TAYLOR’S

PRINCIPLES AND PRACTICE

OF

MEDICAL JURISPRUDENCE

Volume I

AIFRFI) SW AIN'T TAA LOR, M I> , F R S
1880

lor forl^ SIN ^r-irs Leciurer in Mrdical lurl'Jiirudctife ut G»i\'
llo«)>ilal Mcdicfil Sdiool 1 wdon

TAYLOR’S

PRINCIPLES and PRACTICE

OF

MEDICAL JURISPRUDENCE

ELEVENTH EDITIOS

Edited by

SIR SYDNEY SMITH

cm ,LL.D,MD (EdlnLFRCP (Edln),Hon MD (Louvain)
DPH.FRS (Cdln)

EM>iirns rKurEvsuR or Fo«es»io uentcivr t'>i%EBsrTV tr
yoi^BviiBO ^o^fbfTAVT {v FoaEVfrir Mcufn*>E to womio tir^LTH
OROAMXATtON FOKMTKLX rBt'-OFAA MkJIOOiecAl FXrrftT
colPTiAS rovrlitjirw «f«vicf- frofusok or roKessic MCnici^E.

I M\ri AITV OR Er»rr

Assisted by

KEITH SIMPSON

M D . Lend (Path.)

REAoeu IS roHESRis xeoicisk. or London mk*d or

orPAHTHvsT or rt)ke.s»(C WEOieisc I'd ii no>mAL. iondon
AM iyiATF »yro«n-r*a»sc» habaardamatkoti

The Leoal Aspect rnitrd by
Gerald Ho\Nard, Q c, m p

ttARRISTAK AT LAW nrC«>M>C(l<>P trsWlCit
i-riRMPBLv •Fsion TPr»«i ev c«)is«l-i

Ps\ciiiATnY AM) THE Lkw coninbutid by
David StafTord-Clark
M D . M R C P . D P M

riiTSiLiAN IN ciuBcr pert or pstibolooical iiuiriNF ult s
IION riTAt, WRlAToa TMbVORNCKNK

Tiif Chlmical Aspect rtnstd by
L. C. Nickolls, M Sc . A R.G S , F R 1 C

DtntCTOR VrTBOROLtTAN FOlItr IJII MIATORl N<-w NfOTLAND l*M>

VOLUAfE r

1th 1 Coloured Plate and 60 Text-figures

LONDON

J. & A. CHURCHILL ltd

104 Gloucester Place, 1
-* 1936

First Ldition

laoa

(I)« V SWAISL Tamxir)

Second Edition

1873

Tliird Edition

1881

(rcMscd b\ Dll T Sit\fssos)

I-ourth }-<iition

1811

fifth Edition

IOOj

(re\isc<n)v Dit f J Smith) j

Sixth Fdition

1*»!0

i5C%enth I dition

1»)2»

f igMh f dition

1028

(rcMsed h> Pnor Sxd\e% Smi
nnd Dll \\ G H Coo\)

Ninth f dition

) lU

Tentli Fdition

1048

He\cntli fdition

lOoC

(rc\is,ed hv Sir Svuxf^ Smith a
Dn Kfith Simpson wi

collnJjontors)

VLL U1CIIT& ItCSIliVLI)

This book wioy not bf reproduced by anj
means i« j,hote or in jwrt mOoui
] rrmusiott of the jnibtjsl rrs

I rmteit in Great Hr

PREFACE TO THE ELEVENTH EDITION

SisCL brought ovit the edition of this work just 00 >eirs a^o

tlie world has witnessed startling atliinccs in all the phisical sciences and a
great thougli not so spectacular adi ance in the biological sciences It would
be true to saj I think that in the past half centurv progress in science has
liecii greater than in the whole preiioushistorv of mankind Thedeielopment
of new instruments and new teclimques has given the chemist the plivsicist
and the biologist new means of acquiring knowledge ot the intimate structure
and re ictions of matter of the manner in which so called poisonous substances
interfere with the iunctions of cells or the tnxvmes which are essentia! to
their use The serologist lias pursued his researches into the elements of blood
and tissues and has olitiincd greativ increased knowledge of identification
and inheritance

