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THE NEW SYDENHAM SOCIETT.
INSTITUTED MDCCCLVIII.
VOLUME XVI.
HANDBOOK
OF THE PRACTICE OF
FORENSIC MEDICINE,
BASED UPON PERSONAL EXPERIENCE.
JOHANN LUDWIG CASPER, M.D.,
PROTESSOR OP TORBNSIC MEDICINE IN THE UNIVERSITY OF BERLIN,
FORENSIC PH-JMCIAN TO THE COHRTS OF JUSTlCIARr OF BERLIN, AND MEMBER OF THE ROYAL CENTRAL
MEDICAL BOAliD OF PRUSSIA, ETC , ETC., ETC.
VOL. II.
THANATOLOGICAL DIVISION.
TRANSLATED FROM THE THIRD EDITION OF THE ORIGINAL BY
GEORGE WILLIAM BALEOUR, M.D., St. Andrews,
FELLOW OF THE ROTAL COLLEGE OF PHTSICIANS, EDINBURGH.
7 > //■/
THE NEW SYDENHAM SOCIETY, LONDON. p~.
MDCCCLXII. f D V^ % C n • -> ^ i
SERVICK
DATE ACT 2 0 1989.
mi i/.z
Non hypotheses condo, non opiniones vendito quod vidi, scripsi.
Stoerk.
IX)KT)ON : rriatcc ty J. w. Kocbe, » Kirbjr Strict, Hattcn Garacn.
CONTENTS.
SECTION SECOND.
Dynamic death § 20. General
Page
1 1
CHAPTER I.
Death from haemorrhage and exhaustion Mode of origin and diagnosis
21. 22.
23. 24.
Illustrative cases. — A. Death from haemorrhage
B. Death from exhaustion Is the case one of suicide or homicide ? Illustrative cases
2 2 5
7 12 14
CHAPTER II.
Death from starvation . . . . .28
§ 25. General. — Case of starvation for ten days without death . 28
§ 26. Continuation. — Diagnosis . . . .32
§ 27. Illustrative cases . . . . . 33
CHAPTER III.
Death from poisonipg . . . . .38 § 28. Definition of the term poison, and classification of poisons 39
§ 29. Continuation . . . . .43
§ 30. Determination of the fact . . . .45
§ 31. — (a) The morbid phenomena . . . .47
§ 32. — (b) Appearances on dissection . . .49
§ 33. — (c) The chemical analysis . . . .52
§ 34. — Special poisons . . .55
§ 35. — {d) The individual peculiarities of the case . . 65
§ 36.— Conclusions . . . .68
§ 37. Homicide or suicide . . . .70
§ 38. Illustrative cases . . . . .70
h
i,
VI
CONTENTS.
CHAPTER IV.
Death from suffocation § 39. General . § 40. Diagnosis § 41. Continuation § 42. Homicide or suicide 5 43. Illustrative cases
Page
. 123 . 123 . 124 . 130 . 134 . 135
CHAPTER V.
Death by hanging, throttling, and strangling . . .160
§ 44. General . . . . . .160
§ 45. Diagnosis :— (a) The general external appearances . 161
§ 46. Continuation : — (6) The local appearances on the neck. —
The mark of the cord . . . .165
§ 47. Continuation : —The mark of the cord. — Experiments on
the dead body . . . . .169
§ 48. Continuation : — The local appearances on the neck.— The
muscles. — The hyoid bone. — The larynx. — The cervical
vertebrae. — The carotid arteries . . .174
§ 49. Continuation: — (c) The internal appearances . .182
§ 50. Illustrative cases . . . . .184
§ 51. Homicide or suicide? . . . .191
§ 52. Illustrative cases . . . . ,197
CHAPTER VI.
Death from drowning . . . . , 229
§ 53. General . . . . . .229
§ 54. Diagnosis. — (a) The external appearances . . 232
§ 55. Continuation. — (i) The internal appearances . . 237
§ 56. Illustrative cases ..... 245
§ 57. Homicide or suicide ? . . . . 258
§ 58. Continuation.— How long has this body lain in the water?
— The progress of putrefaction in water . . 261
§ 59. Illustrative cases ..... 265
CHAPTER VII.
Death from cold
§ 60. General .
§ 61. Diagnosis of death from cold
§ 62. Homicide or suicide ?
§ 63. Illustrative cases
275 275 276 277 278
CONTENTS. vil
CHAPTER VTII.
Page
Death from chloroform. (Ansesthetics.) . . . 282
§ 64. General. . . . . . ^282
§ 65. Experiments on animals . . . .284
§ 66. Diagnosis . . . . .286
§ 67. Continuation. — Chronic chloroform-poisoning . . 293
§ 68. The external conditions favourable to death from chloro- form . . . . . .297
§ 69. Illustrative cases ..... 300
SUPPLEMENT.
Upon injury and death, said to be caused by unscientific medical procedure. — Malapraxis § 70. General .... § 71. Continuation. — The statutory regulations § 72. Imputation of malapraxis § 73. Continuation § 74. Illustrative cases .
302 303 306 312 313 319
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CASPEE
FORENSIC MEDICINE.
SECTION SECOND.
DYNAMIC DEATH.
§ 20. General.
In this section we include all those forms of death which are not pro- duced^ at least are not specially produced,, like those included in the previous section^ by mechanical injury of the organic machine^ but are brought about dynamically. Such are all the forms of death produced by Anemia, from Haemorrhage, Starvation and Exhaustion ; by Dys- ^MiA from Poisoning and Pyaemia ; by Hyperjemia, including most cases of Death from Drownings Hangiag, Suffocation, and Excessive Cold, and by Neuroparalysis, in which way also many of these unfortunates perish.
VOL ir.
§21. DEATH FROM HEMORRHAGE.
CHAPTER I.
DEATH FROM HEMORRHAGE AND EXHAUSTION.
§ 21. Mode of Origin and Diagnosis.
The diagnosis of this form of death is extremely easy, and can only be obscured by one circumstance — the putrefaction of the body. On external inspection, the hps and gums are found of a dirty pale-red, and the body in most cases of a waxy-white colour ; to this, however, the exceptions are hy no means rare, and in these even the most ex- perienced observer would not expect, from the perfectly normal colour of the corpse, to find that death had occurred from internal haemor- rhage. Following Devergie, all the recent handbooks teach that after death from haemorrhage post-mortem stainings are absent. I have already (§ 8, Gen. Div., p. 20) corrected this error ; the inspection of the body of any one who has died from such a cause will at once prove the truth of my statements. Usually, when not perfectly cleansed, the body and its clothing are copiously soiled "wdth blood, presupposing, of course, that the fatal haemorrhage has not been in- ternal. The internal inspection exhibits total anaemia, or, at least, great deficiency of blood in aU the large venous trunks, except the veins of the pia mater j which are rarely empty, or even strikingly anamic, but are generally, particularly such as are at all dependent, visibly filled with blood (from hypostasis) . This fact, which practical observation has taught us to be constant, must be ever remembered ; lest in some individual case a difference of opinion should arise as to the death being really due to haemorrhage, because the cerebral veins are still visibly full of blood. Besides the large blood-vessels, all the vascular organs are found anaemic, and therefore paler than after other forms of death — a change of colour in no other organ more visible than in the lungs of an adult, which in such cases are of a Hght- grey colour, marbled with dark patches. Moreover, in cases of iater- nal haemorrhage, the effused blood is found m the cavities into which it has been poured, sometimes fluid, sometimes coagulated, sometimes partly both. All these positive diagnostic appearances may, however.
§ 21. DEATH FROM HAEMORRHAGE. 3
be obscured by the putrefactive process, and are indeed obscured in every case in which this process is ab-eady so far advanced that the waxy-white of the surface of the body and the pale colour of the in- ternal organs have been merged in the hues of putrescence, when the general anaemia may be just as equitably supposed to be due to evapo- ration from putrefaction, which is a never failing occurrence, as to any problematical haemorrhage. Any human corpse, however, that dis- tinctly exhibits the appearances described is indubitably that of an in- dividual who has died from haemorrhage. This kind of death occurs when a large quantity of blood escapes from the vessels, and is thus withdrawn from the circulation, so that the heart and lungs are para- lyzed, whether the blood has altogether escaped from the body, or has been merely effused into one of its cavities. How much blood a man must lose before he die is a question as interesting for the physiolo- gist as it is immaterial for the medical jurist, particularly since there is now no longer any question, legally or practically, regarding the existence of any absolute or individual lethahty. The medical jurist must look upon death as having occurred from haemorrhage, when the appearances described are found in a dead body in nowise altered by putrescence, in which no other cause of death can be discovered. We have already several times had occasion to remark that the non-dis- covery of the source of the haemorrhage gives no cause to doubt the correctness of the opinion, nor to throw blame upon the medical in- spectors. Very often, indeed, it is quite easy to discover this source ; for instance, in the case of ruptures and injuries of internal organs and large blood-vessels ; but at other times, when the source of the haemor- rhage is, as it often is^ some imperceptible opening in a deep-seated and minute blood-vessel, which the most careful search cannot discover, it is perfectly impossible to detect it without making use of methods which it is just as impossible to employ at the time of the autopsy, as their result is useless in relation to the main object of the inquiry.
External haemorrhage follows wounds from stabs, cuts, blows, and firearms, which may happen to injure the more superficiaQy situated vessels, such as those of the extremities, of the neck, the temples, &c. This kind of death very often follows stabs, cuts, and blows, and some- times, also gun-shot wounds. We have already treated of these wounds in § 35, Gen. Div., Vol. I., p. 127, andm § 10, Spec. Div., Vol. I., p. 265. Bleeding from the umbilical cord is also an external haemorrhage, treated of in its proper place (§ 117).
Internal haemorrhages generally arise from similar injuries where the
b2
4 § 21. DEATH FROM EXHAUSTION.
vessels and organs in the internal cavities have heen wounded, and also from ruptures of these internal organs, and, in the latter case, it is not necessary that the organ lacerated be itself immediately struck or wounded. The discovery of such ruptures — vM^ch have been already described (§ 36, Vol. I., p. 131) — presupposes the apphcation to the body of very considerable external violence in every case in which the organ'ruptured has been previously healthy. Since healthy lungs, heart, hver, or spleen, never rupture spontaneously from internal causes. In the case of cerebral haemorrhage, this may be open to doubt, and it is precisely these cases of internal haemorrhage that possess a pecuhar practical interest for the medical jurist, on account of the great frequency of cranial injuries. But besides, that in spontaneous cere- bral haemorrhage a careful examination of the ruptured vessel often brings to light the existence of ossification or other anormahty, ex- perience also teaches, that in spontaneous cerebral haemorrhage there is, in most cases, only a very small amount of blood extravasated, whilst in that following injuries the amount of blood effused is always much more considerable. We can scarcely err, therefore, in regarding the discovery of very extensive and consideuable extravasation OF BLOOD WITHIN THE CRANIAL CAViTiY, in dubious cases, as evi- dence that the cause of death has nol heen sjoontaneous apoplexy y but the apphcation of external violence.
Death from exhaustion occurs when, from the persistent loss of corporeal fluids of any kind, and the simultaneous embarrassment of the reproduction of the blood, the wants of the body come to exceed its ■supplies, until at length this disparity increases to a degree incom- patible with the continuance of life. To this category also belong those too common cases, in which death occurs from hectic fever, resulting from an injury received weeks or months previously, and followed by sup- puration of a healthy or unhealthy character. This kind of death is established by the discovery of an extreme degree of emaciation of the corpse, a total absence of fat externally or internally, a general anaemic state of the body, precisely hke that which results from fatal haemor- rhage ; and by the discovery of the previous suppuration, decubitus, or the like, according to the circumstances of the case. To this category of death from general exhaustion also belong those cases, that so frequently occur in low hfe, and therefore in judicial practice, of immoderate punishment or ill-tisage of every kind, as well of adults as of children. Death in such cases occurs sometimes sud^* denly from actual neuroparalysis, sometimes, and that most usually.
§ 22. CASES OF DEATH FROM HAEMORRHAGE. 5
some little time after the infliction of the injuries ; and it is a remark'^ able fact, confirmed by experience, that the person ill-used is often able to walk some distance, or perform some light work, &c., before falling dowTi to die. This kind of death is recognised by the evident traces of injuries on the external surface of the body, without there being of necessity any positive internal appearance to confirm the diagnosis ; on the contrary, any such appearance is usually entirely absent. In such cases, many of which have come before us, it is always to be remembered that each of the many, often innumerable external injuries, hvid patches, stripes, marks of the rod, excoriations, scratches or bites, may by itself be utterly insignificant, and that it is only their multiphcity that has produced this fatal exhaus- tion.
§ 22. Illustrative Cases. — a. Death from H^morehage.
Case CLII. — Wound of the external Iliac Artery.
A wound of the external ihac artery is much more rare than a wound of any of the large vessels of the neck. A young factory workman, aged 18, was stabbed during a riot; he fell to the ground exclaiming, " I am stabbed — ^ia the breast — " and shortly died. The body was much soUed with blood, and exhibited an unusual anaemic condition of the hver and spleen, the abdominal veins were completely empty, the lungs, heart, and large thoracic veins were unusually anaemic ; there was very Kttle blood in the cranial cavity, and the whole of the peritoneal tissues were infiltrated with extravasated blood. It was found that the external ihac artery, behind Poupart's Hgament, was almost completely cut through, a portion of the posterior wall of the artery, a hne broad, being all that was left undivided.
Case CLIII. — ^Wound of the Pericardium and Lungs.
A young blackguard, whose uncanny physiognomy I can never forget, had murdered his master, aged 32, with thirty -two separate stabs with a table-knife, which had followed one another in furious haste ! The wounds of the lungs were the actual cause of death. In the superior lobe of the right lung there was a wound three-eighths of an inch long, and a second one three-quarters of an inch long, not
6 § 22. CASES OF DEATH FROM HAEMORRHAGE.
far removed, and two quarts of blood were effused into this pleural cavity. Beneath the left clavicle there was a gaping wound three- quarters of an inch long, with ecchymosed edges, which penetrated the pleura, and another wound half-an-inch long, which had shghtly pene- trated the apex of the left lung, and from which half-a-quart of red fluid blood had flowed. The pericardium was slit open for a quarter of an inch.^ (The capital punishment to which the youthful criminal was condemned, was graciously commuted to imprisonment for life.)
Case GLIY. — ^Wound of the Heart and Diapheagm.
A woman, aged 34, died instantaneously from haemorrhage, from a wound of the heart, produced by a blow with a triangular instru- ment ground sharp, which had perforated the left ventricle. The wound had also traversed the anterior edge of the left lung and the diaphragm. It was somewhat remarkable to find the tongue jammed between the teeth, as this is not usually expected to be found in cases of death from haemorrhage. We shall, by-and-by, have something to say as to the importance of this symptom in a medic"5-legal point of view.
Case CLY. — Wound of the Diaphragm, Liver, and Stomach.
Death followed a wound of these three organs in twelve hours. The edges of the wound were ecchymosed, both extemaQy and in- ternally. The wound traversed the muscular part of the diaphragm close to the central tendon ; it was here one inch in length, and its edges were deeply ecchymosed. The sharp edge of the left lobe of the hver was cut to the extent of three-eighths of an inch, and on the anterior surface of the stomach there was a wound an inch and a- quarter long, the edges of which were also deeply ecchymosed. The veritable stiletto wound of an Itahan bandit ! The thyroid gland of this body. presented a pathologico-anatomical rarity ; for in its right half there was a cavity the size of a walnut, containing pieces of bone, and lardaceous matter inclosed in an osseous cyst. This was therefore an osteo-steatomatous tumour of the thyroid (or goitre).
• Vtd. Cases XLVIIL, XLIX., and LI., § 33, Gen. Div., Vol. I.
§ 22. CASES OF DEATH FROM HEMORRHAGE.
Case CLVI. — Fatal HiEMOERHAGE from the Saphenous Yein.
The following case strikingly exMbits how unexpectedly a man may lose his life^ even when he dreams not of the possibihty of being ex- posed to danger,, for instance — when he makes use of his chamberpot. This remarkable case was that of a widow of a trumpeter, aged 50, who in making water was killed by her chamberpot. This vessel, made of so-called sanitary- ware (a coarse porcelain), was certainly broken, and had sharp points and edges. In elevating it beneath her dress, she wounded herself, and was afterwards found dead in her room. The chamberpot exhibited appeared externally full of blood, and actually did contain coagulated blood. On the lower part of the left thigh there was a wound one inch and three-quarters long, and three-quarters of an inch wide, with obtuse edges; the immediate mar- gin of the wound certainly exhibited no trace of ecchymosis, but in the subcutaneous cellular tissue adjoining there was an abundant ecchy- mosis, the vena saphena of this leg had an opening in it the size of a pea. The general anaemia of the body was most remarkable ; but the veins of the pia mater in this case also did not partake of this general anaemia (Yol. L, p. 319).
Case CLVII. — Fatal HiEMORRHAGE following Parturition.
In this case the phenomena resulting from putrescence were mingled with those of haemorrhagic anaemia, just as we have already described at p. 320. The child was precipitated into the w^orld while the mother was standing, the umbHical cord was torn across, and the child — as was proved by the appearances found on dissec- tion— ^was killed by being dashed against the floor of the apartment ; whilst the mother, an unmarried woman, aged 24, died of uterine haemorrhage immediately after the birth.
At the time of the autopsy, the body was already so much putrefied, that its waxy colour could no longer be discerned. The abdomen was extraordinarily distended. (An experiment which we frequently per- form in such cases, was in this one unusually successful; the gas which escaped through a small puncture in the abdominal coverings, was Hghted, and it burned for two minutes with a briUiant flame two inches and a-half long.) The whole body was perfectly anaemic, but both pleural cavities contained three ounces of bloody serum — a post- mortem product. Colostrum could be expressed from the breasts.
^ § 22. CASES OF DEATH FROM HAEMORRHAGE.
The vagina, whicli was much dilated, was quite putrefied. Tlie uterus was quite empty and uninjured, its walls thin and flabby, and it mea- sured (immediately after parturition) nine inches long by six broad. The perineum was lacerated to the extent of one inch. On the bed- cover in which the body was rolled, there lay a putrid placenta, and attached to it there was an umbilical cord five inches long and torn across ; its torn edges corresponded with those upon the remains of the cord attached to the child.
Case CLYIII. — Murder of a Child by cutting its Throat.
On the 9th of Pebruary (during severe frost), N., a yoimg unmarried woman, gave rapid birth to her first child (a girl in the ninth month) while sitting on the chamberpot. The child was shot into the utensil, and was speedily followed by the placenta. She confessed that it was bom ahve, and that to prevent its crying she stuck her finger in its mouth, and that shortly after there was no longer any sign of life to be perceived. At the first judicial precognition, when the result of our examination of the body had been communicated to her, she confessed, after some hesitation, that, fearing the child would come ahve again, she cut its throat with a bread-knife. About ten days afterwards, on the 19 th, the child was given over to us for ex- amination, being still perfectly fresh by reason of the severe cold. It was eighteen iuches and a-half long, and weighed only about five pounds (imp.) ; the cranial diameters were three, three and one -quarter, and four and three-quarter inches ; the breadth across the shoulders was three inches and three quarters ; the thorax measured transversely three inches, and vertically two inches and three-quarters ; the breadth across the hips was three inches. Everything else about the child also denoted that it had not yet arrived at complete maturity. On the left side of the neck there was a gaping wound, one inch and a-quarter long and seven-eighths of an inch wide, the edges of which were partly cleanly cut, and partly jagged, covered with moist blood and not ecchymosed ; in the bottom of the wound part of the stemo- mastoid muscle and the half of the thyroid gland were distinctly visible. Separated from this wound by an isthmus of skin a Une broad, there was a second semicircular and quite superficial wound, three-quarters of an inch long and half-an-inch broad; its edges were similar to those of the last ; wheh the head was bent forwards, both of these wounds were found to run in the same direction (the conclusion being
§22. CASES OF DEATH FROM EXHAUSTION. Q
that both resulted from only one cut) . Tlie diaphragm stood between the fourth and fifth ribs. The right lung was tolerably far advanced into the cavity of the thorax, the left was quite contracted. Both lungs with the heart weighed rather more than one ounce and a-half (imp.), and without the heart, only a trifle above fourteen drachms (imp.). Their colour was a bright but pale cinnabar-red. They floated perfectly both when entire and after being cut in pieces. Re- peated incisions revealed a most distinct sound of crepitation, and gave vent to much froth, which was, however, but shghtly bloody. The trachea was pale and empty. All the cavities of the heart were per- fectly empty of blood. On examining the wound in the neck, the carotid artery and jugular vein were found perfectly uninjured. There was no coagulated blood in the bottom of the wound. The only thing else worthy of mention in regard to the ,other appearances was the most remarkable general anaemia of the whole body. Our opinion could not be doubtful. The child was indubitably viable, and had lived after its birth, as was proved both by the docimasia pulmonaris, and also by the nature of the death : it had died from haemorrhage (which of course presupposed the existence of Hfe), and the wound in the neck had been the cause of its death. It was perfectly evident, that sticking the finger in the mouth of the child, which was confessed^ had not killed the child, inasmuch as there were no appearances attributable to death from asphyxia found in the body, and these must have been found had death occurred in this manner. The accused subsequently confessed her guilt, acknowledged that she killed the child intentionally, and was condemned to ten years^ imprisonment.
B. Death from Exhaustion.
Case CLIX. — The Elbow-joint opened by a sabre-cut. — Ampu- tation.— ^Death.
The elbow-joint of a man was struck by the blow of a sabre and laid open. Twelve hours after the receipt of the injury, it was am- putated in the Charite Hospital. According to the Hoc^pital records, this operation was urgently required ; it was speedily followed by an inflammatory affection of the chest, and the patient died of exudative pleuritis four weeks after the receipt of the injury. The stump of the arm was seven inches long, its edges were partially united, but between them ill-looking greyish-green purulent matter was stiU to be seen.
10 § 22. CASES OF DEATH FROM EXHAUSTION.
