 Preface to AIDS to Forensic Medicine and Toxicology by W. G. Atchison-Robertson. 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. Preface to AIDS to Forensic Medicine and Toxicology by W. G. Atchison-Robertson. MD, Doctor of Science, FRCPE. Lecturer on Forensic Medicine, School of Medicine, Edinburgh. Late examiner in the universities of Edinburgh and St. Andrews for the triple board, Diploma in Public Health, etc. Preface to 9th edition. I trust that, having thoroughly revised the AIDS to Forensic Medicine, it may prove as useful to students, preparing for examination in the future as it has been in the past. W. G. Atchison-Robertson. Surgeons Hall, Edinburgh, November 1921. Preface to 8th edition. This work of the late Dr. William Murrell, having met with such a large measure of success, the publishers thought it would be well to bring out a new edition, and invited me to revise the last impression. This I have done, and while retaining Dr. Murrell's text closely, I have made large additions in order to bring the AIDS up to present requirements. I have also rearranged the matter with the object of making the various sections more consecutive than they were previously. W. G. Atchison-Robertson. Surgeons Hall, Edinburgh, June 1914. Contents Part 1. Forensic Medicine. Chapter 1. Crimes. Chapter 2. Medical Evidence. Chapter 3. Personal Identity. Chapter 4. Examination of Persons Found Dead. Chapter 5. Modes of Sudden Death. Chapter 6. Signs of Death. 7. Death from Anesthetics. 8. Deception of Death. Survivorship. 9. Assaults, Murder, Manslaughter, etc. 10. Wounds and Mechanical Injuries. 11. Contused Wounds, etc. 12. Ensized Wounds. 13. Gunshot Wounds. 14. Wounds of various parts of the body. 15. Detection of Blood Stains, etc. 16. Death by Suffocation. 17. Death by Hanging. 18. Death by Strangulation. 19. Death by Drowning. 20. Death from Starvation. 21. Death from Lightning and Electricity. 22. Death from Cold or Heat. 23. Pregnancy. 24. Delivery. 25. Feticide or Criminal Abortion. 26. Infanticide. 27. Evidences of Live Birth. 28. Cause of Death in the Fetus. 29. Duration of Pregnancy. 30. Viability of Children. 31. Legitimacy. 32. Superfutation. 33. Inheritance. 34. Impotence and Sterility. 35. Rape. 36. Unnatural Offences. 37. Blackmailing. 38. Marriage and Divorce. 39. Veined Diseases. 40. Mental Unsoundness. 41. Idiocy. Embecility. Pretenism. 42. Dementia. 43. Mania. Lucid Intervals. Undue Influence. Responsibility. Etc. 44. Examination of Persons of Unsound Mind. 45. Inebriate's Acts. 46. Part 2. Toxicology. 47. Chapter 1. Definition of a Poison. 47. Chapter 2. Scheduled Poisons. 48. Classification of Poisons. 49. Evidence of Poisoning. 50. Symptoms and Postmortem Appearances of Different Classes of Poisons. 51. 6. Duty of Practitioner and Supposed Case of Poisoning. 57. Treatment of Poisoning. 58. Detection of Poison. 59. The Mineral Acids. 60. 10. Sulfuric Acid. 60. 11. Nitric Acid. 60. 12. Hydrochloric Acid. 60. 13. Oxalic Acid. 60. 14. Carbolic Acid. 60. 15. Potash, Soda, and Ammonia. 60. Nitrate of Potassium, etc. 70. Potassium salts, etc. 80. Barium salts. 90. Iodine. Iodide of Potassium. 90. Phosphorus. 91. Arsenic and its Preparations. 92. Antimony and its Preparations. 93. Mercury and its Preparations. 94. Lead and its Preparations. 95. Copper and its Preparations. 96. Zinc, Silver, Bismuth, and Chromium. 97. Gaseous Poisons. 98. Vegetable Eritants. 99. Opium and Morphine. 30. Melodona, Hyociamus, and Strimonium. 31. Cocaine. 32. Camphor. 33. Tetrachlorothane. 34. Alcohol, ether, and chloroform. 35. Chlorohydrate. 36. Petroleum and Paraphen Oil. 37. Antipyrene. 37. Antifibrin, Finacetan, and Aniline. 38. Sulfanol, Trianol, Tetranol, Veranol, Peraldehyde. 39. Cognum and Calabarbein. 40. Tobacco and Lobelia. 41. Hydrocyanic Acid. 42. Aconite. 43. Digitalis. 44. Nux, Vomica, Strychnine, and Brusine. 45. Catharitis. 46. Abortifacience. 47. Poisonous Fungi and Toxic Foods. 48. Tomains, or Caterveric alkaloids. End of Preface and Contents. Section 1 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. Recording by Abahi in November 2009. AIDS to Forensic Medicine and Toxicology by W.G. Etchinson-Robinson. Section 1. Part 1. Forensic Medicine. Chapter 1. Crimes. Forensic medicine is also called medical jurisprudence or legal medicine and includes all questions which bring medical matters into relation with the law. It deals therefore with one crimes and two civil injuries. 1. A crime is the voluntary act of a person, of sound mind, harmful to others and also unjust. No act is a crime unless it is plainly forbidden by law. To constitute a crime, two circumstances are necessary to be proved. A. That the act has been committed. B. That a guilty mind or malice was present. The act may be one of omission or one of commission. Every person who commits a crime may be punished unless he is under the age of seven years, is insane or has been made to commit it under compulsion. Crimes are divided into misdemeanors and felonies. The distinction is not very definite but as a rule the former are less serious forms of crime and are punishable with the term of imprisonment generally under two years while felonies comprise the more serious charges as murder, men slaughter, rape which involve the capital sentence or long terms of imprisonment. An offence is a trivial breach of the criminal law and is punishable on summary conviction before a magistrate or justices only while the more serious crimes, indictable offences, must be tried before a jury. Two. Civil injuries differ from crimes in that the former are compensated by damages awarded while the latter are punished. Any person whether injured or not may prosecute for a crime while only the sufferer can sue for a civil injury. The crown may remit punishment for a crime but not for a civil injury. Chapter Two. Medical Evidence On being called the medical witness enters the witness box and takes the oath. This is very generally done by uplifting the right hand and repeating the oath, Scottish form or by kissing the Bible or by making a solemn affirmation. One. He may be called to give ordinary evidence as a common witness. Thus he may be asked to detail the facts of an accident which he has observed and of the inferences he has deducted. The evidence is what any lay observer might be asked. Two. Expert witness On the other hand he may be examined on matters of a technical or professional character. The medical man then gives evidence of a skilled or expert nature. He may be asked his opinion on certain facts narrated. For example, if a certain wound would be immediately fatal. Then he may be asked whether he concurs with opinions held by other medical authorities. In important cases specialists are often called to give evidence of a skilled nature. Thus the hospital surgeon, the nerve specialist or the mental consultant may be served with a subpoena to appear at court on a certain date to give evidence. The evidence of such skilled observers will, it is supposed, carry greater weight with the jury than with the evidence of an ordinary practitioner. Skilled witnesses may hear the evidence of ordinary witnesses in regard to the case in which they are to give evidence. And it is indeed better that they should understand the case thoroughly, but they are not usually allowed to hear the evidence of other expert witnesses. In civil cases the medical witness should, previous to the trial, make an agreement with the solicitor who has called him with reference to the fee he is to receive. Before consenting to appear as a witness, the practitioner should insist on having all the facts of the case put before him in writing. In this way only can he decide as to whether in his opinion the plaintiff or defendant is right as regards the medical evidence. If summoned by the side on which he thinks the medical testimony is correct, then it is his duty to consent to appear. If, however, he is of opinion that the medical evidence is clearly and correctly on the opposite side, then he ought to refuse to appear and give evidence, and indeed the lawyer would not desire his presence in the witness box unless he could uphold the case. Whether an expert witness who has no personal knowledge of the facts is bound to attend on a subpoena is a mood point. It would be safer for him to do so and to explain to the judge before taking the oath that his memory has not been sufficiently refreshed. The solicitor, if he desires his evidence, will probably see that the fees forthcoming. A witness may be subjected to three examinations. First, by the party on whose side he is engaged, which is called the examination in chief, and in which he affords the basis for the next examination or a cross-examination by the opposite side. The third is the re-examination by his own side. In the first, he merely gives a clear statement of facts or of his opinions. In the next, his testimony is subjected to rigid examination in order to weaken his previous statements. In the third, he is allowed to clear up any discrepancies in the cross-examination, but he must not introduce any new matter which would render him liable to another cross-examination. The medical witness should answer questions put to him as clearly and as concisely as possible. He should make his statements in plain and simple language, avoiding as much as possible technical terms and figurative expressions, and should not quote authorities in support of his opinions. An expert witness, when giving evidence, may refer to notes for the purpose of refreshing his memory, but only if the notes were taken by him at the time when the observations were made or as soon after as practicable. There are various courts in which a medical witness may be called on to give evidence. 1. The Coroner's Court When a corona is informed that the dead body of a person is lying within his jurisdiction and that there is reasonable cause to suspect that such person died either of violent or unnatural death by the sudden death of which the cause is unknown, he must summon a jury of not less than 12 men to investigate the matter, in other words, hold an inquest. And if the deceased had received medical treatment, the coroner may summon the medical attendant to give evidence. By the Coroner's Emergency Provisions Act of 1917, the number of the jury has been cut down to a minimum of 7 and a maximum of 11 men. By the Jury's Act of 1918, the coroner has the power of holding a court without a jury if, in his discretion, it appears to be unnecessary. In charges of murder, manslaughter, deaths of prisoners in prison, inmates of asylums or inebriates homes or of infants in nursing homes, he must summon a jury. The coroner may be satisfied with the evidence as to the cause of a person's death and may dispense with an inquest and grant a burial certificate. Cases are notified to the coroner by the police, parish officer, any medical practitioner, registrar of deaths or by any private individual. Witnesses, having been cited to appear, are examined on oath by the coroner, who must, in criminal cases at least, take down the evidence in writing. This is then read over to each witness who signs it and this forms his deposition. At the end of each case, the coroner sums up and the jury returned a verdict or inquisition, either anonymously or by a majority. If this charges any person with murder or manslaughter, he is committed by the coroner to prison to await trial or, if not present, the coroner may issue a warrant for his arrest. A chemical analysis of the contents of the stomach, etc., in suspected cases of poisoning, is usually done by a special analyst named by the coroner. If any witness disobeys the summons to attend the inquest, he