Our know ledge of the Jium in mind and human behav lour lias been extended
and eid \rgeil md we has e witnessed a regular luU ante m our concepts of the
pi ICC of punishment and reform in cotmeclion therewith It would he wrong
iiowcver to think that tlic enormous advances in medical and social science
liavc been accompanied bv n eomniensuralc improvement m the human
mind

Successive editors of favlor Imvetndcavouicd to Keep the hook ihreast ol
these advances but the field has widened to such an extent tiiat it hasgradu div
^become too vast to be covered bv nn> one man In this edition I have been
fortunate in obtaining the assistance of Dr Keith Simpson in the general
editorship »nd 1 have no doubt that hts inOuence will be observed in most
sections of the work I have also had the priv ilcgcof enlisting the collahur itioii
Cicrnih’ilbwuTa'cfV m illc revision oi**!!!!' ligai’asja-tt^ lUs ibttg
experience of medical affairs ns seen in the Courts of Justice and m the General
/Medical Council should lie of unicjuc \ivUic to our readers The section on
Psvchiatrv and the Law has been largelv rewritten hj Dr Divid Stafford
Clark whose advanced and balanced views on mental disease and behaviour
ate vvell known Mr Nickoni Director of the Metropolitan Police Labora
JVeH Ysni

section from the laboratorj side He has had an experience of toxtcolognal
procedures which is denied to most people m this countrv

In tins new edition a somewhat more radical rev ision has been ittemptcd m
( order to keep Tnjlor ’ abreast of the tinicj. Several sections— notnblv those
oil Post mortem changes cm Inlcrsexuahtv is an idcntitv pniblem on the
general procedure of trimiiial Investigntion on Regional Mounds Hlood in
Idcntitv Traumt and Disease — and the sections on Vsphj'xia and on lift
\ssurance have been verv lirgel> rewritten
In Volume 11 \bortion and Infnnticide— and the greater part of the section
on Toxicologv have been similarlj revised Times change and both modem
•^vicws and current practice demanded major change in the text No less tlian
i02 new cases hav e been introduced into tlie first v ohime together with some

to new illustrations

In tlu section on pist mortem clwnge Dr Keith "Mant give considerable
assistniicfc^and for Ins help we thank him Me desire also to record appreem

van icr to Tin Li)irio\

tion of the ytiicral help in proof reading gi\cn !>} Air II iurbanh and jn
chechmg the bibhognjjhv h\ Mr M Hill Librarian at Cuvi Hospital
Medical Scliool Dr Keith Simpsons secretary, ^Iiss J Scott Diinn under
took the major task of j»ro\idmg t\pcscript from both editors manuscript
and her great care and patience contnbiiteil irnich to the smooth cxilhbomtion
'ichic\ cd «itli the publishers in tins new edition

tpirt from lertam individual ackiiovvlcdj^mcnts for dlustrations there
remains a record of thanks to be made to Imth the Commissioner of Police
of the ^letropohs and to the \s\istant (ummissioncr (Crime) Mr K L
Inckvon for permission to use other unspccincd photographs vvliicli ajijicar
for the first time m this edition

The assistance of the chemist the plivsicist the biologist and of experts
111 other branches of science has given greater prtiision in our work
with a corresponding increase in the value of evidenrt Overall however
there must be someone w ho is ahlt to adv ise on the pnitedure to hf adojilcd
the pitrticulnr scientist whose help should he sought and who takes fi final
rcsponsibihtv of advising tlit Crown Thus there would appear to be no
lessening m the need for a general work such ns this on forensic mcibcine nor
in tlic need for instructing medical pnclitioncrs on accurate observation In
that respect it is of interest to note how accurate Taylor was in lus gerieml
observations and how little his forthright ndvivt liis been changed b> tune