The bracliial art^r}-, which had been tied, was for one entire inch com- pletely obhterated. The right cavity of the pleura was filled with one quart and a-half of yello^vish-green, fluid purulent matter, which had compressed the lung into a leathery compact mass of about one-fourth of its original bulk. On incision the substance of the lung was found to be bright-grey, it contained no bloody froth, but at its base there were many partially softened tubercles. In the left pleural cavity there was an effusion of eight ounces of bloody serum, but the left lung was healthy. On the contrary, the whole of the imder surface of the lobes of the right lung were quite destroyed by sinuous sup- purating fistulse. On the inferior surface of the left lobe of the liver there was a still unopened abscess. The- right kidney was also com- pletely riddled with suppurating fistulse. The general emaciation of the body was extreme.
Case CLX. — A Stab in the Head and Shoulder. — Cerebral
Abscess.
A tradesman, aged 25, was stabbed in a scuffle on the head twice near the centre of the left parietal bone, a third time at the external angle of the left eye, and finally at " the external angle of the left shoulder-blade;" and after the apphcation of a temporary bandage, he was at once removed to the Charite Hospital. At first, under the skilftd attention received in the Hospital, everything seemed to go on well, but upon the 8th day (22nd January) a doughy swelling of the scalp set in, accompanied with such violent fever that, on the 23rd, two venesections were considered necessary. This pseudo-erysipelas passed rapidly into suppuration, so that on the 25th the woimds had to be dilated to permit the escape of the pus. The wounds upon the face and shoulder were also enlarged, and on account of the persistence of the fever a third venesection was made. In spite, however, of repeated dilatation of the wounds, purulent infiltrations occurred, the strength gave way ; from the 5th of Pebruary stimulants became ne- cessary, a typhoid stupor set in, accompanied by diarrhoea ; the wounds and their secretion assumed an unhealthy appearance, and the patient died on the 8th of February — twenty-five days after the receipt of the injury — under symptoms referrible to neuroparalysis. The following were the most important appearances found on dissection : — The body was much emaciated. The bones of the vertex, which were of the usual thickness, were bared of periosteum for about the size of a
§ 22. CASES OF DEATH FROM EXHAUSTION. 11
crown-piece, and were in a state of incipient caries. The dura mater y on the spot corresponding to the wound of the parietal bone, was per- forated hke a sieve, and through its openings yellowish-green matter weUed forth. After the removal of this covering the whole of the left hemisphere was found to be covered with a layer of yeUowish-green, stinking and viscid pus, which could not be wholly removed by the sponge. The whole of the brain was much congested, and the entire posterior half of the right hemisphere was transformed into a large abscess filled with greyish-green pus. The injury to the shoulder was of no importance, and the other appearances found may also be omitted as irrelevant.
Case CLXI. — Blows upon the Head. — Ceeebral Abscess.
A parallel case was exemplified in the suppuration of the brain of a man aged 34, always strong and healthy till he received several blows with a bottle on the head twenty-four days before his death. At the autopsy, the body was found to be much emaciated, and the most important appearances were : the left side of the calvarium (cor- responding to the part injured) was stripped of its periosteum ; there was purulent infiltration between the temporal muscle and the epi- cranial aponeurosis, extending beneath the zygoma, the dura mater covering the right hemisphere was inflamed, that covering the left hemisphere had on it a deposit of pus the size of half-a-crown ; the whole of the left hemisphere was covered with a layer of thick green pus, and the cerebral substance of this hemisphere had suppurated in several isolated larger and smaller patches.
Case CLXII. — A Stab in the Lung. — Suppuration.
A man, aged 41, was stabbed with a knife in the right breast ; the external wound, according to the surgical certificate, was half-an-inch long and two Hues broad. (A second stab in the middle of the left humerus was of no consequence as to the ultimate result.) A surgeon had at once brought the edges of the wound together (with plaster), apphed cold water dressing, and ordered nitre and Glauber's salts. On the third day he found the breathing " short and quick, and the pulse oppressed,^' and he took away four cups of blood. In the afternoon Dr. M. was called to consultation, and he immediately ordered a second venesection to a similar amount, because ^' he found
12 § 23. SUICIDE OR HOMICIDE?
extensive inflammation of tlie lungs and pleura, oppressed breathing, cough, with bloody sputa, urine scanty and high coloured, pain in the wounded side, and great restlessness and feeling of anxiety/' Next morning there was a fresh venesection, leeches were applied, and a nitrous emulsion ordered. On the next day the patient seemed dying, he lay passive, relaxed, pale and senseless, with a small feeble inter- mitting pulse. Dr. M. ordered calomel, with sulphuret of gold, nitre, and hyoscyamus, and applied a bHster to the chest. On the following day the patient was better ; nevertheless, the symptoms of exudation gradually set in, the pus secreted by the wound began to stink, the feet became (edematous, hectic fever set in, and the patient died four and a-half months after the receipt of the wound. At the medico- legal dissection, four-and-twenty ounces of stinking grey purulent matter were found in the left pleural cavity, the pus had partially cor- roded the intercostal muscles of this side, and its source was found to be an abscess, which included almost two-thirds of the right lung ; both lungs were perfectly free from tubercle, so that here we had an example of a purely traumatic suppuration of the lung. The right kmg was strongly adherent to the costal pleura, and that part of it not involved in the abscess was in a state of grey hepatization. The other appearances found were unimportant.
§ 23. Is THE CASE ONE OF SuiCIDE OR OF HoMICIDE ?
We have already said (§ 21, Yol. II., p. 4) that very considerable cerebral haemorrhage seldom or never occurs spontaneously, and that healthy organs never rupture spontaneously ; hence it follows, that in the first set of cases we are generally, and in the case of rupture of internal organs we are always justified in presupposing the apph- cation to the body of very considerable external violence. But this violence may have been produced either by some unfortunate fall, &c., or it may have resulted through the culpabihty of a third party. Exceptional cases may occur, such as when one has permitted himself to be run over, or intentionally given himself a violent fall, whereby internal haemorrhage has been produced in the manner stated, and their true nature will be ascertained from the pecuUar circumstances of the ease. We have also mentioned (§ 9, Vol. I., p. 264) that contused wounds, which may also give rise to death from haemorrhage, point with almost absolute certainty to the culpabihty of a third party ; since suicide by wounds of that nature is an unheard-of rarity. Punctured
§ 23. SUICIDE OR HOMICIDE? 13
and incised wounds are also frequent occasions of death from hsemor- rhage, and both certainly, but particularly the latter, are not infre- quently suicidal. In doubtful cases, the question of murder or suicide must in this, as in every other case, be decided from the rela- tive facts extrinsic to the mere appearances on dissection ; the combi- nation of all the individual circumstances of the case, and particularly the appearances found on and in the body, and its immediate neigh- bourhood. It is evident, that the discovery upon or near the body of any weapon used to produce the death, proves just as little as its non- discovery, since the knife of the suicide is just as likely to be stolen from the body, as that of the murderer is to be intentionally left lying near it. In endeavouring to conceal their crime, criminals frequently, from mental deficiency or confusion, go to work so stupidly, that the very precautions they have taken, at once reveal the culpability of a third party. So it happened here about twenty years ago, that a woman and her daughter by a former marriage, having killed their husband and stepfather by cutting his throat with his razor while asleep, sought to make it appear an act of suicide by folding the hands together and sticking the bloody razor into them ! This case, like the well-known one related by Gruner, and a few others, shows, however, that the direction of the punctured or incised wound is in so far not decisive of suicide, inasmuch as wounds which from their great cer- tainty are chiefly selected by suicides, such as stabs in the heart or incisions in the cervical vessels, are very often also inflicted by third parties, in order to raise the suspicion of suicide. The course and direction of a wound can therefore only testify with absolute cer- tainty against the supposition of suicide, when it would have been impossible for the person to produce such a wound with his own hand ; for example, when the body displays a stab, which commences behind and runs from above downwards towards the anterior part of the lung. In suicidal wounds of the throat, the wound certainly usually runs from left to right, and from above downwards. I have, however, already stated (§ 35, Gen. Div., Yol. I., p. 129), how difficult it is in general to decide where such a wound commences and where it ends, while the direction of course depends upon the determination of these two points. Besides, supposing these points established, they prove nothing, for the deceased may have cut with the left hand, in which case the direction of the wound would be precisely the reverse of that just described; and there are many other accidental circumstances which may interfere with the correctness of any generalization,
14 § 24. ILLUSTRATIVE CASES.
Moreover, it is but rarely that the wound in the tliroat has a perfectly horizontal direction (Cases CLXVI., CLXYII., CLXXIL, and CLXXIII., CLXXVI., and CLXXVII.), and this makes it more difficult to distinguish the commencement from the termination of the incision. Finally, it is precisely in the case of wounds of the throat that cases often occur, in which the destruction of parts by bold and deep incisions is so fearful, that the medical jurist is per- fectly unable to satisfy himseK or make clear to others in the protocol, the original direction of the wound, the evidence of this being also materially altered by the retraction of the muscles, and the manipula- tion of the body in taking off the clothes, during the carriage, &c. "When after all this, the pecuhar combination of circumstances of the individual case is not sufficient to make its nature perfectly clear, it only remains for the medical jurist so to frame his opinion as to ex- press the great probability of the death being due either to suicide or homicide ; or, if even this be impossible, then he must so frame it that even in its apparent uncertainty, it is yet distinct enough to give the judge a hint for the further treatment of the case, and for the investigation of other evidence, which he on his part has to collect, for instance : — " The examination of the body has not revealed any circumstances inconsistent with the supposition that the deceased has died by his own hand;'' this form of opinion we have already repeatedly recommended for similar cases, and we very often employ it.
§ 24. Illustrative Cases.
Case CLXIII. — ^Doubtful Suicide. — ^Wound of the Carotid Artery and Jugular Yein.
The body of a man with his throat cut was found clothed and standing up to the middle in a marsh. The trachea, oesophagus, left carotid artery, and jugular vein were completely divided I Of course, the anaemia of the body was general, except, however, the cerebral veins, which took no share in it, being visibly well filled. The soles of the feet and palms of the hands were bluish-white, and completely corrugated, like the hands of washerwomen who have just been washing, a condition which is always present in bodies that have lain any time in the water. The cap of the deceased lay on the bank, and there waa money in his purse. The fact of suicide was in this case
§ 24. ILLUSTRATIVE CASES. 15
indubitable, and a complex mode of death bad been selected, evidently in the hope of sinking in the water should tbe cut in tbe tbroat not produce a rapid enough end, a procedure often adopted by those weary of life, in order to make sure of attaining their object.
Case CLXIY. — Doubtful Suicide. — ^Wound of the Jugulae
Vein.
The following case of doubtful suicide of a hat manufacturer, who was also found dead, with his throat cut, was much more difficult to unravel. This man was heard walking up and down ia his room till far on in the night, and the next morning he was found lying dead on the floor opposite the looking-glass, with his shirt, boots and trousers on, and a silk neckerchief round his neck. Everything around was smeared with blood ; about two feet from the body there lay a bloody razor, shut, which was amissing from a razor-case standing open in the window. A short distance off there lay a mass of recent human ordure. These circumstances, particularly the fact of there being two superficial wounds at the bends of both elbows, whilst the sleeves of the shirt covered both of the arins, finally, the relations in which the deceased hved, with two concubines, had raised the suspicions of mur- der. Death had been caused by a wound of. the throat, which ran obhquely across it downwards from left to right (the neckerchief being uninjured), and had cut across the larynx and both of the external jugular veins, and so produced death by haemorrhage, as was abun- dantly evidenced by the bloodless condition of the whole body (except the cerebral veins, which still visibly contained blood) . Several re- markable pathological appearances were also found, w^hich facilitated our decision regarding the case. The cartilages of the larynx, ahnost the whole of the trachea, and even the bronchi, were ossified, the latter contained pus j the heart was hypertrophied to one-half larger than usual, its left ventricle was dilated, and the hver was cirrhotic. These complaints, as was proved by medical certificate and the evidence of those who hved with him, had rendered the deceased for many years very ailing and depressed in spirits, and so late as the evening before his death he was heard to say, " only a pistol bullet, and all is over ! " Whilst all these circumstances pointed to the probability of suicide, this was strengthened by the fact that the door of the room was holted on the inside. The only remarkable points were the incisions on the arms, and the fact of the razor being shut, and upon these points we
16 § 24. ILLUSTRATIVE CASES.
expressed ourselves as follows : — '^ These wounds must have been first inflicted, since it is not to be supposed that any man after having given himself such a gash in the throat could still give himself two wounds in the arms. It is also just as impossible to perceive why any mur- derer, after cutting the throat, should then proceed to wound the arms in the manner discovered, as it 'is to suppose that a third party could first inflict these trifling wounds and afterwards the fatal injury. It is well known, however, how often suicides make fruit- less attempts before they attain their end. It is extremely pro- bable that H. has acted in this manner, and that he ia the first place made these superficial incisions, which, as they were but slight, left him all his senses, and ample time to draw down his shirt sleeves and adopt another and more certain mode of death. It is also a striking fact that the bloody razor was found lying near the body, shut. But there is nothing in the circumstances of the case to render this occur- rence irreconcilable with the fact of suicide. Since it is consonant with experience to suppose that death from the wound in tlie throat was not instantaneous, but rather that the deceased, in accord- ance with what has happened in other cases which have been under medical observation, indubitably lived for several minutes at least, perhaps longer, and may very easily, immediately after making the incision, have shut tha razor and flung it away. However remarkable the uninjured condition of the neckerchief may appear, this also speaks more for suicide than murder, since it is scarcely to be supposed that any murderer, even if he had fallen upon H. when asleep, would proceed to work so carefully and leisurely as first to pull down the neck- erchief. Finally, it is difficult to suppose that the situation in which the body was found was pitrely accidental, but the supposition is rather forced upon us, that H. purposely selected this situation, and standing opposite the looking-glass, drew down his neckcloth and made the fatal incision/' These views prevailed, and the fact of the suicide was distinctly proved by subsequent investigation.
Case CLXV. — Doubtful Suicide. — Wound op the Carotid Artery and Jugular Vein.
In another case of fatal wound of the throat, in which the left carotid artery and jugular vein were cut across, we found several very interesting pathological appearances, betokening much prolonged suffering, and which had indubitably been the cause of the suicide.
§ 24. ILLUSTRATIVE CASES. 17
The heart was unusually small^ and yet its left side was hypertrophied. The stomach was almost vertical in relation to the pelvis, and was very distinctly divided into three pouches by two strictures, the whole of its mucous membrane was also thickened. The right kidney, its artery and vein were completely wanting. The cause of death was haemorrhage, of course, evinced by the general absence of blood, except from the sinus durce matris, which were still tolerably well fflled.
Case CLXYI. — Mark of Strangulation and Wound of the Throat. — ^Wound of the Carotid Artery, Jugular Yein, and Trachea.
The case of a man, aged 60, formerly a Government official, and who was stated to have lost his property by speculating on the Stock Exchange, presented a very peculiar complication. We saw the body, previous to the autopsy, lying on its back in the kitchen. Both hands were much besmeared with blood. On the neck a gaping wound, with somewhat obtuse edges, stretched perfectly horizontally from one ear to the other ; there was no ecchymosis surrounding it ; it afterwards appeared, that this incision had cut across the an- terior wall of the trachea immediately beneath the larynx, the right jugular vein, and the anterior wall of the carotid. Three parallel, dark bluish-red stripes, not ecchymosed, and each a line in breadth, coursed round the neck, and were lost at each angle of the incision. At the right angle of the wound there was an actual extravasation of blood beneath the stripes. Close beneath the lower edge of the wound in the throat, a portion of just such another stripe could be distinctly perceived. The anaemia of all the three cavities was very remarkable. Two inches above its bifurcation the abdominal aorta was very much ossified. We declared that the autopsy had revealed nothing inconsistent with the supposition that the deceased had died by his own hand, that even the mark of the cord round the neck, in the absence of every injury to the clothing or wound of the body, was not incompatible with the supposition, but that it rather only afforded a fresh proof of the stability of the suicidal purpose ; that the attempt at hanging must have taken place some time before death (since an ecchymosis had actually occurred), that the notched and bloody razor found might have been the fatal weapon ; and finally, from the cir- cumstance that the clothes were much stained with blood only pos-
VOL. II. c
18 § 24, ILLUSTRATIVE CASES.
teriorly, we stated it to be likely that the deceased had cut his throat either when lying or sitting. All these suppositions, particu- larly that respecting the attempt of strangulation having occurred sometime before death, were subsequently completely confirmed, since a relative stated, that on coming home the day previous to the suicide, he found the deceased lying strangled and senseless, and was fortunate enough to rescue him at that time. The following night, however, he went into the kitchen and killed himself by cutting his throat.
Case CLXVII. — Wound of tsr Throat. — Death from suffoca- tion, AND not from hemorrhage.
The very heading of this case is sufficient to justify its relation as something altogether unusual, or rather extremely rare. A man, aged 60, very much given to drink, and who had been desponding for months, was heard one morning breathing heavily in his room. On entering this he was found sitting close to the entrance door, breathing stertorously and dying. A few feet from the chair, close in front of a night-stool, over which hung a looking-glass, there was a very considerable pool of blood on the floor, and one foot from it there lay an old, rusty, blood-stained, notched, and blunt razor. An incision ran horizontally across the neck, distinctly beginning at the left side, where several superficial wounds showed that several com- mencements had been made. It was at once evident, even on external inspection, that the incision had not reached the larger blood- vessels; and this was subsequently confirmed, but the trachea was completely divided beneath the larynx. The supposition that the man had not died from haemorrhage, founded upon the fact that there was but comparatively little blood effused in the room, that the man's clothes were but little stained with blood, and that he could move about and sit down, w^as also confirmed. Tor the lungs were not anaemic, but very cedematous ; the left side of the heart contained much blood, and the right one was unusually congested vnih. coagulated blood of an inky hue, with which also the pulmonary artery was completely stuffed. The trachea was empty and quite normal. There was no ansemia either in the head or abdomen ; the veTia cava inferior contfiined, indeed, much dark blood, and the kidneys, completely im- bedded in fat, were hypersemic. The death consequently resulted from apoplexy of the heart (asphyxia), caused by the impossibiUty of main- taining respiration by reason of the amputation of the larynx.
§ 24. ILLUSTRATIVE CASES. 19
Cases CLXYIII. to CLXXI. — Murder and Suicide by wounds OP THE Carotid Arteries,, the Jugular "Veins and the Trachea, and also by Cranial injuries. — Survivorship.
The following horrible scene was the most repulsive I have ever witnessed, though of course I have often been present at the judicial removal of the bodies of those that have met a violent death. One night in October, the neighbours heard a great noise and screaming in the smaU dwelling of a subaltern official, and those in its immediate vicinity had heard cries for help coming from the window, but not till the morning was it discovered what had happened. The husband and father was known to be a passionate man, but bore an othermse good character, particularly in his official position. It seemed, therefore, wholly inexplicable and mysterious, when, next morning, none of the family appearing, the house was broken open, and in the little kitchen — the whole family of husband, wife, and two boys were found lying dead upon the floor, all lacerated and besmeared with blood ! The bed of the husband alone had not been slept in, the other three beds had all been occupied. The mother and her children lay upon their backs on the floor, close to one another, with here and there a leg or an arm lying upon the body adjoining ; the sons were in their shirts, the mother in her night- dress ! The body of the father was clad in a sheepskin coat and trousers, and lay on its face, with its head within the room in which his bed lay. Large pools of blood lay scattered over the kitchen, and on the floor there lay an unusually heavy kitchen axe, an old sabre, and a razor, aU of them besmeared with blood. At the first glance the bodies were seen to be much cut and hacked ! How could this have happened ? This was not hkely to be a case of burglary, for nothing was wanting, no press was broken into, &e. The murderer of the family must, therefore, be sought for within itself, and the most natm*al supposition was, that the father, a powerful man of forty years of age, had first murdered his wife and children, and then com- mitted suicide. But no one who knew the family and their habits was aware of any motive that could lead to such a crime ; or was it possible, that the mother, likewise a powerful woman, of just thirty years of age, had killed first her husband and children, and then herself ? A medico-legal exammation of the four bodies was ordered and was carried out by us. To save space, we shall only describe the various
20 § 24. ILLUSTRATIVE CASES.
wounds summarily, omitting the exact description and correct mea- surements, kc, of the original protocol, and shall merely narrate the more important appearances found, as this wiU suffice for our present purpose.
(CLXYIII.) — The Mother. — The whole of the scalp cover- ing the right side of the head was much mangled, the skull-bones were smashed and mingled with the protruding brain ; the face was swollen and ecchymosed. On the front of the neck there was a clean cut, three inches and a-half long, which had completely divided the trachea and both carotids. Beneath the right mamma there was a smooth-edged gaping wound, one inch and a-half long, which had penetrat-ed the interior; further, upon the right thigh there was a somewhat triangular sharp-edged wound, one inch and a-quarter long ; on the back of the neck there was an incised wound an inch and a- quarter long, and smaller punctured wounds on the right side of the abdomen and back, and on the right buttock, as well as ^^ many isolated, hvid, but not ecchymosed spots, particularly on the abdomen, which cannot be more accurately described.^' In the skuU it was found that the right parietal and temporal bones, the occipital bone, and the left side of the frontal bone had been smashed; on the right cerebral hemisphere there was a thick layer of dark coagulated blood, which also extended down over the base of the skuU, which was " completely spht into two halves.^'' In the right lobe of the Hver, there was a pimctured wound an inch long, and there also existed incomplete gene- ral anaemia. It was not difficult to decide that the wounds of the throat and neck had been infficted with some sharp cutting instrument, the cranial injuries with some blunt and heavy weapon wielded with great force, that aU the other wounds had been made by some stabbing instru- ment, and that the razor, axe, and sabre, the latter having a very sharp point, already referred to, must have been the weapons used. In answer to a question, we also stated, that the cranial injuries, irrespective of all the other wounds, completely excluded the idea of suicide ; that it was to be supposed that the cranial injuries had been inflicted before the throat was cut (both carotids divided !), and that several of the smaller wounds (superficial punctures and excoriations) were inflicted after death.
