 Section 7 of AIDS to Forensic Medicine and Toxicology. 29. Duration of Pregnancy. The natural period of gestation is considered as forty weeks, ten lunar months, or two hundred and eighty days. A medical witness would have to admit the possibility of gestation being prolonged to three hundred days. And if this time were not very materially exceeded, it would be well to give the woman the benefit of the doubt. It may be mentioned that three hundred days is the extreme limit fixed by the French and Scottish law. No fixed period is assigned in English or American law to the duration of pregnancy, though it is allowed that utero gestation may be greatly prolonged. In a recent case decided the Lord Chancellor accepted a case where it was alleged pregnancy had extended to three hundred and thirty-one days. A child only five months old may live for a short time at all events. There is considerable difficulty in many cases in fixing the date of conception. The data from which it is calculated are the following. 1. Peculiar sensations attending conception, which are not sufficiently defined to be recognized by those conceiving for the first time. 2. Sensation of the cataminia. Other causes may, however, cause this, and, on the other hand, a woman may menstruate during the whole period of her pregnancy. This datum also gives a variable period and may involve an error of several days or a month, for the menses may be arrested by cold, etc., at one monthly period, and the woman become pregnant before the next. 3. The period of quickening. This, when perceived, which is not always the case, also occurs at variable periods from the tenth to the twenty-sixth week. 4. A single coitus. This does not, however, correspond to the time of fertilization. Several days may elapse before the spermatozoa meet with an ovum and fertilize it. In Scotland, a child born six months after marriage is legitimate, which is allowing an ample margin. 30. Viability of children. A child may be born alive, but may not be viable, by which it is meant that it is not endowed with a capacity for maintaining its life. Speaking generally, one hundred and eighty days represents the lowest limit at which a child is viable. But prolonged survival under these circumstances is the exception. Many cases, however, have been recorded in which children born at six months have been reared. The signs of immaturity and maturity may be thus tabulated. Immaturity. Center of body high, head disproportionate in size, membrana pupillaris present, testicles undescended, deep red color of parts of generation, intense red color, mothled appearance, and downy covering of skin, nails not formed, feeble movements, inability to suck, necessity for artificial heat, almost unbroken sleep, rare and imperfect discharges of urine and meconium, closed state of mouth, eyelids, and nostrils. Maturity. Strong movements and cries as soon as born, body clear, red color, coated with sebaceous matter, mouth, nostrils, eyelids, and ears open, skull somewhat firm and fontanelle not far apart, hair, eyebrows, and nails perfectly developed, testicles descended, free discharge of urine and meconium, power of suction, indicated by seizure of the nipple or a finger placed in the mouth. 31. Legitimacy. A child born in wedlock is presumed to have the mother's husband for its father. This may, however, be open to question upon the following grounds. Absence or death of the reputed father, impotence or disease in the husband preventing matrimonial intercourse, premature delivery in a newly married woman, want of access, and the marriage of the woman again immediately on the death of her husband. In the last case, where either husband might have been the father, the child at the age of 21 is at liberty to select its father from the possible pair. A child born of parents before marriage is in Scotland rendered legitimate by their subsequent marriage. But in England the offspring remains illegitimate whether the parents marry or not after its birth. The offspring of voidable or invalid marriages may be made legitimate by application to the courts. There is a difference between being legitimate and lawfully begotten. A child born in wedlock is legitimate, but if the parents were married only a week previously it could not have been lawfully begotten. The acts and rulings related to marriage and legitimacy are extremely complicated. It is not putting it too strongly to say that a very large number of people in this country who believe themselves to be legally married are not married at all, and that thousands of children who have not the slightest doubt as to their legitimacy are in the eyes of the law bastards. 32. SUPERFETATION By superfutation is meant the conception by a woman already pregnant of a second embryo resulting in the birth of two children at the same time, differing much in their degree of maturity or in two separate births, with a considerable interval between. The possibility of the occurrence of superfutation has been doubted, but there are well authenticated cases which countenance the theory of a double conception. It has been shown that the Oss uteri is not closed as was once supposed immediately on conception. Should an ovum escape into the uterus it may become impregnated a month or so after a previous conception. The most probable explanation is that the case has been one of twins, one being born prematurely, or on the other hand the uterus may have been double, and conception may have taken place in one corneau at a later period than in the other corneau. 33. INHERITANCE In order to inherit, the child must be born alive, must be born during the lifetime of the mother, and must be born capable of inheriting. That is to say, monsters are incapable of inheriting. There is a mode of inheritance called tenancy by courtesy. When a man marries a woman possessed of an estate or inheritance, and has, by her, issue born alive in her lifetime capable of inheriting her estate, in this case he shall, on the death of his life, hold the lands for his life as tenant by the courtesy of England. The meaning of the words born alive in this instance is not the same as in cases of infanticide. In civil law, any motion of the child's body, however slight, or the fact of it having been heard to cry by witnesses, is held to be sufficient proof of the child having been born alive. It may die immediately afterwards, and it is not necessary that the child be viable. End of Section 7. Recording by David Lawrence in Brampton, Ontario, October 2009. Section 8 of AIDS Differential Medicine and Toxicology. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer, please visit LibriVox.org. Recording by Jennifer Stearns. AIDS Differential Medicine and Toxicology. By W. G. H. A. Robertson. Section 8. 34. Impotence and Sterility. In the male, impotence may arise from physical or mental causes. The physical causes may be too great or too tender in age, malformation of the genital organs, cryosoketes, defect or disease in the testicles, constitutional disease, diabetes, neurasthenia, etc., or debility from acute disease as mumps. Masturbation and early and excessive sexual indulgence are also causes. The mental causes include passion, timidity, apprehension, aversion and disgust. The case will be remembered of the man who was impotent unless the lady were attired in a black silk dress and high-heeled French kid boots. If a man is impotent when he marries, the marriage may be set aside on the ground that it had never been consummated. The law requires that the impotency should have existed ab initio, that is, before marriage, and should be of a permanent or incurable nature. Marriage, as far as the law goes, being regarded as a contract in which it is presupposed that both the contracting parties are capable of fulfilling all the objects of marriage. In the case of the Earl of Essex, the defendant admitted the charge as regards to Countess, but pleaded that he was not impotent with others, as many of her waiting maids could testify. When a man becomes impotent after marriage, his wife must accept the situation and has no redress. A man may be sterile without being impotent, but the law will not take cognizance of that. The wife may be practically impotent, but the law will not assist the husband. He must continue to do his best under difficult circumstances. In former times, in case of doubt, a husband was permitted to demonstrate his competency in open court, but this custom was no longer regarded with favor by the judges. The removal of the testicles does not, of necessity, render a man impotent, although it deprives him of his procreated power. Unics are capable of affording illicit pleasure, whilst the male sopranos or castrati are often utilized for that purpose. In the female, impotence may be caused by the narrowness of the vagina, adhesion of the vulva, absence of the vagina, imperforate hymen, and tumors of the vagina. Sterility in women may occur from the above-name causes of impotence, together with absence of the uterus and ovaries, or from great debility, syphilis, constant amenorrhea, dysmenorrhea, or menorrhagia. Rape is the carnal knowledge of a woman by force and against her will. The resistance of the woman must be to the utmost of her power, but if she yield through fear or duress it is still rape. The woman is a competent witness, but her statements may be impugned on the ground of her previous bad character, and evidence may be called to substantiate the charge. The perpetrator must be above the age of fourteen years. The definition of rape, which we have given, is not altogether satisfactory. Take, for example, the case of a woman who goes to bed expecting her husband to return at a certain hour. The lodger, let us say, takes advantage of this fact, and, getting into bed, has connection with her, she not resisting, assuming all the while that it is her husband. This is rape, but it is not by force, and it is not against her will, but it is without her consent, as she has not been fully informed as to all the circumstances of the case. In all cases of rape, in which there is no actual resistance or objection, consent may be assumed. It is not essential that the woman should state in so many words that she does not object. The force used may be moral and not physical. For example, threats, fear, horror, syncope. By forty-eight and forty-nine, Vic, C, forty-nine, the carnal knowledge of a girl under thirteen is technically rape. The consent of the girl makes no difference, since she is not of an age to become a consenting party. In attempt to carnal knowledge of a girl under thirteen is a misdemeanor. Her consent makes no difference, and even the solicitation of the act on the part of the child will not unsonerate the accused. Intercourse with a girl between thirteen and sixteen, even with her consent, is a misdemeanor. This act is a favorite with a blackmailer. The child is sent out to solicit, dressed like a woman, but appears in the witness box in a much more juvenile costume. To constitute rape, there must be penetration. But this must be of the slightest. There may be a sufficient degree of penetration to constitute rape without rupturing the hymen. Proof of actual admission is now unnecessary. The subject of carnal