedinthenew-borninfan,taswellasinthefœtus.Itlastsrfomsixteentotwentyhoursormore. Inilngeringdiseases,atferviolentexeriton,andinwarmclimates,tisetsinquickly,anddisappearsintwoor threehours;inthosewhoareinperfecthealthanddiefromaccidentorasphyxia,itmaynotcomeonuntli rfomtentotwenty-fourhours,andmaylastthreeorfourdays.Afterdeathfromconvulsionsorstrychnine-poisoning,thebodymaypassatonceintoirgormorits.Rigormotrismustbedisitnguishedrfomcadaveirc spasm or the death clutch ;intheformer,articlesinthehandsarereadilyremovable,inthelatterthisisnot thecase.Intetanicspasmthelimbswhenbentreturntotheirformerposition;notsoinirgormoitrs. Putrefaciton appearsinrfomonetothreedaysafterdeath,asagreenish-bluediscolorationofthe abdomen; in the drowned, over the head and face. This increases, becomes darker and more general, a strongpurtefacitveodourisdeveloped,thethoraxandabdomenbecomedistendedwtihgas,andthe epidermispeelsoff.Themusclesthenbecomepulp,yandassumeadarkgreenishcolour,thewholebodyat lengthbecomingchangedintoasotf,semi-lfuidmass.Theorganifrstshowingtheputrefactivechangeisthe rtachea;thatwhichresistspurtefactionlongestistheuterus.Thesepurtefacitvechangesaremodfiiedbythe fatorleancondiitonofthebod,ythetemperature(purtefacitontakingplacemorerapidlyinsummerthanin winter,)accessofai,rthepeirod,place,modeofintermen,tage,etc.Bodieswhichremaininwaterputrefy moreslowlythanthoseinai.r Saponiifcaiton. —Inbodieswhichareveryfatandhavelaininwaterormoistsoliforrfomonetothreeyears thisprocesstakesplace,thefatunitingwtihtheammoniagivenoffbythedecompostiiontoformadipocere . Thisconsistsofamargarateorstearateofammoniumwtihilme,oxideoifron,potash,certainfattyacids,and ayellowishodorousmatte.rIthasafatt,yunctuousfeel,isetiherpurewhtieorpaleyellow,withanodourof decayedcheese.Smallporitonsofthebodymayshowsignsofthischangeinsixweeks. Post-Mortem Examination. —Nevermakeanautopsyincriminalcaseswtihoutawttirenorderrfomthe coronerorProcuratorFiscal.Ifauthorized,however,firsthavethebodyidenitfied,thenphotographedfiithas not been identified. A medical man representing the accused may be present, but only by consent of the CrownauthortiiesorotfheSheirff.Clothingshouldbeexaminedforblood-stains,cuts,etc. Examineexternalsufraceofbodyandtakeaccuratemeasurementsofwounds,marks,deformtiies, tattooings;notedegreeanddisirtbutionofpost-mortemstaining,irgidti,yetc. Examinebrainbymakingincisionrfomeartoearacrossvertex,relfectscalpforwardsandbackwards,and sawoffcalvarium.Examinebraincarefullyexternallyandonsection. Examineorgansofchestandabdomenthroughanincisionmadefromsymphysismenittopubis,relfecitng itssuesfromchestwallandcuttingthroughcostalcatrliages. Incasesofsuspectedpoisoninghaveseveralcleanjarsintowhichyouplacethestomachwtihcontents, intestineswithcontents,pieceofliver,kidney,spleen,etc,.andsealeachupcarefull,yattachinglabelwith nameofdeceased,date,andcontainedorgans,andtransmtithesepersonallytotheanalys.t Exhumaiton. —Abodywhichhasbeenbuiredcannotbeexhumedwithoutanordefrromacoroner,fiscal,or from the Home Secretary. There is no legal limit in England as to when a body may be exhumed; in Scotland, however, if an interval of twenty years has elapsed, an accused person cannot be prosecuted ( prescirpitonof crime ). VII.