(CLXIX.) — ^August, a son, aged 10 years. — The right ear was com- pletely cut in pieces by sharpedged wounds ; two similar womids were upon the head, a third upon the left forehead, and the whole of the left cheek was cut in two by a precisely similar wound ; on the anterior
§24. ILLUSTRATIVE CASES. 21
part of the neck there was another wound two inches and a-half long, and on the breast^ and above and below the umbilicus there were three punctured wounds. The whole of the right side of the skull was smashed,, and the corresponding cerebral hemisphere covered with a layer of coagulated blood, the left side of the frontal bone was frac- tured, and the whole base of the skull smashed. The anterior wall of the trachea and of the left carotid were cut through. There was a punc- tured wound in the lower lobe of the right lung, with effusion of blood ; a punctured wound through the centre of the diaphragm on the right side, through which a part of the hver had passed ; a punctured wound in the inferior surface of the right lobe of the liver ; a punctured wound through a coil of intestine, with escape of faecal matter, and general anaemia. The opinion arrived at was much the same as that in regard to the body of the mother.
(CLXX.) — The other son, William, aged 8 years, was also mur- dered after a similar blood-thirsty fashion. At the umbihcus there was a semicircular skin-wound ; a similar wound in the pit of the stomach, which penetrated the abdominal cavity, and through which the omentum was prolapsed, and two other similar wounds on the left side of the thorax. T«"o parallel contused wounds passed across the face from the middle of the forehead towards the left ear. There were two other contused wounds upon the vertex and upon the left parietal bone ; a smooth-edged incised wound on the anterior part of the neck met another similar one running from behind forwards, so that there was only an isthmus of skin about two inches broad left uninjured in the middle of the neck. This wound, after dividing the cervical vertebrae, had wounded the spinal cord. It was thus a regular attempt at beheading ! At the dissection the whole of the skull, its vault right and left, and its base, was found to be completely smashed ; there was a penetrating wound of the brain on the right side, and a great effusion of dark coagulated blood into the cranial cavity. On the neck the great lateral vessels were in this case uninjured, as were also the oesophagus and trachea, but the second cervical vertebra was completely divided from the third. There was a punctured wound in the lower lobe of the left lung, with effusion of fluid blood ; a punc- tured wound of the left half of the diaphragm with prolapsus of the stomach, the latter organ had also a punctured wound in its posterior wall. General anaemia of the body was of course present. Irrespec- tive of our opinion as to the weapons employed in this case, which was of course the same with that delivered in the case of the other two
22 § 24. ILLUSTRATIVE CASES.
bodies, we explained, that in tMs case also the cranial injuries must have preceded the wounds of the neck, and that the injuries on the breast and belly must have been inflicted after death ; and in stating this we were guided not so much by the condition of the edges of the wounds, or by the fluidity of the blood in the latter instances, and its coagulation in the head, for upon these points alone I would have placed but little value {Fid. Y oh I., pp. 25 and IIS), as by thepecu- har combination of all the wounds when viewed as a whole. — i'inally, (CLXXI.) — T/ie hody of ike Tather. — There were post-mor- tem stains upon the breast, from the prone position in which the body was found lying. The right hand alone was very much besmeared with blood. About the middle of the belly there was a gaping wound thirteen inches long, its edges tolerably shai-p, yet somewhat zigzag, and feebly ecchymosed. " The whole of the neck was cut through round and round, and three different wounds can be distinctly made out, of which the first has divided the right side of the neck, the second the back part of the neck, and the third its left side/' AU the three wounds had very sharp and smooth unecchjonosed edges, the jugular veins on both sides were cut across, ^11 the other im- portant organs in the neck were uninjured. I have only to add, that the ^abdominal wound was not a penetrating one, that everjihing else was normal and uninjured, and that anaemia was the cause of death. We explained that the haemorrhage had taken place from the wound in the neck, that this had been made with the razor akeady mentioned or some similar weapon, that the wound in the belly must have been made before death, and that the case was evidently one of suicide. The presiding Judge felt himself necessitated to inquire which of the two parents had died first ? and he was answered, that the husband had died subsequently to the wife. For the skull and brain of the latter were completely smashed, the base of her skuU broken in two, and a very considerable effusion of blood into its cavity ; both of her carotid arteries were also completely divided, and she also had a wound in her liver, while her husband had only his jugular veins cut ; and, even supposing that these injuries had been inflicted upon these two individuals, simultaneously by a third party, it must of necessity be presumed that such an unusual accumulation of important injuries must have killed the woman long before the man would die from venous hsemorrbige alone. But the totahty of thia fearful case led rather to the conclusion that the husband had first murdered his wife and children, and then committed suicide. It was
§24. ILLUSTRATIVE CASES. 2S
ascertained tliat the man liad returned liome late at night, whether drunk or not (he was no drunkard) is unknown. A quarrel then arose between himself and his wife, which must speedily have become very violent, and led to blows, wakening the sleeping boys, and leading them to run to their mother's assistance, since it was a child's voice that was heard calling over the window for help. And now the brute- like rage of the man seems to have been excited to the utmost, and one after the other seems to have fallen slaughtered beneath it. Evi- dently, he had at first used the heavy kitchen axe alone, and struck with it in frantic rage upon the heads of his victims, and when they had fallen helpless beneath its blows he had cut their throats with the razor while they were yet alive, finishing off by slashing and stabbing them in blind fury with the sabre when dying, and their bodies after death. The position of the bodies, which we have abeady shortly described, the extremity of one being laid over another, proved indu- bitably that he must have meddled with the bodies I One circumstance is, however, remarkable. In the case of the mother and the eldest son the contused wounds of the head were chiefly on the right side of the head instead of, as usual, on the left, and yet it did not appear that the man had been ^' left-handed," smce he had evidently mtide use of his right hand alone to cut the throats of his victims, as was proved by its being the only bloody one. Consequently, we were compelled to regard these contused wounds as having been inflicted from behind, probably while the unfortunates were fleeing from him. The nature of the wounds on the neck of the miscreant himself, being the only fatal wounds upon him, quite distinctly proved his suicide, since no third party could inflict such annular and threefold gashes on the neck of so robust a man without invoking his personal resistance, and yet of this there was no trace upon the body. Evidently, he had, after finishing his bloody work, attempted to kill himself by making an incision in his belly ; and it is a remarkable psychological fact, that the same man, who just before had, with the utmost possible fury and personal exer- tion, so horribly mutilated his family, had (undoubtedly) immediately thereafter laid hands on himself with so feeble a resolution that he only succeeded in cutting the skin of his belly ! ! He then seized the razor — ^which at the examination we found all notched and jagged. Verily it had done terrible work ! !
24 § 24. ILLUSTRATIVE CASES.
Cases CLXXII. and CLXXIII. — Murder by Cutting the Throat. Wound of the Trachea and the Carotid.
On the 17th of January, 18 — , a father cut the throat of his own two sons with his razor, Paul, aged 2>\ years, and Oscar, aged \\ year, and immediately thereafter made several unsuccessful attempts to com- mit suicide hy cutting and hanging himself. The wounded children died immediately, and were examined by us three days subsequently.
(CLXXII.) — The body ^ Paul was not waxy in hue, but presented only the usual corpse-colour. On the neck there was a clean incised wound three inches long, and gaping to the extent of two inches ; its edges were dry and not ecchymosed, and its direction was perfectly horizontal. The trachea was smoothly and completely cut through directly beneath the larynx, the left carotid artery was also completely cut across ; the oesophagus was perfectly uninjured. The body was completely ansemic, excepting a hypostatic congestion of the posterior veins of i\it pia mater.
(CLXXIII.) — The body o/" Oscar was of a dirty pale-green (waxy) colour. The wound of the neck, which was horizontal in this case also, was two inches and a-quarter long, and its lips were two inches apart. The edges of the wound were sharp, smooth, dry, and not ecchjniosed. In this case, also, the trachea was cleanly and smoothly di /ided from the larynx, while the oesophagus was uninjured. This child had no large blood-vessel wounded, but the body was, neverthe- less, completely ansemic, with the exception of the sinuses of the dura mater J which were moderately filled. The decision respecting both cases was, of course, very easy to arrive at. The horrible deed had evidently been committed shortly after a meal, since the stomachs of both children were quite full of potato-soup. We concluded, from the horizontal direction of the wound, that the father must have had the children standing before him (hke a bass fiddle) when he committed the deed. The unfortunate, melancholic, and mentally diseased man, confirmed both of these statements immediately after the completion of the autopsy.
§ 24. ILLUSTRATIVE CASES. 25
Cases CLXXIY. and CLXXV. — Murder by Wound op the Throat. — Wound of the Carotid Artery, Jugular Yein AND Trachea.
Two cases, precisely similar to the foregoing ones, psychologically and traumatically, occurred among the children of an upholsterer, S., who, being mentally diseased, had cut their throats with a razor, one morning while they lay in bed ; the two daughters immediately bled to death, while the two boys survived, and from them we learned that all the children had defended themselves against their father, which could also be partly made out from the nature of the injuries.
(CLXXIV.) — The body of Louisa, aged 7, was of a waxy hue, but had post-mortem stains, and on the left side of the neck an almost rectangular skin- wound, and beneath it the fatal injury, which ran from left to rights and somewhat from above downwards, and had completely severed the carotid artery, the jUgular vein, and the trachea beneath the larynx. There was general anaemia.
(CLXXV.) — The body of her Sister, aged 4, was also of a waxy hue, and had also post-mortem stains. On the left side of the neck there was a wide gaping wound, two inches and a-half long, also running from left to right and from above downwards. The left jugular vein and its anterior wall cut across, and the anterior wall of the trachea was also divided. There was general anaemia. The self- defence of the unfortunate children was proved by the existence on the youngest boy, aged 9 years, of (at the time of my examination) cica- trized wounds at the right angle of the mouth, and on the four fingers of the right hand ; the wound on the neck was on the left side and cicatrized; his brother, aged 10 years, had two small cicatrices of wounds upon two fingers of his left hand ; the wound on his neck was on the right side, somewhat arched, and already cicatrizing ; close beneath it there was a similar wound, more horizontal, and two inches and a-quarter long. It is remarkable that the wound in both the girls had precisely the direction usually found in cases of suicide. In answer to a question put to us at the time of the autopsy regarding the probable position of the perpetrator, we explained that most probably he must have stood behind the children as they lay in bed, and the testimony of the surviving children subsequently confirmed this.
The youngest boy died five weeks afterwards in the Hospital, whither he had been sent for the cure of his wounds, and his body
26 § 24. ILLUSTRATIVE CASES.
was also ordered to be medico-legally examined. The wounds on the neck were completely cicatrized. Both pleural cavities were distended with serous fluid, and the right lung slightly adherent. Both the lungs, as well as all the other thoracic organs, were quite healthy. In the abdomen, also, there was a large amount of a similar exudation, and also a small quantity at the base of the brain. There was, withal, no oedema of the feet, and no decubitus, so that the iUness must have been of but short duration, and the effusion must have been very acute. Added to this, we had the kidneys very large, and their cor- tical substance was throughout distinctly violet from vascular injection, so that we were justified in suspecting, and, on interrogation, expressing our suspicion that the child had died from scarlet fever. Inquiry at the Hospital completely confirmed this supposition.
Cases CLXXVI. and CLXXVII. — Suicide by cutting the Tkroat. — ^Division of the Teachea and (Esophagus.
Upon one and the same day we dissected the bodies of two men, one 21 years of age, and the other 50, both of whom were well known to have killed themselves by cutting their throats with a razor, the former three, and the latter two days previously. I relate these two cases now in connection with the foregoing ones, because, in the first place, although they were both indubitably cases of suicide, yet the wounds were perfectly horizontal, so that it was perfectly im- possible to say where the wounds had commenced, and where they ended. Further, there was this pecuHar circumstance in relation to the body of the older man, that even the hands had been washed before it came before us for examination, and in respect of the younger man, that his left hand was completely besmeared with blood, the right much less so ; further, that the left hand was quite spasmodically con- tracted, the right not. These appearances induced us to suppose that the incision must have been made with the left hand, and this supposition was subsequently ascertained to be correct by the inquiries of the poUce. Both bodies had the usual post-mortem stains, which I have never found absent, even in cases of death from haemorrhage as I have already stated (§ 8, p. 20). But the younger man's back was of a pure cadaverous white, and unstained, while there were post- mortem stains upon the belly, and on the anterior surface of the thighs, and a yellowish parchment-like patch upon the chin. Prom this we concluded, that in dying he must have fallen on his face and so re-
§ 24. ILLUSTRA.TIVE CASES. 27
mained lying. And in perfect agreement with tliis view we found the hypostasis of the veins of the pia maters which were present in the bodies of both of these persons dead from hsemorrliage^ and the hypostasis of both lungs situated anteriorly j thus forming a rare ex- ception to the general rule. It was subsequently asceitained, that the body had actually been found lying upon its face upon a heap of rubbish. Neither suicide had divided any of the large cervical vessels, but both had cut across the trachea and oesophagus; the younger man through the middle of the larynx, the older man between the hyoid bone and the larynx. There was general ansemia of both bodies. Finally, the head of the junior alone was of a dirty-yellowish white, except this, however, neither body presented any peculiar appearance, but only the usual corpse colour.
28 § 25. DEATH FKOM STARVATION.
CHAPTER II.
DEATH FROM STARVATION.
§ 25. General. — Case of Starvation for ten days without
DEATH.
There is very little that is certain known respecting this kind of death. Hundreds of men have pined to death in dungeons, or ship- wrecked, have been tossed up and down on a raft on the ocean, till they sunk, undrowned, beneath the ocean, &c. ; all these have indubi- tably died from starvation ; but who has observed them ? The tolerably numerous cases related by the older authors of healthy men fasting for weeks, or months, or even years, are to be set aside as cases of inten- tional or unintentional deceit. And even the more rare clinical histories and reports of the dissection of cases said to be of death from starva- tion in more recent times, deserve but little confidence, since they date from an epoch in which the purely cadaveric phenomena, which are of great importance in such medico-legal cases, were neither known nor acknowledged, and further, because many of them are related by untrustworthy observers and mere bookmakers. In such a state of matters it says but little for the scientific good taste of even such men as Orfila, whose suppositions have found their way into other and uew^er text-books, to lay down such propositions as, that women succumb to starvation at a later period than men ; that cold and damp permit of a longer abstinence from nourishment than warmth and drought, &c. Since a great many observations must have been necessary to enable such propositions to be laid down ; and where are these observations ? My own experience in this field has been extremely scanty, and relat- ing the results of it now, I am very far from wishing to deduce from it any generally applicable axioms, but would rather leave that to be done by the science of the future. It is well known and certain that there are two kinds of death from starvation, the chronic and the acute. The former is brought about by the gradual withdrawal of all nourishing food, and the restriction of the diet to starvation pitch, whereby diseases of every kind, particularly atrophy and phthisis, are
§25. STARVATION FOR TEN DAYS. 29
produced, and finally death from exhaustion follows ( Vid. Chap. I. Yol. II.) . The latter, the true death from starvation, ensues more rapidly upon the complete and total withdrawal of every article of nourishment. Since only completely isolated cases could afford any correct criterion for deciding how long total abstinence might be borne before death occurred, it is readily explicable how the opinions of authors have varied within so wide a range that this term had been rated at from three to sixty days ! The following case, of which I can at least say that I observed it with the deepest interest and complete impartiality, seems to justify the opinion that a powerful, healthy man is not likeli/ to die in less than ten to twelve days of total abstinence from every article of nourishment, so that conversely, when death from starvation has occurred, we may thence deduce that starvation for at least so long a time has pre-occurred.
A healthy goldsmith, aged 36, had been, for fraud, condemned to imprisonment for more than seven years, against which he had ap- pealed. Having been already in prison for more than a year, he made up his mind to starve himself, and on the morning of the 1 7 th Febrnary, 18 — , he commenced by leaving his breakfast untouched; at dinner he took a httle (how much could not be exactly determined) of the ordinary thick vegetable pottage, which forms the prisoner's usual diet. On the morning of the 18th he took an allowance of soup, and thenceforth refused every nourishment. To my great grief, I did not become aware of the case before the 23rd, when my advice was re- quested ; the two house-physicians having, up to that time, carefully observed the prisoner N., and well acquainted with the usual decep- tions of prisoners, had endeavoured to guard against the possibility of any such deceit. In the first place, I could not but approve of the means taken to observe the conduct of N., and guard against his suicide, by placing with liim in the cell tAvo tolerably well-educated men, who were only in prison for some trifling police offence. On the forenoon of the 23rd, after he had already for five times four-and- twenty hours suffered nothing to cross his Hps, I found him lying on the straw mattress. He appeared pale, yet not much different from those who have been in confinement as long as he ; his features were, however, somewhat coUapsed ; his eye was dull, his bodily tempera- ture perfectly normal, his tongue was covered with a white mucous coating, and in speaking there was a distinct clacking of the tough mucus in the mouth to be heard. The tone of his voice was not hollow, and no bad smell was perceptible coming from
30 § 25. STARVATION FOR TEN DAYS.
his mouth ; his' gums were pale, his respiration normal, his pulse 88, regular, soft but full; his belly was fallen in, but much intestinal flatus was to be felt on pressure. His brain was quite unaffected, and to my question he rephed that he was free from any optical deceptions, but that he was occasionally troubled with siQging ia his ears. He stated that he had slept weU and much, and it was verified that he had had no fsecal evacuation since tlie morning of the 18th. He complained neither of hunger nor of thirst (though this is usually ascribed to such cases) ; he was stated to have made but little urine, and he could be just as little influenced to take open- ing medicine, &c., as he could be persuaded by spiritual exhortation to desist from his fearful determination. On the 24th, his condition remained unchanged. The house-surgeon had forced him to take a few drops of sjpiritus cethereus. On the SSth, there was still no evacuation from the bowels. It was Sunday, and the house-chaplain urged N. to partake of the Sacrament of the Lord's Supper, but this he declined. To me he stated, that he had vowed to God to eat nothing more in prison, come what may. When I asked him whether if allowed to go forth to his friends he would then begin and eat, he answered quickly, to be sure. At that very time his Sunday dinner, potato-soup and giblets, stood steaming untouched beside him. N. is now paler, and evidently becoming thinner. He cannot continue to read the Bible long because liis sight fails him. The singing in his ears is also somewhat more frequent. His tongue is purplish-red in the middle with its edges somewhat dry, and the mucus covering it is still tougher than before, and produces still more clacking than formerly. An ill smell is also now perceived to come from his mouth. The doughy-feel of his belly recalled to my memory that of some cholera patient. His skin is slightly moist, the perspiration warm and normal; for twenty-four hours he has passed no mine; he has not yet had any faecal evacuation, his pulse is as formerly, his mental faculties are undisturbed. He has now fasted for seven days. On the 26th, N. has passed a httle concentrated dark-coloured urine, could, however, no longer go himself to the night-stool for this pur- pose, but must be carried. His voice has now assumed the hollow sound, so commonly observed in abdominal diseases. The pulse is to-day quickened to 96, the tongue moister, otherv^ise his state is as yesterday. In the absence of every alarming symptom, I could not help asking myself how long might this stiQ unendangered hfe yet continue obstinately to prolong its existence ? There was certainly no
§ 25. STARVATION FOR TEN DAYS. 31
good reason to doubt tlie possibility of N. yet living eigbt days longer at least. On the 27tli, I found his bread and other sustenance still untouched. N., who was constantly watched by his fellow-prisoners, no longer felt any hunger, but only a necessity to moisten his dry and clammy mouth, which he has done since yesterday morning with pure cold water, without swallowing any. His belly seems very hollow. He has not the slightest call to stool, and has had no feehng of nausea, chok- ing, vomiting, or pain. His head, however, feels "stupid,^"* and very heavy when he attempts to raise it. The smell from his mouth is now more distinct. The day of the 28th was a remarkable one. The pulse was only 76, and very feeble. Early in the morning N. had complained of double vision, and fi'om time to time of spasms of the stomach, which were relieved by strong pressure. Yesterday after- noon and this morning early, he had from absolute necessity now and then taken a httle sugar-and- water, and used in all about six ounces. He says he has no hunger, and he has not eaten anything. On the other hand he asserts, that everything to-day smells of millv, and in the night between this day and the 29th, hunger suddenly seized and overpowered him, and he ate a little of yesterday^s allowance of bread which still lay near his bed. Founding on his yesterday^s intimation, half-a-pint of milk was given him this monnng (29th), and he con- sumed it. Soon afterwards I saw him, and with his o^wn consent ordered some gruel with milk to be prepared for him, and this he took greedily, and henceforth he contuiued to take his regular meals daily. He was put upon the full diet of the Prison Hospital. Two months afterwards I saw him perfectly healthy, and in his pristine good condition. He assured me that he only experienced hunger during the first three days. Afterwards the '^'^ finest and best^"* of food would not have tempted him. The like has been noticed in all the other cases observed. It is remarkable that the " appetite of swell '' persisted, was the first to re-awaken, and was directed to the simplest of nourishment, to milk, the primitive food of all manlcind.
The morbid phenomena we have just described, are substantially identical with those which have been related as having occurred in every other case of starvation observed. N.'s urine during his pro- longed fast was examined at my request by my well-known colleague Mitscherlich. I was particularly desirous of knowing whether the urea were present or no. The urine, however, w^as not found to deviate from the normal, thereby confirming Lassaigne^s statement, that urea is not wanting in the urme of the starved. I would most
31! § 26. DIAGNOSIS OF STARVATION.
gladly have examined whether during the fast the colouring-matteT and albumen of the blood had suffered any diminution, as Andral, Gavarret, and Fr. Simon, have, ^^ith great probability, supposed. But I did not consider the mere love of science a sufficient reason for sub- jecting any one so much reduced as the subject of my observation was, to the loss of even the most trifling quantity of blood.
§ 26. Continuation. — Diagnosis.