renders himself liable to a fine not exceeding £2 to shillings, but in addition the coroner may commit him to prison for contempt of court. In criminal cases, the witnesses are bound over to appear at the assizes to give evidence there. The coroner may give an order for the exhumation of a body if he thinks the evidence warrant supposed mortem examination. Coroner's inquests are held in all cases of sudden or violent death, where the cause of death is not clear, in cases of assault, where death has taken place immediately or sometime afterwards, in cases of homicide or suicide, where the medical attendant refuses to give a certificate of death, where the attendants on the deceased have been culpably negligent or in certain cases of uncertified deaths. The medical witness should be very careful in giving evidence before a coroner. Even though the inquest be held in a coach house or barn, yet it has to be remembered it is a court of law. If the case goes on for trial before a superior court, your deposition made to the coroner forms the basis of your examination. Any misstatements or discrepancies in your evidence will be carefully inquired into, and you will make a bad impression on judge and jury if you modify, retract or explain away your evidence as given to the coroner. You had your opportunity of making any amendments on your evidence when the coroner read over to you your deposition before you signed it as true. By the licensing act of 1902, an inquest may not be held in any premises licensed for the sale of intoxicating liquor if other suitable premises have been provided. The duties of the coroner are based partly on common law and are also defined by statute, principally by the coroner's act of 1887, 50 and 51 Victoria, chapter 71. They have been modified, however, by subsequent acts, for example the act of 1892, the coroner's emergency provisions act 1917 and the jury's act of 1918. The fee payable to a medical witness for given evidence at an inquest is one guinea, with an extra guinea for making a postmortem examination and report. In the metropolitan area these fees are doubled. The coroner must sign the order authorizing the payment and should an inquest be adjourned to a later day, no further fee is payable. If the deceased died in a hospital, infirmary or lunatic asylum, the medical witness is not paid any fee. Should a medical witness neglect to make the postmortem examination after receiving the order to do so, he is liable to a fine of five pounds. In Scotland the procurator Fiscal fulfills many of the duties of the coroner, but he cannot hold a public inquiry. He interrogates the witnesses privately and these questions with the answers from the precognition. More serious cases are dealt with by the sheriff of each county and capital charges must be dealt with by the High Court of Justice sherry. In Scotland the verdicts of the jury may be guilty, not guilty or not proven. 2. The magistrates court or petty sessions is also a court of preliminary inquiry. The prisoner may be dealt with summarily as, for example, in minor assault cases, or if the cases of sufficient gravity and the evidence justifies such a course, may be committed for trial. The fee for a medical witness who resides within three miles of the court is ten shillings and six pence. If at a greater distance, one guinea. In the metropolis the prisoner in the first instance is brought before a magistrate, technically known as the beak, who, in addition to being a person of great acumen, is a stipendiary and thus occupies a superior position to the ordinary JP, who is one of the great unpaid. In the city of London is the mansion house justice room presided over by the Lord Mayor or one of the elder men. The prisoner may ultimately be sent for trial to the Central Criminal Court, known as the Old Bailey, or elsewhere. 3. Quarter sessions. These are held every quarter by justices of the police. All cases can be tried before the sessions, except felonies or cases which involve difficult legal questions. In London this court is known as the Central Criminal Court, and it also acts as the Assize Court. In borough sessions a barrister known as the Recorder is appointed a sole judge. 4. The Assizes deal with both criminal and civil cases. There is the Crown Court, where criminal cases are tried, and there is the Civil Court, where civil cases are heard. Before a case sent up by a lower court can be tried by the judge and petty jury, it is investigated by the ground jury, which is composed of superior individuals. If they find a true bill the case goes on, but if they throw it out the accused is at liberty to take his departure. At the court of Assize the prisoner is tried by a jury of 12. In bringing in the verdict the jury must be anonymous. If they cannot agree the case must be retried before a new jury. At the Assize Court the medical witness gets a guinea day with two shillings extra to pay for his bed and board for every night he is away from home with his second class railway fare, if there is a second class on the railway by which he travels. If there is no railway and he has to walk he is entitled to three pence a mile for refreshments both ways. 5. Court of criminal appeal. This was established in 1908 and consists of three judges. A right of appeal may be based, one solely on a question of law, two on certificate from the judge who tried the prisoner, three on mitigation of sentence. Speaking generally in the superior courts the fees which may be claimed by medical men called on to give evidence are a guinea day if resident in the town in which the case is tried and from two to three guinea's a day if resident at a distance from the place of trial. This to include everything except travelling expenses. The medical witness also receives a reasonable allowance for hotel and travelling expenses. If a witness is summoned to appear before two courts at the same time he must obey the summons of the higher court. Criminal cases take precedence of civil. A medical man has no right to claim privilege as an excuse for not divulging professional secrets in a court of law and the less he talks about professional etiquette the better. Still in a civil case if he were to make an emphatic protest the matter in all probability would not be pressed. In a criminal case he would promptly be reminded of the nature of his oath. A medical man may be required to furnish a formal written report. It may be the history of a fatal illness or the result of a post-mortem examination. These reports must be drawn up very carefully and no technical terms should be employed. No witness on being sworn can be compelled to kiss the book. The oaths act 51 and 52 Victoria chapter 47 paragraph 5 declares without any qualification If any person to whom an oath is administered desired to swear with uplifted hand in the form and manner in which an oath is usually administered in Scotland he shall be permitted to do so and the oath shall be administered to him in such form and manner without further question. The witness takes the oath standing with the bare right hand uplifted above the head the formula being I swear by almighty God that I will speak the truth the whole truth and nothing but the truth. The presiding judge should say the words and the witness should repeat them after him. There is no kissing of the book and the words so help me God which occur in the English form are not employed. It will be noted that the scotch form constitutes an oath and is not an affirmation. The judge has no right to ask if you object on religious grounds or to put any question. He is bound by the provisions of the act and the enactment applies not only to all forms of the witness oath whether in civil or criminal courts or before coronas but to every oath which may be lawfully administered either in Great Britain or Ireland. A witness engaged to give expert evidence should demand his fee before going into court or at all events before being sworn. With regard to notes these should be made at the time on the spot and may be used by the witness in court as a refresher to the memory though not altogether to supply its place. All evidence is made up of testimony but all testimony is not evidence. The witness must not introduce hearsay testimony. In one case only hearsay evidence admissible and this is in the case of a dying declaration. This is a statement made by a dying person as to how his injuries were inflicted. These declarations are accepted because the law presumes that a dying man is anxious to speak the truth but the person must believe that he is actually on the point of death with absolutely no hope of recovery. A statement was rejected because the dying person in using the expression I have no hope of recovery requested that the words at present should be added. If after making the statement the patient were to say I hope now I shall get better it would invalidate the declaration. To make the declaration admissible as evidence death must ensue. If possible a magistrate should take the dying declaration but if he is not available the medical man without any suggestions or comments of his own should write down the statements made by the dying person and see them signed and witnessed. It must be made clear to the court that at the time of making his statement the witness was under the full conviction of approaching or impending death. Chapter 3 Personal Identity It is but seldom that medical evidence is required with regard to the identification of the living though it may sometimes be so as in the celebrated Titch-Born case. The medical man may in such cases be consulted as to family resemblance, marks on the body, navy maternity, scars and tattoo marks or with regard to the organs of generation in cases of doubtful sex. Tattoo marks may disappear during life. The brighter colors as vermilion as a rule more readily than those made with carbon as Indian ink. After death the coloring matter may be found in the proximal glands. If the tattooing is superficial merely underneath the cuticle the marks may possibly be removed by acetic acid or cantherites or even by picking out the coloring matter with a fine needle. With regard to scars and their permanence it will be remembered that scars occasioned by actual loss of substance or by wounds healed by granulation never disappear. The scars of leech bites, lancet wounds or cupping instruments may disappear after a lapse of time. It is difficult, if not impossible, to give any certain or positive opinion as to the age of a scar. Recent scars are pink in color, old scars are white and glistening. The psychotricks resulting from a wound depends upon its situation. Often sized wounds and elliptical psychotricks is typical linear being chiefly found between the fingers and toes. By way of disguise the hair may be dyed black with lead acetate or nitrate of silver or by steeping some of it in dilute nitric acid and testing with iodide of potassium for lead and hydrochloric acid for silver. The hair may be bleached with chlorine of peroxide of hydrogen detected by letting the hair grow and by its unnatural feeling and the irregularity of the bleaching. Fingerprint impressions are the most trustworthy of all means of identification. Such a print is obtained by rubbing the pulp of the finger in lamp black and then impressing it on a glazed card. The impression reveals the fine lines which exist at the tips of the fingers. The arrangement of these lines is special to each person and cannot be changed. Hence this method is employed by the police in the identification of prisoners. In the determination of cases of doubtful sex in the living the following points should be noticed. The size of the penis are