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OF THE

Medical Jurisprudence.

Medical Jurisprudence.

A SYNOPSIS OF THE OBJECTS OF INQUIRY IN CASES OF SUDDEN, AND MYSTERIOUS SICKNESS, AND DEATH.

THE PATIENT IS LIVING, AND MEDICAL ASSISTANCE IS REQUIRED.

Account given by the patient and his friends.--How far their report deserves credit.--Whether there be any external injuries.--Previous state of the patient, with respect to bodily health and strength.--The age and occupation of the individual in question.--Season of the year.--Present symptoms of the patient; with the circumstances of their accession, progress, intensity, and duration.--Whether any similar attack has been experienced by himself at any previous period, or by any part of his family and friends at the present time; and whether the latter have felt any degree of nausea or uneasiness.--What remedies have been employed, by whom recommended, and by whom administered.--Nature of the food last taken as to quantity and quality.--Whether the patient had observed any unusual flavour, or grittiness in his food.--Condition and nature of the utensils in which it was cooked.--Appearance of the evacuations.

THE PATIENT IS DEAD.--THE ATTENDANTS CAN FURNISH ONLY AN IMPERFECT ACCOUNT OF HIS DISSOLUTION.

Examination of the attendants.--Circumstances to be investigated.--How soon the deceased is supposed to have died, after the alleged cause of his dissolution.--Had the deceased been under the influence of violent passion.--Was he at the time of death in a state of intoxication.--Plan of the inquiry to be adopted according to the principles already explained in CASE I, in combination with those to be developed in the following still more complicated one.

THE BODY IS FOUND DEAD.--ITS HISTORY IS UNKNOWN.

SITUATION and attitude of the body.--General appearance of the countenance, as to colour, vascular turgescence, or congestion, and morbid physiognomy.--Appearance of the eyes, and eye-lids, lips, and gums.--Whether any, and what discharge issues from the mouth, nostrils, ears, or any other orifice.--Apparent age of the deceased.--Description of his person as to bulk, stature, obesity, muscular powers, &c.--Conformation of the neck, with respect to its shortness, fullness, and thickness.--Probable period that has elapsed since the extinction of life.--State of the body, in relation to the degree of stiffness, or flexibility of its limbs, progress of putrescence, &c.--Whether any, and what marks, or ecchymoses are visible upon the throat, or under the ears.--Whether there are any, and what marks, punctures, wounds, contusions, and ecchymoses, dislocations, or injuries, on the chest, abdomen, or in any other parts of the body; and whether their appearance and character lead to any conclusions respecting the nature of the operation or instrument by which they were inflicted.--Whether such wounds were necessarily of a mortal nature, or sufficiently severe to have caused immediate death.--What is their direction.--Whether they were inflicted during life.--If during life, whether they resulted from an act of suicide or otherwise; whether from accident or design.--State of the linen and clothes of the deceased.--Whether torn, or in any way disordered.--Whether stained with blood.--Whether they yield the odour of spirit, sourness, putridity, or that of tobacco.--Whether any articles have been broken, or injured in the pockets.--Whether there is reason to believe that the deceased had been robbed.--What are contained in his pockets.--Whether any soil, or other matter adheres to the shoes, or dress; and if so, how far it corresponds with the surrounding soil or herbage.--Whether the hair of the deceased appears dishevelled.--If the deceased be a female, whether there be any marks or bruises that would indicate the commission of a rape.

Whether the spot in question be of a description to explain the cause of the deceased having been found there; or how far its retired situation excites the suspicion of his having been conveyed thither for concealment, or some other purpose.

Character and condition of different objects surrounding the body.--If in the open country, whether any indications of a struggle having happened on the spot are visible upon the ground, or herbage, near the deceased.--Whether any footsteps can be traced near the body, and if so, what is their exact shape and dimensions, and what their direction.--Can the particular spot in which the body was found have been invested with unwholesome vapour, or with air destructive of animal life.--Has there been any violent thunderstorm.--or can the person have been exposed to any extraordinary degree of heat.--Whether any and what weapons are lying near the body.--If so, what is their exact position in relation to the body and its members.--If the body is found in the water, are there any and what reasons for supposing that he was killed by other means, and subsequently thrown into the water.--What are the principal local circumstances of the water in question.--Was the body found floating or otherwise.--What wounds and contusions are visible on its surface.--If the body were drowned, was the death accidental or malicious; was it perpetrated by himself or others.--Whether any footsteps are visible on the margin of the water.--Whether any soil or herbage be found in the grasp, or under the nails, of the deceased.--If the deceased be found suspended by the neck, was it by an act of suicide or otherwise.--Was he killed by strangulation or by other means, and subsequently suspended.--What is the nature of the ligature, and the manner in which it is fixed.--Are the hands tied.--If the deceased be found in an apartment, whether it be in a house of ill fame, or in one of suspicious character.--If the deceased be found dead in bed, or chair, or on the floor, what is the nature of the excrementitious matter in the night-vessels.--What bottles, and other articles of medicine are in the apartments?