1 dtnburgh 1035

S\DNJ\ SMITH

CONTENTS OF VOLUME I

t iiAvn It j %c I

I Introduction 1

Notts ftnd Reports l^rortiliirt Ftilcnec Ices

II Medico-Iegal Responsibility in the Examination of

Persons AIi>e or Dead 17

Ccrtiliextion rf Death DispoMil of the Deid 1 viiiinntion
Procedure Medico Icpnl Autopsv

III Functions of the General Medical Council ‘id

Milpri'ti’! Negligence in yntstliCMi Ne{,l<cl Quick(>r\
rimslnti Science irjpnotism

n Identltv SO

Idcntifitalii n of L»\»n„ Persins R«d Ibumn Rcmnn''

. \nthropnnictr) I ingerprmts Teeth Scirs and Tattoo

' Muks Sex If'iir Tge Slnliire ^Iiitil iled Hi imins

V DeTtli Ki

Si^ns of Death l'ostn<rlein (lim„es Tiittiicn e if
> Imincision amt Bund

M Apparent Death Premature Burial i04

VII Inferences to be Drawn from the Examination of i De id

Body — Apart from the Cause of Death .'(i-

Mil Legal Presumption of Death and of Sur\i\orship .JO

I>. Wounds and Offences against the Person *JJ

X’OT/*VvT-AvvW' V.^y/A^ Swi'iwA •vorti-aVt

nr Homieidc ttoin l>trSpecial Regi i)s Relitinn^hip
to Dcatli.

X Examination of Blood Stains UJ

Methods nf TxaminnlDn Id id frrriifin„ Bl wl in
Idcntils and ircredit%

XI Firearm Wounds « S

Bnihstits Tntirpretfltiuii of Wiumls tu lent Suicide ir
Homicide Injunes from Evplo^uves Blast

XII Death from Lightning and Electric Currents 107

\

XIII Deaths connected witl^Cold and Heat (JO

'■ tfosthitc hxjosure Burns ireilslnkc Sj inluciiis
CombustK n Trr'i linti mi Clicmiwd Burns

Ml

» I in\~rf vtn f‘f mn Mr /

ru\rii I

\!\ Strtr» 4 tion TamitM

\\ l)fatb> from A^l'h\xl•^ SubovJa \nnvb

Su'T ir-j} <’» V»T>^ tif f '•irjif-r

Tr «usn-»f» \»} } \ \n

\M 1 tfi Uorkman**. I oniprn%atfnn KclJtion-

<htp of TruumJ lo

t«rWT\l Iji's V«-'«JtW*W'C' tfniw Ni^v-'Wil

In^»r«iir«* (Ii») I tru) Iniur^J

\\ II Psvchi itr\ and thr 1 a»\

< » Wrl 1» » f I» \jn l\ afnl frxi Tfir \'i rli"- • f

llir Ij»«» in IVtrfKr (rtlilarati n Ilr«|» * tJv i f
Invinr Kr'ix n» Ml t% f I>njn1.f-n IVrpcm

fnv\j \\

IndfV

1 ’ CHAPTER 1,

'J t ‘l

- I INTRODUCflON

1 rji i ni

Definition Tlie tnnt has long since passed when it could be expected of a
medicxl Vv itncvs tint he should po-,s6*«> An inUt»urte know ledge of^ll liran^ics
oC incclicine Tiie scope of application of the basic sciences tiiid hf the iilahV
sections of niedicme wlneli nnj lend their aid to tht? njcds of-the law — frdili
unitoms or biocliemisf r\ to tberapetdies or patholo^j*— hits so Increasfed Ihrit
It becon’ics iinjiortant to define generd medical practitioner s lUttics at !aU
in eritircfj different terms from those of a specidlist witli purHculu tlaihfi>
m thH field the latter nnj profess n kHb« Wgt of forehsit. ^JAthologi Wvi.
cologi scTologs or ps^cluatrj wlut.h isi^uitooulside thesebpoof th^ onlihtry
medical man’s training m IcgAl'mfcdicme * ‘ ‘