knowledge, CK, or its attempt may be summed up as follows. Under thirteen, CK, felony. Under thirteen, attempt, consent, no defense, misdemeanor. From thirteen to sixteen, CK, misdemeanor. From thirteen to sixteen, attempt, consent, and even solicitation, no defense, reasonable cause to believe the girl over sixteen, is a good defense. Tried must be brought within three months. Misdemeanor. Over sixteen, CK, with consent. Subject to civil action for loss of girls' services by father. Nill. Idiot or imbecile, CK, with violence, rape. Idiot or imbecile, CK, without violence, misdemeanor. Personation of husband, tacit consent, no defense, foreobtained by fraud, rape. Married woman, CK, with consent, adultery. Mother, sister, daughter, granddaughter, CK, consent immaterial, born in wedlock or not, incest. Females, indecent assaults, misdemeanor. It is misdemeanor to give to a woman any drug so as to stupify her, and so enable any person to have unlawful connection with her. Faults, charges, or rape are very often made. The motive may be to extort blackmail, revenge, or mere delusion. On examining such cases, bruises or seldom found, but scratches which the woman has made on the front of her body may be discovered, and the local injuries to the generative organs are slight, if present at all. Physical signs. In the adult, the hymen may be ruptured, the fortunate lacerated, and blood found on the parts, together with scratches and other marks and signs of a struggle. In a child, there may be no hemorrhage, but there will be indications of bruising on the external organs with probable considerable laceration of the hymen. The laceration in some cases extending into the rectum. Severe hemorrhage and even death may follow the rape of a young child. The patient will have difficulty in walking and in passing water and feces. After some hours, the parts are very tender and swollen, and a sticky greenish-yellow discharge is present. These signs last longer in children than in adults. But as a rule, in the adult at least, all signs of rape disappear in three or four days. Young and delicate children may suffer from a vaginal discharge, with swelling of the external genitals, simulating an attempt at rape. Infantile lucaria is common, and many innocent people have been exposed to danger from false charges of rape on children, instituted as a means of living in blackmail. A knowledge of these facts suggests the necessity of giving a guarded opinion when children are brought for examination in suspected cases. Pregnancy may follow rape. Summoned stains render the clothing stiff and grayish-yellow in color with translucent edges. On being moistened, they give the characteristic seminal odor. Seeming may be found on the linen of the woman and man, and will be recognized under the microscope by the presence in it of spermatozoa. Minute filamentary bodies with a pear-shaped head. But it must not be forgotten that the non-detection of spermatozoa is no proof of abstinence of sexual intercourse, for these bodies are not always present in the semen of even healthy, adult young men. Spermatozoa must not be mistaken for the trichomonas vaginae found in the vagina of some woman. The latter have cilia starting the head, which is globular. Florence's microchemical test for spymatic fluid. If a drop of the fluid obtained by wetting a supposed serebranic stain be mixed with a drop of the following solution. Potassium iodide parts 1.65. Pure iodine 2.54. Distilled water 30. In a watch glass, brownish-red pointed crystals resembling hemen crystals are obtained. Barbarios test. Mixed a drop of the spymatic stain with a drop of saturated solution of picric acid when needle-shaped yellow thrombic crystals are formed. Gonorrheal stains. A covered glass preparation stain with methylene blue reveals the gonoconchi lying in pairs within the leukocytes. 36. Unnatural offenses. Trials for sodomy and bestiality are common at the acesis. But as they are rarely reported, they fail to attract attention. Sodomy is a crime both in the active and passive agent, unless the latter is a non-consenting party. The evidence of either associated may be received as against his colleague. If the crime is committed on a boy under 14, it is a felony in the active agent only. As in cases of rape, admission is not essential and penetration, however slight, answers all practical purposes. There can be no doubt that in the majority of these cases, there exists a congenitally abnormal condition of the sexual instinct. These individuals, from their childhood, manifest a perverted sexual instinct. The man is physically a man, but psychically a woman. And vice versa. The tendency nowadays is not to charge these people with a more serious offense, but to deal with them under section 11 of the Criminal Law Amendment Act, 1885. 48 and 49, Vic. C. 69. This section, which is sufficiently comprehensive, runs as follows. Any male person who in public or private commits or is a party to the commission, or attempts to procure the commission by any male person of any act of gross indecency with another male person, shall be guilty of a misdemeanor. The penalty is imprisonment for two years with or without hard labor. It is provided by section 4 of the same act that a boy under 16 may be whipped. Incest. This crime is dealt with under the Punishment of Incest Act, 1908. 8, Edward VII, C. 45. Carnal knowledge with mother, sister, daughter, or granddaughter is a misdemeanor provided the relationship is known. It also applies to the half-brother and half-sister. It is equally in offense whether the relationship can or cannot be traced through lawful wedlock. Consent is no defense. A woman may be charged with an act if she, being above the age of 16, with consent, permits her grandfather, father, brother, or son to have carnal knowledge of her. 37, Blackmailing. There are in London and every large city, scores of men and women who live by blackmailing or chantalage. There are many different forms of this industry. There is the man who knows something about your past life, which he threatens to reveal to your friends or colleagues unless you buy him off. There is a breach of promised blackmailer. And there is the female patient, who threatens to charge you with improper conduct or in decent assault. Men of command from their position are often selected as victims. The introduction of corridor carriages on many of our railways has done much to stamp out one particular form of blackmailing. But public urinals are still a source of danger. It is the worst possible policy to temporize with a blackmailer. If you give him a single penny, you are his for life. It is as well to remember that it is just as criminal to attempt to extract money from a guilty as from an innocent person. It is of no use attempting to deal with these cases single-handed. You must not only deny the allegation, but spurn the alligator. Put the matter into the hands of a good shop criminal solicitor and instruct him to rid you of the nuisance by taking criminal proceedings. 38, Marriage and Divorce. Marriage may be accomplished in many ways. One, by the publication of bonds. Two, by an ordinary license. Three, by a special license. Four, by the superintendent registrar's license. Five, by a special license granted by the Archbishop of Canterbury in consideration of the payment of the sum of 25 pounds. Then, for persons having a domicile in Scotland, there is the marriage by repute. The consent of the parties, which is the essence of the contract, may be expressed before witnesses, and it is not requisite that a clergyman should assist. But it is essential that the expressions of consent must be for matrimonial intent. Have it and repute constitute good evidence, but the repute must be the general, constant and unvarying belief of friends and neighbors. The cohabitation must be in Scotland. Any irregularity in the marriage ceremony, or the non-observance of any formality, will not invalidate the marriage, unless it were known to both the contracting parties. If a man were married in the wrong name, the contract would still be valid if the wife were unacquainted with the deception at the time. If the person who officiated were a bogus clergyman, the marriage would hold good if the contracting party had supposed him to be a properly ordained priest. In a case in which a marriage was solemnized in a building near a church, at the time when the church was undergoing repairs, and were during such alterations, divine service had been performed, it was held that the ceremony was good. To all intents and purposes, marriage comes under the law of contract, C. Anson, W. R. Bart. And the law looks to the intention rather than to the actual details. All marriages between persons within the prohibited degrees of consanguinity or affinity are null and void. This prohibition extends both to the illegitimate as well as the legitimate children of the late wife's or husband's parents. A marriage with a deceased wife's sister is now legal in Great Britain and the colonies, and is recognized in most foreign countries. A common device of people within the prohibited degrees is to get married abroad, but such marriage is strictly speaking inoperative, and the children of such union are illegitimate. Practically, however, it is a matter of no importance for when people live together and say they are married, they are accepted at their own estimate. A man can obtain a divorce from his wife if he can prove that she has been guilty of adultery since her marriage. This may be established by inference. Obviously, it is difficult in the majority of cases to establish by awkwardly demonstration that adultery has been committed. But given evidence of familiarity and affection with opportunity and suspicious conduct, a jury will commonly infer it. A woman cannot obtain a divorce from her husband for adultery alone. She must prove adultery plus cruelty or adultery plus desertion without reasonable cause. Failing this, she may be able to prove either bigamy or incestuous adultery. Legal cruelty is a very comprehensive term and does not, of a necessity, mean physical violence. If a husband, as a result of his infidelity, were to give his wife a contagious disease that would constitute cruelty. Taking a more extreme case, if a husband were to have connection in her house with his wife's maid, that would probably be held to constitute cruelty as it would tend to lower her in the eyes of her servants. A wife can obtain a judicial separation if she can prove one adultery, two cruelty, or three desertion without reasonable cause for two years. If a husband is away in his business, as for example, the case of an officer ordered abroad, that is not desertion. For a woman to get a judicial separation, it is sufficient if she can prove one variety of matrimonial offence. But for a divorce, she requires more than one. A jury may find that Mrs. A has committed adultery with Mr. B, but that Mr. B has not committed adultery with Mrs. A. The explanation is that a wife's confession is evidence against herself, but not against another person. You can confess your own sins, but not on others. The divorce law of Scotland differs materially from that of England. In Scotland, there is no decree nisi, no decree absolute, and no intervention by the king's proctor. Instead, there is a single and final judgment, and what a decree of divorce pronounced the successful litigant at once succeeds to all rights, legal and conventional, that would have come to him or her on the death of a losing party. If the husband is the offender, the wife in such circumstances may claim her right to one-third of his real estate, and if there are children, to one-third of his personal property, and to one-half if there are none. Voidable marriages If a man and woman go through the marriage ceremony, such a contract is null and void under the following circumstances. One, where bigamy has been committed. Two, if one of the parties were insane at the time of the marriage. Three, where the plaintiff is under sixteen years of age. Four, when the marriage has not been consummated or followed by cohabitation. Five, when one of the parties was incapable of performing the marital act. Invitant, and such not known by the other at the time. Six, when drunkenness has been induced so as to obtain consent. Seven, concealment of pregnancy at the time of marriage. End of section eight. Recording by Jennifer Stearns, Concord, New Hampshire. Section nine of AIDS to Forensic Medicine and Toxicology. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer, please visit LibriVox.org. Reading by Bologna Times. AIDS to Forensic Medicine and Toxicology. By W. G. Atchison-Robertson. Section nine. Feigned Diseases. Malingering in its various forms is by no means uncommon, and by many is regarded as a disease in itself. It is necessary, however, to distinguish between those cases in which it is feigned for some definite purpose. For example, to escape punishment or avoid public service. And those in which there is adequate motive and the patient shams simply with a view of exciting sympathy or from the mere delight of giving trouble. It is not uncommon for individuals summoned on a jury or to give evidence in the law courts to apply to their doctor for a certificate, assigning as a cause of exemption, neuralgia, or some similar complaint unattended with objective symptoms. In such cases it is well to remind the patient that in most courts such certificates are received with suspicion and are often rejected, and that the personal attendance of the medical man is required to endorse his certificate on oath. Malingering has become much more common since the National Health Insurance Act has been passed. The possibility of obtaining a fair sum each week without the necessity of working for it induces many persons either to feign disease or to make recovery from actual disease or accident much more tedious than it ought really to be. The feasibility of successfully malingering is greatly enhanced by the possession of some chronic organic disease. An old mitral regurgitant murmur is useful for this purpose. It is not flattering to one's vanity to overlook a case of malingering, but should this occur little harm is done. It is a much more serious matter to accuse a person of malingering when in reality he may be suffering from an organic disease. Here are some of the diseases which are most frequently fanned. Nervous diseases. As headache, vertigo, paralysis of limbs, vomiting, sciatica, or incontinence or suppression of urine, spitting of blood, others, again, simulate hysteria, epilepsy, or insanity. On the other hand, the malingerer may actually produce injuries on his person either to excite commiseration or to escape from work. Thus the beggar produces ulcers on his legs by binding a penny-piece tightly on for some days. The hospital patient, in order to escape discharge, produces fictitious skin diseases by the application of irritants or caustics. It is much more difficult to decide whether certain symptoms are due to a real disease which is present or whether they are merely exagerations of slight symptoms or simulations of past ones. The miner, after an injury to his back, recovers very slowly, if at all. He is suffering from traumatic neurasthenia, a condition only too often simulated and a disease very difficult to diagnose accurately. The miner takes advantage of our ignorance and continues to draw his compensation. A workman, during his work, receives a fracture. Instead of being able to resume work in six weeks, he asserts that the pain and stiffness prevent him, and this disability may persist for months. Such cases as these frequently come before the courts when the employer has discontinued to pay the weekly compensation for the injury. Medical men are called to give evidence for or against the injured workman. Epilepsy is often simulated. The foaming at the mouth is produced by a piece of soap between the gums and the cheek. The true epileptic, especially if he suspects that a fit is imminent, takes his walks abroad in some secluded spot, whilst the imposter selects a crowded locality for his exertions. The epileptic often injures himself in falling. His imitator never. One bites his tongue, but the other carefully refrains from doing so. The skin of an epileptic, during an attack, is cold and pallid, but that of the exhibitor is covered with sweat as the result of his exertions. In epilepsy the urine and feces are passed involuntarily, but his colleague rarely considers it necessary to carry his deception to this extent. In true epilepsy the eyes are partly open, with the eyeballs rolling and distorted, whilst the pupils are dilated and do not contract to light. The imposter keeps his eyes closed, and he cannot prevent the iris from contracting when a bicycle lamp is flashed across his face. A useful test is to give the imposter a pinch of snuff, which promptly brings the entertainment to an end. Lumbago is often feigned, and the imposter should be suspected when there is a motive and when physical signs such as nodes and tender spots are absent. A simple test is to inadvertently drop a shilling in front of him when he will promptly stoop and pick it up. The same principles apply to spurious sciatica. Hemorrhages, purporting to come from the lungs, stomach, or bowels, rarely present much difficulty. The microscope is of use in all cases of bleeding. Possibly the gums or the inside of the cheeks may have been scratched or abraded with a pen. Skin diseases are excited artificially, especially those which may be produced by mechanical and chemical irritants. The most commonly employed are vinegar, acetic acid, carbolic acid, nitric acid, and carbonate of sodium. But tramps frequently use sorrel and various species of renunculus. The lesions simulated are usually inflammatory in character, such as erythema, vesicular, and bulus eruptions, and ulceration of the skin. They may be complicated by the presence of pediculi and other animal and vegetable parasites. Chromydrosis of the lower eyelids in young women often owes its origin to a box of paints. Factitious skin diseases are seen most commonly on the face and extremities, especially on the left side, in other words, on the most accessible parts of the body. Famed menstruation, pregnancy, abortion, and recent delivery are common and should give rise to no difficulty. The same may be said of fanned insanity, aphonia, deaf mutism, and loss of memory. The following hints may be useful to a medical man when called to a supposed case of malingering. Do not be satisfied with one visit, but go again and unexpectedly see that the patient is watched between the visits. Make an objective examination. Compare the indications with the statements of the patient, noting especially any discrepancies between his account of his symptoms and the real symptoms of disease. Ask questions, the reverse of the patient's statements, or take them for granted, and he will often be found to contradict himself. Have all dressings and bandages removed. Suggest, in the hearing of the patient, some heroic methods of treatment. The actual coterie, or severe surgical operation, for example. Finally, chloroform will be found of great use in the detection of many sham diseases. Chapter 40. Mental Unsoundness. The presumption in law is in favor of a person's sanity, even though he may be deaf, dumb, or blind. The terms insanity, lunacy, unsoundness of mind, mental derangement, madness, and mental alienation or aberration are indifferently applied to those states of disordered mind in which the person loses the power of regulating his actions and conduct according to the ordinary rules of society. The reasoning power is lost or perverted, and he is no longer fitted to discourage those duties which his social position demands. In some cases of insanity, as in confirmed idiocy, there is no evidence of the exercise of the intellectual faculties. It is probable that no standard of sanity as fixed by nature can be said to exist. The medical witness should decline to commit himself to any definition of insanity. There is no practical advantage in attempting to classify the different forms of insanity. According to English law, madness absolves from all guilt, but in order to excuse from punishment on this ground, it must be proved that the individual was not capable of distinguishing right from wrong in relation to the particular act of which he is accused, and that he did not know at the time of committing the crime that the offense was against the laws of God and nature. Lunatics are competent witnesses in relation to testimony as in relation to crime if they understand the nature of an oath and the character of the proceedings in which they are engaged. The judge, as in the case of children, examines the lunatic tendered as a witness as to his knowledge of the nature and obligation of an oath, and if satisfied, he allows him to be sworn. A person, if suffering from such a state of mental unsoundness as to be unable to take care of his property may be placed under the care of the Court of Chancery. The court then administers his property and otherwise allows him entire freedom of action. With regard to the care of lunatics, no person is allowed to receive more than one lunatic into his house unless such house is licensed and the proper certificates have been signed. One patient may be taken without the house being licensed, but the usual certificates must in all cases be signed and the lunacy commissioners communicated with. If a person receives another knot of unsound mind into his house and such person becomes subsequently insane, the person so keeping him renders himself liable to heavy penalties unless the legal certificates are at once procured and the commissioners of lunacy communicated with. At common law it appears that a lunatic cannot be placed in an asylum unless dangerous to himself or to others, but under the lunacy acts the placing of a madman in an asylum is considered as a part of the treatment with a view to the cure of the patient. Chapter 41. Idiocy in Facility, Cretanism Idiocy is not a disease but a congenital condition in which the intellectual faculties are either never manifested or have not been sufficiently developed to enable the idiot to acquire an amount of knowledge equal to that acquired by other persons of his own age and in similar circumstances with himself. Idiots, as a rule, are deformed in body as well as deficient in mind. Their heads are