The circumstance that the hitherto recorded experience of death from starvation is far too scanty to permit the statement of any definite time within which it must occur, can never materially interfere with the medico-legal opinion to be arrived at in any given case. Since even in such cases, we repeat, we have to determine in every individual case, not that death from starvation must have, but that it has occurred. And for the determination of this point we must employ the phe- nomena observed during the period of starvation of the deceased, in every case in which we can ascertain them, and always the results of the dissection. The former of these will be found to be abnost pre- cisely such as we have just described them in the case given. Usually, but not in our case, the hunger, at first severely felt, gives place to a burning thirst. The body rapidly emaciates and the strength decreases pari passu. Paintings, delusions of the senses, and a feeling of giddiness, occur as consequences of the depressed \itaHty of the nervous system. AU the evacuations become sluggish; nausea, choking, even vomiting of mucus or a httle bile, eructations, and an ill smeU from the mouth set in, and death follows under the signs of the greatest possible exhaustion. The bodies are described as ex- tremely emaciated and completely anaemic, the stomach as quite empty, and sometimes as corroded by its own acid secretion (the " self-digestion '' of the English, which is most probably only a cadaveric phenomenon), the stomach is further described as shrunk together, the intestines here and there contracted, perfectly empty or containing only isolated hardened faecal masses, the coats of the intes- tines are attenuated to transparency, the gall-bladder distended ^y\ih. a dark viscid bile. It is self-evident that amid all these various vital and cadaveric phenomena there is scarcely one that can be declared to be quite specific and exclusively pertaining to death from starva- vion, if we except the attenuation of the coats of the intestines."*^ It
• This phenomeaon was first observed by Donovan (Dub. Med. Press,
§ 27. ILLUSTRATIVE CASES. 33
is, therefore, all the more necessary to establish m every case by care- ful investigation the negative proof of the absence of every other cause of death, as by this alone the matter may be cleared up in doubtful cases, as the following examples will sufficiently show.
§ 27. Illustrative Cases.
Case CLXXYIII. — Actual death from Starvation.
Three-and-thirty years ago, being then a member of the Medical College of the province of Brandenburg, there came before us for our opinion an actual example of that rare and almost unheard-of cause of death, starvation ; and I give it now, not from memory, but from the official protocol of the autopsy, which is lying before me. The ac- cused, who had in the first instance been condemned to death, had appealed, and so occasioned the bringing of the case before us for our revision and decision. The culprit was a surgeon of the lowest class, whose license to practice did not include any cases requiring internal (medical) treatment ; he had treated a woman by means of mercurial inunctions (at that time a favourite remedy), and that so carelessly that ankylosis of the jaws took place, and the unfortunate patient died of actual starvation ! The dissection is most carefully narrated, and the following are the most important appearances ob- served : — The body was much emaciated. The lower jaw projected strongly in front of the upper one, and the application of great force only sufficed to separate the one from the other but a very short distance. Most of the teeth in both jaws were wanting. After an incision had been made from the angle of the month to the ear, it appeared that there were still six grinders in the lower jaw, which, however, were not vertical, but horizontal in direction. Four of these teeth were so loose that they could be easily extracted. In the upper jaw there were four teeth, three of which were also quite loose. In the neigh- bourhood of the third grinder on the right lower jaw the periosteum and mucous membrane were black-coloured, and the upper edge of the jaw-bone felt rough after the removal of the periosteum. The upper and lower jaws on the right side were firmly connected by an anormal, dense and strong membrane. On the left side this unnatural
1848) during the Irish famine in 1847, and he holds it to be the most im- portant sign of death from starvation.
VOL. II. p
34 § 27. ILLUSTRATIVE CASES.
adhesion likewise existed, but to a less extent. The tongue was com- pletely adherent to the soft parts beneath it^ with which it was so closely united in one mass that its point could no longer be elevated ! ! The anterior part of the tongue, to the extent of one inch, was com- pletely stripped of its mucous membrane, and the muscles lay quite bare. The following were the appearances found internally : — The stomach was so much contracted that its cavity scarce equalled in size that of the colon. In other respects it was quite normal. It con- tained a tablespoonful of muddy yellowish fluid, without any remark- able smell. The small intestines were also so much contracted that their diameter was scarcely the half of what it usually is. They were .of the usual colour, as were also the large intestines, which were Hke- wise much contracted. The whole intestinal tract was completely empty. The Hver was pale and Hi-coloured, very ansemic, and its texture somewhat harder than usual ; the gall-bladder was full of dark bile. The spleen was small, shrivelled, soft and anaemic, partially adherent to the peritoneum. The other abdomuial organs were nor- mal. In the thoracic and abdominal cavities, the only thing remark- able was anaemia ; the small quantity of blood in the heart was thick and treacly. The case, therefore, was one of actual death from starvation, and the results of the dissection accurately agree with those reported to have been found ui the few cases published. (I may remark by the way, that the careless surgeon was condemned to im- prisonment, and his right to practice was wholly forfeited.)
Case CLXXIX. — Supposed death from Starvation.
A journeyman tailor, aged 48, was said to have been starved to death. The case was the common talk of the town, and formed, of course, a peg whereon to hang the most grandiloquent humanity speeches. At the medico-legal autopsy, the body was in truth ex- tremely emaciated m appearance, but internally the cause of death was found to be hypertrophy of the heart, with thickening of the coats of the urinary bladder, while the stomach was distended with potato soup! Accordingly, we found that the deceased had died from internal disease, and not from starvation.
§ 27. ILLUSTRATIVE CASES. 35
Case CLXXX. — Supposed death of a Child feom Starvation. Exhumation of the body after twelve days.
An illegitimate cHld^ aged nine months, that had died on the 12th of May (temperature + 12 to 15 E. = 53-6 to 59 '¥.), was exhumed on the 24th of the same month, because a report had spread that the woman who dry-nursed it had starved it. The body, when delivered to us for examination, five days after the exhumation, lay in a pine- wood coffin, clad in a shift and cotton winding-sheet. The coun- tenance, the inferior extremities and the right fore-arm, were covered with mould ; the eyes had run out. The smell was not yet the faint cheesy odour of bodies exhumed at a later date, but the prevalent stench was that of putrescence. The skin over the whole body, except the inferior extremities, was of a dark-green colour. The extreme degree of emaciation was most remarkable, not a trace of fat being to be seen even upon the omenta. There were no traces of in- juries or other violence to be found. The cranial bones and dura mater were very pale and ansemic ; there was hypostatic congestion of the veins of thejom mater ; the brain, as usual, was transformed to a thick reddish pap ; the sinuses were empty of blood. The lungs were quite pale, perfectly free of tubercles, and remarkably anaemic ; the larger blood-vessels were not quite so empty of blood. Both the large cardiac arteries and the right ventricle contained a Httle blood, no ways remarkable in appearance ; the left ventricle was empty. The trachea and oesophagus were also empty. The stomach — I omit any more particular account of the phenomena due to putrescence in the different organs — contained two tablespoonfuls of curdled milk. Liver, spleen, and kidneys were remarkably ansemic. The intestines were pale and quite empty ; they presented no ulcerations, nor any other anormal appearance, and the mesenteric glands were also free from any such morbid phenomena. The urinary bladder was empty. ^ye declared that the child had died from internal disease, and not from starvation, but that the disease might be assumed to have arisen from want of proper care and nourishment. Besides the data here given in justification of this view, I may state, that this child, which was 9 months old, measured only twenty- one inches and a-half, and that it had only one incisor tooth, on the point of cutting. Moreover, the centre of ossification in the femoral epiphysis (§97) measured only three lines in diameter. In the absence of every symptom of true
D2
36 § 27. ILLUSTRATIVE CASES.
pMhisisj as purulent collections^&c, these signs of retarded growth could only be referred to a general wasting, dependant on insufficient nurture. Our opinion was fully confirmed by subsequent investigation, which ascertained, among other things, that a physician, one month before the child's death, had ordered it to be removed from its nurse, as she only allowed it one pint of bad milk in the day, for its sole nourish- ment.
Case CLXXXI. — Supposed death from Starvation.
An illegitimate female child, aged 5 months, that had been given out by its mother to be dr}^-nursed, died, after having been iU, and suffering for a long time, having particularly laboured under, according to the deposition of the surgeon in attendance, " protracted diarrhoea.'' Its nurse was accused of ha^^ng starved the child, which had been previ- ously healthy, and this occasioned the necessity for a medico-legal examination. The httle body was much emaciated, and sbghtly chafed in the thoracic region. The meningeal vessels were unusually congested, and in the left cerebral hemisphere there was an extravasa- tion of blood the size of a bean. All the sinuses were also congested with dark, tolerably fluid blood. The heart and lungs were very anaemic. The spleen and liver were pale, and also anaemic. The gall- bladder contained only a little bright-green, treacly bile. The stomach presented a well-marked example of gelatinous degeneration, it tore on the shghtest touch, and permitted the escape of about two ounces of milksops. The intestines were perfectly empty; the kidneys and abdominal vessels were anajmic. These appearances justified us, as in the previous case, in giving as our opinion, that not starvation, but internal disease had been the cause of the child's death.
Case CLXXXII. — Death prom Protracted Starvation.
On the other hand, in the following case the autopsy proved the truth of the accusation^ that deficient nourishment and inattention had caused the death of the child in question, aged 3 months. The body was very dirty and emaciated, and the skin on the extremities quite loose from the entire absence of subcutaneous fat, the nates and pos- terior surface of the thighs were of a bright-red, and partially eroded. There was general anaemia ; the lungs healthy, not tuberculous ; the stomach empty, but normal ; the mesenteric glands were not particu-
§ 27. ILLUSTRATIVE CASES. 37
larlj scrofulous ; the large intestines contained no faecal matter, and were unusuallj small in diameter; tlie centre of ossification in the femoral epiphysis measured three lines and a-half in diameter. The child had accordingly died from " marasmus/' without that having any organic origin. The extraordinary dirty skin, and the inflamed and eroded patches upon it were sufficient proof that it had not been properly kept clean. The statement of the accused nurse that she had given the child every day one pint and a-half of good milk, and latterly, half a rusk forenoon and evening, was proved to be untrue by the results of the autopsy ; since such an amount of nourishment was amply sufficient for a three-months' child, and under it a perfectly healthy child could not have atrophied. Moreover, the important phenomenon of contraction of the large intestine, in conjunction with what we have just stated, seemed to justify our opinion that the child had died of general marasmus, occasioned by want of proper attention and insufficient nourishment.
38 STATUTES RELATING TO POISONING.
CHAPTER III.
DEATH FROM POISONING.
Statutory Regulations.
Penal Code, § 197. — Whoever intentionally administers to another poison, or any other substance which is fitted to injure the health, is to be punished with imprisonment for not more than ten years. Should the offence have been folloived by severe personal inJ2iry, the imprisonment is to be from ten to twenty years. Should the offence have been followed by death, it is to be punished by imprisonment for life. These ordinances have no reference to those cases ivhere the per- petrator designed to Tail.
Ibidem, § 304 — Whoever intentionally poisons wells or reservoirs of water, serving for the use of others, or articles of merchandise des- tined for public sale or consumption, or mixes them with any substance which he knows to befitted to injure the health; also, whoever sells or exposes for sale any articles poismied or mixed with substances dangerous to life, openly or clandestinely, is to be punished mith im- prisonment for not less than five or more than fifteen years. Should any one have lost his life in consequence of such an offence, capital punishment is to be infiicted. Should the offence have been caused by neglect, and should any injury have resulted, it is to be punished by imprisonment of not more than six months ; and when any one has lost his life from such an offence, the sentence is to be imprisonment of not less than two mouths, nor more than two years.
Ibidem, § 345. — A fine cf fifty dollars (£7 10*.), or imprison- ment for not less than six weeks is to be inflicted on (1.) omitted ; (2.) whoever prepares, sells, or disposes of to others, any poison or medicine without permission of the police, except in such cases as are, from peculiar circumstances, exempted ; (3.) omitted; (4.) whoever, in the storing or transport of poisonous substances {^c), or in exercising the privilege of preparing or exposing for sale such substances, as well as medicines, does notfollmo the regulations issued in regard to these matters.
§28. DEFINITION OF A POISON. ^
Cei:minal CodEj § 167. — S/wuld there he any susjoicion that the deceased have died from poison, the physicians must analyze chemically any remains of the sicjojoosed poison that may he found, as well as any suspicious matters that may he found i?i the stomach and intestines, and in doing this the greatest care must he exercised hy the Judge, to prevent the possihility of these solid and fluid matters heing changed, and to maintai^i their identity heyond the possihility of a douht. For this purpose, when the chemical analysis cannot he carried out in the presence of the Judge, these matters are to he offi- ' dally sealed and delivered to the two experts, along with a judicial protocol, and they are to he returned in like manner.
Eegulations of 15th November, 1858, § 15. — Where there is any suspicion of poisoning, a douhle ligature must he placed round the lower part of the oesophagus and ahout the middle of the small intes- tines, and these viscera divided between the ligatures. The stomach and upper imrt of the small intestines is now to he taJcen out of the ahdomen, and after a provisional anatomical inspection they are to he placed in a clean vessel of porcelain or glass, and delivered to the legal officials for their further disposal. The oesophagus, after having been ligatured close to the fauces, is to he cut across ahove the ligature, and placed in the vessel beside the stomach, after being anatomically inspected. Finally, other matters, as blood, urine, pieces of liver, spleen, ^c, should there be any reason to suppose that traces of poison may be found in them, are to be removed from the body, placed in separate vessels and delivered to the legal officials for their further disposal,
§ 28. Definition of the term Poison, and Classification OF Poisons.
In spite of tlie great progress made in cliemistry and physiology, tlie doctrine of poisonings is still tlie weakest side of medical juris- prudence, both theoretically and practically. In regard to the first, the new Prussian penal code has in very simple and happy manner disposed of the difficulties in regard to the definition of the term '''Poison,'-' at least in so far as regards the interests of justice, with which alone forensic medicine has to do in this matter. Whether the substance reproduces itself in the body or no, whether it can be secretly administered or not, whether it is not also used as a remedy, and yet cannot to be struck out of the hst of " poisons," &c. ; whether, therefore, and finally, in any individual case it may
40 § 28. DEFINITION OF A POISON.
not be disputed whether the substance administered is actually a poison ; all this now-a-days requires no further consideration, if it be only determined that the substance administered is one "fUedio injure the health/' Tliis is the sole criterion indisputably common to every so- called poison without exception, and which applies ahke to brandy and to arsenic, to poppy-heads and to phosphorus. Of course, poisoning is therefore that *^*^ offence '^ (§197 Penal Code), whereby any such substance " is intentionally administered to another/' that is, whether it be apphed externally, or given to be swallowed. How- ever, there is still another difficulty which not unfi-equently comes practically home to the medical jurist, particularly in cases of mere attempts to poison, which the injured party survives, — a matter of course of special interest in the eye of justice, and one which must come under medical cognition : I mean the question as to the quantity of poison administered, which very often coincides with the definition of the form (dilution, &c.) in which the poison has been administered. Tor instance, cases often enough occur in which sul- phuric acid has been added to drinks or fluid messes. That sulphuric acid is a '^ poison " has never been disputed. But in this, as well as in every other poison, there is a limit to the dose beyond which it ceases to be a poison in a medical point of view. Should any attempt to poison be made with an acidulated fluid, composed of a few drops of sulphuric acid added to a quart, a physician neither can nor will call this feebly acid mixture " a poison,'' since he knows it can no longer act as such. In another case a similar mixture may be ad- ministered, but in a dilution so much stronger that any physician, who knows the taste and action of this acid, cannot but assume that the acid and corrosive nature of the fluid would render it quite impos- sible for the person intended to be injured to drink it out. The Judge J however, views these matters in another light. The accused, N., had poured concentrated sulphuric acid into a kettleful of coffee belonging to the woman, J. The coffee weighed nearly one pound (imp.), and the quantity of concentrated sulphuric acid found in it on analysis amounted to about twelve drachms and a-lialf (imp.), making thus a dilution of about the strength of 1 : 25. Such a mixture, we explained, would be extremely acid, and would, if taken at once, perhaps not kiQ, but would certainly be " fitted to injure the health," by producing inflammation of the mucous membrane of the stomach. But we felt bound also to take into consideration the fact that no man in his senses would swallow at one time one whole pound
§ 28. DEFINITION OF A POISON. 41
of decoction of coffee with twelve dracliins of sulphuric acid_, because, independent of the largeness of the quantity, its strongly acid and corrosive taste would be sufficient to induce him to desist from drinking such ' coffee. Taking this view of the matter, we ex- plained '^ that the mixture analyzed coidd not be considered as poison or as a substance fitted to injure the health." At the subsequent jury trial, how^ever, the public prosecutor, after a violent discussion with the advocate for the defence, took his stand upon my opinion as to the nature of concentrated sulphuric acid, setting aside any hypo- thetical views of the nature of the dilution in question, of course I could not but say that sulphuric acid was a '^ poison." On the other hand, the advocate for the defence maintained that the view of the public prosecutor was unjust, since the accused had not administered concentrated sulphuric acid, but only the coffee mixture. Similar ca^es have often come before us, particularly in regard to drugs, used as abortives. The view taken by the public prosecutor in the case just quoted is also that of our superior courts of law. The accused, L., had three times given her husband a decoction of a small quantity of stramonium seeds, whereby he remained uninjured, and L. was condemned " for intentionally producing bodily injury by ' poison."* " Her advocate pleaded the non-occurrence of any such bodily injury, and maintained, amongst other things, that it is not sufficient that the substance administered be poisonous in quality, but that it must also be proved that a quantity sufficient to produce death or bodily injury has been administered. The Eoyal Obertribunal, however, set aside these objections, and decided in regard to this point, that any such view is directly opposed to the definition of the term poison ; that is, any substance which from its quality alone is fitted to injure the health ; therefore, according to this view, the administration of any amount of j^otson, that is, of any substance of itself fitted to injure the health, adequately represents the crime intended in § 197, clause 1, of the Penal Code^ {vid. § 197, p. 38, Yol.lL).
Taught by the case we have just related, I have in every similar subsequent one, after detailing the various physical and medical points, contented myself with declaring the substance administered to be in itself " a poison," leaving the decision of the question of dilution for the judgment of the court.f
* Archiv fiir Preuss. Strafreclit, iv. 6, s. 842.
t How little unanimity there is among those learned in the law, in regard to whether the administration of any quantity of poison is to be regarded as
42 § 28. CLASSIFICATION OF POISONS.
The problem of an efficient classification of poisons has long seemed incapable of solution. And, although this is of no consequence in forensic practice, since in that, — particularly now that the new penal code has been published, — ^we have always only the one individual case to deal with, yet the requirements of science must always be striving after a general classification. But there is no denying that we do not possess a sufficient amount of facts for the construction of any such ar- rangement. In place of this we are constrained to employ the reac- tions of the poisons on the hviag body (the pathological phenomena) and the appearances found on dissection. I do not mean to say that a sufficient amount of clinical histories and records of dissections of poisoning of every kind, have not been collected, on which to base a scientific classification; there is quantity enough, no doubt, of such materials, accumulated in toxicologies, magazines, and judicial records ; but, alas ! the quahty of these materials is not scientifically good enough for this object; hundreds of thousands of those dead of cholera have been carefully and scientifically observed ^nd watched from the very comimencement of the disease, and yet the disease is just as obscure as ever. On the other hand, amid the very much less nu- merous known cases of poisoning which have occurred, a large number have never been seen during life at all, or, what is all the same, have been only superficially observed by non-professional persons, or only seen by medical men at a later period, and towards the close of the disease; and to this we have to add the difference of symptoms which arise from the same poison ha\dng been given in one case in solution, in another enveloped in gruel or peas-porridge ; in one case in a concentrated form, in another clandestinely in small and repeated doses, from antidotes having been used in one case and not in another. Hence, the rarity and insufficience of the exact scientific observation of the whole clinical history of a case of poisoning. In respect to the basis which a sufficient material of good histories of dissection might give, we must remember that most of these date from a time when purely cadaveric phenomena were not known or recognised as such, this having been reserved for our own day, and, even in it, due regard to this point is paid by but few physicians and medical jurists ; and that further, in estimating the phenomena observed in dissections after death by poison in individual cases, appearances peculiar to the case,
a punishable attempt to poison, is proved both by what we have stated above and also by the treatise of the Judicial Assessor, Dalke, on this subject, in the Archiv fiir Preuss. Strafr. 1858, vi. 4, s. 456.
§ 29. CLASSIFICATION OF POISONS. 43
^nd wholly unconnected witli the actual effects of tlie poison^ liave but seldom met with proper attention. Hence the most confusing and opposite opinions, and the total want of agreement to be found, when we take the trouble, as I have done, to examine critically innumerable reports of the dissections of persons poisoned, both in former and in recent times. In one case we find blue or livid stains on the body mentioned, which have not been further examined, but were, indubi- tably, only the usual post-mortem stains ; and forth"wath the compilers have assumed hvid stains to be one of the post-mortem proofs of a poisoning of the character in question ! In another, after poisoning with hydrocyanic acid, hvid venous cords have been seen coursing over the external surface of the stomach, and in the report of the dissection we find these ^' stases^"* made of some importance, and no suspicion entertained that this appearance is merely one of the ordinary phenomena of putrescence. In a case of chronic poisoning a flabby heart, a large spleen, and a very smaU contracted stomach have been found, and conclusions have been dra^vn from these appearances, which, after aU, were most probably purely individual and perfectly indepen- dent of the poisoning.
§ 29. Continuation.
In spite of this deficiency, which cannot as yet be remedied, we must confess that any classification of poisons, to be useful, can only be based upon pathological and pathologico-anatomical phenomena, since to classify poisons, as the ancients did, into mineral, vegetable, and animal may be useful enough for school-children, but not for science, and a perfectly general division of them into organic and in- organic is from its very generality useless. But to the only useful criteria there is this important objection, that the actual and characteris- tic action of each poison is almost wholly unknown, that toxicology has only very recently laid the foundation of a truly scientific doctrine, in recognising the passage of the poison into the blood and its chemical relations to the solids and fluids, &c., and that if we must confine ourselves to the action of poisons as exhibited in their external phe- nomena, these are well known to vary very considerably, according to the difference in dose, the different preparations, state of oxidation, &c., of the same poison, which must therefore be included in sundry different categories. We do not require to wander far in search of examples, since the commonest poisons supply these. Mineral acids.
44 § 29. CLASSIFICATION OF POISONS.
e.g., sulphuric acid, diluted, or in a moderate dose, produces only a slight inflammation of the mucous membrane of the stomach, or if more aggravated, superficial excoriations ; but when taken in a con- centrated form and in large doses, they produce rapid gangrenous disorganization of all the coats of the stomach, &c., phenomena which are peculiar to these acids, and would justify their being made to constitute a distinct class of poisons by themselves. Bichloride of mercury is a perfectly different poison from mercurial fumes, as exhibited in the phenomena observed during life and after death ; acetate of lead is quite different from the fumes of lead, oxide of zinc from chloride of zinc, while the compounds of mercury with sulphur can scarcely be reckoned as mercurial preparations at all in respect of their poisonous action, &c.