clitoris and whether perforate or not the form of the prepuse, the presence or absence of nymphae and of testicles or ovaries. Openings must be carefully sounded as to their communication with bladder or uterus. After puberty inquiry should be made as to menstrual or vicarious discharges. The general development of the body, the growth of hair, the tone of voice and the behavior of the individual towards either sex. With regard to the identification of the dead in cases of death by accident or violence the medical man's assistance may be called. The sex of the skeleton if that only be found may be judged from the bones of the female generally being smaller and more slender than those of the male. With the female thorax being deeper, the coastal cartilages longer, the ilia more expended, the sacrum flatter and broader, the coccyx movable and turned back, the tuberosities of the ischia wider apart, the pubes shallow and the whole pelvis shallower and with larger outlets. But of all these signs the only one of any real value is the roundness of the pubic arch in the female as compared with the pointed arch in the male. Before puberty the sex cannot be determined from an examination of the bones. Age may be calculated from the presence, nature and number of the erupted teeth from the cartilages of the ribs which gradually ossify as age advances from the angle formed by the ramus of the lower jaw with its body, obtuse in infancy, a right angle in the adult and again obtuse in the aged from loss of the teeth and in the young from the condition of the epiphysis with regard to their attachment to their respective shafts. To determine stature the whole skeleton should be laid out and measured, one and a half to two inches being allowed for the soft parts. Chapter 4 Exemination of Persons Found Dead When a medical man is called to a case of sudden death he should carefully note anything likely to throw any light on the cause of death. He should notice the place where the body was found, the position and attitude of the body, the soil or surface on which the body lies, the position of surrounding objects and the condition of the clothes. He should also notice if there are any signs of a struggle having taken place. If the hands are clenched, if the face is distorted, if there has been foaming at the mouth and if urine or feces have been passed involuntarily. Urine may be drawn off with a catheter and tested for albumin and sugar. If required to make a postmortem examination every cavity and important organ of the body must be carefully and minutely examined, the seat of injury being inspected first. Chapter 5 Modes of Sudden Death There are three modes in which death may occur. 1. Syncopy 2. Asphyxia 3. Coma 1. Syncopy is death beginning at the heart, in other words, failure of circulation. It may arise from 1. Anemia or deficiency of blood due to hemorrhage, such as occurs in injuries or from bleeding from the lungs, stomach, uterus or other internal organs. 2. Asthenia or failure of the heart's action met within starvation in exhausting diseases such as pthysis, cancer, pernicious anemia and brides disease and in some cases of poisoning, for example, aconite. The symptoms of syncopy are faintness, giddiness, pallor, slow, weak and irregular pulse, sighing respiration, insensibility, dilated pupils and convulsions. Postmortem the heart is found empty and contracted. When, however, there is sudden stoppage of the heart, the right and left cavities contain blood in the normal quantities and blood is found in the vene cave and in arterial trunks. There is no engorgement of either lungs or brain. 2. Asphyxia or death beginning at the lungs may be due to obstruction of the air passage from foreign bodies in the larynx, drowning, suffocation, strangling and hanging from injury to the cervical cord, effusion into the plurae which consequent pressure on the lungs, embolism of the pulmonary artery and from spasmodic contraction of the thoracic and abdominal muscles in striccin poisoning. The symptoms of this condition are fighting for breath, giddiness, relaxation of the sphincters and convulsions. Postmortem, cadaveric levidity is well marked especially in nose, lips, ears etc. The right cavities of the heart and the vene cave are found gorged with dark fluid blood. The pulmonary veins, the left cavities of the heart and the aorta are either empty or contain but little blood. The lungs are dark and engorged with blood and the lining of the air tubes is bright red in color. Much bloody froth escapes on cutting into the lungs. Numerous small hemorrhages, tardiocespots are found on the surface and in the substance of the internal organs as well as in the skin of the neck and face. 3. Coma or death beginning at the brain may arise from concussion, compression, cerebral pressure from hemorrhage and other forms of apoplexy, blocking of a cerebral artery from embolism, chronic and oremic conditions and from opium and other narcotic poisons. The symptoms of this condition are stupor, loss of consciousness and stoutorous breathing. The postmortem signs are congestion of the substance of the brain and its membranes with accumulation of the blood in the cavities of the heart more on the right side than on the left. It must be remembered that owing to the interdependence of all the vital functions of demarcation between the various modes of death, in all cases of sudden death, think of angina pecturis and the rupture of an aneurysm. The following is a list of some of the commoner causes of sudden death. A. Instantaneously sudden death. 1. Syncope by Father Commonest Cause 2. Our ticking competence 3. Rupture of heart 4. Rupture of a valve 5. Rupture of aortic aneurysm 6. Ambolism of coronary artery 7. Angina pecturis B. Less sudden but unexpected death 1. Cerebral hemorrhage or embolism 2. Mitral and tricuspid valvular lesions if the patient exerts himself 3. Rupture of a gestric or duodenal ulcer 4. Rupture of liver, spleen or extrauterine gestation or abdominal aneurysm 4. Suffocating during an epileptic fit vomited matter or other material drawn into the trachea or air passages 5. Arteriosclerosis may lead to thrombosis, embolism or aneurysm 6. Poisoning as by hydrocyanic acid cyanide of potassium inhalation of carbonic acid or coal gas edema of glottis following inhalation of ammonia 7. Rapid onset of some acute specific disease such as pneumonia or diphtheria collapse from cholera 8. Heat stroke, lightning, shocks of electricity of high tension 9. Mental or physical shock 10. Exertion while the stomach is overloaded 11. Diabetic coma, uremia 12. Status lymphaticus This is a general hyperplastic condition of the lymphatic structures in the body and is seen in enlargement of tonsils, thymus, spleen as well as of pyrus patches and mesenteric glands It is a frequent cause of death during chloroform anesthesia for slight operations in young people In addition, it may be as well to remember that death sometimes occurs suddenly in exoptalmic guiter, hypertrophy of the thymus and in Edison's disease In some cases of sudden death nothing has been found post-mortem even when the autopsy has been made by skilled observers and the brain and cord have been submitted to microscopic examination End of section 1 Section 2 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 Recording by Avayee in November 2009 AIDS to Forensic Medicine and Toxicology by W. G. Etchison-Robertson Section 2 Chapter 6 Signs of Death 1. Cadaveric appearance Ashy white color 2. Sensation of the circulation and respiration No sound being heard by the stethoscope Sensation of the circulation may be determined by a. Placing a ligature around the base of a finger Magnus test b. Injecting a solution of fluorescein i. Card's test c. Looking through the web of the fingers at a bright light diaphanous test d. The dulling of a steel needle when thrust into the living body e. The clear outline of the dead heart when viewed in the fluorescein screen 3. The state of the eye The tension is at once lost iris insensible to light fundus yellow in color cornea dull in sunken 4. The state of the skin pale livid with loss of elasticity 5. Extinction of muscular irritability the above signs afford no means of determining how long life has been extinct the following however do cooling of the body the average internal temperature of the body is from 98 to 100 degrees Fahrenheit the time taken in cooling is from 15 to 20 hours but it may be modified by the kind of death the age of the person the presence or absence of clothing on the body the surrounding temperature and the stillness or otherwise of the ear about the body still the body other things being equal may be said to be quite cold in about 12 hours hypostasis or postmortem staining is due to the settling down of the blood in the most dependent parts of the body while the body is cooling it is a sure sign of death and occurs in all forms of death even in that due to haemorrhage although not so marked in degree postmortem staining cadaveric lividity begins to appear in from 8 to 12 hours after death and its position on the body will help to determine the length of time the body has lain in the position in which it was found the staining is of a dull red or slaty blue color it must be distinguished from achemosis the result of a bruise by making an incision into the part in the case of hypostasis a few small bloody points of divided arteries will be seen in the case of achemosis the subcutaneous tissues are infiltrated with blood clot internally hypostasis must not be mistaken for congestion of the brain or lungs or the results of inflammation of the intestines if the intestine is pulled straight inflammatory redness is continuous hypostasis is disconnected about the neck hypostasis must not be mistaken for the mark of a cord or other ligature when the blood is of a bright red color after death as happens in poisoning by carbon monoxide or hydrogen cyanide or in death from cold the hypostasis is bright red also cadaveric rigidity rigomortis for some time after death the muscles continue to contract on the stimuli when this irritability seizes and itself exceeds 2 hours rigidity and hardening sets in and in all cases precedes putrefaction it is caused by the coagulation of the muscle plasma it commences in the muscles of the back of the neck and lower jaw and then passes into the muscles of the face, front of the neck, chest, upper extremities and lastly to the lower extremities it has been noticed in the newborn infant as well as in the fetus it lasts from 16 to 20 hours or more in lingering diseases after violent exertion and in warm climates it sets in quickly and disappears in 2 or 3 hours in those who are in perfect health and die from accident or asphyxia it may not come on until from 10 to 24 hours and may last 3 or 4 days after death from convulsions or strichnein poisoning the body may pass it once into rigomortis rigomortis must be distinguished from cadaveric spasm or the death clutch in the former articles in the hands are readily removable in the latter this is not the case in titanic spasm the limbs when bent return to their former position not so in rigomortis putrefaction appears in from 1 to 3 days after death as a greenish blue discoloration of the abdomen in the drowned over the head and face this increases becomes darker and more general a strong putrefactive odor is developed the thorax and abdomen become distended with gas and the epidermis peels off the muscles then become pulpy and assume a dark greenish color the whole body at length becoming changed into a soft semi-fluid mass the organ first showing the putrefactive change is the trahia that which resists putrefaction longest