MEDICAL JURISPRUDENCE, or, as it is now more usually termed, FORENSIC MEDICINE, is that branch of state medicine which treats of the application of medical knowledge to the purposes of the law. The term medical jurisprudence, though sanctioned by long usage, is not an appropriate one; since the subject is, strictly speaking, a branch of medicine rather than of jurisprudence; it does not properly include sanitation or HYGIENE (q.v.), both this and medical jurisprudence proper being distinct branches of state medicine. The connexion between medicine and the law was perceived long before medical jurisprudence was recognized, or had obtained a distinct appellation. It first took its rise in Germany, and subsequently, but more tardily, received recognition in Great Britain.
Forensic medicine, or medical jurisprudence proper as distinguished from hygiene, embraces all those questions which bring the medical man into contact with the law, and embraces (1) questions affecting the civil rights of individuals, and (2) injuries to the person.
I. QUESTIONS AFFECTING THE CIVIL OR SOCIAL RIGHTS OF INDIVIDUALS
1. Development of the Human Frame.The development of the physical and mental powers of the human being is a matter of the highest importance, and is a factor of great consequence in determining criminal responsibility, civil responsibility, or the power of giving validity to civil contracts, and in determining the personal identity of a living person or of a corpse. Human life is usually divided into the five periods of infancy, childhood, youth, manhood, and old age. Some writers increase the number of these, unnecessarily, to seven periods, without any practical advantage.
Infancy is the period from birth till the first or milk set of teeth begin to be shed usually about the seventh year. During this period the body increases in size and stature more, relatively, than at any other period of existence; and the mental faculties undergo great development. The milk teeth, twenty in number, are evolved in a definite order, beginning with the central incisors at about six months, and ending with the second molars about the termination of the second year. From the size and stature of the body, the development of the teeth, and the more or less advanced state of ossification or solidification of the bony skeleton, conclusions may be drawn as to the probable age of the infant.
Childhood extends from the commencement of the shedding of the milk teeth to the age of pubertyusually from tile seventh to the fourteenth or fifteenth year. During this period the body expands, as welt as the bony structures, without any clearly marked difference in structure being observable between the sexes except as regards the genitals, so that it is impossible to distinguish absolutely between the male and the female skeleton during this period. The milk-teeth are shed, and are replaced by the second or permanent set, thirty-two in number, though these do not usually all make their appearance during childhood. Marked differences between the proclivities of the sexes are noticeable even at an early period of childhood, and long before the characteristic functions begin to be developed.
Youth, is marked at its commencement by the changes which occur at puberty the development of the genitals in both sexes, the appearance of hair on the genitals, the appearance of a beard in the male, the development of the breasts in the female, the appearance of the monthly flow in the female, and the ability to secrete semen in the male. Marked mental changes now occur, and the generation functions are perfected. Youth terminates at the age of legal majority, twenty-one years; or perhaps the period ought to be extended to twenty-five years of age, as it is with some nations.
Manhood (or Womanhood) is the period of perfection of all the bodily and mental powers. It ceases in woman with the cessation of the monthly flow at about forty-five years of age; but in man it often extends to a much later period of life.
Old Age begins with the decay of the bodily and mental faculties, and is characterized by wrinkling of the skin, loss of the teeth, whitening of the hair, and feebleness of the limbs. In its later stages decay of the mental faculties, deafness, obscurity or loss of vision, and bowing of the spine are added.
2. Duration of Human Life.The chances of human life form an important subject of inquiry, which has been elucidated by the labours of Price, Milne, Farr, and others; and on deductions from comparisons of birth and death rates is founded the system of annuities, insurance against loss in sickness, and the insurance of lives. Since the establishment of compulsory registration of deaths, our knowledge of the ordinary and extraordinary chances of human life, has been much extended, and surer data are now available for calculations of probabilities of life, of survivorships, and of the payments which ought to be made in benefit clubs. See INSURANCE and LONGEVITY.
3. Personal Identity.It might be imagined that there is little danger, with the exercise of ordinary care, of mistaking one person, for another; but the remarkable case of the Tichborne claimant, and some other less-known but perhaps equally singular instances, have demonstrated that mistakes as to the identity of individuals are easily made, and are more frequent than is commonly supposed. Where the identity has to be established or disproved after long absence, exposure to foreign climates and great hardships, wounds, &c., the problem is often one of extreme difficulty. The data for identifying a person are individual and family likeness, stature, the colour of the eyes, peculiarities of garb and manner, recollection of antecedent events, but more especially marks on the person either congenital or acquired. Such are naevi or mothers marks, scars, and disunited or badly united fractures, known to have existed upon the missing person. An accurate solution of the question is, nevertheless, often a matter of the greatest difficulty.
4. Marriage.Under this head the medical jurist has to deal principally with the nubile age, viewed in the light of nature and according to legislative enactments, and with such physical circumstances as affect the legality of marriages, or justify divorce.
In Great Britain the age at which the sexes are first capable of propagating the species is later than in more southern climes. Ordinarily it does not occur before fifteen years of age for the male and fourteen for the female; exceptionally, however, it occurs at the ages of thirteen and of twelve (or even less) respectively in the male and female. By legislative enactment, nevertheless, parents and guardians may, in England at all events, forbid the marriage of young people till the age of legal majority. The only physical circumstances which in Great Britain form a bar to marriage are physical inability to consummate, and the insanity of one of the parties at the time of marriage. Both those circumstances have been pleaded and sustained in the law courts. In other countries minor physical circumstances, as disease, are held to invalidate marriage.