The following classification does not pretend to be sufficient to meet all these objections ; and we ourselves set no particular value upon it, since our only object in labouring in the field of medical jurisprudence is the attainment of practical utility, and for this, as we have abeady stated, any classification is unnecessary. TVe classify poisons into —
(1.) Irritant poisons, poisons which irritate and inflame; they produce primarily irritation, which may pass into inflammation and all its consequences, ulceration, gangrene, disorganization of the skin or mucous surfaces, with which they come in contact, and consecutively, most probably, as is already acknowledged in the case of many of them, by blood-poisoning (dyssemia), irritation of the nervous system. To tills class belong the following poisons which occur in practice : the mineral acids, the preparations of arsenic, mercurial preparations (except mercurial fames and the compound of mercury with sulphur), poisonous preparations of zinc and antimony, oxalic acid, caustic potass and soda, chroraate and bichromate of potass, phosphorus, ajtherial oils, colchicum, colocynth, gamboge and croton oil, the poisonous fungi, and cantharides.
(2.) Poisons which produce hyper-emia, narcotic poisons; these prove fatal by sanguineous congestion of the brain, lungs, heart or spinal marrow ; and this action, which is uniform in poisons of this class, permits of a most simple explanation of all the phenomena observed during life or after death. To this category belong all the preparations of opium, belladonna, nux vomica, strychnine, veratrine, brucine, hyoscyamus, conium, cicuta, digitalis, stramonium, tobacco.
§ 30. MODE OF DETERMINING A POISONING. 45
as well as their respective alkaloids, all the irrespireable gases and alcohol.
(3.) Neeve-paealyzing poisons. — ^These operate fatally by para- lyzing the central organs of the nervous system, by poisoning the blood ; hence the instantaneous death or death ushered in by the primary occurrence of paralysis or spasm, and the more or less ne- gative results of the dissection. In this class we include hydrocy- anic acid, cyanide of potassium, that oil of bitter almonds which contains hydrocyanic acid (only this one), cyanide of zinc, of lead, of copper, of silver, of kobalt and of chromium, ergot (?) and chloro- form.
(4.) Poisons which produce maeasmus. — These usually occur in the form of chronic poisonings, and fatally ruin the health by slowly, but certainly, and seriously undermining and injuring the digestion, thereby inducing defective nutrition of the body, extreme emaciation, consecutive phenomena attributable to paralysis of the nerves, and hectic fever. In this category we reckon white bismuth, white-lead, the fumes of lead, mercury and arsenic, and probably the fumes of most metals.
(5.) Septic poisons ; substances and morbid products which pri- marily produce a poisoning of the blood and thereby prove fatal. These are sausage, cheese, fish, and every kind of food-poison, which not infrequently becomes developed in perfectly innocuous food- materials in a manner wholly inexplicable, also such morbid products as glanders, cattle typhus and pyaemia.
§ 30. Determination of the fact.
All that the former Prussian penal code (§ 858, Tit. 20, Part II., of the General Common Law) required to determine the fact of a doubtful poisoning, when the post hoc was established, that is, " when it was ascertained with certainty that the deceased had died after the administration of poison,^' in respect to the propter hoc, the causal connection between the poisoning and the death which had followed it, was nothing more than proof that the death had pt'^ohabl^ been caused by the poison. In the former position of the science of crimi- nal laAV and of legislation, without this wise direction of the legislator, many murders by means of poison could never have been recognised and punished as such, since, had strict proof been required, a hundred
46 § 30. MODE OF DETERMINING A POISONING.
subterfuges, possibilities, doubts, remarkable experiences of poisonings which had not proved fatal, even when the substance administered had been most distinctly poisonous, &c., would have been brought as counter-proof before the Judge. This statutory regulation also sim- plified very much the duty of the Prussian experts ; since if it were once ascertained, either by the Judge, with his means of proof, or by the experts from the cUnical history of the case, the results of the autopsy and of the chemical examination, " that poison had actually been administered,^^ then the medical jurist was justified in supposing it " probable " that the fatal event in any given case had been pro- duced by this poison, provided the cHnical history of the case and the appearances on dissection corresponded in at least the more important particulars with what medical experience had already learned respecting the symptoms produced by the poison in question, and the autopsy had not revealed any other cause of death. It is quite different, how- ever, with the present penal code, which, in every case of suspected death from poisoning, according to the clear and indisputable meaning of § 197 already quoted, requires nothing less than certainty (of course from the experts) that the death has been the result of the poison administered. We need not now inquire how far this impor- tant alteration has been the result of purely legal views on the part of the new legislator, or how far it has perhaps been only a logical se- quence of the change of views in regard to the former general lethality categories. Since, if now every case of violent death is to be regarded in- dividually (Fi*^. p. 238, Vol. I.), we can easily understand that the legis- lator regarded every single case of poisoning as a special case, and "wdll have it ascertained whether the administration of this particular poison has caused death in this case, as in the other case it is required to know, whether this particular injury has been the cause of death in this particular instance. Though it cannot be denied that the difficulty of giving a medico-legal opinion is much increased, since the medical jurist must now state " positively, '' whereas he could formerly -vnthout hesitation say " probably, " and certainty was never asked for, yet ac- cording to the explanation we have just given, his conscience can find a resting-place in the fact than he has to abstract the case in question entirely from every case of recovery after poisoning with the same amount of the same poison, from all idea of the possibility of the life of the person poisoned having been saved by a different mode of treatment, or of the possible concurrence of other injurious influences, &c., and that he has only to consider whether the substance X could
§ 31. (a) THE MORBID PHENOMENA. 47
produce the results in question, and whether, taking into considera- tion all the circumstances brought to Hght in the investigation of the case, it can be assumed thafc X has actually produced these results ? The expert must therefore always remember § 185 of the penal code (p. 236, Yol. I.), and avoid all that absurd exhibition of scepticism to which this question is so apt to give rise, and which is so common both with medical jurists and authors in regard to determining the fact of a suspected poisoning. The physician has four criteria whereon to base his opinion, when he is asked, whether '^poison, or any other matter fitted to injure the health,^^ has been administered to the deceased, and the " offence " of the administration of poison has not been otherwise determined by the Judge — viz. (1.) The morbid phenomena wliich the deceased has exhibited during life subsequent to the suspected poisoning ; (2.) the morbid appearances found at the autopsy; (3.) the results of the chemical analysis of the contents of the body, and (4.) finally, the combination of all the external circum- stances wliich have accompanied the illness and death of the deceased.
§ 31. [a) The morbid phenomena.
It must be confessed, that this criterion affords the least certain support whereon to base an opinion. Since, in the first place, it is well known how often in cases where the law has taken cognizance of this crime, which is distinguished above all other crimes by the secrecy with which it can be carried out, there are no witnesses, par- ticularly no medical witnesses, who have ever seen the person poisoned previous to death, to say nothing of having carefully observed the case, so that afterwards nothing is to be learned respecting the nature of the illness, or what is learned is superficial and not to be depended upon. In the second place, and tliis is a point not sufficiently insisted on hitherto, we must reflect, that, taken as a ivhole, all poisons — except those which produce an instantaneous or peculiar form of death, such as hydrocyanic acid, sulphuric acid, &c. — produce tolerably similar symptoms, such as vomiting, purging, rapid loss of strength, disturbance of the circulation, sensorial and motorial anomalies, &c. In the tliird place, and finally, there are many diseases which arise quite independently of the ingestion of any poison, and the totality of whose symptoms is either identical with those described, or very closely resembles them, so that it is perfectly possible to make a mistake in the diagnosis. Accordingly, even should the doubts, rea-
48 § 31. {a) THE MORBID PHENOMENA.
sonable enough in themselves as to the fact of a supposed poisoning, be removed by the consideration of the morbid phenomena (when these are known), still, on the other hand, it must be remembered that in medicine generally, and still more in medico-legal matters, we must never conclude as to the existence of any peculiar vital con- dition merely from the presence of one symptom or one group of symptoms, but that to enable us to do so we must always take into consideration the entire complexity of the symptoms as a whole. The physician does not diagnose the existence of measles from the decep- tive exanthem alone, nor from the catarrhal symptoms by themselves ; nor does he suspect pregnancy merely because the abdomen is enlarged and the menses have ceased ; nor strangulation, merely because there is the mark of a cord, &c., and it is also perfectly right for him not to diagnose poisoning from the pathological phenomena alone. But it is most unjustifiable to make from this the logical deduction that the discovery of the poison is the only means of making the diagnosis certain, because by so doing all intermediate influences and support- ing proofs are completely disregarded (and these deserve as much credit as the morbid phenomena), and thus in respect to poisoning, a doctrine is propounded which is justly rejected in every other kind of medical diagnosis. And while modern science, not content with the totality of the symptoms known to the ancients, is always endea- vouring to determine important morbid conditions by the invention and employment of physical, chemical, and microscopical aids, &c., in order to use this greater totality of all the phenomena thereby obtained as a foundation for the judgment, shall, in the doctrine of poisonings, the dogma be maintained that the result of the chemical analysis alone is the only certain proof of the fact ! This traditional dogma is the consequence of the reprehensible attempt to emancipate judicial from ordinary medicine, and to reduce the former to a mere department of legal science, to a " Jurisj)rudentia medica/^ and to engraft the theory of strict and invincible proof, from which even the modern science of penal justice has liberated itself, upon a science, which is a science of probabilities and not of mathematical facts.* We will return to this subject when considering the other criteria, and we now append the general morbid phenomena observed according to the classification of poisons aheady given.
• We rejoice that this doctrine of ours has been recently shared and confirmed by a high authority in criminal law. ** The view," says Mittermaier (Archiv
§ 32. (b) APPEARANCES ON DISSECTION. 49"
(1.) Irritant poisons produce, in general, heat and burning in the mouth and fauces, burning and violent pain in the stomach, and also over the whole abdomen, choking, vomiting, violent thirst, purging, coldness of the skin, cold perspiration, quickened and oppressed pulse, tenderness of the abdomen on pressure, rapid sinking, and death.
(2.) Poisons j^roducing hyper cemia: dilatation of the pupil, loss of consciousness, sopor, slow irregular respiration, vomiting, constipation, collapse, clonic or tonic convulsions, paralysis, death.
(3.) Nerve-paralyzing poiso7is : sudden death, or should this not be immediate, choking, eructations, vomiting, paleness of the counte- nance, cold perspiration, feeble slow pulse, dilatation or contraction of the pupils, tetanic convulsions, froth over the mouth and nose, diffi- culty of respiration, death.
(4.) Poisons wliicli produce marasmus : gradual wasting, cachectic appearance ; in lead and mercurial poisonings the gums have a livid or bluish margin, the tongue coated, loss of appetite, constipation (lead colic), trembhng of the limbs, paralysis, death from hectic fever.
(5.) Septic poisons: general depression, sickness, vomiting, local symptoms of a specific inflammation (in cattle typhus), general pheno- mena of a putrid fever, death.
The symptoms of the most important individual poisons will be found in § 34.
§ 32. Continuation. — ip) Appeaeances on Dissection.
Taken by itself, the criterion of the appearances found on dissection more readily affords conclusions as to the fact of the poisoning, than the mere morbid phenomena observed during hfe, and there is one class of poisons, in which the cadaveric phenomena alone are so con- vincing that no doubt can be entertained, and further chemical analysis is, in truth, unnecessary, 1 mean the poisoning with the strong mineral acids in large doses. There is no other possible cause of death that presents the same peculiar destruction of the tissues as
fiir Preuss. Strafr. v. 2, s. 150) " wHch required exact chemical proof of the existence of poison in the body, was a consequence of the former opinion, that crimes which left evident traces of their perpetration could only be proved by the ocular demonstration afforded by their traces ; and this view was also in unison with the legal dogmas then current," &c. " But the groundlessness and danger of this earlier view is daily becoming more clearly recognised. The value of chemical evidence is thereby very much over- estimated.''' ( Vid. remarks to § 36, further on.)
VOL II. E
50 § 32. (b) APPEARANCES ON DISSECTION.
these poisons, and it is impossible to produce these appearances to such an extent as to cause confusion, even by pouring sulphuric acid into a dead stomach, as we have proved by expermient ( Fid. § 34, further on). There are also other specific results of the dissection which permit of a certain opinion being arrived at without having recourse to the "only valuable '"' criterion of chemical analysis. When in the stomach of the body white granular bodies are found, which, when removed from the mucous membrane, dried and throA\Ti on the coals, give forth a distinct odour of garlick, or when amor- phous yellow particles, which have been taken from the stomach of the body, shine in the dark, and take fire on friction, or when (Case CCVI.) phosphorescent fumes stream forth from the natural openings of the body, we can, and must, at once decide upon the case being one of poisoning by arsenic or phosphorus. The like is the case when the botanically recognisable stramonium seeds. Belladonna berries, &c., are found in the stomach, the respective poisoning being at once assumed to be present without proceeding further. We must also, finally, include in this category all those bodies at whose dissection all the by-standers perceive a smell of bitter almonds, distinctly and indubi- tably in the brain, in the chest, and still more so in the stomach, which, in by far the greatest number of cases of poisoning, may with certainty be referred to some compound of cyanogen, since there is, we can no longer say no other, but only one other substance which, when swallowed, completely impregnates the body and its organs with the smell of this \drulent poison. I mean the nitro-benzin, used by perfumers to scent their soap, &c., this smells strongly of bitter almonds, and thoroughly impregnated with tliis odour the body of an animal killed with, it by us in the course of our experiments.^ I quote all these instances from my own experience, to show how umnse it is to undervalue the results of dissections, or to assign all the value exclusively to the chemical analysis. In the greatest number of cases, however, the appearances on dissection will not afford perfect cer- tainty. Since purely local inflammatory products in the fauces, oesophagus, stomach, &c., like those that follow irritant poisoning, may also have another origin. The hke is the case with those hyperaemiae Avhich follow the class of poisons producing them, which occur in the same form more frequently from other causes. Further, most poisons present such variable products upon the dissection table, • Vid. Casper's Vierteljsohft. fiir Gerichtl. Medic, 1859, xvi. 1, s. 1.
§ 32. (b) APPEARANCES ON DISSECTION. 51
and have as yet been observed in such insufficient numbers^ that it would be worse than rash to put a decisive value upon the alterations observed in the body in any individual case. Finally, that foe of all scientific examination and consideration of every cadaveric pheno- menon, putrefaction, very often completely prevents the observation of any of these post-mortem appearances. Tor while, on the one hand, many poisons favour so rapid an invasion of putrescence, that its disturbing influence is felt even at the usual period of the autopsy, so on the other, it often happens that, from the secrecy connected with the deed, suspicions of poisoning do not arise till after the body has been buried ; and after the lapse of weeks or months the body has to be exhumed for examination ; its tissues being probably already so decomposed as to render any exact observations perfectly impossible, wliile so much of the blood has evaporated, as to make it impossible to ascertain whether any hypersemia did formerly exist, &c. Never- theless, viewing the matter generally, the results of the dissection taken in connection with the morbid phenomena observed during life, possess a veri/ high value, and viewed in this manner do not deserve to be so much mistrusted as is generally the case. Finally, in properly estimating the value of this criterion in determining the existence of a merely suspected poisoning, we must not overlook the fact, that it alone may negatively decide the case and remove every doubt. In these, by no means rare cases, for instance, in which the supposition of poisoning has arisen from a combination of suspicious-looking circumstances, such as when death has suddenly followed some remarkable morbid phenomena which have originated shortly after a meal, or when a man has died in some remarkable manner, in circum- stances which abeady appear suspicious from other causes, &c.; in such cases, these suspicions would be completely allayed by the discovery of an incarcerated hernia, of a perforating ulcer of the stomach, &c. We shall by-and-by give some cases in proof of this {Vid. Cases CCXXII. and CCXXIII.).
As to the classification of the results of the dissection, we generally find—
(1.) After irritant poisons : in many cases inflammation, or burn- ing of the mucous membrane with which they have come in contact, a corrugated and tanned appearance of the oesophagus, erosion, ulcera- tion, gangrene, perforation, or thickening and swelling of the mucous membrane of the stomach, which, even when it still appears to be
e2
52 § 33. (c) THE CHEMICAL ANALYSIS.
firm, may be easily divided by the handle of the scalpel, often there are traces of consecutive inflammation in the lungs, and in the heart, as well as in the lower parts of the intestines.
(2.) After those poisons wJiich produce hypercRmia: in the body, particularly in the stomach, perceptible remains of the poison are sometimes found, which may be recognised by the smell, form, botanical characters, &c.; we also find extensive congestion of the brain, lungs, heart, spinal cord, the large venous trunks of the body, and isolated insular congested patches, which appear here and there like livid stains (stases) upon the mucous membrane of the stomach and intestines.
"We shall by-and-by relate more particularly the appearances found subsequent to death from the more important individual poisons in these categories {Vicl, § 34). As to those found subsequent to death from poisons belonging to any of the other classes, they are, as yet, undetermined and but little known, and in the occurrence of any individual case, it would be well to seek for analogies. Por this purpose we shall give as full a collection as possible of illustrative cases, which have come under our own observation.
§ 33. — (c) The Chemical Analysis.
It cannot be denied that the discovery of the chemical, and also in appropriate cases, of the botanical characteristics of poisons in the body, may be of itself an efiicient proof of the actual occurrence of the poisoning ; but this is a very different statement from \\i^ dogma we have already objected to, that this proof alone can be relied on. The objection which is often made, that the poison may be adminis- tered after death, is of no practical value, since such an occurrence is never seen in practice, and, even if it did happen to occur, the total absence of every reactionary phenomenon would prevent any but the most careless medical jurist from being deceived. But, on the other hand, it often enough liappens in medico-legal practice that poisons are chemically detected in the body, without there being in that any reasonable justification for suj^posing death to have been caused by poison. The poison may have been administered in the form and dose of a medicine, and to this the fact that the physician who may have been treating the case knows nothing about it, and denies his complicity, forms no objection, since it is well enough knoA^Ti that people often take clandestinely mercurial (laxative) pills, arsenical (fever) drops, and the like — or articles of nourishment tliemselves
§ 33. (c) THE CHEMICAL ANALYSIS. 53
may have deposited the poison in the body. Wackenroder"^ has found very considerable quantities of copper and lead in the blood of human beings, and of domestic animals living on mixed articles of diet, whose source, independent of other contingencies, could only be sought for in articles of nourishment containing copper and lead. We ourselves have very frequently seen in the course of our numerous medico-legal examinations, that besides the suspected and discovered poison, there have been also found in the body small quantities or traces of poisonous or not poisonous metals, which could only have got into the body in this, or some other accidental manner. In this respect, consequently, the quantity of the poison found must prove decisive, and the decision in such a case is very easy. So -called homoeopathic quantities of poison in the stomach, blood, &c., can be no longer reckoned poisons. But the fact now comes to be considered, that the quantity of the metal — arsenic for instance, chemically recognised, or the amount of stramonium seeds for ex- ample, botanically appreciated — by no means justifies the conclusion that t/iis is all that has been swallowed, since the double, or even tenfold, the quantity may have been evacuated during life. In other cases the poison has been actually loTiolly evacuated, the person has died solely from the effects of the poisoning, and the chemical (or botanical) criterion leaves us in this case completely in the lurch. In such cases, by no means unfrequent, modern chemistry displays the great advances she has made by detecting the absorbed poison in the tissues and secretions of the body, particularly in the liver, spleen, blood, urine, even in the muscles and bones. In very many cases arsenious acid has been already thus detected. Orfilat has, in this way, found copper. Stasf discovered nicotine in the liver and lungs of the Count Bocarme ; our experts, Schacht and Hoppe, have found hydrocyanic acid in our own cases (CCIII. and CCIY.) ; E. Schafer § has found antimony in the urine, &.c. ; and we can,
* Archiv. f. Pharm., 1853, October, s. 11.
t Toxicologie, 5 Aufl. 1853.
\ Henke's Zeitschrift, &c., 1853, s. 139.
§ Wiener, Zeitschrift, &c., neue Folge, 1858, 1, 10, particularly interesting from its affording proof of so rapid an absorption. In the case of a patient treated with tartar emetic, three hours and a-half after taking the first grain a distinct deposit of pure antimony was obtained from the urine, and this subsequently became better marked. E. Schafer has found traces of arsenic one hour after using Fowler's solution, and still more distinctly several hours after the endermic employment of the powder of Frere-Cosme.
54 § 33. (c) THE CHEMICAL ANALYSIS.
with almost certainty, predict that there are a great many other poisons which shall yet be detected in tliis manner. The chemical criterion becomes, however, also uncertain, when the poison has been destroyed by antidotes, or by the putrefactive process. Hydrocyanic acid, wliich, particularly in the stomachs of perfectly recent bodies, is tolerably easily detected, is, in general, no more to be found several days after death ; since it is so readily decomposed when in combination with organic matters."^ Phosphorus, which is so easily oxidized, is, from that very cause, no longer to be found in the body of a person w'ho has lived several days after being poisoned with it. Further, in respect to the value to be placed upon the chemical analysis of the body, we do not require to be reminded that even the advanced chemistry of modern times must always leave many mysteries unsolved, and that there are not a few poisons — many alkaloids, for instance — which cannot be discovered by chemical tests ; these, however, always rare kinds of poisoning, can scarcely be said to occur in Germany. Further, the chemical analysis may be without result, when the poison has been actually assimilated, and of this the case CCXXI. gives a remarkable example. There is still another consideration, which I cannot refrain from producing, in opposition to the common opinion which places far too high a value upon the chemical proof of the deed. The study of the writings of chemists will convince any one how much the opinions of the best authorities differ, as to the most ehgible method of analysis in any given case ; and whoever, like myself, lives daily amid the practical reaHties of medical jurisprudence, and is in the habit of constant intercourse with many renowned chemists, such as those which Berlin is so fortunate in possessing, w^ell knows how much these views make themselves felt in actual life and in medico-legal practice, how a method of analysis highly praised by one, is rejected by another as uncertain, &c. All these reasons must make a medical jurist scepti- cal, for in these matters he must always remain only haK an expert, and they have been the cause of my adding to the three admitted criteria, the fourth one already specified, the combination of all the
* In a case of suicide by prussic acid, related by Scbauenstein (Prager Vierteljsclift. 1857, iii. s. 99), twenty-six hours after death there was no longer any trace of it to be found in the stomach, but a considerable quantity of formic acid^ the result of the metamorpliosis of the prussic acid. We have subsequently found this confirmed ; and it deserves to be remembered in cases of i)oisoning by hydrocyanic acid.