generally small and badly shaped and their features ill-formed and distorted. The teeth are few in number and very irregular. The hard palate has a very deep arch or may even be cleft. The complexion is shallow and unhealthy, the limbs imperfectly developed, and the gait is awkward, shambling, and unsteady. In his legal relations an absolute idiot is civilly, disabled, and irresponsible, but in regard to crime or as a witness see remarks made above. Imbossility is a form of mental defect, not usually congenital, but commencing in infancy or in early life. The line of demarcation between the imbecile and the idiot may be found in the possession by the former of the faculty of speech and distinction from the mere parent-like utterance of a few words which can be taught the idiot. Imbossility may be intellectual, moral, or general. Questions frequently arise as to the responsibility for actions done by them or as to their ability to manage their own affairs. Cretanism is a form of aementia which is endemic in certain districts, especially in some of the valleys of Switzerland, Savoy, and France. The malady is not congenital, but its symptoms usually appear within a few months of birth. The characteristics of this form of idiocy are an enlarged thyroid gland constituting a goiter, or broncocele, a high-arched palate, dwarfed stature, squinting eyes, shallow complexion, small legs, conical head, large mouth, and indistinct speech. Fable-minded These are persons who are capable of earning a living under favorable circumstances, but are incapable from mental defect which has existed from birth or from an early age of, a, competing on equal terms with their normal fellows, or, b, of managing themselves and their affairs with ordinary prudence. Fable-mindedness may affect the moral nature only, rendering the person selfish, untruthful, obscene, or unemployable. The Act of 1899 controls feeble-minded children. Many such become poppers, criminals, prostitutes, etc. Mental Deficiency and Lunacy Act, 1913. Those included under this Act are idiots, imbeciles, feeble-minded persons, and moral imbeciles. The parents or guardians of such children between the ages of five and sixteen years must provide for them education and proper care. If they are unable to do so, the school boards or parish councils must do so. Chapter 42. Dementia, acute, chronic, senile, and paralytic. In dementia the mental aberration does not occur until the mind has become fully developed, thus differing from amencia, which is congenital or comes on very early in life. Acute dementia. This is a condition of profound melancholy or stupor, which arises from sudden mental shock, the mind being, as it were, arrested and fixed in abstraction on the event. Chronic dementia is generally caused by the gradual action on the mind of grief or anxiety by severe pain, mania, apoplexy, paralysis, or repeated attacks of epilepsy. Senile dementia is a form which is incidental to aged persons, and commences gradually with such symptoms as loss of memory for recent events, dullness of perception, and inability to fix the attention. Later on the reasoning powers begin to fail and finally memory, reason, and power of attention are quite lost, the muscular power and force remaining intact. In the last stage there is simply bare physical existence. General paralysis of the insane. Paralytic dementia. This is a most interesting form of dementia. It is closely allied to, if not identical with, local motor, a taxi. Its most prominent and characteristic symptom consists in delusions of great power, exalted position, and unlimited wealth, megalomania. The exultation is universal, and the patient may maintain at one and the same time that he is running a theatrical company, that he is the Prince of Wales, and that he is the Almighty. Moral perversion is a common symptom, and the patient is often guilty of criminal assaults and decent exposures, bigamus marriages, and the like. It is accompanied with progressive bodily and mental decay. Women are comparatively rarely affected by it, and it generally commences in men about middle age, and its duration is from a few months to three years. It is commonly parasyphalitic in origin. Paralytic symptoms first appear in the tongue, lips, and face. The speech becomes thick and hesitating. The paralytic symptoms gradually go on increasing. The sphincters refuse to act, and death may occur from suffocation and choking. Sometimes, during the earlier stages especially, there may be maniacal paroxysms or epileptic fits. The delusions remain the same throughout. The patient always expresses himself as being happy, and his last words will probably have reference to money and other observed delusions. When a person of hitherto blameless life is charged with an act of indecency, he should be examined for GPI. The condition of his prostate should also be investigated. He may be suffering from either mental or physical disease, or both. CHAPTER 43 MANIA Under the term mania are included all those forms of mental unsoundness in which there is undue excitement. It is divided into general, intellectual, and moral, and each of the two letter classes again into general and partial. General mania affects the intellect as well as the passions and emotions. Mania is usually preceded by any incubative period in which the patient's general health is affected. The duration of this period may vary from a few days to fifteen or twenty years. When the disease is established, the patient has paroxysms of violence directed against himself as well as others. He tears his clothes to pieces, either abstains from food and drink, or eats voraciously and sustains immense muscular exertion without apparent fatigue. The face becomes flushed, the eyes wild and sparkling. There is pain, weight, and giddiness in the head with restlessness. General intellectual mania, attacking the intellect alone is rare, but some one emotion or passion as pride, vanity, or love of gain may obtain ascendancy and fill the mind with intellectual delusions. A delusion may be defined as a perversion of the judgment, a comirical thought, an illusion, an incorrect impression of the senses, counterfeit appearances. Hence we speak of a delusion of the mind, an illusion of the senses. Lawyers lay great stress on the presence of delusions as indicative of insanity. An hallucination is a sensation which is supposed by the patient to be produced by external impressions, although no material object acts upon his senses at the time. Partial intellectual mania, or monomania, also called melancholia, is a form of the disease in which the patient becomes possessed of some single notion, contradictory alike to common sense and his own experience. General moral mania. This is a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of the intellect, or knowing and reasoning faculties, and particularly without any insane illusion or hallucination. It is often difficult to distinguish this form of mania from the moral depravity which we associate with the criminal classes. Partial moral mania. Paranoia, delusional insanity. In this form one or two only of the moral powers are perverted. Delusions are always present, and very frequently are those of persecution. The patient's conduct is dominated by his delusion. Thus murder and suicide may be committed. There are several forms. Kleptomania, a propensity to theft. Common in women in easy circumstances. Dipsomania, or oinomania, an insatiable desire for drink. Morphinomania, a craving for morphine or its preparations. Iratomania, or amorous madness. When occurring in women this is also called nymphomania, and in men satiriasis. It consists in an uncontrollable desire for sexual intercourse. Pyromania, an insane impulse to set fire to everything. Homicidal mania, a propensity to murder. Suicidal mania, a propensity to self-destruction. Some consider suicide as always a manifestation of insanity. Insanity of pregnancy. This may show itself after the third month of pregnancy in the form of melancholia. It is not recovered from until after delivery. Perperomania. This form of mania attacks women soon after childbirth. There is, in many cases, a strong homicidal tendency against the child. Insanity of lactation comes on four to eight months after parturition. Either as mania or melancholia. The mother may repeatedly attempt suicide. Mania with lucid intervals. In many cases mania is intermittent or recurrent in its nature, the patient and the interval being in his right mind. The question of the presence or absence of a lucid interval frequently occurs where attempts are made to set aside wills made by persons having property. In these cases the law from the reasonableness of the provisions of the will may assume the existence of the lucid interval. A will made during a lucid interval is valid. When an attempt is made to set aside the provisions of the will on the ground of insanity in a person not previously judged insane, the plaintiff must show that the testator was mad. When the provisions of the will of a lunatic are attempted to be upheld, the plaintiff must show that the will was made during a lucid interval. The testator is capable of making a valid will when he has, one, a knowledge of his property and of his kindred. Two, memory sufficient to recognize his proper relations to those about him. Three, freedom from delusions affecting his property and his friends. And four, sufficient physical and mental power to resist undue influence. The fact of a man being subject to delusions may not affect his testamentary capacity. He may believe himself to be a tea kettle and yet be sufficiently sound mentally to make a valid will. Undue influence. Persons of weak mind or those suffering from senile dementia are often said to have been unduly influenced in making their wills, and subsequently their dispositions are disputed in court. Before witnessing the will made by such a person, the medical man should satisfy himself that the testator is a sound disposing mind. This he will do by questioning, and his knowledge of the home life of the patient will either confirm or set aside the idea of influence. A person who is aphasic may be competent to make a will. He may not be able to speak, but may understand what is said to him, and may be able to indicate his wishes by nods and shakes of the head. Ask him if he wishes to make a will. Then inquire if he has ten thousand pounds to leave. Then if he has one hundred pounds, and in this way arrive approximately at the sum. Then ask him if he wishes to leave it all to one person. If he nods assent, ask if it be to his wife or some other likely person. If he wishes to divide it, ascertain his intention by definite questions, and having ascertained his views, commit them to writing, read the document over to him, and ask if it expresses his intentions. That being settled, a mark which he acknowledges in the presence of two witnesses, preferably men of standing, will constitute a valid document. In certain forms of neurasthenia, the phobias are common, but must not be regarded as evidence of insanity. Agoraphobia is the fear of crossing an open space. Bataphobia is the fear that high things will fall. Sideraphobia is the fear of thunder and lightning. Pathophobia is the fear of disease, whilst pantophobia is the fear of everything and everybody. Epilepsy in relation to insanity. The subjects of this disease are often subject to sudden fits of uncontrollable passion. Their conduct is somewhat brutal, ferocious, and often very immoral. As the fits increase in number, the intellect deteriorates, and chronic dementia or delusional insanity may super-being. 