is the uterus these putrefactive changes are modified by the fat or lean condition of the body the temperature, putrefaction takes place more rapidly in summer than in winter excess of air, the period, place, mode of interment, age, etc bodies which remain in water putrefy more slowly than those in air saponification in bodies which are very fat and have lain in water or moist soil for from 1 to 3 years this process takes place the fat uniting with the ammonia given off by the decomposition to form a depulsory this consists of a margarite or a stereate of ammonium with lime, oxide of iron, potash, certain fatty acids and a yellowish odorous matter it has a fatty, unctuous feel is either pure white or pale yellow with an odor of decayed cheese small portions of the body may show signs of this change in 6 weeks postmortem examination never make an autopsy in criminal cases without a written order from the corona or procurator frisco if authorized, however, first have the body identified, then photographed if it has not been identified a medical man representing the accused may be present but only by consent of the crown authorities or of the sheriff clothing should be examined for blood stains, cuts, etc examine external surface of body and take accurate measurements of wounds, marks, deformities, tattooings note degree and distribution of postmortem staining, rigidity, etc examine brain by making incision from ear to ear across vertex reflect scalp forwards and backwards and saw of calvarium examine brain carefully externally and on section examine organs of chest and abdomen through an incision made from symphysis menti to pubis reflecting tissues from chest wall and cutting through costal cartilages in cases of suspected poisoning have several clean jars into which you place the stomach with contents intestines with contents, piece of liver, kidney, spleen, etc and seal each up carefully attaching label with name of disease, date and contained organs and transmit these personally to the analyst Exhumation a body which has been buried cannot be exhumed without an order from corona, fiscal or from the home secretary there is no legal limit in England as to when a body may be exhumed in Scotland however if an interval of 20 years has elapsed an accused person cannot be prosecuted prescription of crime Chapter 7 death from anesthetics, etc the corona in England and Wales and Ireland must inquire into every case of death during the administration of an anesthetic the anesthetist has to appear at the inquest and must answer a long series of questions relative to the administration of the drug before therefore giving an anesthetic and so as to furnish yourself with a proper defense in the event of death occurring you ought to examine the heart, lungs and kidneys of the patient to see if they are healthy should a fatal result follow the anesthetist will require to prove that it was necessary to give the anesthetic that the one employed was the most suitable that the patient was in a fit state of health to have it administered that it was given skillfully and in moderate amount that he had the usual remedies at hand in case of failure of the heart or lungs and that he employed every means in his power to resuscitate the patient the condition of the lungs is of more importance than the state of the heart the chloroformist ought always to use the best chloroform an anesthetic should never be administered except in the presence of a third person this applies especially to dentists who give gas to females malpractice in every case where a medical man attends a patient he must give him that amount of care, skill, knowledge or judgment that the law expects of him if he does not then the charge of malpractice may be brought against him it is most frequently alleged in connection with surgical affections that is overlooking a fracture or dislocation before a major operation is performed it is well to get a written agreement Chapter 8 presumption of death, survivorship presumption of death if a person be unheard of for seven years the court may on application by the nearest relative presume death to have taken place if however it can be shown that in all probability death had occurred in a certain accident or shipwreck the decree may be made much earlier presumption of survivorship when two or more related persons perish in a common accident it may be necessary in order to decide questions of succession to determine which of them died first it is generally accepted that the stronger and more vigorous will survive longest Chapter 9 assault, murder, manslaughter, etc. assault this is an attempt or offer to do violence to another person it is not necessary that actual injury has been done but evil intention must be proved when a corporal hurt has been sustained then assault and battery has been committed the assault may be aggravated by the use of weapons, etc. homicide may be justifiable as in the case of traditional execution or excusable as in defense of one's family or property felonious homicide is murder this means that a human being has been killed by another maliciously and deliberately or with reckless disregard of consequences manslaughter or culpable homicide Scotland is the unlawful killing of a human being without malice as homicide after great provocation signal man who allows a train to pass and so collide with another in front End of Section 2 Section 3 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 recording by Jeannie Whitfield AIDS to Forensic Medicine and Toxicology by W. G. H. S. Robertson Section 3 Chapter 10 Wounds and Mechanical Injuries a wound may be defined as a breach of continuity in the structures of the body whether external or internal suddenly occasioned by mechanical violence the law does not define a wound but the true skin must be broken wounds are dangerous from shock, hemorrhage from the supervention of chrysepolis or paema and from malum regimen on the part of the patient or surgeon is the wound dangerous to life? this question can only be answered by a full consideration of all the circumstances of the case a guarded prognosis is wise in all cases burns are caused by flames highly heated solids or very cold solids as solid carbonic acid scalds by steam or hot fluids burns may cause death from shock, suffocation, edema, glutitis inflammation of sero-surfaces bronchitis, pneumonia, duodenal ulcer coma or exhaustion a burn of the skin inflicted during life is followed by a bleb containing serum the edges of this blister are bright red and the base seen after removing the cuticle is red and inflamed if sustained after death a bleb if present contains but little fluid and there are no signs of vital reaction there are 6 degrees of burn 1. superficial inflammation 2. formation of vesicles 3. destruction of superficial layers of skin 4. destruction of cellular tissue 5. deep parts charred 6. carbonization of bones the larger the area of skin burnt the more grave is the prognosis burns of the abdomen and genital organs are especially dangerous young children are specially liable to die after burns Chapter 11 contused wounds and injuries unaccompanied by solution of continuity if a blow be inflicted with a blunt instrument there is produced a bruise or ecumosis of which it is unnecessary here to describe the appearance and progress a bruise may be distinguished from a postmortem stain by the cuticle in the former having been abraded and raised when an incision is made into the bruise the whole of the subcutaneous tissues are found to be infiltrated with blood clot and there is no clear margin in the case of a postmortem stain the edges are sharply defined not raised and on section near bloody points are seen which are the cut ends of the divided blood vessels Chapter 12 incised wounds and those accompanied by solution of continuity these comprise incised punctured and lacerated wounds in a recent incised wound inflicted during life there is copious hemorrhage the cellular tissue is filled with blood the edges of the wound gape and are averted and the cavity of the wound is filled with coagula lacerated wounds combine the character of incised and contused wounds they are caused by falls, being ridden over machinery crushes, bites, blows from blunt weapons, etc the wounds healed by superation punctured wounds come intermediate between incised and lacerated they are greater in depth than in length being caused by sword or rapier thrust they cause little hemorrhage externally but death may be due to internal hemorrhage they may be complicated by the introduction of septic material adhering to the instrument 2. the entrance of foreign bodies which lodge in the wounds not only carrying in septic manner but acting as mechanical irritants 3. injury to deeper parts which may at the time be difficult to detect an apparently incised wound may be produced by a hard blunt weapon over a bone for example a shin or cranium it is often difficult to distinguish between a wound of the scalp inflicted with a knife and one made by a blow with a stick a puncture with a sharp edged pointed knife leaves the fusiform or spindle shaped wound a wound from a blow with a stick might be of this character or it might present a jagged swollen appearance at the margin with much contusion of the surrounding tissues if the wound is seen soon after it is inflicted examination with a lens may disclose irregularities of the margin or little bridges of connective tissue or vessels running across the wound and so be inconsistent with its production by a cutting instrument lacerated wounds as a rule bleed less freely than those which are incised symptoms of concussion would favour the theory of the injury having been inflicted by a heavy instrument again it is often difficult to decide whether the injury which caused death was the result of a blow or a fall a heavy blow with a stick may at once cause fatal effusion of blood but this might equally result from fracture of the skull resulting from a fall the wound should be carefully examined for foreign bodies such as grit, dirt or sand the distinction between incised wounds inflicted during life and after death is found in the fact that a wound inflicted during life presents the appearances as already described whereas in a post-mortem incised wound only a small quantity of liquid venous blood is effused the edges are close, yielding, inelastic the blood is not effused into the cellular tissue and there are no signs of vital reaction the presence of inflammatory reaction or pus shows that the wound must have been inflicted some time before death probably two or three days self-inflicted wounds are made by the person himself in order to divert suspicion or in order to bring accusation against another such wounds are always in front not over vital organs and superficial in character note the condition of the clothes in such cases Chapter 13 Gunshot Wounds these may be punctured, contused or lacerated round balls make larger opening than those which are conical small shot fired at a short distance make one large ragged opening while at distance is greater than three feet the shots scatter and there is no central opening the Lee Metford bullet is more destructive than the Mauser the former is larger but the difference in size is not great the Martini Henry bullet weighs 480 grains the Lee Metford 215 and the Mauser 173 speaking generally a gunshot wound unlike a punctured wound becomes larger as it increases in depth the aperture of entrance is round, clean with inverted edges and that of exit larger less regular than that of entrance and with inverted edges in the case of high velocity bullets from smooth bore rifles including the Mauser and