5. Impotence and Sterility.These may arise from organic or from functional causes, the former being alone irremediable, and as such taken cognizance of by the law courts. On this subject it is unnecessary to enlarge here.
6. Pregnancy. This subject presents one of the widest fields for medico-legal evidence. The limits of age between which it is possible, the limits of utero-gestation, and the signs of pregnancy may all in turn be the subjects of investigation.
The limits of age between which pregnancy is possible are usually fixed by the appearance and cessation of the monthly flow; and these ordinarily begin about fourteen and cease at forty-five years of age. Exceptionally they appear as early as the tenth year, and may not cease till the end of the fifth decade of life. Cases, however, have occurred where a woman has conceived before menstruating; and a few doubtful cases of conception are recorded in women upwards of fifty, or even sixty, years of age. The general fact of pregnancy being limited by the age of puberty on the one hand and the cessation of the monthly flowor fifty years as the extreme limit of agemust be accepted as the safest guide in practice.
The limits of utero-gestation are not in England fixed by legislation. The French code fixes the extreme limit of three hundred days. The ordinary period is forty weeks and a half, or two hundred and eighty-three days from the cessation of the last monthly flux. The limit of three hundred days, as fixed by the French code, is perhaps never exceeded, if ever reached. The uncertainty of females in fixing the exact date of conception has given rise to the discrepant opinions of physiologists on the subject. It is well known, however, that among the higher animals the period is not a precise one; and impregnation and conception are doubtless not necessarily coincident.
The signs of pregnancy are of the utmost importance to the medical jurist. He may be called upon to pronounce upon the virtue of a female, to sustain or rebut a plea for divorce, to determine whether a capital sentence shall be carried out, or to determine whether it is probable that an heir will be born to an estate. Should he err in his judgmentand mistakes are very possible in the earlier months of utero-gestationhe may commit a grievous wrong. Medical jurists are in the habit of classifying the signs of pregnancy as uncertain or certain; it is the former which are most regarded by the public, but the latter are alone of probative value to the jurist. The usual and uncertain signs are the cessation of the monthly flow, nausea, sickness, a darkening of the areola and the formation of a secondary areola around the nipple, enlargement of the breasts, increased size of the abdomen, the formation of a tumour in the womb, quickening, and the motions of the foetus. There are also other minor signs of less importance. The certain signs are the uterine souffle, which is a peculiar soft sound heard over the abdomen, and synchronous with the maternal pulse; ballottement, or the examination for a floating tumour in the abdomen between the fifth and eighth months of pregnancy; and the pulsations of the foetal heart, beard by means of the stethoscope. These pulsations are much quicker than, and not synchronous with, the maternal pulse. This is the only indubitable sign of pregnancy. It is inapplicable before the fourth month of gestation.
7. Parturition.The imminence of the process of parturition is of comparatively little interest to the medical jurist; but the signs of recent delivery are all-important. These signs are the bruised, swollen, and lacerated state of the external genitals, relaxation and dilatation of the vagina and womb, the existence of a peculiar vaginal discharge known as the lochia, a relaxed and fissured condition of the abdominal walls, a peculiar aspect of the countenance, and the distended state of the breasts due to the secretion of milk. The lochial discharge is the most characteristic sign. All the signs may disappear within ten days of delivery, though this is not usual.
Connected with parturition, the question of viability of the child is not unimportant. After the intra-uterine age of seven months is reached a child is certainly viable. The period of which the foetus becomes viable cannot be stated with certainty; but five calendar months, or one hundred and fifty days, is perhaps the nearest approximation which can be made. The viability of a child is judged by its size and weight, its general state of development, the state of the skin, hair, and nails, its strength or feebleness, the ability to cry, and its power of taking maternal nourishment. The question of viability has important bearings upon the crime of infanticide, and the succession to property.
The subject of superfoetation, or the possibility of two conceptions having occurred resulting in the birth of twins with a considerable intervening interval, is a very obscure one, and has given rise to much controversy,its existence being affirmed by some medical jurists, and denied by others. There is much, however (e.g., the existence of a double or bifid womb), to countenance the view that a double conception is possible.
In the curious case of a man marrying a woman having possession of an estate of inheritance, and by her having issue born alive and capable of inheriting her estate, the man on the death of his wife holds her lands for life as a tenant by the "curtesy" of England. Here the meaning of "born alive" is different from the meaning of the same expression as used respecting infanticide. In questions of tenancy by the curtesy it has been decided that any kind of motion of the child, as a twitching and tremulous motion of the lips, is sufficient evidence of live-birth. As regards infanticide, proof of a conclusive separate existence of the child is demanded before live-birth is admitted.
8. Monsters and Hermaphrodites.To destroy any living human birth, however unlike a human creature it may be, is to commit a crime. Blackstone states that a monster which hath not the shape of mankind hath no inheritable blood; but the law has not defined a monster, nor what constitutes a human form. The same author states that if, in spite of deformity, the product of birth has human shape, it may be an heir. Hermaphrodites are beings with malformations of the sexual organs, simulating a double sex. Physiologists do not admit, however, the existence of true hermaphrodites with double perfect organs, capable of performing the functions of both sexes.