1. Before a fit, the patient may develop paroxysms of rage with brutal impulses, pre-paroxysmal insanity, and may commit crimes such as rape or murder. 2. Instead of the usual epileptic fit, the patient may have a violent, maniacal attack, masked epilepsy, epileptic equivalent, psychic form of epilepsy. 3. After the fit, the patient may perform various automatic actions, post-epileptic automatism, of which he has no subsequent recollection. Thus the patient may urinate or undress in a public place, and may be arrested for indecent exposure. Epileptics who suffer from both petit and grand mal attacks are especially liable to maniacal attacks. Such insanity differs from ordinary insanity and its sudden onset, intensity of symptoms, short duration and abrupt ending. To establish a plea of epilepsy in cases of crime, one must show that the individual really did suffer from true epilepsy, and that the crime was committed at a period having a definite relation to the epileptic seizure. Alcoholic insanity. This may occur in three forms. 1. Acute alcoholic delirium. Manya epatu, due to excessive amount of alcohol consumed. 2. Delirium tremens, due to long continued overdrinking. The patient suffers from horrible dreams, illusions, and suspicions, which may lead him to attack people or commit suicide. 3. Chronic alcoholic insanity. Loss of memory is the chief symptom, with paralysis of motion, hallucinations, and delusions of persecution. Responsibility for criminal acts. To establish a defense on the ground of insanity, it must be proved that the prisoner at the time when the crime was committed did not know the nature and quality of the act he was committing and did not know that it was wrong. At the present time, however, the power of controlling his actions has usually made the test. The plea of insanity is brought forward as a rule only in capital charges, so that the prisoner, if found guilty, will escape hanging. If proved guilty but insane, the person is sentenced to be kept in a criminal lunatic asylum during his Majesty's pleasure. Examination of persons of unsound mind The following hints with regard to the examination of patients supposed to be insane will be useful. The general appearance and shape of head, complexion, and expression of countenance, gait, movements, and speech should be noted. The state of the general health, appetite, bowels, tongue, skin, and pulse should be inquired into, and in women the state of the minstrel function should be ascertained. The family history must be traced out and the personal history taken with care, especially as to whether the unsoundness came on late in life or followed any physical cause. Ascertain whether it is a first attack, whether the patient has suffered from epilepsy, has squandered his money, grown restless, has observed delusions, etc. In order to ascertain the capacity of the mind, questions should be asked with regard to age, birthplace, profession, number of family, and common events, such as the day of week, month, and year. The power of performing simple, arithmetical operations may be tested. It may be necessary to pay more than one visit. The examiner should be careful to ask questions adapted to the station of life of the supposed lunatic. A man is not necessarily mad because he cannot perform simple, arithmetical operations or does not know about things with which his questioner is well acquainted. The opinion of a supposed lunatic that his examiner's feet were large was not considered by the commissioners among the facts indicating insanity. Yet statements quite as observed are made by medical men as facts of insanity observed by themselves. Reads his Bible and is anxious about the salvation of his soul is another example of a bad certificate. Some well-marked delusion should be recorded. For a lunacy certificate, reception order on petition or judicial reception order, except in the case of a pauper patient, there are required the signatures of two independent medical men and of a relation or friend. The medical men must not be in partnership or in any way interested in the patient. They must make separate visits at different times, and write on the proper forms the facts observed by themselves and those observed by others, giving the name of the informer. A certificate is valid only for seven days. In very urgent non-pauper cases, the signature of one medical man is sufficient, but such certificate, or urgency order, is only valid for two days. And, as the patient can only be detained in the asylum under this order for seven days in England or three in Scotland, it must be supplemented by another signed as above directed. The medical certificate must contain a statement that it is expedient for the alleged lunatic to be placed forthwith under care, with reasons for making such statement. The certifying medical practitioner must have personally examined the patient not more than two clear days before his reception. In London, and other large towns, where an expert opinion is readily obtainable, it is not expedient to resort to such urgency orders. Medical men should be careful how they sign certificates of insanity. No medical man is bound to certify, but if he does so, he is prepared to take the responsibility of his acts. There must be no reasonable ground for alleging want of good faith or reasonable care. The practitioner must exercise that amount of care and skill which he may reasonably be expected to possess. Chapter 45 The Ennebarites Acts It is somewhat difficult to define an inebriate, but for the moment the following will suffice and will ultimately, in all probability be officially adopted. An inebriate is a person who habitually takes or uses any intoxicating thing or things, and while under the influence of such thing or things or in consequence of the effects thereof is a. dangerous to himself or others, or b. a cause of harm or serious annoyance to his family or others, or c. incapable of managing himself or his affairs or of ordinary proper conduct. Under the provisions of the Habitual drunkards acts 42 and 43 of Victoria c. 19 and 51 and 52 Victoria c. 19 Any Habitual drunkard may voluntarily place himself under restraint. He must make an application to the owner of a licensed retreat stating the time during which he undertakes to remain. His application must be accompanied by a statutory declaration of two persons stating that they knew the applicant to be a confirmed drunkard. Without this testimony as to moral character his application cannot be entertained. His signature must also be attested by two justices who must state that he understands the effect of his application and that it has been explained to him. The limit to the term of restraint is 12 months after which he must resume his former habits if he wishes to qualify for another period. The act works automatically and when it has been set for a certain time the patient cannot release himself until the period has expired. The inebriate's retreat must be duly licensed and the licensee incurs distinct obligation and return for the powers entrusted to him. It is an offence against the act to assist any habitual drunkard to escape from his retreat and should he succeed in affecting his escape he may be arrested on a warrant. A drunkard who does not obey orders to conform to the rules of the establishment may be sent to prison for seven days. It may be as well to mention that it is an offence to supply any drunkard under the act with any intoxicating drink or sedative or stimulant drug without authority and that the penalty is a fine of twenty pounds or three months imprisonment. The act is a good one but might be carried farther it has been ruled that a crime committed during drunkenness is as much a crime as if committed during sobriety. A person is supposed to know the effect of drink and if he takes away his senses by drink it is no excuse. He is held answerable both for being under the influence of alcohol or of any other drug and for the acts such influence induces. The inebriate's act if an habitual drunkard be sentenced to imprisonment or penal servitude for an offence committed during drunkenness or if he has been convicted four times in one year the court may order him to be detained for a term not exceeding three years in an inebriate reformatory. End of Section 9 Section 10 of Aids to Forensic Medicine and Toxicology This is a LibriVox recording All LibriVox recordings are in the public domain. For more information or to volunteer please visit LibriVox.org Recorded by Laurie Ann Walden Aids to Forensic Medicine and Toxicology by W. G. H. H. Robertson Section 10 Part 2 Toxicology 1. Definition of a Poison Though the law does not define in definite terms what a poison really is it lays stress on the malicious intention in giving a drug or other substance to an individual. It is a felony to administer or cause to be administered any poison or other destructive thing with intent to murder or with the intention of stupefying or overpowering an individual so that any indictable offence may be committed. It is a misdemeanor to administer any poison or destructive or noxious thing merely to aggrieve, injure or annoy an individual. For working definition we may state that a poison is a substance which when introduced into or applied to the body is capable of injuring health or destroying life. A poison may therefore be swallowed, applied to the skin, injected into the tissues or introduced into any orifice of the body. 2. Sale of Poisons Scheduled Poisons The sale of poisons is regulated by various acts like the Pharmacy Act 1868 and by the Poisons and Pharmacy Act 1908. Only registered medical practitioners and legally qualified drugists are permitted to dispense and sell scheduled poisons. They are responsible for any errors which may be committed in the sale of poisons. If a drugist knows that a drug in a prescription is to be used for an improper purpose he may refuse to dispense it. The practitioner who carelessly prescribes a drug in a poisonous dose is not held responsible but the dispenser would be if he dispensed it and harmful or fatal consequences followed on its being swallowed. When a dispenser finds an error in a prescription it is his duty to communicate with the prescriber privately pointing out the mistake. A great responsibility rests on the medical man who does his own dispensing as there is no one to check his work. If a doctor prescribes a drug with the intention of curing or preventing a disease but that contrary to expectation and general experience it causes illness or even death no responsibility can rest with the prescriber. It has to be proved that actual injury has been sustained by the complainant before an action for damages can be commenced and that the plaintiff was free from all contributory negligence. Scheduled Poisons By the Pharmacy Act of 1868 two groups of poisons are