Lee Metford the aperture of entry is small the aperture of exit is slightly larger and tends to be more slit like there is but little tendency to carry in portions of clothing or septic material and the wound heals by first intention if reasonable precautions be taken the external cicatrices finally look very similar to those produced by bad acne pustules the contents of all gunshot wound should be preserved as they may be useful in evidence a pocket revolver as a rule leaves the bullet in the body wounds inflicted by firearms may be due to violent homicide or suicide blackening of the wound, singeing of the hair scorching of the skin and clothing show that the weapon was fired at close quarters while blackening of the hand points to suicide even when the weapon is fired quite close there may be no blackening of the skin and the hand is not always blackened in cases of suicide smokeless powder does not blacken the skin wounds on the back of the body are not usually self inflicted but a suicide may elect to blow off the back of his head a bullet in the back may be met with a sportsman who indulges in the careless habit of dragging a loaded gun after him if a revolver is found tightly grasped in the hand it is probably a case of suicide whilst if it lies lightly in the hand it may be suicide or homicide if no weapon is found near the body it is not conclusive proof that it is not suicide for it may have been thrown into a river or pond or to some distance and picked up by a passerby a bullet penetrating the skull even from a distance of 3,000 yards may act as an explosive scattering the contents in all directions but the bullet from a revolver would usually be found in the cranium the prognosis depends partly on the extent of the injury and the parts involved there is also risk from secondary hemorrhage and from such complication as pleurisy, pericarditis and peritonitis death may result from shock, hemorrhage, injury to the brain or important nervous structures chapter 14 wounds of various parts of the body one of the head wounds of the scalp are likely to be followed by one ericipilaceous inflammation two inflammation of the tenderness structures with or without superation a severe blow on the vertex may cause fracture of the base of the skull injuries of the brain include concussion, compression, wounds, contusions, and inflammation concussion is a common effect of blows or violent shocks and the symptoms follow immediately on the accident death sometimes taking place without reaction compression may be caused by depressed bone or effused blood rupture of middle meningeal artery and serum the symptoms may come on suddenly or gradually wounds of the brain present very great difficulties and very greatly in their effect very slight wounds producing severe symptoms and vice versa a person may receive an injury to the head recover from the first effects and then die with all the symptoms of a compression from internal hemorrhage this is due to the fact that the primary syncope arrests the hemorrhage which returns during the subsequent reaction or on the occurrence of any excitement inflammation of the meningees or brain may follow injuries not only to the brain itself but to the scalp and adjacent parts as the orbit and ear inflammation does not usually come on at once but after variable periods two, injuries to the spinal cord may be due to concussion, compression, fracture, dislocation, or wounds that the wound has penetrated the meningees is shown by the escape of cerebral spinal fluid the cord and nerves may be injured one by the puncture, two by the extravasation of blood and the formation of a clot three by subsequent septic inflammation division or complete compression of the cord at or above the level of the fourth cervical vertebrae is immediately fatal as happens in judicial hangings when the injury is below the fourth the diaphragm continues forcibly in action but the lungs are imperfectly expanded and life will not be maintained for more than a day or two when the injury is in the dorsal region there is paralysis of the legs and of the sphincters of the bladder and rectum but power is retained in the arms and the upper intercostal muscles act the extent of paralysis depending on the level of the lesion in injuries to the lumbar region the legs may be partially paralyzed and the rectal and bladder sphincters may be involved railway spine or traumatic neurasemia may be set up by concussion of the cord as a result of blows or falls passengers after railway accidents or minors often suffer this affection three, of the face these produce great disfigurement and inconvenience and there is a risk of injury to the brain the seventh nerve may be involved giving rise to facial paralysis punctured wounds of the orbit are especially dangerous wounds apparently confined to the external parts often concealed deep seated mischief four, of the eye the iris may be injured by sharp blows as from the cork of a soda water bottle it is usually followed by hemorrhage into the anterior chamber and there may be separation of the iris from its ciliary border wounds at the edge of the cornea are often followed by prolapse of the iris acute traumatic eritis may supervene four or five days after the injury the lens is frequently wounded in addition to the cornea and iris in dislocation of the lens into the anterior chamber as the result of a blow the lens appears like a large drop of oil lying at the back of the cornea the margin exhibiting a brilliant yellow reflex partial dislocation of the lens as the result of severe blows generally terminate in cataract five, of the throat very frequently inflicted by suicides division of the carotid artery is fatal and of the internal jugular veins very often dangerous on account of an entrance of air wounds of the larynx and trachea are not necessarily or immediately dangerous but septic pneumonia is very apt to follow wounds of the throat inflicted by suicides are commonly situated at the upper part involving the hyoid bone and the thyroid and cricoid cartilages the larynx is opened with the large vessels often escape in most suicide wounds of the throat the direction is from the left to the right the incision being slightly inclined from above and downwards at the termination of a suicidal cut throat the skin is the last structure divided the wound being shallower as it reaches its termination the wounds often show parallelism the weapon is often firmly grasped in the hand inquiries should be made as to whether the patient is right or left-handed or ambidextrous homicidal cut throat is usually very severe and situated low down in the neck or far to the side six, of the chest insized wounds of the walls are not of necessity dangerous but severe blows by causing fracture of the bones and internal injuries are often fatal the symptoms of penetrating wounds of the chest are one, the passage of blood and air through the wound two, hemoptysis three, pneumothorax and four, protrusion of the lung forming a tumor covered with pleura fracture of the ribs may be due to direct violence as from a blow when the ends are driven inwards or to indirect violence as from a squeeze in a crowd when the ends are driven outwards seven, of the lungs these usually cause hemorrhage and are frequently followed by pleurisy and pneumonia eight, of the heart penetrating wounds are fatal from hemorrhage of the base more speedily than of the apex but life may be prolonged for some time even after severe wound to the heart injury to the right ventricle is the most fatal injury and the most frequent rupture from disease usually occurs in the left ventricle rupture from a crush is usually towards the base and on the right side nine, of the aorta and pulmonary artery fatal ten, of the diaphragm generally fatal owing to the severe injury of the other abdominal organs if the diaphragm be ruptured hernia of the organs may result eleven, of the abdomen of the walls may be dangerous from division of the epigastric artery ventral hernia may follow internal hemorrhage, etc blows on the abdomen are prone to cause death from cardiac inhibition twelve, of the liver divide the large vessels venous blood flows profusely from a punctured wound of the liver wounds of the gallbladder cause a fusion of bile and peritoneal inflammation laceration of the liver may result from external violence without leaving any outward sign of the injury it is commonly fatal there is a rapid and acute anemia from the pouring out of blood into the abdominal cavity this may also occur with injuries of other organs in the abdomen thirteen, spleen fatal hemorrhage may result from penetrating wounds or from rupture due to kicks blows, crushes, especially if the spleen be enlarged fourteen, of the stomach may be fatal from shock from hemorrhage, from extravization of contents or from inflammation the dangers materially lessened by prompt surgical intervention of the intestines may be fatal in the same way as those of the stomach more dangerous in the small and large intestines sixteen, of the kidneys may prove fatal from hemorrhage extravization of urine or inflammation seventeen, of the bladder dangers from extravization of urine in fracture of the pelvis the bladder is often injured and extraperitoneal infiltration of urine occurs with frequently a fatal issue eighteen, of genital organs incised wounds of penis may produce fatal hemorrhage removal of testicles may prove fatal from shock to nervous system wounds of the spermatic cord may be dangerous from hemorrhage, wounds of the vulva are dangerous, owing to hemorrhage from the large plexus of veins without valves End of Section 3 Recording by Ginny Whitfield Section 4 of AIDS to forensic medicine and toxicology This is a LibriVox recording All LibriVox recordings are in the public domain For more information auto-volunteer please visit LibriVox.org Recording by Linda Ferguson AIDS to Forensic Medicine and Toxicology by W.G. Akinson Robertson Section 4 Chapter 15 Detection of Blood Stains etc. Stains may require detection on clothing instruments, on floors and furniture etc. The following are the distinctive characters of blood stains A. Ocular Inspection Blood stains on dark coloured materials which in daylight might be easily overlooked may be readily detected by the use of artificial light as that of a candle brought near the cloth Blood spots when recent are of a bright red colour if arterial or if venous the latter becoming brighter on exposure to the air After a few hours Blood stains assume a reddish brown or chocolate tint which they maintain for years This change is due to the conversion of hemoglobin into methemoglobin and finally into hematone The change of colour in warm weather usually occurs in less than 24 hours The colour is determined but is influenced by the presence or absence of impurities in the air such as the vapours of sulphuris sulphuric and hydrochloric acids If recent a jelly-like material may be seen by the aid of a magnifying glass lying between the fibres If old a cinnabar red streak is seen on drawing a needle across the stain B. Microscopic Demonstration With the aid of the microscope blood may be detected by the presence of the characteristic blood corpuscles The human blood corpuscle is a non-nucleated bioconclaved disc having a diameter of about one 3,500th of an inch All mammalian red corpuscles have the same shape except those of the camel which are oval The corpuscles of birds, fishes, reptiles and amphibians are oval and nucleated The corpuscles of most mammals are smaller than those of man but the size of a corpuscle is affected by various circumstances such as drying or moisture so that the medical witness is rarely justified