9. Paternity and Affiliation. These are often matters of great doubt. A considerable time may elapse between the absence or death of a father and the birth of his reputed child. As has already been said, three hundred days is the utmost limit to which physiologists would extend the period of utero-gestation. This subject involves questions respecting children born during a second marriage of the mother, posthumous children, bastardy, and alleged cases of posthumous children.
10. Presumption of Survivorship.When two or more persons perish by a common accident, when a mother and her newborn child are found dead, and in a few analogous cases, important civil rights may depend upon the question which lived the longest; and great ingenuity has been displayed in elucidating the disputes which have arisen in the law courts in such cases.
11. Maladies Exempting from Discharge of Public Duties frequently demand the attention of the medical man. He may be called upon to decide whether a man is able to undertake military or naval service, to act as a juryman without serious risk to life or health, or to attend as a witness at a trial. An endeavour to give a fearless and honest certificate should animate the medical man in the discharge of this delicate duty.
12. Feigned and Simulated Diseases often require much skill and acuteness in order to detect the imposture. Where there is reason to suppose that a disease is simulated, much caution as to procedure is also required.
13. Insanity or Mental Alienation.This subject presents an enormous field to the medical jurist. A medical man may be required to give evidence in any of the law courts, civil, criminal, or ecclesiastical, before commissions de lunatico inquirendo, or before a magistrate, as to the sanity or insanity of an individual; and he may have to sign certificates of unsoundness of mind with the view of providing for the safe custody and proper treatment of a lunatic. Hence he must be familiar with the chief forms of insanity (see INSANITY), and be able to distinguish and treat each of these. He will also be required to detect feigned insanity, and to examine persons charged with crime with the view of preventing real lunatics from being treated as criminals.
The terms "unsoundness of mind," applied to the condition of the mind itself, and "non compos mentis" to the person whose mind is affected, are legal terms applied to insanity. Lawyers have disputed as to whether imbecility should or should not be included under the head of insanity; but medical men include under this category all disorders or defects of the mind which disqualify a person for managing his affairs, and entering into a binding contract, or which render the individual morally irresponsible for his or her otherwise criminal actions. There is good legal authority for recognizing four forms of unsoundness of mindidiocy, dementia, mania, and monomania.
The chief questions respecting unsoundness of mind which present themselves to the medical jurist areis the person of sound or unsound mind; if unsound, are there real lucid intervals; is he fit to manage his affairs, to contract a marriage, or to execute a will; is he dangerous to others?
As grounds for restraint, the law recognizes only these conditionsdanger to himself, inability to manage his own affairs and property, and danger to the person of others. Before an individual can be placed under restraint in an asylum the certificates of two medical men must be obtained, and the formal order of a relation or friend. The certificates to be valid must be signed by legally qualified medical practitioners having no interest, direct or indirect, in the patient, or in the asylum to which he is to be sent. The medical examiners must pay separate visits, each medical man examining the patient separately. The certificates, which remain valid for seven days only, must bear the exact, address of the lunatic, his occupation, and the date of the examination; they must also set forth distinctly the grounds of the opinion they express, under the separate heads of facts observed by the examiner, and facts (to be specified) communicated by others. In the case of pauper lunatics one medical certificate only is required, which is supplemented by an order from a justice of the peace. In urgent cases also one medical certificate suffices for incarceration in an asylum, provided that within three days of the patients reception two other such certificates are signed by two other medical practitioners, not being connected with the asylum, upon a like examination. The superintendent or proprietor of the asylum must in all cases forward to the commissioners of lunacy a notice of admission within one clear day from the patients admission. Any infringement of the statutory regulations subjects the person who commits it to a heavy penalty.
II. INJURIES TO THE PERSON
1. Defloration.The signs of defloration are obscure and uncertain ; and it is rather by the coexistence of several of the usual marks than the existence of any one sign, that any just conclusion can be arrived at.
2. Rape.This crime consists in the carnal knowledge of a woman forcibly and against her will. The resistance must be to the utmost, else the crime of rape has not been committed in the legal sense of the word. The proofs of rape, accordingly, apart from the consistency of the womans story, mainly depend on the presence of the signs of defloration, and on marks of injury on the man.
3. Mutilation.This may consist in the cutting or maiming of any member; castration is the most important, and perhaps but rarely effected as a crime. Self-mutilation, giving rise to false accusations, is occasionally resorted to.
4. Criminal Abortion.The crime of abortion consists in unlawfully administering to a woman, or causing to be taken by her (whether she be with child or not), with intent to procure her miscarriage, any poison or noxious thing, or using for the same purpose any instrument or other means whatsoever; also in the use of the same means, with the same intent, by any woman being with child.
5. Homicide.The legal sense of the term homicide excludes such injuries as are the result of either accident or of suicide. It embraces murder or wilful homicide, manslaughter or culpable homicide, casual homicide, and justifiable homicide.
As a preliminary in all cases of homicide, it is the duty of the medical jurist in the first place to ascertain the fact of death, and to distinguish between real and apparent death; and then to determine, if possible, the period at which death took place.