scheduled. Part 1 contains a list of those which are considered very active poisons i.e. arsenic, alkaloids, belladonna, cantherides, coca if containing more than 1% alkaloids, corrosive sublimit, diacolon, cyanides, tartar-imetic, ergot, noxfomica, laudanum, opium, savon, picrotoxin, verinal, and all poisonous urethanes, pusic acid, vermin killers, etc. Such poisons must not be sold to strangers, but only to persons known to or introduced by someone known to the drugist. If sold, the latter must enter into the poison register, the name of the poison, the name of the person to whom it is sold, the quantity and purpose for which it is to be used, and date of sale. The entry must be signed by the purchaser and by the introducer. The word poison must be affixed to the bottle or package, and also the name and address of the seller. Part 2 contains a list of poisons supposed to be less active. These may only be sold if on the bottle, box, or package there is affixed a label with the name of the article, the word poison, and the name and address of the seller. It is not necessary to enter the transaction in a register. Chemists are required to keep poisons in specially distinguishable bottles and these in a special room or a lot cupboard. Dangerous Drugs Act, 1920 The regulations restrict the manufacture and sale of opium, morphine, cocaine, and heroin so as to prevent their abuse. Preparations containing less than one fifth percent of the first two or less than one tenth percent of the last two are excluded. Prescriptions containing the above drugs must be dated and signed with the full name and address of the prescriber and must have also those of the patient. The total amount of the drug to be supplied must be stated and it must not be dispensed more than once. The dispenser retains the prescription. Special books must be kept recording the purchase and sale of these drugs. Proprietary Medicines Bill introduced in 1920 and likely soon to become law. The sale of any unregistered proprietary medicine purporting to cure certain diseases or produce abortion is made in offense. A register of proprietary medicines etc. is established. The object is to protect the public against quack remedies. Notification of Poisoning Every case of poisoning which occurs in any industry lead, arsenic, anthrax, etc. must be notified by the medical attendant to the chief inspector of factories in workshop act 1895. Action of Poisons Classification of Poisons Action of Poisons They may act either locally or only after absorption into the system. Local Action As seen in Corrosive Poisons Irritant Poisons Causing congestion and inflammation of the mucus membranes. Metallic and vegetable irritants Stimulants or sedatives to the nerve endings as aconite, conium, cocaine. Remote Action This may be of reflex character as seen in the shock produced by the pain caused by corrosive poisons or the poison may exert a special action on certain structures as belladonna on the cells of the brain strictening on the motor nerve cells of the spinal cord. Both ways Certain Poisons that act as carbolic or oxalic acids act in this way. Age, idiosyncrasy, tolerance and disease all exert modifying influences on the action of a poison. The form in which the poison is swallowed and the quantity also determine its action. In the gaseous form Poisons act most rapidly and fatally. When in solution and injected hypodermically they also act very rapidly. In the solid form they act as a rule slowly and may even set up vomiting and so may be entirely ejected by vomiting. Poisons act most energetically when the stomach is empty. If taken when the stomach already contains food, solution and absorption may be greatly delayed. Some poisons are cumulative in their action and thus even if infinitesimal doses be swallowed each day there is a certain amount of storage in the tissues though a certain percentage of the poison is constantly eliminated. And at last symptoms of poisoning show themselves. Classification of poisons as an aid to memory the following classification is perhaps the best. 1. Inorganic Sub 1. Corrosive acids and alkalis and caustic salts Carbolic and oxalic acids also Sub 2. Irritant Practically all the metals and the metalloids. Iodine, chlorine, bromine, phosphorus. 2. Organic Sub 1. Irritant Animal, venomous bites food poisoning, quenthardies Vegetable All strong purgatives. Heleborus, Savin, U, Urgot, Hemlock, Labyrinum, Bryony, etc. Sub 2. Neuronic A. Somniferous Opium and its alkaloids B. Deliriant Belladonna, Hyosciamus, Stromanium, Cannabis, Cocaine, Cocholus, Campfer, Fungi C. Inebrients Alcohol, Ether, Chloral, Carbolic Acid, Weak, Benzol, Aniline, Nitroglycerin Sub 3. Sedative or Depressant A. Neural Cognum, Labelia, Tobacco, Phytostigma Cerebral, Hydrocyanic Acid C. Cardiac Acanite, Digitalis, Colchicum, Viratrum Sub 4. Excitomotory or Convulsives Noxvomica, Strychnine Sub 5. Vulnerance Powdered Glass 3. Asphyxia Poisonous and Irrespirable Gases 4. Evidence Evidence of Poisoning It may be inferred that poison has been taken from consideration of the following factors. Symptoms and postmortem appearances, experiments on animals, chemical analysis, and the conduct of suspected persons. 1. Symptoms in poisoning usually come on suddenly when the patient is in good health and soon after taking a meal, drink, or medicine. Many diseases, however, come on suddenly and in cases of slow poisoning the invasion of the symptoms may be gradual. 2. Postmortem appearances These, in many poisons and classes of poisons, are characteristic and unmistakable. The postmortem appearances peculiar to the various poisons will be described in due course. 3. Experiments on animals These may be of value but are not always conclusive. 4. Chemical analysis This is one of the most important forms of evidence as a demonstration of the actual presence of a poison in the body carries immense weight. The poison may be discovered in the living person by testing the urine, the blood abstracted by bleeding, or the serum of a blister. In the dead body it may be found in the blood, muscles, viscera, especially the liver, and secretions. Its discovery in these cases must be taken as conclusive evidence of administration. If, however, it be found only in substances rejected or avoided from the body, the evidence is not so conclusive as it may be contented that the poison was introduced into or formed in the material examined after its rejection from the body, or if the quantity be very minute, it will be argued that it is not sufficient to cause death. A poison may not be detected in the body owing to defective methods, smallness of the dose required to cause death, or to its ejection by vomiting or its elimination by the excretions. Five. Conduct of suspected persons. A prisoner may be proved to have purchased poison, to have made a study of the properties and effects of poison, to have concocted medicines or prepared food for the deceased, to have made himself the sole attendant of the deceased, to have placed obstacles in the way of obtaining proper medical assistance, or to have removed substances which might have been examined. Five. Symptoms and post-mortem appearances of different classes of poisons. Whilst recognizing the fact that toxic agents cannot be accurately classified, the following grouping may for descriptive purposes be admitted with the view of saving needless repetition. One. Corrosives. Characterized by their destructive action on tissues with which they come in contact. The principal inorganic corrosives are the mineral acids, the caustic alkalis, and their carbonates. The organic are carbolic acid, strong solutions of oxalic acid, and acetic acid. Symptoms. Burning pain in mouth, throat, and gullet. Strong acid, metallic or alkaline taste, wretching and vomiting, the discharged matters containing shreds of mucus, blood, and the lining membrane of the passages. Inside of mouth corroded. There are also dysphagia, thirst, dyspnea, small infrequent pulse, anxious expression, shock. Death may result from shock, destruction of the parts, for example, perforation of stomach or duodenum, suffocation, or some weeks subsequently death may be due to stickotritional contraction of the gullet, stomach, or pylorus. Post-mortem appearances. Those of corrosion with corrugation from strong contraction of muscular fibers and followed by inflammation and its consequences. The mouth, gullet, and stomach, and in some cases the intestines, may be white, yellow, or brown, shriveled and corroded. The corrosion may be small, or may extend over a very large surface. Sometimes considerable portions of the lining membrane of the gullet or stomach may be discharged by vomiting or by stool. Beyond the corroded parts, the textures are acutely inflamed. The stomach is filled with a yellow, brown, or black gelatinous liquid, or black blood, and may, in rare cases, be perforated. Two, irritants. These are substances which inflame parts to which they are applied. The class includes mineral, animal, and vegetable substances, and contains a larger number of poisons than all the other classes to gather. They can be divided into two groups. One, those which destroy life by the irritation they set up in the parts to which they are applied. Two, those which add to local irritation, peculiar or specific remote effects. The first group includes the principal vegetable irritants, some alkaline salts, some metallic poisons, etc. And the second comprises the metallic irritants, the metalloids, phosphorus and iodine, non-animal substance, cantharides. Symptoms. Burning pain and constriction in throat and gullet, pain and tenderness of stomach and bowels, intense thirst, nausea, vomiting, purging and tenazmus, with bloody stools, dysuria, cold skin, and feeble and irregular paltz. The vomit consists at first of the food, then it becomes bile stained, and later dark coffee grounds in appearance, due to inflammation of blood from the over-destinted vessels and the gastric mucous membrane. Death may occur from shock, convulsions, collapse, exhaustion, or from starvation on account of chronic inflammation of the gastrointestinal mucous membrane. Postmortem appearances. Those of inflammation and its consequences. Coats of stomach, faussies, gullet and duodenum may be thickened, black, ulcerated, gangrenous, or sloughing. Vessels filled with dark blood ramify over the surface. Acute inflammation is often found in the small intestines, with ulceration and softening of mucous membrane. The rectum is frequently the seat of marked ulceration. Poisons acting on the brain. Three classes, the opium group producing sleep, the belladonna group producing delirium and delusions, and the alcohol group causing exhilaration followed by delirium or sleep. Symptoms. Of the opium group, giddiness, headache, dimness of sight, contraction of the pupils, noises in the ears, drowsiness and confusion passing into insensibility. Of the belladonna group, delirium, illusions of sight, dilated pupils, dry mouth, thirst, redness of skin, coma. Of the alcohol group, excitement of circulation and of cerebral functions, want of power of coordination and of muscular movement, double vision, mania, followed by profound sleep and coma. In the chronic form, delirium