Report of witnesses.--Is the body in the same situation and condition as when first discovered.--Can the body be identified.--Period at which the deceased was last seen, by whom, in what place, under what circumstances, and in whose society.--Are there any moral reasons to excite the suspicion of his having committed suicide.--What was his occupation.--Had he lately met with any disappointment or misfortune.--Had he appeared dejected or melancholy.--Are there any persons with whom he associated, who had any remarkable interest in his death.

A COMMENTARY

UPON THE

PRECEDING OBJECTS OF INQUIRY:

THE PATIENT IS LIVING, AND MEDICAL ASSISTANCE IS REQUIRED.

This is the least complicated case that can occur; the medical inquirer has not only the advantage of the patient's testimony, but that also of his own observations upon the symptoms and circumstances of the case. We have already stated that the declaration of a person, made under an apprehended pending dissolution, is by the law of this realm considered tantamount to an oath, , and we have also stated what it becomes our duty to repeat in this place, that in recording such testimony, we must be prepared to combat various errors and prejudices: we do not mean to deny that the awful situation in which the patient is placed will not, in general, secure us against any wilful misrepresentation, but we contend, that a person acting under the influence of bodily suffering is very apt to fall into numerous fallacies respecting the transactions in which he may have been previously engaged; especially in such cases as usually constitute the objects of medico-judicial inquiry, where the passions not unfrequently increase the natural disturbance of the mind, while the eagerness which is so justly felt for the detection of the author of the injury, will tend rather to heighten than to correct any hallucinations under which the sufferer may happen to labour; for on such occasions the imagination is always ready to supply the want of testimony, and to fill up the spaces which actual observation may have left vacant.

But of all the fallacies with which we have to contend, no one is more dangerous in its effects, or more frequent in its occurrence, than that which leads them to mistake the identity of the offender; we have already alluded to this fallacy , and we shall hereafter have occasion to refer to it.

When a medical practitioner is summoned to investigate a case, in which severe sufferings have supervened, without any apparent or assignable cause, the following interrogatories are calculated to elicit data for a just conclusion.

A knowledge of the nature of the medicines that may have been taken, will also assist the chemist in his examination of the matter vomited, as we have fully explained under the history of Poisons.

THE PATIENT IS DEAD.--THE ATTENDANTS CAN FURNISH ONLY AN IMPERFECT ACCOUNT OF HIS DISSOLUTION.

In conformity with the plan upon which we have arranged the objects of inquiry into the causes of sudden sickness and death--that of beginning with the most simple and plain, and passing in regular gradation to the more complicated and obscure problems, the present case, in which the patient is dead, but the attendants are able to furnish some history, however imperfect, very naturally constitutes the connecting link between that in which the patient is living, and that in which the great avenues of information are entirely closed upon us by the death of the individual, and the total absence of all direct testimony. The plan, therefore, upon which the investigation of this case is to be conducted, is in a great measure to be derived from the application of those precepts which are contained in the other cases; that relating to the examination of the attendants being collected from the first, and all that concerns the death, from the third.

THE PERSON IS FOUND DEAD, AND THE HISTORY OF HIS DISSOLUTION IS UNKNOWN.

The deep obscurity in which this case is necessarily involved, can alone be dissipated by the concentrated light of circumstantial evidence, derived from the inspection of the dead body, in the exact situation and posture in which it was found, and that of the surrounding objects; from the information afforded by competent witnesses, respecting the previous history of the individual in question; and, lastly, from anatomical dissection.