Infanticide or child murder is by the British law treated with the same severity as the murder of an adult. Indeed infanticide as a crime distinct from murder has no legal recognition. Practically this severity defeats itself, and offences which are really cases of child murder are often treated simply as cases of concealment of birth. The iniquity of the old law which threw the onus of proof of still-birth on the mother now no longer exists, and the law demands strict proof of live-birth at the hands of the prosecution. Hence the subject involves very nice points of forensic medicine. The child must be proved to have arrived at the period when there was a probability of its living (proof of viability); and as the establishment of respiration is necessary to prove live-birth the evidences of this act must be carefully investigated. The size and position of the lungs, and the state of the vessels concerned in foetal circulation, must be carefully noted. The foetal lungs are dark, dense, and liver-like in appearance and consistence, and sink when immersed in water; whilst the fully respired lungs are rosy, marbled, and soft and crepitant when handled. Minor degrees of respiration are recognized by the appearance of little groups of dilated air-vesicles, and by the fact that, although the lungs as a whole may sink in water, certain portions of them, into which respired air has penetrated, float in water even after subjection to firm pressure in the hand. Care must be taken, nevertheless, to exclude buoyancy of the lung due to putrefaction; in this case the air may be expelled by gentle pressure, and the previously buoyant portion of lung now sinks in water. It is impossible, however, to distinguish certainly between a lung naturally inflated and one artificially insufflated.
It must be borne in mind that, although live-birth cannot be affirmed in the absence of signs of respiration, the presence of these signs is not proof of live-birth in the legal sense of the term. The law demands for live-birth a separate existence of the child after delivery; and breathing may take place whilst the child is still either wholly or partially within the maternal passages, and in some special cases whilst still within the womb itself.
When proofs of respirationit may be to such an extent as to leave no doubt as to live-birth have been found, the cause of death is then to be investigated. Wounds, and other forms of injury, must be sought for. There may be signs of strangulation, suffocation, puncture of the fontanelles, and consequent injury to the brain, the administration of a poison, or other means of procuring death. It must be borne in mind that some of these causes may be brought about by omission, or even by accident. Thus strangulation may arise from natural and unrelieved pressure of the navel string on the neck of the child; suffocation from immersion of the face of the child in the maternal discharges, or by pressure of clothes on the mouth. Death may result from haemorrhage through neglect to tie the navel string, or the infant may perish from exposure to cold.
In the case of exposed infants it is very important to ascertain the real mother. As such exposure usually takes place soon after birth, comparison of the age of the infant with the signs of recent delivery in the suspected mother is the best method of proving the relation.
Ordinary homicide may be accomplished by several modes that may sometimes be ascertained by examination of the body. Of one of the most important of these consideration is deferred to the article POISONS.
Death by asphyxia is a common mode of accomplishing homicide, as by suffocation, drowning, hanging, strangulation, or by exposure to mephitic air. Suicide and accidental death from these causes are still more common. (1) Drowning is thought to produce death occasionally by the suddenness of the shock causing suspension of the functions of circulation and respirationby shock without a struggle. The usual mode of death appears, however, to be by the circulation of unoxygenated blood through the brain acting as a poison upon that organ; and this is attended with all the phenomena of asphyxia, as in suffocation. The phenomena attending asphyxia are as follows. As soon as the oxygen in the arterial blood, through exclusion of air, sinks below the normal, the respiratory movements grow deeper and at the same time more frequent ; both the inspiratory and expiratory phases are exaggerated, the supplementary respiratory muscles are brought into play, and the breathing becomes hurried. As the blood becomes more and more venous, the respiratory movements continue to increase both in force and frequency. Very soon the expiratory movements become more marked than the inspiratory, and every muscle which can in any way assist in expiration is brought into play. The orderly expiratory movements culminate in expiratory convulsions; these violent efforts speedily exhaust the nervous system, and the convulsions suddenly cease and are followed by a period of calm. The calm is one of exhaustion; all expiratory active movements have ceased, and all the muscles of the body are flaccid and quiet. But at long intervals lengthened deep inspiratory movements take place; then these movements become less frequent; the rhythm becomes irregular, so that each breath becomes a more and more prolonged gasp, which becomes at last a convulsive stretching of the whole body; and with extended limbs and a straightened trunk, with the head thrown back, the mouth widely open, the face drawn, and the nostrils dilated, the last breath is taken. The above phenomena are not all observed except in cases of sudden and entire exclusion of air from the lungs. In slow asphyxia, where the supply of air is gradually diminished (e.g., in drowning), the phenomena are fundamentally the same, but with minor differences. The appearances of the body after death from drowning are various. There may be pallor of the countenance, or this may be livid and swollen. The air passages are filled with frothy mucus, and there may be water in the stomach. The ends of the fingers are often excoriated from grasping at objects; and weeds, &c., are sometimes found grasped in the hands. The distinction between murder and suicide by drowning can rarely be made out by examination of the body alone, and is usually decided from collateral circumstances or marks of a struggle. Attention must also be paid to the existence of wounds on the body, marks of strangulation on the neck, and the like. (2) Hanging may result in death from asphyxia, or, as is more particularly the case in judicial hanging, some injury is inflicted on the upper portion of the spinal cord, resulting in instant death. The ordinary appearances of death from asphyxia may be found: dark fluid blood, congestion of the brain, intensely congested lungs, the right cavities of the heart full, and the left comparatively empty of blood, and general engorgement of the viscera. Ecchymosis may be found beneath the site of the cord, or a mere parchmenty appearance. There may even be no mark of the cord visible. The mark, when present, usually follows an oblique course, and is high up the neck. The fact that a body may be suspended after death, and that if this be done speedily whilst the body is still warm there may be a post-mortem mark undistinguishable from the mark observed in death from hanging, must not be forgotten. (3) Suffocation may occur from the impaction of any substance in the glottis, or by covering up the mouth and nose. It is frequently of accidental origin, as when substances become accidentally impacted in the throat, and when infants are overlaid. The phenomena are those of pure asphyxia, which have already been detailed. On post-mortem examination the surface of the lungs is found covered with minute extravasations of blood, known as punctuated ecchymosis. (4) Strangulation may be accomplished by drawing a cord tightly round the neck, or by forcibly compressing the windpipe (throttling). Hence there may be either a circular mark round the neck, not so oblique as after hanging, or the marks of the fingers may be found about the region of the larynx. The cartilaginous structures of the larynx and windpipe may be broken. The mark of the ligature is often low down in the neck. The signs of asphyxia are present in a marked degree. (5) Mephitism.Death from the inhalation of irrespirable gases is a mode of assassination seldom employed, but is frequently resorted to on the Continent by suicides, charcoal fumes being commonly used for the purpose (see POISONS).