in going farther than stating whether the stain is that of the blood of a mammal or not Unfortunately the corpuscles are usually so dried that little information regarding their size can be given C. Action of Water Water has a solvent action on blood Fresh stains rapidly dissolving when the material on which they occur is placed in cold distilled water forming a bright red solution The hematone of old stains dissolves very slowly so employ a weak solution of ammonia and this will give a solution of alkaline hematone Rust is not soluble in water D. Action of Heat Blood stains on knives may be removed by heating the metal when the blood will peel off at once distinguishing it from rust Should the blood stain on the metal be long exposed to the air rust may be mixed with the blood when the test will fail The solution obtained in water is coagulated by heat the colour entirely destroyed and a flocculant muddy brown precipitate formed E. Action of Caustic Potash The solution of blood obtained in water is boiled when a coagulamase formed soluble in hot caustic potash the solution formed being greenish by transmitted and red by reflected light F. Action of Nitric Acid Nitric acid added to a waterly solution produces a whitish grey precipitate G. Action of Guiacum Tincture of Guiacum produces in the watery solution a reddish white precipitate of the resin but on addition of an aqueous solution of peroxide of hydrogen or of an ethereal solution of the same substance known as ozonic ether a blue or bluish green colour is developed. This test is delicate and succeeds best in dilute solutions. It is not absolutely indicative of the presence of blood but Guiacum is coloured blue by milk, saliva and pus H. Hymen Crystals Teichmann's Crystals These are produced by heating a drop of blood or a watery solution of it with a minute crystal of sodium chloride on a glass slide and evaporating to dryness A cover glass is placed over this and a drop of glacial acetic acid allowed to run in It is again heated until bubbles appear Crystal of hymen may now be detected by the microscope They are dark brown or yellow rhombic prisms An improvement on this test is the use of formic acid alone On slowly evaporating it numerous very small dark crystals are visible if hemoglobin has been present Whitney's Test Eye Spectroscopic appearances If a solution of a recent stain be examined by the spectroscope we get two absorption bands situated between the lines D and E the one nearer E being doubly as broad as the other These bands indicate oxyhemoglobin If we now add a little ammonia sulfide to this solution we get the spectrum of reduced hemoglobin which is a single broad absorption band situated at the interval between the preceding oxyhemoglobin bands By shaking the solution oxyhemoglobin is again reproduced and gives it special absorption bands If ammonia be added to the original solution alkaline hemitin is produced or if acetic acid be chosen acid hemitin is produced and each gives it appropriate absorption bands Metahemoglobin is formed in stains which have been exposed to the air for a few days and hemitin is found in old stains Hemochromogen is given a very characteristic spectrum and is obtained by reducing alkaline hemitin by ammonia sulfide Carbon monoxide hemoglobin gives a spectrum which resembles that of oxyhemoglobin but it is not reduced by ammonia sulfide J Precipitin test This allows us to tell whether the blood is from a human being or not A specific serum must be attained from a rabbit which is sensitized as follows 10 cc of human blood is injected into its peritoneal cavity at intervals until from 3-5 injections have been given The serum of this animal's blood will then give a wire precipitate only when brought into contact with dilute solutions of human blood but with blood of no other animal This is known also as the biological Ullenhoeth's test Rust stains These are yellowish red in color and do not stiffen the cloth The iron may be dissolved by placing the stain in a dilute solution of hydrochloric acid when, on adding ferrocyanide of potassium Prision blue is produced Fruit stains Are seldom so dark as blood stains Solutions of these do not change color or coagulate on boiling ammonia changes the color to blue or green Acid brightens the original color while chlorine bleaches it Heirs Human hairs must be identified and distinguished from those of the lower mammals If the hair has been pulled out from the root the microscope will show that the bulbous root has a concave surface which fitted over the hair per pillar or that the root is encased in a fatty sheath Fibers of clothing Microscopically wool fibres are coarse, curly and striated transversely Cotton fibres appear as flattened bands twisted into spirals Linen fibres are round jointed at frequent intervals with small root-like filaments Silk fibres are solid, continuous and highly glistening Chapter 16 Death by Suffocation Signs and Symptoms There are usually three stages One Exaggerated respiratory activity Air hunger Anxiety Congested appearance of face Ringing in ears Two Loss of consciousness Convulsions Relaxation of sphincters Three Respirations feeble and gasping and soon cease Convulsions of stretching character Heart continues to beat for three to four minutes after breathing ceases Post-mortem appearances External Cadaveric levidity well marked Nose, lips, ears, fingertips almost black in colour Appearance may be placid or if asphyxia has been sudden the tongue may be protruded and eyeballs prominent with much bloody mucus escaping from mouth and nose Internal The blood is dark and remains fluid great engorgement of the venous system right side of heart great veins of thorax and abdomen liver, spleen, etc. Lungs dark purple in colour much bloody froth escapes on squeezing them mucus lining of trachea and bronchi congested and bright red in colour cells distended or ruptured many small hemorrhages on surface of lungs and other organs as well as in their substance tardius spots due to rupture of venous capillaries from increased vascular pressure Chapter 17 Death by Hanging In hanging death occurs by asphyxia as in drowning Sensibility is soon lost and death takes place in four or five minutes the eyes in some cases are brilliant and staring tongue swollen and livid blood or bloody froth is found about the mouth and nostrils and the hands are clenched In other cases the countenance is placid with an almost entire absence of the science just given The mark on the neck which may be more or less interrupted by the beard shows the course of the cord which in hanging is obliquely around the neck following the line of the jaw found in strangulation In judicial hanging death is not due to asphyxiation but owing to the long drop the cervical vertebrae are dislocated and the spinal cord injured so high up that almost instant death takes place On dissection the muscles and ligaments of the windpipe may be found stretched bruised or torn and the inner coats of the carotid arteries are sometimes found divided In ordinary suicidal hanging there may be an entire absence of injury to the soft parts about the neck the length of the drop modifying these appearances The mark of the cord is not a sign of hanging is a purely cadaveric phenomenon and may be produced some hours after death Chapter 18 Death by strangulation This differs from hanging in that the body is not suspended It may be affected by a ligature around the neck or by direct pressure on the windpipe with the hand in which case death is said to be caused by throttling Strangulation is frequently suicidal but may be accidental When homicidal much injury is done to the neck owing to the force with which the ligature is drawn In throttling the marks of the fingernails are found on the neck Chapter 19 Death by drowning Death by drowning occurs when breathing is arrested by watery or semi-fluid substances blood, urine, etc The fluid acts mechanically by entering the air cells of the lung and preventing the due oxidation of the blood The post-mortem appearances include those usually present in death by asphyxia together with the following peculiar to death by drowning Excoration of the fingers with sand or mud under the nails fragments of plants grasped in the hand water in the stomach this is a vital act and shows that the person fell into the water alive Fine froth at the mouth and nostrils cutis and serina retraction of penis and scrotum On post-mortem examination the lungs are found to be increased in size, ballooned On section froth, water, mud, sand in air tubes The presence of this fine blood-stained froth is the most characteristic sign of drowning Froth like that of soapsuds in the trachea is an indication of a vital act and must not be mistaken for the tenacious mucus of bronchitis The presence of vomited matter in the trachea and bronchi is a valuable sign of drowning The blood collects in the venous system and is dark and fluid Tadiyu's spots are not so frequently met as in other forms of asphyxia The other signs of death by asphyxia are present wounds may be present on the body due to the falling on stakes injuries from passing vessels etc The methods of performing artificial respiration in the case of apparently drowned are the following The best and most easily performed is Schaefer's prone pressure method One Schaefer's Place the patient on his face with a folded coat under the lower part of the chest Unfasten the collar and neckband Go to work at once Kneel over him a thwart or on one side facing his head Place your hands flat over the lower part of his back and make pressure on his ribs on both sides and throw the weight of your body onto them so as to squeeze out the air from his chest Get back into position at once but leave your hands as they were Do this every 5 seconds and get someone to time you with a watch Keep this going for half an hour and when you are tired get someone to relieve you Other people may apply hot flannels to the limbs and hot water to the feet Hypodermic injections of 150th grain of atropine superrenal or pituitary extracts may be found useful 2. Silvestres In this method the capacity of the chest is increased by raising the arms above the head holding them by the elbows and thus dragging upon and elevating the ribs The chest being emptied by lowering the arms against the sides of the chest and exerting lateral pressure on the thorax The patient is in the supine position but first the water must have been drained from the mouth and nose by keeping the body in the prone position The tongue must be kept forward by transfixing with a pin 3. Marshall Halls This consists in placing the patient in the prone position with a folded coat under the chest and rolling the body alternately into the lateral and prone positions 4. Howards This consists in emptying the thorax by forcibly compressing the lower part of the chest on relaxing the pressure the chest again fills with air Here the patient is placed in the supine position The objections to the supine position are that the tongue falls back and not only blocks the entrance of air but prevents the escape of water, mucus and froth from the air passages 5. Leboard's method This consists in holding the tongue by means of a handkerchief and rhythmically drawing it out fully at the rate of 15 times per minute This excites the respiratory centre and this method may be employed along with any of the other methods End of Section 4 Recording by Linda Ferguson Section 5 of AIDS to Forensic Medicine and Toxicology This is the LibriVox recording All LibriVox recordings are in the public domain For more information or to volunteer, please visit LibriVox.org Recording by Linda Ferguson AIDS to Forensic