In conducting such an inquiry the most trifling incidents connected with the deceased should not pass unheeded, for however unimportant they may at first, individually, appear, we shall often find that in combination they will afford the principal data for the solution of our problem. With how many examples will the history of crime present us where the more minute circumstances have alone furnished the "damning proofs" of guilt? Their apparent insignificance in such cases would seem to exempt them even from the usual precautions of concealment, and more especially from those artful measures by which the designing assassin seeks to cast an impenetrable veil over the more direct evidences of his crime.

That the inspection of the body could furnish the satisfactory means of discovering the cause of its death, is an opinion which has been very naturally entertained from the earliest ages; although it is easy to perceive that the extent and just value of the indications, which such a practice is capable of affording, could never have been appreciated until the more advanced periods of physiological knowledge.

"O gentlemen, see, see! dead Henry's wounds Open their congeal'd mouths, and bleed afresh! Blush, blush, thou lump of foul deformity; For 'tis thy presence that exhales this blood From cold and empty veins, where no blood dwells; Thy deed, inhuman and unnatural, Provokes this deluge most unnatural."--

If it be determined that such wounds have been inflicted during life, it then becomes important to solve the following questions.

The information which may be occasionally derived from the state of the objects surrounding the body, will be best illustrated by the numerous cases in which they have furnished the principal means of discovery.

In cases where a violent effort has preceded death, violet-coloured spots containing venous blood may be perceived on the surface of the lungs, and which are true ecchymoses, occasioned by the rupture of some small vessels. Such phenomena must be carefully distinguished from the livid, black spots, which have been observed in cases of narcotic poisoning, and which are characterised by a more dense, and less crepitating texture. In this stage of the dissection, we may conveniently extend our examination into the trachea, and bronchiae, and observe whether these tubes contain frothy mucus as in drowning; coagulated blood, as in pulmonary hemorrhage; pus, as in the event of the rupture of a vomica or impostume; or ropy and tenacious mucus or lymph, as in croup, tracheal inflammation, and bronchitis; or chyme, as may occur in cases of intoxication, and diseases of the brain, where vomiting has taken place during a state of insensibility. We shall at the same time be enabled to ascertain whether any mechanical obstruction, from the presence of foreign bodies, exists in the pulmonary passages, and which might have occasioned death to the patient, as related under our history of suffocation, vol. ii, p. 57.

The spleen may be brought into view for our examination by drawing the stomach towards the right side, when the one viscus will follow the other. This organ, like the liver, may be ruptured by violence; of which we have already cited an instance.

EXAMINATION OF THE SKELETON.

It will appear in the course of the present inquiry, that the anatomist may be called upon to examine a part, or the whole skeleton of a person supposed to have been murdered; and his evidence upon such occasions will be of the greatest importance. Convinced of this fact, we are induced to offer the following observations.

THE CASE OF THOMAS BOWERMAN.

ABORTION AND INFANTICIDE.

The prisoner's counsel insisted that he was entitled to an acquittal on the ground that the medicine was misdescribed.

ABORTION.

INFANTICIDE.

The objects of this inquiry may be conveniently arranged under four divisions, viz.

On the discovery of the body of a newly-born infant, it becomes our first duty to ascertain whether the spark of life be entirely extinct; if the sensible proofs of absolute death should be absent, no time is to be lost in subjecting it to those means which are best calculated to excite it to vigorous life, such as external warmth, frictions, inflation of the lungs, &c.

Having satisfied ourselves that the child is dead, we are to proceed to such inquiries, as may enable us to furnish the best possible evidence on the case, in a court of judicature, viz.

The surface of the foetus will moreover present an appearance, arising from its great vascularity, which is very characteristic of its immaturity; the red hue, however, to which we more particularly allude, is not acquired until the vessels have attained a certain capacity, and the circulation a considerable degree of vigour; and it is worthy of remark that the appearance becomes again obscure, as the developement of the foetus advances, from the increasing opacity of the integuments, but in those parts where the deposition of fat in the cellular membrane is wanting, the redness will remain conspicuous, as in the palms of the hands, or in the soles of the feet. The head still maintains an unjust proportion to the rest of the body; the bones of which it consists are extremely soft and yielding; and, on account of the extent of the fontanelles, the connection between them is extremely imperfect. The eye-lids are closed; the hair on the eye-brows and the eye-lashes but thinly scattered; the pupil is generally closed by a membrane; the nails are wanting, or scarcely apparent. The sexual organs will also afford some characteristic appearances. In the male, the testes, between the sixth and eighth month are in progress towards the scrotum; at the end of the seventh they are not yet found there. The scrotum is generally of a bright red colour. In females the vulva is projecting, and the labia separated by the protuberance of the clitoris.