6. Death from Starvation.Cases occur in which it is important to distinguish this from other modes of death. In such cases the skin becomes harsh and dry, and may acquire a peculiar odour; the subcutaneous fat disappears; the gums shrink away from the teeth; the tongue and mouth become dark-coloured and dry; the eyes are bloodshot ; the intestines become thin and their coats translucent ; the gallbladder is distended. The period of total abstinence from food required to kill an adult is unknown, and greatly depends upon whether there be access to liquid. In some cases persons have been able to subsist on little or no nourishment for long periods, the body being in a state of quasi-hibernation.
7. Death from Extremes of Temperature.(1) Death from cold is not often observed in the British Isles. A portion only of the body, as the extremity of a limb, may perish from extreme cold. After the first sensation of tingling experienced on exposure to severe cold, loss of sensation supervenes, with languor and an irresistible propensity to sleep. The tendency to this forms an extreme danger in such cases. (2) Death from extreme heat usually occurs in the form of burning and scalding, attended with destruction of a large portion of the cutaneous structures. Here the cause of death is obvious. The human body is capable of exposure to very hot airas is seen in Turkish bathsfor a considerable period with impunity. Sun-stroke is a cerebral affection brought on by too great exposure to a hot atmosphere, especially whilst undergoing fatigue.
8. Death by Lightning.Lightning an artificial electric current may cause instant death. No visible marks of the effects of the electric current may be left, or the body may be singed or discoloured, or the skin may be perforated at one or two spots.
9. Wounds.The examination of wounds, whether fatal or not, often becomes an important branch of forensic medicine. Wounds are usually divided into contused, lacerated, incised, punctured, and gunshot wounds. For poisoned wounds see POISONS. Each kind of wound requires to be minutely examined and described, as they are in approved works on surgery. The degree of danger from each should be familiar to the medical jurist; and he should recollect that there is no wound which may not become incidentally fatal from improper treatment, peculiarities of constitution, or accidental inoculation with septic material. Punctured wounds or stabs require minute attention; for there have been instances in which death has been produced by an instrument so small as a pin thrust into a vital part. Wounds of the head are always dangerous, especially if the blow has been severe. The person so wounded may die without division of the skin, or fracture of the bones, as happens in what is known as concussion of the brain. Contusions which do not divide the skin may fracture the skull; or the inner table of the skull may be fractured without the outer being broken or depressed. Even wounds of the scalp may prove fatal, from inflammation extending towards the brain. Punctured wounds of the head are more dangerous than cuts, as more likely to excite fatal inflammation. When the brain and its membranes are injured, all such wounds are generally fatal. Wounds of the face or organs of sense are often dangerous, always disfiguring, and productive of serious inconvenience. Wounds of the neck are always very serious wherever more than the skin is divided. The danger of opening large blood-vessels, or wounding important nerves, is imminent; even the division of a large vein in the neck has proved immediately fatal, from the entrance of air into the vessel, and its speedy conveyance to the heart. A blow on the neck has instantly proved fatal, from injury to an important nerve, generally the pneumogastric or the sympathetic. Dislocations and fractures of the bones of the neck prove instantly fatal. Wounds of the chest are always serious when the cavity is penetrated, though persons may recover from wounds of the lungs, and have even survived for some time considerable wounds of the heart. This last is an important fact; because we are not always to consider the spot where the body of a person killed by a wound of the heart, and apparently remaining where he fell, is found as that in which the fatal wound was inflicted. Instances have occurred of persons surviving severe wounds of the heart for several days. Broken ribs are never without danger; and the same may be said of severe contusions of the chest, from the chance of inflammation extending inwards. Wounds penetrating both sides of the chest are generally considered as fatal; but possibly there may be recovery from such. Wounds of the abdomen, when they do not completely penetrate, may be considered as simple wounds, unless when inflicted with great force, so as to bruise the contents of the abdominal cavity; in that case they may produce death without breach of surface, from rupture of some viscus, as sometimes happens from blows or kicks upon the belly. Wounds injuring the peritoneum are highly perilous, from the risk of severe inflammation. Wounds of the stomach or intestines, or of the gall-bladder, generally prove mortal, from the effusion of their contents into the peritoneal cavity producing fatal inflammation. Wounds of the liver, spleen, or kidneys are generally soon mortal, from the great vascularity of those organs. Wounds of the extremities, when fatal, may generally be considered so from excessive haemorrhage, from the consequences of inflammation and gangrene, or from the, shock to the system when large portions of the limb are forcibly removed, as in accidents from machinery, and in wounds from firearms.