Medical Turuprudence, an older term for legal or forAnSie fnetliClfie is &
subject (w Inch should equip botli the gehcml practitioner and lliefipeclhli'ltffor
their partJculnhscreices to the I iw and thepurpose of this trOrk is to bring
•nithin tho reach ot both medirino and the law some knowlcclge of those
-prwVfcw«s c,ss ^w*v«5r\ ^s?5sks.s'A ^

M ^ } if o i

Scope Slcolieo legal knowlcdgc’comists not so VmiOh in the Acquisition df
hirtj> in the pow cr of Arranging them in rtn onlerh Way nn drawing toUilil
conclusion?, from them' and Mi applj mg these to the rteed-f of the law V tAifi
nnyshow skill nrtd competence m fhehnndlhigof prAfcssional matters /ind 'Art
* erudition in his subject vet lack the nbilitv to express Ins'Vlew'J td dtlidrs-i
, Icastofnll peihaps to thoscsulhontkiiOwlcilgeofTncfiica) matters^ Vma'ltbr
? Ill his art TO IS ho incompetent ns ft witness surpassed perhaps mthfK *41x11150!!
^ evidcnechr one wlio IS much inferior in professional itahding I ^ *'

1 Palmer in his I ife of Ilontcr 'vrotc
S / M 111 1 1l JUlT>

Tojin Ifuntcr stood at the Jiead of l|is ppifcasiop and if ^ouw^ prqrt")^(Oqal
“ knoolcd^ could lute qual lied ant imw fo act as a medical wltiieas. Hunter was
/ull\ qtiaiili^d Vti tbirf gre-it man w-lieii pi Ing ciadeiice in ITSl nn a’^Hetrcorablc
trial for poisoning tw, obliged to lonfdss ihnl he ww*! unible to give a doflintd
wnsv-cT to- tire Important (question pMttO l»nv Hunter was-the onh ptbfcsaionnl
nllni-ss called on tiu, pirt of tlip ptiscwwr to cjuiTge^oC poi,soning tfits

^ decca«cd In laurel water IIis ett e\.iii^natic«i however, rather strengthened the
la e f >r flic prosecution Irtd tlic, final qt^tlAn 1 ut bv the court was, Gu<. \bur
^ jH In tlu best mJiiiiCr von enh nhfcwfiv^ lit'tht otliw* avhether uponflfcaiholt*
1 ^ uC the svnvptnms descnbetl the death proceeded from tlie medicine (laurel w iter)

1 1 an^ wvlret llt3;nttswer]waa 1 di> i\ot mean to eqiuypijilei huVofben

T IfU the scniirneijjs of ms own mind wjiat fwJ al|tl^ time,, I c^in jpvi^ notlung

Tf e" facts ( f tlie nse were lltaf^a toung m*in prevlousli^ m good ^Tcalth expired
in eouvwlsioiis about InU nn hour after tnfcittg A draught t fThubathand jaTijVstnf
b\ J b mciluaimau with nh[rh ^fcvras alleged the accused had nu-ved iautal w4t^

2 lhTltODtCTlO\

llie -vncljms mother obscr\Td Hunt the draught smelt of bitter almrmls alen^
oclmlnl^tc^ct! Ten days after death tlie body was exlmmetl and e\aniined b\
several mcfhc-il men TJic examiners did not open the brain and thc\ did not
investigate the condition of the intestines No analysis either of the contents of
the stomach or of tlie remainder— if an\ — of the drought was made Hunter'
dcposetl lint the appearances found m tlie stomach were ordiiiirj post morlen'
changes with which lie was quite familiar anil that the sjmj toms with which the
MCtim dietl were quite compatible with apoplexy or epdep-sv He admittwl in
cross-examination Huai the occurrence of tlie symptoms immcdiatelv iftcr taking
the draught was a circumstance in favour of its having caused them and if sai I
he I / nnc that the draught had contained poison I should saj that most pri bablj
the symptoms arose from tliat. He was however directed bj the judge to
separate tfie medical /nets v\ lucti lu: I»ad obserxM from the suggestion that poison
had been administered and on this direction lie declared that there was no direct
medical cv idenee to show how death liad l>ecn caused The accused was convicted
and liangccl