Medicine and Toxicology by W. G. H. S. Robertson Section 5 Chapter 20 Death from Starvation The post-mortem appearances in death from starvation are as follows There is marked general emaciation The skin is dry, shriveled and covered with a brown bad-smelling excretion The muscles soft, atrophied and free from fat The liver is small but the gallbladder is distended with bile The heart, lungs and internal organs are shriveled and bloodless The stomach is sometimes quite healthy in other cases it may be collapsed empty and ulcerated The intestines are also contracted empty and translucent In the absence of any disease productive of extreme emaciation example, tuberculosis, stricteroesophagus diabetes, Addison's disease such a state of body will furnish a strong presumption of death by starvation In the case of children there is not always absolute deprivation of food but what is supplied is insufficient in quantity or of improper quality The defence commonly set up is that the child died either of mirasmus or of tuberculosis In cases where it is alleged that a child has been starved and ill-used, one must examine the body for signs of neglect example, dirtiness of skin and hair, presence of vermin bruises or skin eruptions Compare its weight with a normal child of the same age and sex If the disproportion be great and signs of neglect present then the probability is great provided there be no actual disease present that the child has been starved The signs of death from lightning vary greatly in some cases there are no signs in others the body may be most curiously marked wounds of various characters contused, lacerated and punctured may be produced there may be burns vesications and echemosis arborescent markings are not uncommon The hair may be singed or burnt and clothing damaged Rigor mortis is very rapid in its onset and transient post-mortem there are no characteristic signs but the blood may be dark in colour and fluid The presence or absence of a storm may assist the diagnosis Injuries by electrical currents of high pressure are not uncommon speaking generally 1000 to 2000 volts will kill In America where electricity is adopted as the official means of destroying criminals 1500 volts is regarded as the lethal dose but there are many instances of persons having been exposed to higher voltages without bad effects The alternating current is supposed to be more fatal than the continuous Much depends on whether the contact is good perspiring hands or damp clothes Death has been attributed in these cases to respiratory arrest or sudden cessation of the heart's action The best treatment is artificial respiration but inhalation of nitrite of amyl may prove useful Rescuers must be careful that they also do not receive a shock The patient should be handled with India rubber gloves or through a blanket thrown over him Chapter 22 Death from cold or heat Cold The weak aged or infants readily succumb to low temperatures The symptoms are increasing latitude, drowsiness, coma with sometimes illusions of sight Post-mortem bright red patches are found on the skin surface and the blood remains fluid for long Heat Death may result from syncope exposure to great heat Sunstroke The person loses consciousness and falls down insensible The body temperature may be 112 degrees Fahrenheit The pulse is full and a peculiar pungent odor is given off from the skin Coma Convulsions with, rarely, delirium may precede death Treatment consists in lowering the body temperature by application of cold cloths, stimulants of acne or digital and hypodermically End of Section 5 Recording by Linda Ferguson Section 6 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 Recording by Jeannie Whitfield Aids to Forensic Medicine and Toxicology by W. G. H. S. Robertson Section 6 Pregnancy through cause of death in the fetus Chapter 23 Pregnancy The signs of the existence of pregnancy are of two kinds Uncertain and certain or maternal and fetal Amongst the former class are included cessation and menstruation which may occur without pregnancy mourning, vomiting, salivation enlargement of the breast or of the abdomen, quickening pregnancy. The test which afford conclusive evidence of the existence of a fetus in uterus are allotment, the uterine suful, intermittent uterine contractions, fetal movements and above all, the pulsation of the fetal heart. The uterine suful is synchronous with the maternal pulse. The fetal heart is not being about 120 beats per minute. Evidence of pregnancy may also be afforded by the discharge from the uterus early ovum, of molds, hydatids, etc. Diseases of the uterus and ovarian drops may be mistaken for pregnancy. Careful examination is necessary to determine the nature of the condition present. Pregnancy may be pleaded in bar of immediate capital punishment in which case the woman must be shown to be quick with child. A woman may also plead pregnancy to delay her trial in Scotland and both in England and Scotland in civil cases to produce a successor to estates to increase damages for seduction in compensation cases where a husband has been killed to obtain increased damages, etc. A woman may become pregnant within a month of her last delivery. In cases of rape and suspected pregnancy it must be borne in mind that a medical man who examines a woman under any circumstances against her will renders himself reliable to heavy damages and that the law will not support him in so doing. If on being requested to permit an examination the woman refuse. Such refusal may go against her but of this she is the best judge. The duty of the medical man ends on making the suggestion. Chapter 23 Delivery The signs of recent delivery are as follows. The face is pale with dark circles around the eyes. The pulse quickened. The skin soft, warm and covered with a peculiar sweat. The breast full, tense and knotty. The abdomen distended. Its entanglement relaxed with irregular light pink streaks on the lower part. The labia and vaginus show signs of distention and injury. For the first three or four days there is a discharge from the uterus more or less sanguinous in character consisting of blood, mucus, epithelium and reds of membrane. During the next four or five days it becomes a dirty green color and in a few days more of a yellowish, milky mucus character. Continuing for two or three weeks the change in character of the locule discharges due to the quantity of blood decreasing and its place being taken by fatty granules and leukocytes. The oscutary is soft, patuous and its edges are torn. The uterus may be felt for two or three years above the pubis as a hard, round ball regaining its normal size in about eight weeks after delivery. Most of these signs disappear about the tenth day after which it becomes impossible to fix the date of delivery. In the dead the external parts have the same appearance as given above. The uterus will vary in appearance according to the time elapsed since delivery. If death occurred immediately after delivery about nine or ten inches long with clots of blood inside and the inner surface line by decidua. The signs of a previous delivery consist in silvery streaks in the skin of the abdomen which however may be due to distention from other causes. Similar marks on the breast circular and jagged condition of the oscutary the virgin osc being oval and smooth. Marks of rupture of the perineum or foreshade of the vaginal rugae dark colored areola around the nipples etc. The difference between the virgin corpus luteum and that of the recent pregnancy is not so marked as to justify a confident use of it for medical legal purposes. Chapter 25. Phetocide or Criminal Abortion This consists in giving to any woman or causing to be taken by her with intent to procure her miscarriage any poison or other noxious thing or using for the same purpose any instruments or other means whatsoever. It is a felony to procure or attempt to procure the miscarriage of a woman, whether she be pregnant or not, and it is a felony for the woman if pregnant to attempt to procure her own miscarriage. It is a misdemeanor for any person or persons to procure drugs or instruments for a like purpose. It is not necessary that the woman be quick with child. The offense is the intent to procure the miscarriage of any woman, whether she be or be not with child, when from any cause it is necessary to procure abortion. A medical man should do so only after consulting with a brother practitioner. Even in these cases there is no exemption legally. Any medical man who gives even the most harmless medicine when he suspects the possibility of pregnancy may render himself liable to grave suspicion should the woman abort. An abortion is said to occur when the fetus is expelled before the sixth month. After that it is premature birth. In law however, any expulsion of the contents of the uterus before the full time is an abortion or miscarriage. In deciding whether any substance expelled from the uterus is really a fetus or a mole and therefore the result of conception or the code of the uterus and unconnected with pregnancy, the examination of the substance expelled must be carefully made. Moles are blighted fetuses and examination of the woman will be necessary, though it is not easy during the early months of pregnancy and especially in those who have born children to say whether abortion has taken place or not. The history must be inquired into. The regular or exceptional use of drugs to promote menstruation is important for in the former case no criminal intent may exist although pregnancy be present. The weight of the breast, the hymen and the ossuteries should all be carefully examined, putting a few apparently unimportant questions as to the frequent use of purgatives, the presence or absence of constipation, will often assist the diagnosis as showing that the woman has acted in an unusual manner. Abortion may be procured by the introduction of instruments by falls, violent exercise, blows on the abdomen, etc. In the hands of ignorant persons the use of instruments sounds, boogies, skewers, etc. is attended with great danger. Perforation of the vaginal walls, bladder, cervix or uterus may follow their use. Septic pelvic peritonitis may ensue, and the woman may lose her life. The person who has employed such means for inducing abortion is liable to be charged with the crime of murder. There is no evidence to show that ergot, savin, bitter apple, penny-royal, or any other drug administered internally, will cause a woman to abort, except when taken in such large doses that actual poisoning results, with inflammation of the contents of the true pelvis. In such cases reflex uterine contractions may be set up and abortion may follow. Diakylan pills are largely employed to induce abortion, and very often the woman taking them suffers severely from lead poisoning. Chapter 26. Infanticide The murder of a newborn child is not treated as a specific crime, but is tried by the same rules as in cases of felonious homicide. The term is applied technically to those cases in which the mother kills her child at, or soon after, its birth. She is often in such a condition of mental anxiety as not to be responsible for her actions. It is usually committed with the object of concealing delivery and to hide the fact that the girl has, in popular language, passed the virtue. The child must have had a separate existence. To constitute life-birth the child must have been alive after its body was entirely born, that is entirely outside the maternal passages, and it must have had an independent circulation, though this does not imply the severance of the umbilical cord. Every child is held in law to be born dead until it has been shown to have been born alive. Killing a child in the act of birth, and before it is fully born, is not it, but if before birth injuries are inflicted which result in death after birth it is murder. Medical evidence will be called to show that the child was born alive. The methods of death usually employed are 1. Suffocation by the hand or a cloth. 