trimmins. Postmortem appearances. In the opium group, fullness of the sinuses and veins of the brain with the fusion of serum into the ventricles and beneath the membranes. In the belladonna group, nil. In the alcohol group, signs of inflammation, congestion of brain and membranes, fluidity of blood, long continued rigor mortis. Four. Poisons acting on the spinal cord. Strychnine, brucine, thebaine. The leading symptom is totanic spasm. Five. Poisons affecting the heart. These kill by sudden shock, syncope or collapse. They comprise prosic acid, dilute solution of oxalic acid and oxalates, aconite, digitalis, strophanthus, convalaria and tobacco. Six. Poisons acting on the lungs. These have for their type carbonic acid gas and coal gas. The fumes of ammonia are intensely irritating and may give rise to laryngitis, bronchitis and even pneumonia. Nitric acid fumes sometimes produce no serious symptoms for an hour or more. But there may then be coughing, difficulty of breathing and tightness in the lower part of the throat, followed by a capillary bronchitis. End of section 10. Chapter 11 of AIDS to Forensic Medicine and Toxicology. This library works recording is in the public domain. Recording by Zonya. AIDS to Forensic Medicine and Toxicology by W.G. H.H. Son and Robertson. Chapter 11. Six. Duty of practitioner and supposed case of poisoning. If called to a case supposed or suspected to be one of poisoning, the medical man has two duties to perform. To save the patient's life and to place himself in a position to give evidence if called on to do so. If life is extinct, his duty is a simple one. He should make inquiries as to symptoms and time at which fruit or medicine was last taken. He should take possession of any food, medicine, vomited matter, urine, or feces in the room and should seal them up in clean vessels for examination. He should notice the position and temperature of the body, the condition of rigor mortis, marks of violence, appearance of lips and mouth. He should not make a post-mortem examination without an order in ranging from the coroner. In making a post-mortem examination, the elementary canal should be removed and preserved for further investigation. A double ligature should be passed around the esophagus and also around the duodenum a few inches below the pyrus. The gut and the gullet being cut across between these ligatures, the stomach may be removed entire without spilling its contents. The intestines may be removed in a similar way and the whole or a portion of the liver should be preserved. These should all be put in separate jars without any preservative fluid, tied up, sealed, labelled and initialed. All observations should be at once committed to writing, or they will not be admitted by the court for the purpose of refreshing the memory whilst giving evidence. If the medical practitioner is in doubt on any point, he should obtain technical assistance from someone who has paid attention to the subject. After poisoning, is it the duty of the doctor to inform the police? He would be unwise to do so. He had much better stick to his own business and not act as an amateur detective. 7. Treatment of Poisoning The most of treatment may be ranged under three heads. One, to eliminate the poison. Two, to antagonize its action. Three, to avoid the tendency to death. First, the first indication is met by the administration of ametics to produce vomiting or by the application of the stomach tube. The best ametic is that which is at hand. If there is a choice, give epimorphine hypodermically. The dose for an adult is 10 minutes. It may be given in the form of the injection of the pharmacopoeia or preferably as a tablet dissolved in water. Epimorphine is not elated in physiological action to morphine and may be given in cases of narcotic poisoning. Cipher of zinc, salt and water, epikakurana and mustard are all useful as ametics. Tickling the forces with a feather may excite vomiting. In using the elastic stomach tube some fluid should be introduced into the stomach before attempting to empty it. Or a portion of the mucus membrane may be sucked into the aperture. The tube should be examined to see that it is not broken or cracked, as excellence have happened from neglecting this precaution. The bowels and kidneys must also be stimulated to activity to help in the elimination of the poison. Second. The second indication is met by the administration of the appropriate antidote. Antidotes are usually given hypodermically or if their mouth in the form of tablets. In the absence of the hypodermic syringe the remedy may be given by the rectum. In the selection of the appropriate antidote a knowledge of pharmacology is required especially of the physiological antagonism of drugs. Antidotes may act one, chemically, by forming harmless compounds, a slime and acylic acid poisoning. Two, physiologically the drug which is administered neutralizing more or less completely the poison which has been absorbed. Three, physically, as charcoal. Every doctor should provide himself with an antidote case. The various antidotes will be mentioned under their respective poisons. Third. To avoid the tendency to death we must endeavor to palliate the symptoms and neutralize the effects of the poison. Pain must be relieved by the use of morphine. Inflamed mucus membrane soothed by such demarkens as oils, milk, starch. Stimulants to overcome collapse saline and fusions and shark, etc. In the case of narcotics and depressing agents stimulants, electricity and cold effusions may be found useful. We should endeavor to promote the elimination of the poison from the body by stimulating the secretions. Eight. Detection of Poisons. Notice the smell, color and general appearance of the matter submitted for examination. The odor may show the presence of pussic acid, alcohol, opium or phosphorus. The color may indicate salts of copper, cantherides, etc. Seeds of plants may be found. This examination having been made the contents of the elementary canal and any other substances to be examined must be submitted to chemical processes. Simple filtration will sometimes suffice to separate the required substance. In other cases, dialysis will be necessary in order that crystallite substances may be separated from colloid bodies. In the case of volatile substances distillation will be required. The poisons thus sought for are alcohol, phosphorus, iodine, chlorval, ether, acid, carbolic acid, nitrobenzyl, chloroform and aniline. The organic matters are placed in a flask, diluted with distilled water if necessary and acidulated with tartaric acid. The flask is heated in a water bath and the vapor is condensed by a Leavix condenser. In the case of phosphorus the condenser should be of glass and the process of distillation conducted in the dark so that the luminosity of the phosphorus may be noted. For the separation of an alkaloid, the following is the process of Stas Otto. This process is based upon the principle that the salts of the alkaloids are soluble in alcohol and water and insoluble in ether. The pure alkaloids with the exception of morphine in its crystalline form are soluble in ether. Make a solution of the contents of the stomach or solid organs minced very fine by digesting them with acidulated alcohol or water and filtering. The filtrate is shaken with ether to remove fat etc. The ether is separated the water resolution neutralized with soda and then shaken with ether which removes the alkaloid in a more or less impure condition. The knowledge of these facts will help to explain the following details which may be modified to suit individual cases. One, treat the organic matter after distillation for the volatile substances just mentioned with twice its weight of absolute alcohol. Free from fusel oil to which from 10 to 30 grains of tartaric or oxalic acid have been added and subject to a gentle heat. Two, cool the mixed-gen filter. Wash the residue with strong alcohol and mix the filtrates. The residue may be set aside for the detection of the metallic poisons if suspected. Expel the alcohol by careful evaporation. On the evaporation of the alcohol the resinous and fatty matter separate. Filters will filter moistened with water. Evapuate the filtrate to a syrup and extract with successive portions of absolute alcohol. Filters will filter moistened with alcohol. Evapuate filtrate to dryness and dissolve residue in water the solution being made distinctly acid. Now shake watery solution with ether. Three, ether from the acid solution dissolves out colchicin, digitallin, cantheridin and pyquotoxin and traces of varotin and atropine. Separate the ethereal solution and evaporate. Hot water will now dissolve out pyquotoxin, colchicin and digitallin but not cantheridin. Four, the remaining acid watery liquid holding the other alkaloids in solution or a suspension is made strongly alkaline with soda. Mixed with four or five times its spike of ether, chloroform or benzene bristly shaken and left to rest. The ether floats on the surface holding the alkaloids except morphine in solution. Five, a part of this ethereal solution is poured into a washed glass and allowed to evaporate. If the alkaloid is volatile, all the streaks appear on the glass. If not volatile, crystalline traces will be visible. If a volatile alkaloid add a few pieces of calcium chloride to ethereal solution to absorb the water. Draw off the ethereal solution with a pipette, allow to evaporate and test the residue for the alkaloids conine and nicotine. If a fixed alkaloid treats the acid solution with soda or potash and ether, evaporate ethereal solution after separation when the solid alkaloid will be left in an impure state. To purify it, add a small quantity of dilute sulfuric acid and after evaporating to three quarters of its bulk, add a saturated solution of carbonate of potash or soda. Absolute alcohol will then dissolve out the alkaloid and leave it on evaporation in a crystalline form. General reactions for alkaloids 1. Wagner III agent iodine dissolved in a solution of potassium iodide yields a reddish brown precipitate. 2. Meyers III agent potassium mercuric iodide gives the yellowish white precipitate. 3. Phosphorum molybdic acid gives the yellow precipitate. 4. White or brown precipitate. 