§ 34. SYMPTOMS OF SPECIAL POISONS— (1.) ARSENIC. 55
external circumstances which have attended the illness and death of the deceased; but to this we shall bj^-and-by return (§ 35).
Since the practical part of forensic chemistry, which falls to the lot of the associated chemical experts, must be left to works upon Chemistry, and the special details respecting all the poisons known to works upon Toxicology, I have only now to add a statement of the mode of action of those poisons which are of most importance, or of most usual occurrence in practice, and in doing so, wherever my own experience has been insufficient, I have made use of the most trustworthy sources.
§ 34. Continuation. — Special Poisons.
(1.) AusENious Acid. — The absence of any odour, its tastelessness and solubility in water and in all watery fluids, its want of colour, and finally, its destructive action upon all organic life makes this poison at once dangerous and convenient. In chronic arsenical poisoning the symptoms are those of general cachexia and dyssemia, increasing to a fatal hectic fever. After an acute poisoning the symptoms are, nausea, vomiting, sometimes hsematemesis, pre- cordial anxiety, pain in the stomach, often but not always colic, excessive thirst and dryness of the fauces, diarrhcea, moist skin, a vesicular eruption has been sometimes observed, suffusion of the eyes, vascular excitement, great depression, frequently, at the last, convul- sive attacks. But there have also been cases of fatal arsenical poisoning without the occurrence of any of those striking phenomena which we have just mentioned.
Dissectio7i. — Partial hypersemia, inflammation, excoriation, hse- morrhagic erosion of the mucous membrane of the fauces, oesopha- gus and stomach; it is also softened and easily separable. The inflammation, which may amount to gangrene, extends into the duodenum, and sometimes to the commencement of the small intestines. The blood in the heart and large venous trunks is dark and gelatinous, not firmly coagulated; the blood generally in acute arsenical poisoning is deficient in coagulating power, and never forms a firm clot. Sometimes there are ecchymotic spots upon the ventricles of the heart, and frequently hypersemia of the brain. The phenomena of inflammation are often to be seen even when death has followed but a few hours after the poisoning. But we must expressly state, that all these cadaveric phenomena are by no means constant. The mummification of the body is
56 § 34. SYMPTOMS OF SPECIAL POISONS— (1.) ARSENIC.
a specific action of this poison {Vid. §§ 14, 21, Gen. Div.). It seems to occur in every case in wliicli considerable doses have been administered, which have not been wholly evacuated during life. This mummification cannot, however, be termed "a certain sign of arsenical poisoning, even when this cannot be otherwise proved '' (Burdach) . Since the bodies of those who have not been so poisoned mummify when buried in marshy or peaty soil which con- tains much humic acid, also in the hot sands of the desert, in wliich whole caravans have been found mummified ; and finally, when placed in certain conditions which are as yet wholly unknown, as is proved by the mummified bodies in the lead cellar at Bremen, one to be seen in a vault at Charlottenburg, near Berlin, and those others which are known to exist in vaults in many other places. I myself have seen very evident mummification of the upper extremities and face of a child, aged four years, who had died not from arsenical poisoning, but from the leaf of a door having fallen on its head, and whose body was exhumed for examination after it had been buried for nine months. Should, however, the other circumstances of the case favour the supposition of arsenical poisoning, tliis will be materially enhanced by the discovery of mummification of the body, and still more so, should the chemical analysis of the contents of the stomach, which may in such a case be still possible, reveal traces of arsenic. This has taken place in not a few cases, and in one after the lapse of ten years'^ (as yet the latest period after death in which arsenic has been detected). Mummification does not, however, occur immediately after death, but very gradually, whilst at first (probably before the arsenious acid has been metamorphosed into ar- seniuretted hydrogen, and has impregnated the body ?) the process of putrefaction proceeds as usual, na}^, older observers assert that it proceeds more rapidly than usual. Hence it follows, that the absence of mummification of the body, particularly recently after death, can neither prove nor give the slightest reason to suppose that there has been in that case no arsenical poisoning. We find the growth of mould upon the body described as characteristic of arsenical poison- ing, because compilers have found tliis appearance described in individual cases ; but this appearance is found upon every body, with- out exception, which has been exhumed after being buried for some ^ time, and is, therefore, by no means characteristic of this or any other form of poisoning. The occurrence of arsenic normally in the • Archiv f. Pharm. 1853, s. 150.
§ 34. SPECIAL POISONS— (2.) SULPHURIC ACID. 57
bones, as supposed by Couerbe, Raspail, and Devergie, bas not been confirmed.
(2.) Sulphuric Acid. — Tbis poison, from its well-known violent and instantaneous corrosive action, can only be used to murder young children, of whicli a few cases come before us almost every year, or adults in a state of unconsciousness. On the other hand, cases of accidental, or suicidal poisonuig from this cause occur (in Prussia) more frequently than from any other poison whatever. The external skin, when acted on by this acid, becomes yellowish-brown, and of a leathery hardness, the mucous membrane, with which it comes in contact, as that of the tongue, cheeks, &c., becomes im- mediately white (yellow when the acid is nitric from the formation of xanthoproteic acid), and, after two cases which have recently come before me, shortly after one another, I must warn against the white coating of the tongue from muguet (white thrush) in young children being confounded with that produced by the corrosive action of the acid. Immediately on the administration of the poison there is pro- duced a most violent burning pain in the mouth, fauces (often accompanied by a feeling of constriction) and stomach, burning thirsty vomiting, hsematemesis ; and should the dose of the poison swallowed have been anything considerable, rapid death. At the autopsy, any external stains visible about the lips, or, as frequently happens, about the angles of the mouth, running in streaks down towards the neck, are yellowish or dirty-brown, leathery to cut, and the true skin beneath them often completely destroyed ; the mucous membrane of the tongue and fauces white, the oesophagus is only, in the rarest cases, carbonized like the stomach, generally only hard to cut, as if tanned, and of a grey colour ; the vascular injection of its mucous membrane may still be recognised. On the other hand, after any- thing like an acute case of poisoning, the stomach is found to be quite peculiarly and diagnostically unmistakably black, as if carbon- ized; its tissues completely gelatinous, and it is almost impossible to remove it from the body, since the very gentlest touch of the forceps tears it to shreds.^ Sulphuric acid, when permitted to act upon capillary vessels, takes a long time to destroy them, but in a few hours their tissue is so softened, and probably partially dissolved, that they fall to pieces at the slightest touch. Their coats therefore become so soft that in the living man they cannot efficiently with- stand the pressure of the blood, but rupture, and give rise to effusion * Vid. the representation of such a stomach, Plate ix. Fig. 26.
58 § .34, SPECIAL POISONS— (3.) PHOSPHORUS.
of blood. These extravasations of blood coming thus into direct contact with the acid, explain the black colour of the coats of the stomach and of its contents. And this also explains why, as I have found by experiment on dead bodies, sulphuric acid poured into a dead stomach does not produce an appearance at all resembling that described, but only corrodes, and finally destroys and dissolves the stomach, its colour remaining all the while only a hght greyish-black, because in this case we have no extravasation of blood-corpuscles. When the sulphuric acid acts less intensely, or has been immediately neutralized by absorbents, life may be either saved, or at least pro- longed for weeks, and there is then found in the stomach only the traces of an acute or chronic inflammation, particularly thickening or ulceration of the mucous membrane, — an appearance which of course precludes any certainty of conclusion as to the pre-existence of poisoning by sulphuric acid. I have never found the blood in the body, after acute poisoning by sulphuric acid, fluid, but always syrupy at least, and sometimes more ropy. It has a cherry-red colour, and acid reaction; indeed, I shall by-and-by relate a case (CXCYII.), in which I found the pericardial fluid and the liquor amnii acid, the person poisoned having been pregnant. In many cases the chemical investigation of articles of clothing belonging to the body, which may have on them stains or holes, may supplement the diagnosis (§ 46, Gen. Div., p. 206). A remarkable, and not hitherto related, effect of poisoning by sulphuric acid (and possibly of all the other mineral acids ; but of these others I have had no experi- ence) is its antiseptic virtue. The bodies of those thus poisoned remain, ccF.t. par., very long fresh, and usually give forth no ill smell upon dissection. The reason of this cannot w^ell be any other than that the acid neutralizes the ammonia arising from the putrefactive process until itself is neutralized. Independent of the correctness of our explanation, the truth of our observation will be found con- firmed in the case of every such body (§ 14, Gen. Div.).
(3.) Phosphorus. — The necrosis of the jaw-bones, w^hich occurs in the lucifer-match manufactories, and which it is doubtful whether it be due to phosphorus or no, is a matter of medical police, and not of medical jurisprudence. On the other hand, to our department belong those cases of the poisoning of children by lucifer-mntches which have several times occurred, and specially those cases of actual and fatal poisoning, whether as murder or suicide, which in recent times have become more and more frequent since the introduction of
§ 34. SPECIAL POISONS— (3.) PHOSPHORUS. 50
phosphorus-paste as a means of destroying rats, has made the public acquainted with a poison so fearful as this, of which one or two grains taken at once is sufficient to cause death. Its immediate effects are a violent burning pain in the stomach and belly, frequent eructations of gas smelling of garlick, vomiting of matters having the same smell, which, as well as the watery stools, shine in the dark, great anxiety and restlessness, pulse small and scarcely to be felt, cold perspiration, subsequently a peculiar prostration; some- times in men there is priapism, and rapid death, which is sometimes quite peaceful, at others attended by convulsive phenomena.
Dissection. — Peaceful expression ; slight excoriations in the mouth and fauces ; a distinct smell of phosphorus coming from the mouth of the body, and a streaming of phosphoric vapour from the vagina and the relaxed open anus, which by dayhght appears like thin smoke, but sliines in the dusk of the evening, as I myself have seen (Case CCYI.) ; sometimes, but not constantly, there is a petechia-Iike exanthem, which has come out towards the close of life ; the peri- toneum is reddened and inflamed ; sometimes the stomach is dis- tended with gas which stinks of garlick, and often in the folds of its mucous membrane particles of phosphorus may be found which, when lightly dried and rubbed, take fire."^ The whole of the con- tents of the stomach shine in the dark, especially when gently warmed; the mucous membrane of the stomach is partly ash- coloured, partly of a dark purplish red, and exhibits gangrenous ulcers which peneti'ate deeply into the muscular coat ; the duodenum and even the lower parts of the bowels exhibit the same anomalies ; the pancreas and kidneys are deeply reddened ; the abdominal veins are strongly congested with a dark and somewhat treacly blood, with which also the lungs are completely gorged ; the heart is flaccid, its coronary veins and right side hypersemic, the mucous membrane of the oesophagus is deeply reddened and partially eroded. There are no peculiar appearances in the cranial cavity. But as in the case of death from other organic poisons, the appearances on dissection may be more or less negative, and of this I shall relate two instructive
* For the most recent and delicate method of detecting phosphorus, vid. a paper by Mitscherlich, in Casper's Yierteljahrschft., Band. viii. s. 6, &c. And for a large number of cases of intentional or accidental poisoning with phosphorus, chiefly in France, collected by Henry and Chevallier, vid. Etudes Chimiques et Medicales sur le Phosphore, in the Annales d'Hygiene, publ. 1857, April, 8.414, &c.
CO § 34. SPECIAL POISONS— (4.) COLCHICUM.
cases (CCY. and CCVI.). Death in this case, then, as perhaps in the case of many more poisons than it has as yet been recognised, occurs dynamically by destroying the life of the blood. In the cases we have related, the hlood-corpuscules were deprived of their colouring- matter and were colourless and transparent^ the colouring -matter being dissolved in the uncoagulated plasma, the whole presenting the appearance of a syrupy, cherry-red, translucent fluid. By such alterations the blood would lose its power of nourisliing the body and preserving life."^
(4.) CoLCHicuM and Colchicine. — The rare occasion afforded us of making a medico-legal examination of the bodies oifoiir men poisoned at the same time by the same preparation of colchicum {T'lnct. Sem. Colch. Pharm. Borr.), and the careful investigation to which these cases gave rise, and in which the most distinguished chemists took part, has not only originated the discovery of a method of detect- ing colchicine,t but has also taught us that colchicine is a most virulent poison, scarcely to be compared in deadhness with phos- phorus itself among those poisons which occur with us, since our four poisoned men (Cases CCXI. — CCXIV.), aged from 15 to 40 years, had each taken at once only at the most from two-fftJis to halfa-grain of colchicine, and yet this dose was sufficient to produce rapid death. The effects of the colchicum in those cases described by ns, as well as in the few others known, were a feeling of oppres- sion and anxiety, a burning sensation in the mouth and fauces, violent pains in the belly, which are not always increased by pressure; violent and continuous vomiting of greenish or orange-yellow bdious matter, an equally violent diarrhoea, burning thirst, collapse, pale countenance, normal pupils, moist and clammy skin, spasmodic pulse, beating 80—90 times per minute; retention of urine, and rapid death from exhaustion.
Dissection, — ^We found in all our four cases — no unusually rapid occurrence of putrefaction ; acid reaction of the gastric fluids and of the urine; the dark cherry-red, treacly condition of the blood, precisely as in poisoning by sulphuric acid; J most remarkable
* Vid. also a like remarkable destruction of the blood-corpuscles by poisoning with a solution of caustic soda, in Case CCXY., and by suffocation in carbonic acid and sulphuretted hydrogen gases, in Case CCLXI.
t Vid- Casper's Vierteljschft. 1855, s. 1, &c.
\ Prof. K. Schroff has found a similar condition of the blood in six rab- bits experimentally poisoned with about seven grs. (imp.) of colchicine, viz., the treacly condition of the blood and its colour, called " pitchblack" by him. Vid. (Esterr. Zeitschrift fiir pract Heilk. 1856, No. 22-24.
§ 34. SPECIAL POISONS— (6.) OXALIC ACID. 61
congestion of the vena cava; considerable hjpersemia of the kidneys ; urinary bladder more or less full ; hyperoemic congestion of the right side of the heart and of the cerebrum, and moderate congestion of the lungs. The stomachs, on the other hand, pre- sented different appearances ; in one case there was a vascular network, visible externally; internally a uniform scarlet appear- ance of the mucous membrane, consequently true inflammation ; in another, there was great distention of the blood-vessels of the smaller curvature, the mucous membrane, on the contrary, pale and only ecchymosed posteriorly ; in the third and fourth, the stomachs were quite normal. In the other cases on record, the stomach and intes- tines are also sometimes described as having no trace of inflammation, and in two cases, particularly, nothing at all anormal was found on dissection.
(5.) Poisonous Pungi. — To this class belong particularly agaricus phaUoides, muscarius, integer and Boletus luridus, as unquestionably poisonous, whilst the deleterious action of other suspicious fungi is still doubtful. They produce a disagreeable harsh taste in the throat, a feeling of disgust and nausea, vomiting, giddiness, exhaustion, colic, diarrhoea with tenesmus, violent thirst, difiicult breathing, convulsions, and death.
The reports of the dissection of such cases are not extant in suf- ficient numbers to justify any diagnostic inferences from them. Gastro-intestinal inflammation has been found, along with a dark- coloured and very fluid blood, with which the right side of the heart was distended and the lungs congested.
(6.) Oxalic acid [and salt of sorrel — hinoxalate of potash). — I cannot from my own experience confirm the statement that this ex- tremely dangerous poison, which may be very readily taken by mis- take, is particularly fancied by suicides, specially by such as work in cotton printing estabhshments where it is employed as a bleaching agent, since not one single case of poisoning by oxalic acid has ever come before me, though Berlin possesses the largest cjotton factories in Germany. Throughout the whole monarchy also cases of poison- ing by oxalic acid are extremely rare, as my official position enables me to state positively, while in England such cases are said to be ex- tremely frequent. The reports as to the action of this poison are tolerably unanimous ; it produces burning in the mouth, nausea, constriction of the throat, frequent acid eructations, violent colics, diarrhoea, very rapid prostration of strength, convulsive attacks, and extremely rapid fatal termination.
02 § 34. SPECIAL POISONS-(8.) HYDROCYANIC ACID.
Dissection. — The mucous membrane of the fauces and of the (Esophagus is whitish, that of the stomach and duodenum of a pale or bright-red colour, patches of it gangrenous, of an ashy-grey, and elevated in rugae, when death has not been rapid, and usually wliite, soft and brittle ; the blood is dark and treacly ; the brain, lungs, right side of the heart and large thoracic and abdominal veins are all much congested. When sufficiently diluted to be absorbed, this poison has produced tetanus and paralysis of the heart in animals.
(7.) CoEROsiVE SUBLIMATE. — ^This also scarcely occurs in practice. According to recorded observations, it produces a disagreeable metallic taste, violent burning in the fauces, inflammation and ero- sions of the gums and tonsils, vomiting of blood, burning thirst, bloody stools ; no important alteration in the pulse, suppression of urine, no particular distention nor pain in the stomach, and finally death, which, even after a dose of three drachms (9viijss. Eng. ap. w.), did not ensue till the sixth day.
Dissection, — ^Violet, or in other cases, whitish coloration of the mucoys membrane of the mouth and fauces ; the mucous membrane of the stomach is thickened, corroded and gangrenous ; the mucous membrane of the intestines is for a considerable extent inflamed and covered with bloody mucus ; the large intestines are contracted ; the kidneys somewhat reddened; the urinary bladder small and contracted; there is also vascular injection of the trachea and bronclii.
(8.) Hydrocyanic acid (and cyanide of potassium^ cherry laurel- water , and the essential oil of hitter almonds containing pnissic acid) . — When prussic acid is employed as a poison, that is taken in any con- siderable quantity, we have no vital morbid phenomena to observe, for death is either instantaneous, or very speedily follows a primary attack of complete general paralysis.
Dissection, — The perception of the odour of bitter almonds in the interior of the body, which has been disputed, depends entirely on the time that has elapsed between the death and the autopsy. Should the prussic acid in the body be already decomposed, which it very readily becomes when in contact with organic matter, then there will be no odour perceptible, but this will never be absent from any of the cavities, but particularly from the stomach, when- ever the autopsy has been proceeded with as soon after death as possible, as I and my assistants have often experienced. The blood in the body is always fluid and very dark ; there is con- siderable hypenemia in the cranium ; the lungs and heart are not
§34. SPECIAL POISONS— (9.) OPIUM. 63
always congested ; on the other hand, congestion of the liver, kid- neys and inferior cava has been always present. Tlie stomach, in a perfectly recent body, except the odour of bitter almonds, betrays no other constant symptom ; " dark, reddish-brown coloration ''■' of the entire organ, externally as well as internally, with " apparent congestion of isolated venous cords,^^ which have been seen after such cases of poisoning, are characteristic of putrefaction, and not the result of the poison.
(9.) Opium and its constituents and compounds (also poppy heads), — The effect of small doses has been learned at the sick-bed. In poisonous doses, opium produces first nausea, inclination to vomit and actual vomiting, which is not, however, apt to become violent ; sometimes the face is hot and swollen, particularly in the case of httle children poisoned with decoction of poppy heads (given to soothe them), sometimes it is the exact opposite, pale and collapsed, the skin is bathed in cold perspiration, great drowsiness up to actual stupor, pulse firm and rapid, fits of spasms extending even to general convulsions ; breathing slow and stertorous, the mouth covered with froth, complete prostration of the sensibility, so that the most power- ful stimulants are no longer responded to, constipation and retention of urine (after acetate of morplua there is said to be constantly (?) an itching in the skin and a petechia-like eruption) ; death follows these phenomena, but is frequently kept ofi" by active treatment, even when the symptoms are most threatening. There is, moreover, no other poison besides opium, after which the morbid phenomena have been observed so variously modified, and still less than after most others can its symptoms be reduced to an appropriate semeiotic scheme, according as its course has been acute or chronic. And the same may be said of the appearances on dissection. In jecent cases, and after large doses of opium, e.g., the officinal tinctures, the stomach exhales a distinct odour of opium. This, along with the evidence of the presence of opium obtained by chemical analysis, will be sufficient proof, while other morbid phenomena, such as ecchy- motic patches in the mucous membrane of the stomach, hypersemia of the stomach and large abdominal veins, of the lungs and heart, and particularly excessive hypersemia of the cranial cavity, as well as remarkable fluidity and dark colour of the blood, all occur much too frequently after other poisons, or indeed after entirely different kinds of death, to be of any important diagnostic value."^ The hair of
* In the case of a woman, aged 28, poisoned by an ounce of laudanum,
64 § 34. SPECIAL POISONS— (10.) ALCOHOL.
those poisoned, particularly by narcotic poisons, is said to be easily pulled out, and this has been generally admitted as adjuvant proof of the fact of the poisoning in doubtful cases. Now it is quite true, that particularly after narcotic more than after any other poisonings, the hair of the body is so easily pulled out, that the shghtest touch brings away a whole handful. It is quite erroneous, however, to sup- pose this to be diagnostic of poisoning, as it is 7iothing else than the result of putrefaction, which after poisoning of every kind, but par- ticularly after narcotic poisoning, ensues, ccft.par.j with great rapidity. Every body somewhat advanced in putrefaction affords a proof of the correctness of this statement. There is one other important point in relation to poisoning wath opium to which I must direct attention ; the chemical constituents of opium are, generally, those of our food, and from this the fact that often even large doses of opiates are digested, and are then no longer to be chemically detected in the body, receives its explanation, and this circumstance may increase the difficulty of determining the fact of a poisoning with opium. (r^'^.CaseCCXXL)
(10.) Alcohol. — The effects of alcohol on the living body are far too well known to require any description here. We have had occasion to examine very many bodies of those who have died sud- denly when very drunk from an actual alcoholic blood-poisoning. The dissection revealed as sometliing specific the very slow advance of putrefaction, as shown not only by the entire absence of every trace of it externally, even at a period when it might otherwise have been expected, but also in the internal organs themselves which exhaled no cadaveric odour at all, but rather that of recent flesh, or in some cases a faint odour of brandy, which according to Duchek's investi- gation (Prager Vierteljahrschft., 1853, 111.) depends upon the rapid oxidation of the alcohol remaining in the blood in such cases, and its conversion thereby into aldehyde.* The appearances constantly found were, hypera^mia of tlie brain, sometimes cerebral haemorrhage ; hypersemia of the large abdominal veins, or hypersemia of the lungs and heart, and always visible fluidity and dark colour of the blood.
the dark " tarry" condition of the blood in the large veins, the four cardiac cavities in the aorta, was something quite remarkable. Maschka, in the Prager Vierteljschft. 1859, i. s. 138.