10. Poisonous Food.Under certain conditions, various articles of diet, especially butcher meat, eggs, milk, butter, cheese, and honey, may become possessed of poisonous properties, and this may arise from a variety of causes besides the introduction of known and specific poisons. Moreover, certain kinds of animal foodfish chieflymay have definite toxic properties, Food may be more or less poisonous(1) from unsoundness, either from putridity or decomposition or disease ; (2) from the presence of parasites (3) from mouldiness, or presence of deleterious microscopic fungi and (4) where the flesh is that of animals which have fed on noxious plant,and under this head ma also be classed poisonous boney, which bees have gathered from poisonous plants. (5) It may be of the nature of poisonous fish, using the term fish in the popular sense. (6) Certain fungi or mushrooms are poisonous. Parasitic diseases would, strictly speaking, come under the first head; but the preventive measures to be adopted in the use of food infested with parasites will alone be treated of in this place.
(1) Poisonous Vegetables.Unsound or even rotten vegetables and fruits may be consumed, and become fertile sources of varied forms of poisoning, especially in hot summers. The symptoms produced by the ingestion of large quantities of unsound fruit or vegetables are of a diarrhoeal character, not often of an alarming severity, except in the cases of the young and feeble. They may, however, sometimes attain a fatal severity. The cause is usually obvious, and the treatment is simple; mild purgatives, as rhubarb or castor oil, with or followed by opiates, to remove peccant matters from the intestines; and stimulants, as ammonia or alcohol, if there be much collapse. Certain fungi or mushrooms are known to be specifically poisonous, such as the Amanita muscaria, or fly-fungus, and others. Certain kinds of mushrooms, usually innocuous, are occasionally poisonous or deleterious; and the cause of this is not always clear. Poisonous fungi produce narcotic and irritant symptoms.
(2) Poisonous, Tainted, or Putrid Meat.The obvious characteristics of good sound flesh meat are that its colour is redneither pale pink nor deep purple ; that it is marbled in appearance ; firm and elastic to the touch, scarcely moistening the fingers ; having a slight and not unpleasant odour ; and that when exposed to the air for a day or two it should neither become dry on the surface nor wet and sodden. Sound meat is acid to litmus paper; unsound meat may be neutral or alkaline. Meat may be tainted with physic administered to the animal. It is a common practice, when a fat and valuable animal is unwell, to physic it, and if its recovery be not speedy to slaughter it. The meat of such animals may often be met with in our markets, and may induce illness from tile physic with which it is contaminated. The effects of simple putridity are most varied. It is well known that some nations habitually eat putrid meat, and even prefer it to fresh; and the development of rottenness in eggs for the epicure is an art in China. There is no doubt that habit has much to do with the tolerance by the stomach of putrid meat, whether cooked or uncooked. But tainted game, and indeed all kinds of meat in which putrefaction has commenced, may indubitably produce disease. This is chiefly of a diarrhoeal character, preceded by rigors, and attended with collapse and, it may be, convulsions and other signs of a profound affection of the nervous system. The effects of such tainted meat are slight as compared with those which are produced by the sausage-poison, developed by a sort of modified putrefaction in certain German sausages. These sausages, when they become musty and soft in their interior, nauseous in odour and flavour, and strongly acid to test paper, acquire a highly poisonous character, and are frequently fatal in their effects. The symptoms produced by the use of poisonous flesh are gastric pain, vomiting, diarrhoea, depression, coldness of the limbs, and weak irregular action of the heart. Fatal cases end in convulsions and oppressed respiration, death ensuing from the third to the eighth day. The nature of the sausage-poison, which is probably akin to that of putrid and indeed all nonspecifically tainted meats, has been a matter of considerable controversy. Some have held that the poisonous action is due to the development of rancid fatty acids; others believe that a so-called catalytic body is produced, capable of setting up by contact a similar catalytic action. Others have regarded the sausage-poison as due to the formation of pyrogeneous acids during the drying or smoking of the sausages. The recent discovery by Selmi of a class of poisonous alkaloids or amides, termed ptomaines, developed during putrefaction of animal matters, on the one hand, and the discovery by Ballard and Klein, still more recently, that the fatally poisonous properties of hams prepared according to the American method may be due to the presence of a parasitic bacillus, point to one or other of these two latter causes as that of the effects of sausage-poison. Others again have referred the effects to the presence of a microscopic fungusSarcina botulina.
The poisonous nature of the flesh of animals which have fed on certain plantsfor example, hares which have fed on certain species of rhododendron, pheasants on the kalmia shrub, &c.has been abundantly demonstrated, and need only be referred to here. The honey from bees which have garnered on poisonous plants, as the azalea, may likewise be deleterious; and the fact is of classic interest. The milk even of goats which have browsed on poisonous herbs has also proved poisonous.
(3) Diseased Meat.The poisonous effects of meat affected with, certain parasitestrichinae, cysticerci, trematodes, &c., is an undoubted fact. Great quantities of meat pass through our markets which is undoubtedly the flesh of animals affected with disease, such as foot-and-mouth disease, pleuro-pneumonia, pig typhoid, the so-called scarlatina of swine, sheep-pox, &c.; and the question is quite undecided as to whether such flesh produces any injurious effects. To stop the sale of such meat would be to cut off large sources of our meat supplies. The evils attending the use of such diseased meat, when well cooked, have undoubtedly been exaggerated; but, on the other hand, there is enough evidence to show that the use of certain kinds of diseased meat may be followed by serious results. Thus it is generally admitted that the flesh of animals which have suffered from pleuro-pneumonia and murrain will give rise to boils and carbuncles. Braxy mutton may also produce disease when eaten. Trichinae will produce trichinosis, flukes, the tape-worm, &c. Hams are occasionally fatally poisonous; and this has been traced to the presence of certain low organisms known as bacilli.