5. Tenic acid etc. In order to isolate an inorganic substance from organic matter, Frosinius method is adopted. Boil the finely divided substance with about one-eighths its bulk of pure hydrochloric acid. Add from time to time potassium chloride until the solids are reduced to a straw-yellow fluid. Treat this with excess of bisulfate of sodium, then saturate the ferrated hydrogen until metals are thrown down as sulphides. These may be collected and tested. From the acid solution hydrogen sulphide precipitates copper, lead and mercury. Dark. Arsenic, antimony and tin yellowish. If no precipitate, add ammonia and ammonium sulphide. Iron, black, zinc, white, chromium, green, anganese, pink. The residue of the material after digestion with hydrochloric acid and potassium chloride may have to be examined for silver, lead and barium. For the detection of minute quantities the microscope must be used and geese and halvex method of sublimation will be found advantageous. Crystalline poisons may be recognized by their characteristic forms. End of chapter 11. Chapter 14. Of AIDS to Forensic Medicine and Toxicology This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer please visit LibriVox.org AIDS to Forensic Medicine and Toxicology by W.D. Acheson-Robertson Chapter 9. The Mineral Acids These are sulfuric, nitric acid. Symptoms of poisoning by the mineral acids. Acid taste in the mouth with violent burning pain extending into the esophagus and stomach and commencing immediately on the poison being swallowed. Irrectations, constant retching and vomiting of brown, black or yellow matter containing blood, coagulated mucus, epithelium or portions of the lining membrane of the gullet and stomach. The vomited matters are strongly acid in reaction and pain articles of clothing on which they may fall. There is intense thirst and constipation with scanty or suppressed urine, tenesmus and small and frequent pulse. The lips, tongue and inside of the mouth are shriveled and corroded. Exhaustion succeeds and the patient dies either collapsed, convulsed or suffocated. The intellect remaining clear to the last. After recovering from the acute form of poisoning the patient may ultimately die from starvation due stricture of the esophagus, stomach, etc. Postmortem appearances common to the mineral acids. Stains and corrosions about the mouth, chin and fingers or wherever the acid has come in contact. The inside of the mouth, fausties and esophagus is white and corroded, yellow or dark brown and shriveled, epiglottis contracted or swollen, stomach filled with brown, yellow or black glutinous liquid, its lining membrane is charred or inflamed and the vessels are injected. Pylorus contracted. Perforation when it takes place is on the posterior aspect. The apertures are circular and surrounded by inflammation and black extravasation. The blood in the large vessels may be coagulated. Avoid mistaking gastric or duodenal ulcer with or without perforation for the effects of a corrosive poison. Treatment Calcined magnesia or the carbonate or bicarbonate mixed with milk or some musilaginous liquid are the best antidotes. In the absence of these, chalk, whiting, milk, oil, soap suds, etc., will be found of service. The stomach pump should not be used. If the breathing is impeded, tracheotomy may be necessary. Injuries of external parts by the acid must be treated as burns. Chapter 10. Sulfuric Acid Sulfuric acid or oil of vitriol may be concentrated or diluted. It is frequently thrown over the person to disfigure the features or destroy the clothes. Parts of the body touched by it are stained first white, then dark brown or black. The presence of corrosion of the mouth is as important as the chemical tests. Black will enclose our turn to a dirty brown, the edges of the spots becoming red in a few days. Due to the dilution of the acid from the absorption of moisture, the stains remain damp for long, owing to the hygroscopic property of the acid. Method of extraction from the stomach. The contents of the stomach or vomited matter should, if necessary, be diluted with pure distilled water and filtered. The stomach should be cut up into small pieces and boiled for some time in water. The solution, filtered and concentrated, is now ready for testing. Blood, milk, etc. may be separated by dialysis and the fluid so obtained tested. A sulfate may be present. Take a portion of the liquid, evaporate to dryness and incinerate. A sulfate, if present, will be obtained and may be tested. Caution. Sulfuric acid may not be found even after large doses, due to treatment, vomiting or survival for several days. In all cases, every organ should be examined. Vomited matters and contents of stomach should not be mixed, but each separately examined. This rule holds good for all poisons. On cloth, the stain may be cut out, boiled in water, the solution filtered and tested with blue litmus and other tests. Postmortem appearances. Where the acid has come in contact with the mucous membranes, there are dark brown or black patches. The stomach is greatly contracted. The summits of the mucous membrane ridges being charred and the furrows greatly inflamed. The contents are black or brown. Tests. Concentrated acid chars organic matter, evolves heat when added to water and sulfurous fumes when boiled with chips of wood, copper cuttings or mercury. Dilute acid chars paper when the paper is heated, gives a white precipitate with nitrate or chloride of barium and is entirely volatilized by heat. Dilute solutions give a white precipitate with barium nitrate, insoluble and hydrochloric acid even on boiling. Fatal dose. In an adult, one drachm. Fatal period. Shortest three-quarters of an hour. Average period from onset of primary effects, 18 to 24 hours. Chapter 11 Nitric acid. Nitric acid or aquafortis is less frequently used as a poison than sulfuric acid. The fumes from nitric acid have caused death from pneumonia in 10 or 12 hours. Method of extraction from the stomach. The same as for sulfuric acid. In beer, etc., the mixture may be neutralized with carbonate of potassium. Dialized, the fluid concentrated and allowed to crystallize. When crystals of nitrate of potassium may be recognized. Postmortem appearance. The mucous membranes are rendered yellow or greenish if bile be present. They are also thickened and hardened. Tess. Concentrated acid gives off irritating orange colored fumes of nitric acid gas. When poured on copper, it gives off red fumes and leaves a green solution of nitrate of copper. It gives a red color with brucine turns the green sulfate of iron black and with hydrochloric acid dissolves gold. A delicate test for the acid, free or in combination, is to dissolve in the suspected fluid some crystals of ferrous sulfate and then to gently pour down the test tube some strong sulfuric acid. Where the two liquids meet, if nitric acid be present, a reddish brown ring will be formed. It turns the skin bright yellow and does the same with woolen clothes from the formation of picric acid. Fatal dose, two drachms. Fatal period, shortest one hour and three quarters in an adult, in infants in a few minutes from suffocation. Chapter 12 Hydrochloric acid Hydrochloric acid, myriadic acid or spirit of salt is not uncommonly used for suicidal purposes being fifth in the list. Method of extraction from the stomach, the same for sulfuric acid. As hydrochloric acid is a constituent of the gastric juice, the signs of the acid must be looked for. Postmortem appearances. The mucus membranes are dry, white and shriveled and often eroded. Tess. The concentrated acid yields dense white fumes with ammonia. When worn with black oxide of manganese and strong sulfuric acid, it gifts off chlorine recognized by its smell and bleaching properties. Diluted it gives with nitrate of silver a white precipitate which is insoluble in nitric acid and in caustic potash but is soluble in ammonia and when dried and heated melts and forms a horny mass. Stains on clothing are reddish brown in color. Fatal dose half an ounce. Fatal period, shortest two hours, average 24 hours. Death may occur after an interval of some weeks from destruction of the gastric glands and the inability to digest food. Chapter 13 Oxalic acid Oxalic acid is used by suicides though not often by murderers. The crystals closely resemble those of epsom salts or sulfate of zinc. Oxalic acid has been taken in mistake for the former. It is in common use for cleansing brass and laundry work for dying purposes and especially for bleaching straw hats. Symptoms. If a concentrated solution be taken, it acts as a corrosive causing a burning acid intensely sour taste which comes on immediately great pain and tenderness and burning a pit of stomach, pain and tightness in throat. Vomiting of mucus, bloody or dark coffee ground matters, purging and tenesmus, followed by collapse, feeble pulse, cyanosis and pallor of the skin also swelling of tongue with dysphagia. In some cases cramps and numbness in limbs, pain in head and back, delirium and convulsions may be tetanus or coma. If taken freely diluted the nervous symptoms predominate and may resemble narcotic poisoning sometimes almost instant death. Post-mortem appearances. Mucous membranes of mouth, throat and gullet, white and softened as if they had been boiled there are often black or brown streaks in it. Stomach contains dark, grimace matter and is soft, pale and brittle intestines slightly inflamed stomach sometimes quite healthy. Treatment. Warm water then chalk, carbonate of magnesium or lime water freely not alkalis as the oxalates of the alkalis are soluble and poisonous. Castor oil emetics but not stomach pump. Fatal dose one dracum is the smallest but half an ounce is usually fatal. Method of extraction from the stomach. Mince up the coats of the stomach and boil them in water or boil the contents of the stomach and subject them to dialysis. Concentrate the distilled water outside the tube containing the vomited matters etc. and apply tests. Tests. White precipitate with nitrate of silver, soluble in nitric acid and ammonia. When the precipitate is dried and heated on platinum foil it disperses as white vapor in that nation. Sulfate of lime in excess gives a white precipitate soluble in nitric or hydrochloric acid but insoluble in oxalic, tartaric, acetic or any vegetable acid. Oxalate or bin oxalate of potash. Salts of sorrel or salts of lemon is almost as poisonous as the acid itself. Chapter 14 Carbolic Acid Carbolic acid, phenic acid or is mostly employed as a disinfectant and is often supplied in ordinary beer bottles without labels. Symptoms. An intense burning pain extending from the mouth to the stomach and intestines. Indications of collapse soon supervene. The skin is cold and clammy and the lips, eyelids and ears are livid. This is followed by insensibility, coma, stratoris breathing, abolition of reflex movements, hurried and shallowed respiration The pupils are usually contracted and the urine, if not suppressed is dark in color or even black. Patients often improve for a time and then die suddenly from collapse. When the poison has been absorbed through the skin or mucous membranes, a mild form of delirium with great weakness and levidity are the first signs. Postmortem. If strong acid has been swallowed, the lips and mucous membranes are hardened, whitened and corrugated. In the stomach the tops of the folds are whitened and eroded while the furrows are intensely inflamed. Treatment. Soluble sulfates which form harmless sulfo carbolates in the blood should be administered at once. An ounce of epsom salt or globbers salts dissolved in a pint of water will answer the purpose admirably. After this an emetic of sulfate of zinc may be given. White of egg and water or olive oil may prove useful. Warmth should be applied to the body. Fatal dose. One dracum, but recovery has taken place after much larger quantities if well diluted or taken after a meal. Tests are not necessary as the smell of carbolic acid is characteristic. Local action of carbolic acid produces anesthesia and necrosis. Accidents sometimes happen from two strong lotions applied as surgical dressings. Lysol is a compound of creasol and linseed oil soap and is much less toxic than carbolic acid. End of section 12 chapters 9 through 14