• Duchek's explanation has been, however, proved to be erroneoup, by the investigations and experiments of II. Masing, Diss. Inaug. de Muta- tionihus Spiritus Vini in corpus ingesti. Dorpat, 1854. Vide also Beitriige Crigaischer ajrzte) zur Ileilkunde 1 1 J., 3. Riga, 1855, s. 331.
§ 35. (fl) THE PECULIARITIES OF THE CASE. 65
Lympliatic exudation between the cerebral meninges, so tbat the pia mater upon the cerebal hemispheres is seen here and there whitish and as if varnished, is not a result of death from drinking, but is the gradual result of the chronic irritation of the brain by habitual drunkenness, and is, therefore, a very common appearance in the bodies of all drunkards from whatever cause they .have died. The action of a few other poisons will be found exemplified in the illus- trative cases related farther on. And for suffocation from irrespirable gases and death from chloroform [Fid. §§39 and 64).
§ 35. Continuation^. — (d) The individual peculiarities of
THE CASE.
We have already pointed out (§30), that the combination of all the external circumstances coincident with the illness and death in any given case, may be taken as a fourth criterion in determining the fact of the poisoning where doubtful, and in reality practical expe- rience teaches us that the consideration of these circumstances is by no means to be neglected in forming even a medico-legdl opinion. Even the physician by the bedside cannot escape the necessity of taking these circumstances into consideration in a case where the diagnosis is doubtful, and we cannot see, why a medical jurist should act otherwise, and exclude the aid to be derived from the universal principles of human reasoning, particularly in regard to a question in which pure and exact science is much more apt to leave him in the lurch, even than in the case of doubtful suicide, in which, how- ever, the consideration of these external circumstances, has always, and rightly, been recommended. A few examples from my own. ex- perience may suffice to exhibit what is here meant : — A man was said to have been poisoned by the seducer of his wife, and with her cognizance, by means of electuary of phosphorus spread upon bread and butter. He only took the half of this piece of bread because he did not like it, but severe symptoms of poisoning were rapidly de- veloped, and after a short illness he died. The body was not examined till some time afterwards when suspicion arose, and then it had to be exhumed for this purpose, when, of course, the advance of putrefac- faction had rendered the appearances on dissection very uncertain, nevertheless, distinct traces of inflammation of the intestines were still to be found. The chemical analysis, on the other hand, was quite resultless ; we may remark, however, that it was by no means so VOL. II. r
66 § 35. {d) THE PECULIARITIES OF THE CASE.
accurate as it ought to have been. (It was made in a small country town.) The precognition now revealed, amongst many other highly suspicious circumstances which had no relation to the medical evidence, by the unanimous testimony of several witnesses, simple country folk, servants and the like, the remarkable circumstance that the fingers of -that hand of the deceased with which he held the bread and butter while eating, shone in the darkness of the stable, whither he had immediately afterwards gone, and that the remains of the bread and butter next day smelt of lucifer matches, which the witnesses did not know how to explain ! Has the man been poisoned with phosphorus? Does the consideration of these circumstances, involving the peculiar properties of phosphorus, belong to the pro- vince of tke pk^sician ? In another case, in which there was the same motive for the crime, a man, moving in the higher circles of society, who had a liaison with a young and pretty woman, was said to have poisoned her husband, his own friend, with arsenic ; it was ascertained that so often as the accused, who did not live on the spot, came to visit his friend, the latter, a robust and healthy man, was always taken violently ill after a meal, with symptoms indicative of some irritant poison, which, however, under the existing circum- stances, was never for one instant thought of. Finally, the husband died, and his friend married the widow. After the lapse of a long time the body was exhumed. It displayed a great amount of mum- mification, but no arsenious acid could be detected chemically. On the other hand, in searching the house of the accused, there was found in a jar lying in a trunk a quantity of white arsenic, from which a con- siderable quantity was missing, according to the poison receipt which he exhibited. Has arsenic been administered to the deceased ? I may call to mind the case of doubtful arsenical poisoning (related in § 28, p. 71, Yol. I.) which belonged to an earher period of my of&cial practice, in which so many external circumstances seemed to point to the reality of the poisoning, which the accused had, as it were, confessed by committing suicide in prison shortly after the opening of the inquiry, but which, according to the usual medico- legal scepticism, could not be proved. Similar circumstances are in the course of the investigation ascertained to have accompanied the illness and death in almost every case of secret poisoning; and, to lay them wholly aside in estimating a case medico-legally, is to reject a most valuable adjuvant to the judgment. An adjuvant only ! Tor I have no desire to lay down the doctrine that the medical jurist.
§ 35. ((I) THE PECULIARITIES OF THE CASE. 67
in the absence of all and every other criterion, should,, or ought to draw conclusions from accessory circumstances alone, this he may safely leave to the jury ; but my own long experience has convinced me that the theoretical subtilties, the i/s and buts of most of the text- books of medical jurisprudence, in relation to many queries, particu- larly in relation to cases of doubtful poisoning, do not assist in attaining the desired end, and lead to a declaration of incompetence on the part of the medical jurist, which is destructive to his science, and actually without foundation ; so long as we must confess that circumstances, such as the shining of the fingers in the dark, a peri- odical illness following meals in any given case, always accompanied by the same suspicious symptoms, and occuring at different times, any exclamation of the sick person, such as " That tastes strongly of garlic,^^ &c., are data susceptible of a medical explanation. And, after all, what foundation is there for this subtle scepticism ? Does it rest upon the fact that the phenomena attendant upon many kinds of poisoning resemble those, for instance, of Asiatic cholera, and that this must consequently lessen the value of the proof to be derived from these phenomena ? But the cholera was not then raging in the place, and no one has been ill of such a disease either before the illness, or after the death of the deceased ! It might, however, have been a sporadic case ! ! Will not, I ask, the post-mortem appearances make this clear ? In other cases, the incontestable fact is called to mind, that after many poisons the appearances found on dissection are almost negative, or resemble those found after other kinds of death, as, for instance, in the case of narcotic poisoning and suffoca- tion. It is not, therefore, proved that the deceased has died of narcotic poison, he may have been suffocated ! But with what, or in what has he been suffocated ? Not the faintest semblance of a fact speaks for this supposition, save the resemblance of the post-mortem appearances found in the one case with those found in the other. Even in cases in which it was positively known that poisonous sub- stances had been swallowed, as where several cliildren have, out of frolic, eaten bread and butter spread with rat-poison, and have shortly after sickened with the same symptoms, and speedily died ; and in other equally evident cases, which I could and shall relate from my own experience, the same customary scepticism has put in its claim to be heard, and although the deaths have happened under such peculiar and striking circumstances, and could not be otherwise explained in accordance with any of the known laws of medical experience, yet it
f2
68 § 36. CONCLUSIONS AS TO PROOF OF POISONING.
was only, and even thaf with reluctance, assumed that " probably^ poison had been the cause of death, " because the only certain proof of death from poison, the discovery of the poison by chemical analysis in the contents of the body,'' could not be made, owing to the cir- cumstances of the case ! We strive against this dangerous dogma, as well as against many others derived from a priori views, and deep- rooted in the traditions of our science, in the full belief of which we ourselves commenced our practice, because our extensive prac- tical experience has firmly convinced us of their complete un- tenability, and perfectly satisfied us that, from the deficiences inalienable from the nature of the matter, from the scientific defects and inaccuracies inherent in the chemical investiga- tion, it is perfectly impracticable, and that it is an unwarranted disparagement of general medical experience in regard to the origin and course of fatal diseases, as well as of a sound understand- ing, to seek for the conclusive and only proof exclusively in the test- tube of the chemist. This is our confirmed opinion, and it has recently obtained a tranquillizing confirmation from the forensic authority already mentioned; for Mittermaier says, {op.cit., p. 152), " Because chemical analysis is unable to afford any proof that poison has been administered, we may not conclude that none has been given ; we must fall back upon the proof afforded by other sources of information;'' and the renowned criminal lawyer adds thereto, the following instructive remark : — " This doctrine may be regarded as the recognised one in all the law courts of Germany, France, England, North America, Italy, and the Netherlands.''
§ 36. GONTINUATION. CONCLUSIONS.
In taking a retrospective glance at what we have just said respecting the determination of the fact in cases of doubtful poisoning, we arrive at the following conclusions : —
Should chemical analysis determine the existence of any poison in the body, this is a certain proof of the previous occurrence of poison- ing, even when the clinical history and morbid appearances found after death do not contribute any further evidence."'^
• I need scarcely repeat here, that I do not now speak of mere "traces" of poison, which may have heen chemically detected, but which cannot be recognised as poisonous. In regard to this, I may refer to p. 53, Vol. XL, where this matter has been already considered.
§ 36. CONCLUSIONS AS TO PROOF OF POISONING. 69
But the reverse of this is not true^ and for this we have already given our reasons (§33). The praof frorii cli^rnical analysis dare not he further ^mshed.
In the absence of chemical proof, should the clinical history^ the post-mortem morbid appearances, and the individual concomitant circumstances of the case, point to the cxjcurrence of poisoning, whilst the phenomena observed during life and after death do not permit the assumption of any other cause of death, then the medical jurist is justified in assuming with certainty the fact of poisoning having occurred. In the absence of chemical proof, and the total want or absolute insufficiency of any clinical history, should the appearances on dissection, and the concomitant circumstances of the case, agree in excluding the idea of any other cause of death, the medical jurist is justified in assuming the fact of poisoning either with the greatest, or only with a high degree of probabihty. The individual circum- stances of each separate case must here point out the limitations. In such cases the physician may do much by the mere manner of wording his opinion, e. g., " That according to all the circumstances of the case, which we have just related, the supposition that the deceased had died from poison seems the most probable, and no other supposition meets with such support from the circumstances of the case,'" &c.
rinally, we have already pointed out (p. 49, Yol. II.) that there are cases which require no chemical analysis nor clinical history, but in which the appearances found on dissection are alone sufficient to de- termine with certainty the fact of a poisoning having occurred. In con- clusion, as regards the question whether, the fact of the poisoning having been determined, this has actually been the cause of death ? (Penal Code, § 197), the answer to this can never be doubtful. JTor when we reflect that the action of any poison is as yet scarcely deter- mined even generally, and is utterly unknown in its individual rela- tions; that, therefore, the fact is well enough known, though it cannot be explained, that A. is not killed by ten or twenty grains of the poison X., of which from two to four grains suffice to poison B. and C. ; that the very same poison, administered in different forms, may produce quite a different series of morbid phenomena ; t]iat the treatment of the symptoms of poisoning is still very unsettled ; and, finally, that § 185 of the Penal Code expressly excludes all general categories of lethality, and requires each case to be individually regarded ; so we of necessity arrive at the following conclusion,
70 § 38. ILLUSTRATIVE CASES— ARSENIC.
when the fact of the administration of poison has been proved, and the person has died under phenomena attributable to poisoning, and the post-mortem appearances reveal no other cause of death, — then the death is to be regarded as the actual result of the poison. Under certain peculiar circumstances, of course, doubts may indeed be justifiable, but then these very peculiar circumstances will subse- quently easily permit the rectification of these doubts in the opinion given.
§ 37. Homicide or Sthcide?
In the case of poisoning there is seldom any doubt whether death has arisen from suicide or the crime of a third party. Since only such poisons as are generally known to be certain poisons, as sul- phuric acid, arsenic, prussic acid, and phosphorus are used by suicides. On the other hand, poisons which have a very disagreeable taste, or which produce instant and violent pain in the mouth, as, for example, sulphuric acid, corrosive sublimate, nitrate of silver, the extremely bitter (poisonous) alkaloids, &c., exclude all idea of murder, for no man in his senses would willingly swallow such poisons. Little children are, however, not unfrequently poisoned with sulphuric acid by their unnatural mothers. Poisons which are in daily use, either in the household as sulphuric acid, or arsenic, phosphorus, and nux vomica (strychnine) ; as rat-poisons, or are employed in manufactories or trades, as all the many poisonous dye- stuffs, &c., occasion many cases of accidental poisoning. But it is not difficult to decide this question according to the circumstances of the individual case.
§ 38. Illustrative Cases.
Cases CLXXXIII. and CLXXXIV.— Two Cases op Poisoning waTH Arsenic.
According to a police notice, the boy Teld, aged 6 years, and the boy Massow, aged 5 years, were stated to have died on tlie 13tli of June, 18 — , from the effects of rat-poison. It was ascertained that the ratcatcher had placed arsenic upon biscuit, and that the children had eaten some of it. Feld died after six, and Massow after twenty- four hours' continuous vomiting (notliing further could be learned as to their illness I). The following were the most important appear-
§38. ILLUSTRATIVE CASES.— ARSENIC. H
ances found at tlie medico-legal examination of the bodies^ wliich took place upon the 15th of June:— (1.) in Teld^s case, the first traces of putrefaction were visible in the abdominal coverings, the stomach was externally pale, and contained about five ounces (imp.) of a yellowish-green alimentary fluid ; on the posterior part of its mucous membrane there were numerous ecchymotic patches, and several excoriations, and on these spots granules were distinctly to be felt ; the intestinal canal was empty and pale and displayed no vascular injection ; the blood in the large abdominal veins was dark and treacly, the peritoneum and all the other abdominal organs were normal. The lungs and heart were not remarkably congested, nor in any other way anormal ; the large blood-vessels contained a little dark, treacly blood ; the oesophageal mucous membrane was pale. There was shght engorgement of the meningeal vessels and the sinuses; the brain displayed nothing unusual. (2.) The body of Massow was still perfectly fresh, the intestines were quite empty, and displayed the usual cadaveric colour, without any remarkable vascular injection ; the stomach appeared somewhat more injected externally ; it contained about three ounces (imp.) of a bloody fluid; the whole of its mucous membrane was of a purplish-red, and almost entirely covered with purphsh-red ecchymoses; there were no ulcerations. The vena cava contained a tolerable quantity of dark treacly blood ; the abdominal organs displayed nothing remarkable. The cesophagus was empty, its mucous membrane pale, and all the thoracic organs normal in every respect. The cerebral meninges were much con- gested, indeed on the posterior half of the left hemisphere there was an extravasation of blood three inches long and one inch and a-half broad; the choroid plexuses were also tolerably congested, but neither the substance of the brain nor the sinuses were so. Along with our sworn chemical expert we examined the stomach and its contents, as well as the blood, of both bodies in the usual manner, and we found that the stomachs of both children contained white arsenic both in substance and in solution, but no trace of any other metallic poison, while the blood of neither body contained any trace of arsenic, which, from the short duration of the illness, had not had time to be absorbed into the blood. We could, therefore, have no difficulty in declaring that the death of both children had been caused by poisoning with arsenic.
72 § 38. ILLUSTRATIVE CASES.— ARSENIC.
Case CLXXXV. — ^Poisoning with Aesenic.
On the 4th of July, 18 — , E., a journeyman tinsmith, aged 20, "was received into the Charite Hospital, labouring under continuous vomiting and purging. He could no longer speak so as to make him- self understood, but his thoughtfulness was evinced by a piece of paper in liis waistcoat pocket, on which was written, " 1 have taken arsenic.^' Hydrated Sesquioxide of Iron was administered to him in large quantities, but he died, nevertheless, in twenty-four hours. On the 7th of July his body was examined, and we found, a l!vid-red countenance, and commencing putrefaction of the abdominal cover- ings; the posterior wall of the stomach dispLiyed externally around, dark, livid stain, about two inches in diameter, and one, the size of a silver threepenny-piece, on the anterior wall, two inches from its cardiac extremity ; the whole of the anterior wall was of a more or less bright- red colour ; in the stomach there were about thirteen ounces (imp.) of a chocolate-coloured homogeneous fluid (oxide of iron) ; at those parts of the internal mucous membrane corresponding to the patches already described, there were a great many striated and insular black stains (hsemorrhagic erosions), and many white granules firmly ad- herent to the mucous membrane could be recognised by means of a glass. One of these, dried and burnt, gave forth a garlicky odour. The peritoneum was not inflamed. The steel-grey (drunkard's) liver somewhat congested \vdth dark fluid blood, the gall-bladder was full, the spleen soft, the urinary bladder was empty, the intestines were empty, and displayed nothing unusual, the vena cava contained but little blood. The lungs were normal ; the right side of the heart distended with dark grumous blood, the left side contained only about a tablespoonful of more fluid blood ; the large thoracic vessels also contained much grumous blood ; the larynx and trachea were pale, and contained a little dark-coloured mucus, the oesophagus was pale and empty, but beset with a number of small white granules. In the head there was only the usual amount of blood, and there nothing else of importance was found. The stomach and its con- tents, the oesophagus, pieces of the liver, and blood from the body were chemically analyzed. Both in the stomach and oesophagus, as well as in the deposit from the contents of the stomach, arsenious acid and oxide of iron were found ; these were also easily discovered
§ 38. ILLUSTRATIVE CASES.— ARSENIC. 73
in the fluid part of tlie contents of the stomach, but neither the blood nor the L'ver contained any arsenic."^
Case CLXXXVI. — Arsenical Poisoning feom a Cake of Watee-colour.
A boy, aged two years and a-half, had, on the 30th of June, swallowed a piece of a cake of gieen colour out of a box of water- colours, and died in five hours in spite, of medical aid. After swal- lowing the poison his mother immediately gave him some vinegar, which he instantly vomited. Milk, which was now given him, he vomited continuously, quite green. I have not learned what his medical attendant gave him. The body was examined on the 4th of July ; the cadaveric rigor was still present, but along with it the abdomen was also green. Tlie anterior w^all of the stomach was of the usual pale cadaveric colour ; posteriorly, on the small curvature, there was a dirty bluish-red gelatinous patch, two inches long, in which no vascular injection could be seen, even with the aid of a magnifying glass (post-mortem product!). The stomach contained half-a-cupful of a brownish-red fluid, " from the cardiac orifice over one-tliird of its surface a layer of brownish mucus covered the mucous membrane, which over its whole extent was of a feeble violet colour, and displayed no isolated, reddened, nor dark-coloured patches, nor any erosions or the like." The liver and spleen were anaemic. On the inferior surface of the jejunum there were a few small isolated round black patches visible on the mucous membrane, and which could not be washed off ; the rest of the intestinal mucous membrane was pale and normal ; all the intestines were empty ; the vena cava was moderately filled with normal-looking blood. The lungs were ansemic, not oedematous ; the left side of the heart con- tained half-a-teaspoonful, and the right half-a-tablespoonful of semi- coagulated blood, while the large blood-vessels contained a quantity of similar blood. Larynx and trachea were pale and empty; the (Esophagus was also empty, and its mucous membrane quite normal. The veins of the pia mater and the sinuses were hypersemic. The cortical substance of the brain had a faint bluish appearance > there was nothing else remarkable. The chemical analysis of the cake of colour, part of which the child had swallowed, revealed, as was to be * Vid. also Cases CCYIII. to CCX.
74 §38. ILLUSTRATIVE CASES.— ARSENIC.
expected, that it was the arsenite of copper (Sclieele's green). The stomach and oesophagus, when tested by Marshes process, gave a very distinct though feeble arsenical stain. Copper could not be detected in the stomach. The duodenum, and a suspicious-looking black- coloured part of t\\ejejun'u?nj gave no trace either of arsenic or copper. The blood also contained no arsenic, but pieces of the liver and spleen gave distinct though feeble arsenical stains (after an illness of only five hours !), and the presence of arsenious acid in the body was thereby distinctly proved.
Case CLXXXYII. — ^Pretended poisonixg with Arsenic. — Can Arsenic pass into the hair?
A very rich, old and childless, woman had died after a tedious ill- ness from a recto-vesical fistula, and its sequelae, hectic fever and dropsy. The very considerable amount of property which she left behind her gave rise to family quarrels, and a female collateral rela- tion in particular asserted that the deceased had been secretly and slowly poisoned with arsenic, and went even so far in her denuncia- tions as to term certain respected members of the family "murderers.^' Always repulsed with the answer that inquiry had been made, she always returned to the public prosecutor with some fresh story, till at length she gave notice, that she had given some of the hair which she had cut from the deceased when in her cofiin to the Apothecary H., in X., for analysis, and that he had found arsenic in it ! On ac- count of this discovery, she required the exhumation of the body and its medico-legal examination. The public prosecutor requested my ad\dce regarding this extraordinary assertion, and the proposed in- quiry. " I cannot,^^ I stated in my opinion, " suppress the remark that (1.) it nowhere appears from the documentary evidence that the hair examined has been actually that of the deceased. It also appears (2.) from the declaration of the accuser herself, that she had only given the hair to the apothecary for analysis after she had read in a book that arsenic had been found in the hair of animals poisoned with arsenic; and this is the more remarkable when we consider, (3.) that the sister of the -accuser, in a letter to another member of the family, in which she very correctly states the position of affairs, calls her a person ' who will use every means to attain her end.' " According to this, the pretended fact, that H. has found arsenic in certain hairs given him by the accuser to be tested for arsenic, is not of the slightest medico-
§ 38. ILLUSTRATIVE CASES.— SULPH. ACID. 75
legal value. Moreover, the investigation itseK lias not been carried out with the caution requisite to permit of any correct opinion being based upon it, for not only has the Marshes apparatus employed not been itself previously tested to prove it to be free ixom arsenic, but even the metallic stain obtained has not been chemically tested for antimony, to which even the arsenical stain has so great a resem- blance, that it can only be distinguished from it by chemical analysis. And besides aU this, my distinguished colleague, Privy-Councillor MitscherHch, has been unable to find any trace of arsenic in the hair of the deceased, cut off after her death, which he received from her heir. When I further state, that there is no known instance of arsenic having been found in the hair of those who have been poisoned with it, and when I also state, that any arsenic present in the hair must have been there during life, and must of necessity have caused some vital reaction in the scalp, no trace of which was ob- served in the deceased, I think I have given sufficient reason for stating it to be my opinion that the investigation in question of hair said to be taken from the head of N. N., has given no further reason for supposing any truth to be in the statement that she has been poisoned with arsenic, and, therefore, an exhumation of the body now, after it has been buried above a year, and must be completely putrefied, cannot be productive of any result. The accuser and her accusation were alike dismissed.