2. Strangulation with the hands by tape or ribbon, or by the umbilical cord itself. 3. Blows on the head or dashing the child against the wall. 4. Drowning by putting it in the privy or in a bucket of water. 5. Omission by neglecting to do what is absolutely necessary for the newly born child. That is not separating the cord, allowing it to lie under the bed closed and be suffocated. With regard to the question of the maturity of a child, the differences between a child of six or seven months and one at full term may be stated as follows. Between the sixth and seventh month, length of the child 10 to 14 inches. That is, the length of the child after the fifth month is about double the lunar months. Weight 1 to 3 pounds. Skin, dusky red, covered with downy hair, lagoon-o. And sebaceous matter, membrane of pupillaris disappearing, nails not reaching the ends of the fingers, meconium at upper end of the large intestine, testes near the kidneys, no appearance of convolutions in the brain, points of ossification in four divisions of the sternum. At nine months, length of the child is 18 to 22 inches. Weight 7 to 8 pounds. Skin, rosy. Lagoon-o only about the shoulders, sebaceous matter on the body, hair on head about an inch long, testes past inguinal ring, clitoris covered by the labia, membrane of pupillaris disappeared, nails reached to the ends of fingers, meconium at the end of the large intestine, points of ossification in center of cartilage at lower end of femur, about one one-half to two and one-half lines in diameter. A mellicus midway between the insiform, cartilage and pubis. Going to the difficulty of proving the crime of anthanocyte has been committed. The woman may in England be tried for concealment of birth and in Scotland for concealment if she concealed her pregnancy during the whole time and failed to call for assistance in birth. Either of these charges would only be brought against a woman who had obviously been pregnant and now the child is missing or its dead body has been found. It is expected that every pregnant woman should make provision for the child to be born and so should have talked about it or have made clothes, etc. For it, the punishment for concealment is imprisonment for any term for two years. The charge of concealment is very often alternative to anthanocyte. To substantiate the charge, however, it must be proved that there had been a secret disposition of the dead body of the infant as well as an endeavor to conceal its birth. A woman may be deliberate of a child unconsciously or the contractile power of the womb is independent of volition. Under an aesthetic the uterus acts as energetically as if the patient were in full emotional presences. Nowadays a woman is rarely hanged for anthanocyte and it is a mere travesty of justice to pass on her the death sentence while knowing that it will never be executed. Chapter 27 Evidences of live birth The signs of live birth prior to respiration are negative and positive. A negative opinion may be formed when evidence is found of the child's having undergone intrauterine maceration. In this case the body will be flaccid and flattened. The ilia prominent. The head softened and yielding. The cuticle more or less detached and raised into large bull-eye. The skin of a red or brownish-red color. The cavities filled with abundant blood serum. The umbilical cord straight and flaccid. A positive opinion is justified when such injuries are found on the body as could not have been inflicted during birth and are attended with such hemorrhage as could only have occurred while the blood was circulating. Fractures of the cranium from accidental falls precipitate labor are as a rule stellate and are situated on the vertex or in the parietal protuberance. The fractures from violence are more extensive, usually depressed and accompanied by laceration of the scalp. The evidence of live birth after respiration has taken place are usually deduced from the condition of the lungs, though indications are also found in other organs. The diaphragm is more arched before than after respiration and rises higher in the thorax in the former case than in the latter. The lungs before respiration are situated in the back of the thorax and do not fill the cavity. They are of a dark red-brown color and the consistency of liver without modeling. After respiration they have expanded and occupied the whole thorax and closely surround the heart and thymus gland. The portions containing air have a light brick-red color and crepotate under the finger. The lungs are modeled from the presence of islands of aerated tissues surrounded by arteries and veins. The weight of the lungs before respiration is about 550 grains. After an hour's respiration 900 grains. But this test is of little value. The ratio of the weight of the lungs to that of the body, Pochette's test which is also unreliable is before respiration after 1-35. Lungs in which respiration has taken place float in water those in which it has not sink. There are exceptions to this rule on which however is founded the hydrostatic test. As originally performed this test consisted merely in placing the lungs with or without the heart in water and noticing whether they sank or floated. The test is now modified by squeezing and by cutting the lungs up into pieces. The objections to the test as originally performed are 1. that the lungs may sink as the result of disease for example double pneumonia. 2. that respiration may have been so limited in extent that the lungs may sink owing to large proportions of the lung tissue remaining unexpanded atlectasis. 3. Putrification may cause the lungs to float when respiration has not taken place. 4. The lungs may have been inflated artificially. Few of these objections apply however when the hydrostatic test modified by pressure is employed. To take these objections in detail it may be stated 1. If the lungs sink from disease the question of live birth is answered. 2. This objection is too refined for practical use. The lungs sink there is an absence of any of the signs of suffocation and the matter ends. The examiner has only to describe the conditions which he finds and is not required to indulge in conjectures as to the amount of respiration which may or may not have taken place. 3. Gas due to putrification collects under the pleural membrane and can be expelled by pressure and is not found in the air cells. The lungs decompose late hence in a fresh body putrification of the lungs is absent in a putrified child if the lungs sink it must have been stillborn. The so called emphysema pulmonum neonatum is simply incipient putrefaction. The lung test simply shows that the child has breathed but affords no proof that the child has been born alive. The child may have breathed as soon as his head protruded the rest of his body being in the maternal passage. The child is not born alive until it has been completely expelled although it is not necessary that the umbilical cord should have been cut. In addition to these tests live birth may be expected from the following conditions. The stomach may contain milk or food recognized by the microscope and by traumas test for sugar. The large intestines and stillborn children are filled with meconium. In those born alive they are usually empty. The bladder is generally empty soon after birth. The skin is in a condition of exfoliation soon after birth. The organs of circulation undergo the following changes after birth and the extent to which these changes have advanced to give an idea of how long the child has lived. The ductus arteriosus begins to contract within a few seconds of birth. At the end of a week it is about the size of a crow quill and about the tenth day is obliterated. The umbilical arteries in vein. The arteries are remarkably diminished in caliber at the end of 24 hours and obliterated almost up to the iliacs in three days. The umbilical vein and the ductus minosis are generally completely contracted by the fifth day. The foramen ovale becomes obliterated at extremely variable periods and may continue open even in the adult. Importance of late has been attracted to the stomach bowel test if the stomach and duodenum contain air and consequently float in water. The chances are that the child did not die immediately after birth. This is known as Breslau's second life test and the lower the air in the intestinal canal the greater the probabilities that the child survived birth. The umbilical cord in a newborn child is fresh, firm, round, and bluish in color. Blood is contained in its vessels. The cord may be ruptured by the child falling from the maternal parts in a precipitant labor and the ruptured parts present ragged ends. It is seldom that a child bleeds to death from untied or cut umbilical cord and the chances in a torn cord are still more remote. The changes in the cord are follows. First it shrinks from the ligature towards the stable. This change may begin early and is rarely delayed beyond 30 hours. The cord becomes flabby and there is distinct inflammatory circle around its insertion. The next change is that of desiccation or mummification. The cord becomes reddish brown, then flattened and shriveled, then translucent and of the color of parchment and falls off about the fifth day. The third stage, that of capiturization, then ensues about the tenth or twelfth day. The bright red rim around the insertion of the cord with inflammatory thickening and slight purulent secretion may be considered as evidence of live birth. And the stage at which the separation of the cord by all sorts of process has arrived will point to the probable duration of the time the child has existed after birth. There are many fallacies in the application of any of these tests and the whole subject bristles with difficulties. The medical witness would do well to exhibit a cautious reserve for if the child dies immediately after birth it is almost impossible to prove that it was born alive. Chapter twenty-eight, cause of death in the fetus. The death of the fetus may be due to one immaturity or intrauterine malnutrition or simply from deficient vitality. Two, complications occurring during and immediately after birth which may either be unavoidable or inherent in the process of parteration or may induced with criminal intent. In the latter category comes such accidents as the pressure of tumors in the pelvic passage of disease of the bones in the mother or pressure on the cord from malposition of the child during labor, asphyxiation from the funnice being twisted tightly around the neck or limbs or from the injuries due to falls to the floor in sudden labors where the test of the fetus has been induced with criminal intent it may be due to punctured wounds of the fontanelles, orbits heart or spinal marrow. Dislocation of the neck, separation of the head from the body fracture of the bones of the head and face strangulation, suffocation, drowning in the closet, pan or privy or from being thrown into water. Under the head of emphaticide by commission we have injuries of all kinds under emphaticide by omission neglecting to tie the cord allowing it to be suffocated by discharges in the bed, neglecting to provide food, clothes and warmth for the newborn child. End of Section 6 Aids to Forensic Medicine and Toxicology by W. G. A. Shison Robertson Recording by Jeannie Whitfield from Mississippi