(4) Poisonous Fish.Fish is sometimes a poisonous article of food. Cases of poisonous by the so-called shellfish of the British islands are not unfrequently met with. Generally it is the eating of crabs, lobsters, and mussels which produces such results. These are usually of a distressing rather than of a serious character, nettle-rash being a common symptom. Occasionally, however, fatal results have ensued from the use of mussels. In tropical seas poisonous fish are more plentifulthe golden sardine, the bladder fish, the grey snapper, &c.; and, these being eaten by larger fish, as the barracuda, perch, globe-fish, conger eel, &c., the latter may in turn become poisonous.
Good cookery, that is, exposure to a sufficiently high temperature for a sufficiently lengthened time, is undoubtedly the best measure to adopt short of absolute destruction of unsound and diseased meat. So long as meat is high-priced, and the effects of diseased meat so little understood and so undefined, it will be impossible to induce medical officers of health and sanitary inspectors to seize all the diseased and unsound meat which is daily offered for sale. Notwithstanding all that has been said to the contrary, experienced observers are pretty well agreed that, thorough exposure of the meat throughout to the temperature at which albumen is coagulated is destructive to the parasites of flesh. Smoking is less effective. Salting is more effective than smoking; but there is some evidence to show that salting may merely hold the life of organisms in suspense without entirely destroying their vitality; and thus in the conversion of salted pork into hamsa process of re-salting and subsequent dryingthe specific germ (a bacillus) has been known to be again rendered harmful. It is not known whether efficient cooking entirely removes the deleterious effects of flesh affected with other than parasitic disease, as for example pleuro-pneumonia.
The curative measures for the results of eating poisonous food cannot be specifically described. They are those which must be arrived at on general principles. Symptoms are to be treated, and the powers of the patient sustained until the deleterious matter is removed by the ordinary channels, or the trichinae have become encysted.
HISTORY OF FORENSIC MEDICINE
The true origin of medical jurisprudence is of comparatively recent date, although traces of its principles may be perceived in remote times. Among the ancient Greeks the principles of medical science appear only to have been applied to legislation in certain questions relating to legitimacy. In the writings of Galen we find, however, remarks oil the differences between the foetal and the adult lungs; he also treats of the legitimacy of seven months children, and discusses feigned, diseases. Turning to Rome, we find that the laws of the Twelve Tables fix three hundred days as the extreme duration of utero-gestation. It is doubtful whether the Roman law authorized medical inspections of dead bodies. In the code of Justinian we find De Statu Hominum; De Poenis et Manumissis; De Sicariis; De Inspiciendo Ventre Custodiendoque Partu; De Muliere quae peperit undecimo mense; De Impotentia; De Hermaphroditis,titles which show obvious traces of a recognized connexion between medicine and law. It was not, however, by the testimony of living medical witnesses that such questions were to be settled, but on the authority of Hippocrates.
Medical jurisprudence, as a science, dates only from the 16th century. In 1507 the bishop of Bamberg introduced a penal code in which the necessity of medical evidence in certain cases was recognized; and in 1532 the emperor Charles V. persuaded the diet of Ratisbon to adopt an uniform code of German penal jurisprudence, in which the civil magistrate was enjoined in all cases of doubt or difficulty to obtain the evidence of medical witnesses,as in cases of personal injuries, infanticide, pretended pregnancy, simulated diseases, and poisoning. The true dawn of forensic medicine dates, however, from the publication in 1553 of the Constitutio Criminalis Carolina in Germany. A few years later Weiher, a physician, having undertaken to prove that witches and demoniacs are, in fact, persons subject to hypochondriasis and hysteria, and should not be punished, aroused popular indignation, and was with difficulty rescued from the flames by his patron, William duke of Cleves.
At the close of the 16th century Ambrose Paré wrote on monsters, on simulated diseases, and on the art of drawing up medico-legal reports; Pineau also published his treatise on virginity and defloration. About the same time as these stimuli to the study of forensic medicine were being made known in Paris, the first systematic treatise on the science appeared in Sicily in the form of a treatise De Relationibus Medicorum by Fidele. Paulo Zacchia, the illustrious Roman medical jurist, moreover, published from 1621 to 1635 a work entitled Quaestiones Medico-Legales, which marks a new era in the history of the science,a work which displays an immense amount of learning and sagacity in an age when chemistry was in its infancy, and physiology very imperfectly understood. The discovery of the circulation of the blood by Harvey soon followed, and gave a new impetus to the study of those branches of forensic medicine having direct relations to physiology; and to Harvey we owe the idea how to apply Galens observations on the differences between the foetal and the adult lungs to the elucidation of cases of supposed infanticide. About this time, too, Sebiz published two treatises, on the signs of virginity and on the examination of wounds respectively. In the former he contended that the hymen was the real mark of virginity; but this was denied by Augenio and Gassendi. In 1663 Bartholin, a Danish physician, investigated the period of human uterine gestation, a subject which had engaged the attention of Aristotle. He also proposed the "hydrostatic test" for the determination of live-birtha test still in use, and applied by observing whether the lungs of an infant float or sink in water. Swammerdam explained the rationale of the process in 1677; but it was not till 1682 that it was first practically applied by Jan Schreyer.