Case CLXXXVIII. — Poisoning by Sulphuric Acid adminis- tered ONE HOUR BEFORE DEATH.
This case deserves to be related here, because the child only lived one hour after receipt of the poison, and we had before us at the autopsy a body not in the slightest altered by putrefaction. The criminal was the unnatural mother, who had poisoned her daughter, aged one year and a-half, with sulphuric acid ; the child died within an hour after, in spite of the antidotes administered. The tongue was white and leathery, and had no acid reaction, and we also found the usual dirty-yellow parchment-like streaks (extending from the left angle of the mouth to the ear), arising from the trickling down of the corrosive poison, and similar stains were also found upon both arms and hands of the child, evidently from scattered drops of the poison. The stomach was quite grey, both externally and internally, and filled with a dark, bloody, acid mucus ; its tissues fell to pieces
76 § 38. ILLUSTRATIVE CASES.— SULPH. ACID.
when touched, the vena cava was moderately filled with a cherry-red syrupy and acid blood, and the liver and spleen were congested with blood of the same quality. The lungs were pale and moderately con- gested; all the cavities of the heart contained only a few drops of blood, and the veins of the thorax were but moderately filled. The trachea and larjoix were empty and normal. The tissues of the cesophagus were in this case, as in most other similar ones, quite firm, and its mucous membrane was greyish-coloured, and had an acid reaction. The cranial cavity presented notliing remarkable.
Case CLXXXIX. — Poisoning by Sulphuric Acid, administered TWO hours before death.
I found the most fearful effects of this poison, so destructive of every organic material, that can possibly be imagined in the body of a hat manufacturer, aged 30 years. This man had risen early and taken, in the dark — whether intentionally or accidentally was never learned — a good drink of crude sulphuric acid, such as is used in his trade. His wife, hearing him cry, ran to him, and sent off immediately for assistance. The physician who obeyed the call bled him, and the blood is stated to have flowed "syrupy'' from the vein. After the administration of milk and soapy water, vomiting occurred several times, but death occurred within two hours. We found the whole of the tongue, from the extreme point backwards sphacelated, its mucous membrane here and there completely separated. Ex- ternally, the cesophagus displayed nothing aiiormal, internally, how- ever, it, as well as the fauces, was of a greyish-black colour. On the other hand, the stomach was externally, as well as internally, of a coal-black colour, and, of course, so macerated and brittle that in only drawing it forwards the forceps tore it like wet blotting paper. Of course it was impossible to ligature it (as directed), and its con- tents were at once removed from the abdominal cavity. The great omentum was also for the most part carbonized, evidently because either during life or shortly after death the corrosive poison had per- forated the stomach, and directly destroyed the omentum. The duodenum and the commencement of the jejunum displayed only a blackish-grey coloration. The mucous membrane, which could here be examined, was thickened, condensed, and looked as if boiled. The blood was entirely of the colour of cherry -juice, its consistence was that of thin syrup, with a few isolated coagula of the consistence
§ 38. ILLUSTRATIVE CASES.— SULPH. ACID. 77
of moist clay. All the other abdominal organs except those men- tioned were not affected by the destroying agent^ and were quite normal, affording proof that the corrosive poison had not had time during the two hours of life to penetrate to the lower bowels. The lungs and heart were quite normal, and they, as well as the cranial sinuses, were tolerably congested witli blood. Although the chemical analysis of the contents of the stomach was quite unnecessary inlhis case, seeing that the fact of poisoning by sulphuric acid was already sufficiently made plain by tlie results of the dissection, yet it was in- stituted because it is so directed in the statutes. And from it it appeared that the stomach, its contents, the duodenum and oeso- phagus contained about three drachms (imp.) of anhydrous sulphuric acid.
Case CXC. — Poisoning with Sulphuric Acid three days before death.
On the 9th of July, 18 — , the boy S., aged 2i years, drank an unascertained quantity of commercial sulphuric acid from a bottle ; his mother, who saw that his lips, tongue and fauces were white, gave him some milk to drink, which was immediately brought up coagu- lated ; he then got, from a surgeon, an emetic, which evacuated a '^ black mass )' he subsequently passed into the hands of a physician, whose treatment of the case was not mentioned in the documentary evidence, and he died upon the 11th of July, after three days' illness. The autopsy was made about five days after the taking of the poison, and the following are its most important results : — Putrefaction was already (in July) far advanced. The tongue was not swollen, and lay fixed between the teeth. The stomach, on the whole, was pale, only on its back part there was a purplish-red spot, half-an-inch in diameter, which immediately ruptured in attempting to bring it care- fully forward. The examination of the posterior wall of the stomach from the interior brought to light a flat circular ulceration, two inches long and one inch broad, the colour of which did not differ from the rest of the stomach ; that is, an erosion of the mucous membrane, such as is found in every case of poisoning with sulphuric acid where death is not immediate, but where sufficient time has elapsed to permit of the employment of proper medical aid. The mucous membrane of the oesophagus displayed many black points, but no true erosion. There was nothing else remarkable in the body, except
78 § 38. ILLUSTRATIVE CASES— SULPH. ACID.
its general anaemia, which, however, could only be regarded as the result of its advanced state of putrefaction. The most careful in- vestigation of the contents of the body did not reveal the presence of any inorganic acid, and, of course, of no sulphuric acid. Never- theless, we did not hesitate to declare that the child had died of ulcera- tion of the stomach, and that this had been produced by the swal- lowing of commercial sulphuric acid. It is evident that the charac- teristic burning of the mucous membrane of the mouth and fauces, the continuous vomiting of curdled milk, and of "black masses," as well as the discovery of the pecuhar ulceration of the stomach, which is quite characteristic of this form of poisoning in a child which had been perfectly healthy up to the moment of swallowing the poison, were all circumstances which favoured this view of the case, while the mere fact of the non-discovery of the sulphuric acid in the body would not be accepted as any counter proof, since it was well known that the child had been medically treated, and had conse- quently received so-called antidotes. The whole sum of the evidence from the chnical history and post-mortem appearances, does not permit the assumption of any other supposition.
Case CXCI. — ^Poisoning with Sulphuric Acid eight days before death,
An illegitimate female child, seven weeks old, was poisoned eight days before her death by her mother, as she afterwards confessed, pour- ing concentrated sulphuiic acid into her mouth. The usual symptoms followed. At the post-mortem examination the first thing that struck one was a part upon the left side of the neck, from which the entire skin was removed, so that the hard and leathery muscles were seen lying bare at the bottom of the wound. The edges of this sore were already granulating, and it was surrounded by a narrow red areola. The oesophagus was somewhat greyish-black in colour, and so disor- ganized that it tore on the slightest touch. The stomach was quite (remarkably) pale, and there was an ulceration (erosion) of the mucous membrane the size of a half-crown upon its anterior wall. The blood was dark and treacly. TTiere were only a few true blood coagula in the right ventricle of the heart, and in the sinuses of the dura mater. Tlie other appearances were unimportant. The liquid which had been confiscated, was found to be crude sulphuric acid. No trace, however, of this acid could be found in the contents of the
§ 38. ILLUSTRATIVE CASES.— SULPH. ACID. 79
stomach or duodenum, and, in regard to this, we may mention that the child had carbonate of magnesia given it very soon after the poisoning.
Case CXCII. — Poisoning by Sulphueic Acid.
The suicide of a servant-maid, aged 19 (and abeady deflowered), presented a very remarkable example of poisoning with sulphuric acid. At the external inspection of the body the most striking points observable were the tongue, which protruded to the extent of one line from between the teeth, and two parallel streaks which ran from the middle of the under lip down to the chin, each f of an inch broad, dark brown, and hard to cut, and which had evidently been caused by the running down of the sulphuric acid. On opening the body, the stomach was found perfectly black ; after it and the duo- denum had been ligatured and removed, we found a quart of dark- brown fluid, giving an acid reaction with litmus paper ; the mucous membrane was also universally softened, and its surface coal-black. The omentum was also black, although the stomach had not been perforated. Liver, pancreas, spleen, intestinal canal, kidneys, urinary bladder, and the unimpregnated uterus displayed notliing anormal. Nine ounces of dark and very fluid blood were scooped out of the abdominal cavity. The vena cava contained only a small quantity of dark, very fluid, and acid blood. The whole of the left half of the diaphragm was of a deep black colour, such as I have never seen it in any other case. The lungs were healthy, and contained only the normal quantity of blood. The heart was flaccid, and almost empty of blood. The trachea was empty, and there was, therefore, not one single sign of death from asphixia present^ and yet the tongue was protruded from between the clenched teeth (a similar condition was also found in Case CXC). The appearances of the tongue and palate were quite unexpected, nothing unusual being found on either of them. On the other hand, the whole of the mucous membrane of the oesophagus was greyish-black in colour, and felt as if it had been tanned. The blood in the thoracic vessels precisely resembled that in those already described. The vascular cerebral meninges, and the brain itself, were unusually congested with dark and perfectly fluid blood. The cerebellum and all the sinuses were equally congested.
so § 38. ILLUSTRATIVE CASES.— SULPH. ACID.
Case CXCIII. — Death feom poisoning with Sulphuhic Acid^ and not from strangulation.
Tin's case was peculiar (but not difficult to decide), since there was a suspicion, I know not from what cause, that the person concerned, a woman, aged 70 years, had been strangled. Round the neck of the body there lay a soft neckerchief, in which there were many gnawed-looking holes, which, both from their taste and appearance, seemed to have been produced by the corrosion of some mineral acid. The abdomen was already green from putrefaction. The mucous membrane of the mouth and tongue were not decolorized, but were easily stripped off. Prom the right angle of the mouth a brownish- red leathery stripe, J of an inch in breadth, ran down to the collar- bone, a characteristic proof that some corrosive fluid had run down at this spot. On the neck there was no swelling of the veins, nor any trace of the mark of a cord to be seen. In the brain and cranial cavity there was no hypersemia, the lungs were normal, the heart perfectly empty of blood, the larynx and trachea were quite free from froth, mucus, &c., and the mucous membrane only displayed the usual (brownish-red) colour of putrefaction ; the mucous membrane of the oesophagus was quite grey, the liver was steel-grey and anaemic, the gall-bladder distended with gall-stones, the whole of the external surface of the stomach was blackish-grey, it had no contents, and its mucous membrane was universally of a grey colour ; the whole of its tissues were extremely friable, and gave an acid reaction with litmus paper. Kidneys, spleen, and intestinal veins were ansemic, the vena cava was almost empty, the blood had a feeble acid reaction (the anaemia apparent in the body was obviously due to the putrefaction present). The chemical investigation proved that the holes in the neckerchief were due to sulphuric acid, and also determined the existence of free sulphuric acid in the stomach and oesophagus.
Case CXCIY. — ^Disavowed suicide prom Sulphuric Acid.
A strong healthy apprentice, aged 16, had declared, during his illness (why ? was not known), that some one had given him sul- phuric acid to drink instead of a dram. The circumstances that there were no marks of cauterization on the lips, and that the appearances on dissection betokened that no inconsiderable quantity had been
§ 38. ILLUSTRATIVE CASES.— SULPH. ACID. 81
swallowed, proved indubitably that this statement was untrue, and that his illness and death had been voluntarily induced. The tongue was white, and the epithelium easily scraped off The pharynx and oesophagus were grey, but their tissue still firm. The stomach was externally reddish-brown, black and gelatinous at its inferior curva- ture, where there was a perforation the size of a silver threepenny- piece, through which about a pound (imp.) of muco-sanguinolent fluid had escaped into the peritoneal cavity. The stomach, which internally appeared quite black, still contained about four ounces (imp.) of black grumous blood. The transverse mesocolon was also quite black, the intestines reddish, the urinary bladder empty ; liver, lungs and heart remarkably ansemic ; but, on the other hand, there was in this case also distinct congestion of the brain and cranial veins. The whole of the blood in the body was dark, syrupy, and had an acid reaction.
Case CXCV. — Murder by Sulphuric Acid voluntarily submitted to.
This case was not less interesting psychologically than patho- logically, and truly it is only in great towns that such cases are found. A girl, aged 20, was poisoned with sulphuric acid by her lover. He was a married man, and had slept the previous night in one bed with his wife and this girl his sweetheart ! and both had, as agreed upon, taken advantage of the getting up of the wife, to drink sulphuric acid together. The girl stated that she had drank about two tablespoonfuls, the man somewhat less. The man had imme- diately spat out the corrosive poison, and was restored to health j the girl, however, died after five days' treatment in an Hospital, during which she had got magnesia usta, and had leeches applied to her neck and to the upper part of her abdomen ; and we ascertained that during her illness she had repeatedly vomited blood. The tongue was perfectly normal, evidently it had become so during the course of the illness. The pharynx and oesophagus were, in tins case also, grey but firm ; the stomach was empty and black, and at its greater curvature it was very friable. The general anaemia of the whole body was easily explained by the repeated attacks of hsemate- mesis and the defective nutrition during the last few days of life. The blood was of a dark cherry-red colour and treacly consist- ence, and presented in this case also an acid reaction in all the
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82 § 38. ILLUSTRATIVE CASES.— SULPH. ACID.
organs, which were healthy enough in other respects. It was also very remarkable to see how energetically the sulphuric acid had acted in withstanding the advance of putrefaction, since the iDody of the girl was still quite fresh, when dissected eight days after her death, and this though the temperature had been rather mild, viz., from + 2 to + 4 E. = 36^^.5 to 41° P. The girl was also— not de- flowered. Consequently this was a true case of Platonic lo\^, strong enough to lead to an attempt at mutual murder ! The chemical analysis in this case must be interesting. The stomach, the oesophagus, and pieces of the liver, spleen, and kidneys were sub- mitted to analysis, which was obhged to be delayed for six days, after which those organs were no longer capable of reddening htmus paper, but, on the contrary, restored a faint blue to litmus paper already reddened, because an excess of ammonia was now present in the putrefying organs. As it was well known that the deceased had taken large doses of magnesia usta, and perhaps also of other alkaline earths, capable of neutralising free acids, we endeavoured to ascer- tain the presence of any remarkable amount of neutral sulphates in the organs mentioned. Por this purpose, they were cut in pieces, repeatedly boiled in distilled water, and the decoction concentrated by evaporation in a water-bath. Nitric acid was then added to the solution, which was filtered and tested by a solution of nitrate of baryta ; the result was a triflitig white precipitate, which when washed upon a filter, dried, brought to a red-heat, and weighed, was found to amount only to | of a grain. The amount of sulphuric acid corresponding to this precipitate was far too small to afi'ord any evidence as to the fact of this case having been one of poisoning with sulphuric acid, and yet this was very well known to have been the case, and was proved by the appearances on dissection ! The analysis only proved the accidental presence of a trifling amount of alkaline sulphates in the organs of the body.
Cases CXCVI. and CXCVII. — Suicide of two Pregnant Women by Sulphuric Acid.
Omitting a great number of cases of poisoning Anth concentrated sulphuric acid, which are precisely similar to those already related, I will only further relate the two following cases, both of them relating to pregnant women, who had poisoned themselves with this corrosive acid. Both of these cases presented the pecuhar acid
§ 38. ILLUSTRATIVE CASES.— SULPH. ACID. 83
reaction of the whole of the bloody which we have seen to have been constantly present in the cases already related,, and which may be regarded as indisputably proved to exist in every case ; in the second we made the remarkable discovery, that the liquor amnii also had an acid reaction. We had not thought of this when the first case occurred, and therefore, alas ! neglected to test it.
(CXCYI.) A woman, aged 40, of whose illness and death we obtained no information. Milk could be expressed from both of her breasts. The mucous membrane of the lips was partially detached, the upper lip was of a dirty yellowish-brown and hard to cut ; the tongue was whitish and uninjured. The lungs were livid, healthy, and anaemic; the heart was almost completely efnptied of blood. The blood was also in this case of a cherry-red, but more fluid than usual, throughout the whole body it gave an acid reaction. The large venous trunks of the thorax were much distended ; the trachea was empty ; the cesophagus uninjured, but grey in colour. The stomach was greyish-black, distended with a blackish -brown fluid ; on its anterior surface there were many erosions, the size of a pea, with black edges ; its mucous membrane was coal-black and easily stripped off; the other tissues of the organ were still tolerably firm. The duodenum resembled the stomach in appearance, but there was nothing particular to be seen in the rest of the intestines. The liver was pale and anaemic, the gall-bladder full of dark bile. The other abdominal organs were only somewhat ansemic, and in the vena cava there was but little blood. The uterus, w4iich, to judge from the development of the foetus, must have been six months pregnant, was six inches long and five inches broad ; its walls were half-an-inch thick. The foetus, eleven inches long, was a well-formed male ; the pupillary membrane was still present, and the scrotum was empty. The umbilical cord, which was wound round its neck, was nineteen niches long.
(CXCYII.) This girl, aged 20 years, had been already dead seven days in June, and we were not told how long she had survived the taking of the poison ; the appearances on dissection, however, showed that death must have been very rapid, as the poisoning had been very acute. In this case also putrefaction was so little advanced that the abdominal coverings were only just beginning to turn green. A watery milk could be expressed from both breasts. The hps, which were hard to cut, were black, as were also the teeth; the tongue was greyish-black, and as if tanned. The acid had run down
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84 § 38. ILLUSTRATIVE CASES.— SULPH. ACID.
from both corners of the mouth, as was shown by the usual dirty- yellowish brown leatheiy streaks. The lungs were normal and anaemic, in the pericardium there was about one tablespoonful and a-half of a darkish brown acid fluid ; the left side of the heart was moderately filled with remarkably firm and black coagula, which had an acid reaction ; the right side of the heart was more distended, and contained a larger quantity of fluid blood mixed with similar coagula. The larynx and trachea were empty ; the oesophagus was firm, but greyish-coloured. The stomach was entirely destroyed and metamorphosed into a pultaceous mass, which was more grey than black in colour ; its contents, partly the remains of food and partly a dirty fluid, were very acid, made the hand smart, and were effused into the abdominal cavity. The Uver was anaemic, the gall- bladder empty. The spleen, kidneys, and omenta were also ana3mic. The intestines were empty, and grey in colour from the action of the contents of the stomach. The greyish-black uterus contained a foetus, at the fourth month, which could be readily made out, by the aid of a glass, to be a male. The liquor atnnii had a decidedly acid reaction upon litmus paper. The bladder was empty. The vena cava contained only a small quantity of coagulated blood. The meningeal vessels were congested with half-coagulated blood, the sinuses were, however, almost empty, although we had intentionally placed the body with its head hanging downwards for twenty-four hours before the dissection, which was not a judicial one.
Case CXCVIII. — Poisoning with diluted Sulphuric Acid.
I include this case, because it was the first that came before us after the introduction of the new Regulations, by which, in order to prevent accidents, the apothecaries and shopkeepers of Berhn are forbidden to retail sulphuric acid, except when diluted with six times its bulk of water, and also, because of the careful analysis of the body, made by our present judicial expert. Dr. Hoppe. E., an un- married woman, had, on the 4th of July, been induced by want to pour, intentionally, a teaspoonful of sulphuric acid thus diluted, down the throat of her six weeks' old child. On the same evening, a medical man found the child with very staring ghstening eyes, with insensible pupils, distorted and anxious features, the mucous mem- brane of the tongue and lips thickened and white coloured, the pulse scarcely to be felt, the breathing difficult, and swallowing almost
§ 38. ILLUSTRATIVE CASES.— SULPH. ACID. 85
impossible^ but there was neitlier vomiting, movement of the bowels,, nor convulsions. He prescribed magnesia, but the child died about midnight. At the autopsy on the 6th, the following were the most im- portant appearances observed: — In spite of the high atmospheric tem- perature, the body was still quite fresh, the tongue was wliitish, witli an acid reaction, the lips hard, and of a dirty-brown colour ; in the ab- dominal cavity there was about six drachms (imp.) of dark, coagu- lated, acid blood, a similar quantity lay upon the omentum; the posterior wall of the stomach (and it alone) was of a dirty leaden- grey, and torn throughout its whole length, with irregular dirty bloody edges; the mucous membrane covering this wall was of the same leaden- grey colour, and its structure was quite unrecognisable. The liver was ansemic, the bile acid. The duodenum displayed exactly the same condition as the stomach, and this also extended for nine inches downward into the small intestines ; the intestinal canal, urinary blad- der, and vena cava were empty. The lungs, heart, and pulmonary artery contained no blood. The oesophagus was of a uniform pale grey, internally as well as externally ; the mouth and fauces were also grey. The cranial cavity was anaemic.
The greater part of the stomach, of the small intestines, and of the oesophagus were rapidly cut in pieces, put into a porcelain vessel, covered with distilled water, and continually stirred till they boiled ; then filtered, and the undissolved remains well washed with distilled water. The filtrate was rapidly evaporated in a water-bath to less bulk, a large quantity of absolute alcohol added to it, stirred round and filtered.
A. The alcohoHc filtrate was evaporated to a small residuum in the water-bath, nitric acid was added to this abeady acid residuum, and a few drops of a solution of chloride of barium dropped into it. This ad- dition caused only a slight haziness, which did not increase during twenty-four hours, and which, when filtered, dried on the filter, and ignited in a platinum crucible, was found to be perfectly imponderable.
B. That portion of the original residuum of the watery extract which proved insoluble in alcohol, was again dissolved in water, and decomposed by the addition of nitric acid and a solution of chloride of barium; then heated, and a solution of chloride of