—DEATH FROM ANÆSTHETICS, ETC. ThecoroneirnEnglandandWalesandIrelandmustinquireintoeverycaseofdeathduirngtheadministraiton ofananæstheitc.Theanæsthetisthastoappearattheinques,tandmustansweralongseiresofquesitons relaitvetotheadminisrtaitonofthedrug. Before, therefore, giving an anæsthetic, and so as to furnish yourself with a proper defence in the event of deathoccurring,yououghttoexaminetheheart,lungs,andkidneysofthepaitenttoseeiftheyarehealthy. Shouldafatalresultfollow,theanæstheitstwllirequiretoprovethaittwasnecessarytogivetheanæstheitc, thattheoneemployedwasthemostsuitable,thatthepatientwasinaftistateofhealthtohaveti administered,thatitwasgivenskfliullyandinmoderateamount,thathehadtheusualremediesathandin caseoffaliureotfheheartorlungs,andthatheemployedeverymeansinhispowertoresuscitatethepatient. Thecondiitonofthelungsisofmoreimportancethanthestateofthehea.tr The chloroformist ought always to use the best chloroform. An anæsthetic should never be administered except in the presence of a third person .Thisappiles especiallytodenitstswhogivegastofemales. Malpractice. —In every case where a medical man attends a patient, he must give him that amount of care, skil,lknowledge,orjudgmen,tthatthelawexpectsofhim.Ifhedoesno,tthenthechargeofmalpracticemay bebroughtagainsthim.Itismostrfequenltyallegedinconnecitonwtihsurgicalaffections— e.g. ,ovelrooking afractureordislocaiton.Beforeamajoroperationisperformed,itiswelltogetawrtitenagreemen.t VIII.—PRESUMPTION OF DEATH; SURVIVORSHIP Presumption of Death. —Ifapersonbeunheardofforsevenyears,thecoutrma,yonapplicaitonbythe nearestrelative,presumedeathtohavetakenplace.If,howeve,ritcanbeshownthatinallprobabilitydeath hadoccurredinacetrainaccidentorshipwreck,thedecreemaybemademucheailre.r PresumpitonofSurvivorship. —Whentwoormorerelatedpersonspeirshinacommonacciden,titmay benecessary,inordertodecidequesitonsofsuccession,todeterminewhichofthemdiedfirst.Itisgenerally acceptedthatthestrongerandmorevigorouswillsurvivelongest. IX.—ASSAULT, MURDER, MANSLAUGHTER, ETC. Assaul.t —Thisisanattemptoroffertodoviolencetoanotherperson;tiisnotnecessarythatactualinjury hasbeendone,butevilintentionmustbeproved.Whenacorporalhurthasbeensustainedt,henassault and battery has been committed. The assault may be aggravated by the use of weapons, etc. Homicide may be justifiable ,asinthecaseojfudicialexecution,or excusable ,asindefenceofone'sfamliy orpropert.y Felonious homicide ismurde.rThismeansthatahumanbeinghasbeenkliledbyanothermailciouslyand deliberatelyorwtihrecklessdisregardofconsequences. Manslaughter or Culpable Homicide (Scoltand)istheunlawfulkliilngofahumanbeingwithoutmalice—as homicideatfergreatprovocaiton;signalmanwhoallowsatraintopass,andsocoilldewtihanotherinfron.t X —WOUNDS AND MECHANICAL INJURIES . Awoundmaybedefinedasa'breachofcontinuityinthesrtucturesofthebody,whetherexternalorinternal, suddenlyoccasionedbymechanicalviolence.'Thelawdoesnotdeifne'awound',butthertueskinmustbe broken .Woundsaredangerousfromshock,hæmorrhage,fromthesupervenitonofcrysipelasorpyæmia, andrfommalum regimen onthepatrotfhepatientorsurgeon. Isthewounddangeroustolfie? Thisquesiton can only be answered by a full consideration of all the circumstances of the case; a guarded prognosis is wise in all cases. Burns arecausedbylfames,highlyheatedsolids,orverycoldsoilds,assolidcarbonicacid;scalds,by