The state of the cervical vertebrae should also be carefully examined, for the death of the infant may have been occasioned by a fatal luxation, produced perhaps by some sudden contortion of the neck. Any marks of pressure, or violence about this part should therefore be carefully noted; and it will be obviously more convenient to examine the spine, before the large cavities of the bodies are exposed; and which may be accomplished in the following manner. After dissecting the soft parts from the vertebrae, the dorsal parts may be readily removed by scissars, while the apophyses of the true vertebrae can be very easily cut through. The practitioner will thus be enabled to estimate the nature and extent of any wound, or laceration, or effusion of blood, that may be discovered in connection with the spinal marrow. The appearance and condition of the umbilical cord should also be examined before any of the great cavities are laid open; for it is obvious where a ligature has not been properly applied to it, death may have arisen as the result of hemorrhage from this part. Other reasons also exist which render such an inspection of the greatest importance.

The ample directions which have been already offered upon this subject, will in a great degree supersede the necessity of very minute details on the present occasion. There are, however, some few phenomena that exclusively relate to the evidence of infanticide, and must accordingly receive a due share of our attention. Certain peculiarities, moreover, exist in the mode of conducting the dissection of an infant, which demand some explanation.

It will be adviseable to commence our incision through the integuments, from the under lip to the top of the sternum, passing quite through the former part; another incision is to follow the inferior margin of the lower jaw; then the triangular portions thus marked out are to be separated from the parts beneath; the head should be bent back in order to put the soft parts that are to come under the knife upon the stretch. The jaw may now be divided at its symphysis, so as to separate it into two lateral portions, which may be turned aside by dividing with a scalpel all the parts which adhere to its internal surface. The object of this arrangement is to bring into view the cavities of the mouth, oesophagus, larynx, and trachea, the condition of which is so frequently connected with the death of the child that they ought never to escape examination. The position of the tongue should be noticed, and the contents of the mouth, if any, ought to be recorded, for cases have occurred in which extraneous matters, such as mud, sand, feathers, &c. have been accidentally, or criminally introduced. It will at the same time be extremely proper to ascertain the state of the nasal cavities, and to observe the quantity and consistence of the mucus in these parts, as well as in the fauces. The tongue may now be gradually pulled downwards, until the isthmus of the fauces is stretched, when, by cutting through the arch of the palate, the whole of the pharynx will be exposed; the dissection should then be extended in order to bring the commencement of the oesophagus into view, which should be carefully examined. The position of the epiglottis is the next object of inspection; and lastly, the interior of the larynx and trachea may be disclosed by making an incision through the thyroid, crycoid, and tracheal cartilages, at their anterior parts. Ligatures should be placed on the lower parts of the oesophagus and trachea.

The heart is now to be separated from the lungs, having previously applied a ligature to the pulmonary vessels, to prevent the escape of the blood they may contain; and the weight of the heart alone then determined, that it may be subtracted from that of the heart and lungs together, as previously ascertained. The lungs are now to be placed alone in the water, and great attention must be paid to the position they assume in it; that is, whether they sink rapidly or slowly, or float near the surface; whether, by reversing their vertical situation in the water, they sink more readily or with more difficulty; and, if any part constantly rises and is drawn under water by the rest, this part should be particularly marked.

The two lobes must be separated, and the above-mentioned experiment made with each distinctly, and any difference in the results remarked; if one lobe float, and the other sink, it should be noticed whether it is the right or left that floats. Each lobe is then to be cut into several pieces, taking care not to confuse those of the right with those of the left."

We have thus then presented to the reader the various avenues of information, which the sciences of anatomy and physiology are capable of disclosing; and it will, we trust, appear evident, that the forensic physician can rarely furnish more than presumptive evidence in the support of cases of imputed child-murder.

OF CRIMINAL RESPONSIBILITY, AND PLEAS IN BAR OF EXECUTION.

As the fact of absolute infancy may generally be ascertained by the mere view of the party, and his capacity ascertained by questions propounded by the court, an infant prisoner may, as before stated, be discharged without further trial; not so however in cases of idiotcy, madness, or lunacy, these must be tried by a jury, for they may easily be feigned, and it is therefore by evidence of previous conduct that the question is to be determined, rather than by reference to the prisoner's demeanor in court, which may probably be counterfeit.

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