Analysing this case in the light of our present day knowledge so far at
least as the medical ev idcnce is concerned the conv iction seems to hav c rested
almost entirelv on circumstantial evidence Ihere can be no doubt that if
death was due to poisoning at all it was due to poisoning by n dilute solution of
hvdrocvanic acid but the post morttm evidence, apart from the smell was
indecisive Hunter s evidence was as slnightfonvnrd ns his knowledge would
permit for the smell would probably hire passed off m ten days and there
were then no means av ailable forexacl analysis of the contents of tlicstounch
but he might reasonahlv hive been expected to have gi\cii a more definite
answer on the balance of prob ibihtics
The liw isks that i ineclicai practitioner shoiihl exhibit a degree of know
ledge commensunte with lus station and a care m its application to practice
which could be regarded a.s reasonable in the circumstances This pnnciple
applies to practice m all branches of medicine, to surgery obstetrics public
health etc and of course to forensic medicine It must not lie forgotten that
It applies equally to the discharge of routine kgal duties hv the ordinnn
practitioner in Jus examination and treatment of patients in certification and
m his relation to civ il or cnnnnat procedure in vvjiicli his help is sought He
should be an impartial observ er intent only on seeking the truth of a case m
relation to its circunistanecs the conscience with which he discharges lus
duties IS but a corollary to his putting into practice the medico legal knowledge

he has aquired

Some members of the medical profession have been iiiclinetl to regard
medico'Ieg'il matters as an unwelcome even unnecessarv adilitcnjii*’to*iiren
ordinary duties but no doctor can be m practice for long w ithout hav mg to
shoulder the responsibility for decisions of medico legal importance He must
face the problems of legal responsibilitv, of certification and compensation of
his relations with the coroner and other legal anlhorites and with lus duties m
courts He may at anv time be requirevl to give a report on and siibscqucntlv
appear in court m connection vviUi cases of accident assault, suspected
poisoning of abortion and infant death and in a v ariety of otlirr rases whu h
may come before him either m lus capacity as a general practitioner or as a

hospital officer

It IS almost inevntablc that in siicli cases lie will be asked to pve not only
factual ev idence about matters whicli he has observ cd but also lus opinion on

such facts He may of course, excuse himself from answering questions on
matters outside his ordinary province 4 practitioner mav for example
safely admit he does not feel qualified to answer questions on the grouping of

MAU\G MEDICO LEGAL OnSHRJ ATIONS 3

blood stoms ttoil the forensic pnthologist ma} eqmH> excuse luraself from
comment on criminal ps>chmtr\ or Uic ECG but a great tnan\ of the
^ questions on nlncJi he is oskc<! to gise an opinion might nell be considered
' nithm the competence of a %\ell educated practitioner

A kno'\>kilge of the principles on 'wtiich forensic medicine is based must
therefore be n ithm the grasp of oH practitioners not onlv in the matter of aid
to tliose c oncerned m the iidministration of justice but also to presen e their
own reputation and the good name of tlie medical profession A doctor
tnnnot afford to be ignorant of eserydaj problems m legal medicine

IVIAKING MEDICO-LEGAI OBSERVATIONS
Sour medical men who haie treated forensic medicine with iiidifTerence
ba\e occ isioiiallv aentured to appear as witnesses and have believed that
the subjects on which thej were likclj to be examined were so much bejond
the knowledge of the judge and of the lawjets engaged m the case that even
iiazardoiis or rash statements would escape obsenation Nothing could be
further from the truth mnnv lawjers possess a good deal of medicolegal
kiiowledj.e md arc quite able to detect when a witness is attempting to avoid
giving n proper answer b\ vague or evasive statements or b) the use of
tcclmical language Counsel engaged mnnv civil or criminal case of importance
take care to inform thomseUts of the views of slamlard medical writers and
tUev arc not hkcl> to be put od bs an erroneous or evasive answer to a
medico legal question