Germany, ever the leader in questions of forensic medicine, introduced the first public lectures on medical jurisprudence. Michaelis gave the first course about the middle of the 17th century in the university of Leipsic; and these were followed by the lectures of Bohn, who also published De Renunciatione Vulnerum; cui accesserunt Dissertationes binae de partu enecato, et an quis vivus mortuusve aquis submersus, strangulatus, aut vulneratus fuerit, and De Officiis Medici Duplicis, Clinici et Forensis. Welsch and Amman wrote on the fatality of wounds, and Licetus on monsters.
From the time of Ambrose Paré the mode of conducting investigations in forensic medicine had attracted attention in France; and in 1603 Henry IV. authorized his physician to appoint persons skilled in medicine and surgery to make medico-legal inspections and reports in all cities and royal jurisdictions ; in 1692, difficulties having arisen, Louis XIV. created hereditary royal physicians and surgeons for the performance of like duties. These, having become a corrupt and venal body, were suppressed in 1790. The only works on forensic medicine which appeared in France during the 17th century, however, were Gendrys Sur les .Moyens de bien rapporter à Justice, and Blégnys Doctrine des Rapports en Chirurgie. At the beginning of the 18th century the latter was superseded as a textbook by Devauxs Lart de faire des rapports en Chirurgie. Valentini followed with two works, which were finally incorporated in his Corpus Juris Medico-Legale which appeared in 1722. This work is a vast storehouse of medico-legal information, and a summary of the knowledge of the time.
Professorships for teaching the subject were founded in the German universities early in the 18th century, and numerous treatises on forensic medicine were published. Teichmeyers Institutiones Medicinae Legalis long formed the textbook of the subject; and Alberti, professor of legal medicine at Halle, in his Systema gave to the world a most complete and laborious treatise on the science. His industrious collection of facts renders his works a precious mine of information. Indeed towards the close of last century the Germans were almost the only cultivators of legal medicine. But in France the celebrated case of Villeblanche attracted attention to the subject, and called forth Louis, who in a memoir on utero-gestation attacked with powerful arguments the pretended instances of protracted pregnancy, and paved the way for the adoption in the Code Napoléon of three hundred days as the limit of utero-gestation, a period in precise accordance with the ancient Roman law of the Twelve Tables. Louis also wrote on death from hanging, and pointed out the mode by which we may distinguish murder from suicide under such circumstances. It is he who is credited with having been the first in France to publicly teach the just application of medical knowledge to jurisprudence. Foderés celebrated Traité de Médecine Légalé appeared in 1798, and marks a new era in the annals of legal medicine.
No British author wrote systematically on forensic medicine till 1788, when Dr Samuel Farr published a short treatise on the Elements of Medical Jurisprudence; but this was merely an abridgment of an earlier work of Fazelius. Previous writers, as Mead, Munro, Denman, Percival, and the two Hunters, had, however, dealt with fragments of the subject; nevertheless the science as a whole was little appreciated or recognized in this country during the last century.
In the present century France took the lead ; and the institution of three professorships of forensic medicine at the end of the 18th century produced excellent fruits. In 1814 Orfila, a Spaniard by birth, but naturalized in France, published his Toxicologie, a work which revolutionized this branch of medical jurisprudence, and first placed the knowledge of poisons upon a scientific basis. Since the time of Orfila, France has never ceased to have one or more living medical jurists, among the most recent of whom we must enumerate Tardieu, whose treatises on abortion, on poisons, on wounds, &c., are justly celebrated. Germany too has industriously pursued the subject, and Caspers great work on forensic medicine will ever remain a classic in the science. In Russia Dragendorff has greatly contributed to our knowledge of poisons.
Though forensic medicine may be said to have been entirely neglected in England till the beginning of the present century, its progress has since been by no means slow or unimportant; and the subject now forms a recognized and obligatory portion of medical study. The first lectures delivered in Great Britain were given in the university of Edinburgh in 1801 by the elder Dr Duncan; and the first professorship was held by his son in 1803. Dr Alfred Swaine Taylor gave the first course of lectures delivered in England, at Guys Hospital in 1831; and in 1863 the university of London made forensic medicine a separate subject for examination and honours for medical graduates. In 1822 there was not in the English language any treatise of authority either on medical jurisprudence or on any important division of the subject; for it was not till the following year that the useful compendium of Paris and Fonblanque was published; and even half a century ago medical jurisprudence may be said to have been almost in its infancy as compared with what it is now. Since 1829 Great Britain has produced an abundant crop of literature on forensic medicine. Sir Robert Christisons admirable treatise on Toxicology, Dr A. S. Taylors Principles and Practice of Medical Jurisprudence, the same authors Elements of Medical Jurisprudence, Dr Guys Forensic Medicine, and Ogstons Lectures on Medical Jurisprudence are well-known and widely circulated works. The separate memoirs of Taylor, Christison, Guy, and others are also storeshouses of facts and deductions in the science.
America, too, has not been behind hand in the race. Wharton and Stillés Manual and Wormleys Toxicology are the best-known works of American authors. (T. S.*)
The above article was written by: T. Stevenson, M.D., Lecturer on Chemistry, Guy's Hospital, London.