It IS oeriamly a common fault ol medical men tiiat thej are often not
prepared for the complex and difficult questions which are hkeh to arise m
a cose upon which thej know thej will he required to give evidence This
lack of preparation app'ics to facts ns well as to opinions For instance in a
case of death which mav result m a charge of murder or manslaughter a
medical man who attended the deceased maj often omit to observe many
circumstances connected with the case because thej appeared at the time to
be irrclev ant or of little importance although at the subsequent trial he may
find that upon them depends the Imal issue As a result of pnifessional habit
medical observation is on these occasions confined as a rule to only one set
of circumstances i e the diagnosis and treatment of disease or personal
mjurv, but medicolegal observation should take a much widci range and
f should be directed to all the surrounding facts and incidents of the case.

Circumstances which are of no interest from a medical or surgical point of
^ V icw arc often of the greatest value and importance in legal medicine If all
these facts ore not observ ed hj n medical witness upon lus first dealing with
the case it mav be bc>oiid Jus power to answer manj questions which must
arise dunng the trial The lack of careful observ ation is a serious matter and
maj result m an imputation of professional ignorance

Uic first dutv therefore, of a medical practitioner is to cultivate a habit of
/ accurate observ ation the exercise of wrliich is bj no means inconsistent w tlh
the jverformance of the duties of a pUvsjcian or surgeon Medical men possess
this power to a variable degree as the following jncidents show

SwamcTuvlorinstanc-eci a casern which Sir \sUev Cooper wnscalJerl to Deptf rdlo
<« a man who while silting in a cltair in lus private room Iiail lieen m< rtally
wout (led 1>\ a pistol shot fired bv an unseen person Sir A-stlc) linving attended to
the vvovind TOmpamt closely the direction ftom velucli the pistol was firetl watU tlio
jiositinn of the wounded man and rnme to tlie conclusion Ih it tl c pistol must liavc
been fireil by a left lianded man The only left lianded man known to be on the

1 V iKI^a-MIiDJCOLEGML OnSnilUTIOVS

irremUefeot tlic timoTn^ fan intimate fneml otUic-tlcpedscdi n)jn;n tlierr >rni
no siMnidon but this ncule ohvqrvption I«l to tlic nrrest and tml of the friend and
to hi^ subsequent couMction for murder , j ^

\ doctor was called to n I-cj-ton liou^ tOKt n man who Iwul been found ileiid { u
the return ^fhes irifcfrom a two lioue alwppiiig trip, She Iiad just beffire leasing
Qunuttea a strn^tr who Ind an appoiplmcnt to see hei^Jimbaod ihcrc was no
distiifldncL III thd Worn and V.ithout biosing the Ixlds or cIo4els csaminlnff it tii6
doctor rvliorfdl tin tlcath a«l “‘a suddin death frnfn onuses ilnfcnown t Inter
cxamin-itlon shnml a hilUrt hole in the idort ami n jwnl of blood lictn-een the
shouldor blades oijd the floor Jhere ssns nq weapon there and thij casew-ns pHmls
one of murder ts n result of tire Improper medical opinion an armed suspect
tcn,a,ncdutlar^,^at,p«rad->s„^ , ,- ] I jl(, ■

Tlie cireum'stances the lc>crtht>, ih>siIjoh of Ihe hbdj of n pefsou svlio has
been foufKl dead, Hie position of iiij weapon found on the scene and the
condition of the clothmj; ns, well ms tin /orm ■ami direction pf nn\ woiind
are notnlwa\s nolu'cd with fiiiflicicntinceuraeji TliCj maj instintls disolose
the ttature of a e^se ) i

One of ihl^ authors was i-alled ton ti< Use nf Wutfonl litre a womiit and dilhl las
d^ (don the floor of the kilt hen somltwdlmgthe fifOoTcneli Suspicion of fvoisomng
liail nnsen nnd the huslxind w’ls suspectetl t / « " r

d jiohce t Hirer left to guard tlie scene w as found after two jiours to tie compi lining
of heijlselic, dimness and naufcu It was notice*! that lioth IkmIi^ bore sers pink
IiMi\ sLiuis and search rescalcHl two sitMif somtarj j arks obslnieting the flue of the
kitihcn sltnt <4usuig CO fumes to necumulate Ixdh deatllA were leehl^ntal

Kcasoinlile care m making ohscrvation ma\ disjwl «u«jufnin and ntert enimnaf
aiqiiirji 1

On tlife bllicr hand lack of ohscrvillion iiKt ’lend to the ncqaittil of
litetm? ' l'‘ , ‘ II

\ woman was found ileail jn her bed The scalp was Inwraled and tlure were
grounds for lielit san^ that the svounds liad been prCHluccd b> crimmal moIcik’c
I'O t'fUe defence it wn^ suggr^teil tlial as there lerre nrojcrtlng nuls at the ht ul t f
the bisi thtse- lacerations might liasoi arisen frorft netident— isU|s*’^hin'»lmh wa^
sapportcil til some extent lis l the mcflu-nl cridenee- \n. t xjicricnced ivitncss,
hntvcscr, Mated that fromhs cxaminalinn be ilul not;l>ehe\e that the nails esrn if
t^ics were jn tlic bedstead at the tune of the occurremjr could hast produeid the
wounds ITc eaid also tlial as lilootl had issucsl from the wounds and as there was
noliloml upon -the Mails orujion tht ^Urt of tlrelicil ftround them he did not behest
flifat tin head had at nuv time eoinc Into eonlait with the. naiU i 1 hose' who wire
Orstmlled to the dead bodj luid otnittr*! to notice whether tliere waq anvthmg on
or near Uie bed p?. nccoupt par tlic wounds on Uic scalp and thn/ rcfrc jwi/e unofiir fo
>nj » ) rther Uihe irrre or icrre not ant/ projrrttnfi nails at lie I end (if the bed xchra theif
firs/ ‘en^anunid ll e hod/ The 'uecuswT b Iv dischargetl on the Scottish verdat of
'Vot pnWen nnd there was som^ reason to behiVe Ihit he est qiei! through
manufactured e\ ulener m that lire naiU had been driven Into the head of tf le lied
sul)sequn)t to the death pf the woman ll <«nls perftacOj clear, JiowisTr fn m
a general \new of the medical esadenoe tliat the wpunds could not hart, been
produceil b\ naiK in the manner suggeslcil Tlrc nctused sias given the lientfit of
the dbubt which had been raised in fire bimlls oftlic ntr\ ^

01 • t / ' I

^ Thc^udge who tned tbi>,pasc re/nflrkccjjthat '•at/irihcnl man^itjirn he sees a
(lea I body shotilb notice c'crr/lhitig** aVpiedicaUnan sliould piakc it a tide to
observe ev er\ thing which could throw n light upon the production of leouncls or^
of other injuricsfound upon lhe<lead bodvtit should not lieonlj for tlie police
tosd) wlretherthbrevccrcana mark-sof blood on theilothing oron the hands
6f fhe ile^WsLal 6r on the funntore in Utf toftm Thecjothmd df the Hcceaiwl,
as v^ell aS the bodj, should alwavx tie ypsclj p’inntmcd liv i nwhcil man a^

opfe, PM the pjiot ( m n f > X t i af r < r /■ *

^ 07 IS i\D mvonis

Anotiier naUer of gre-tt iniportance/kvIiirJt is fre^jiienH\ omitted 'vrlicn
examining a dead bod\ KtllcdiiK tofabsme ftliethcr htitJic limeoferaimri-f
alien the b(M5\ oraiu part of it nax still uamd, nhelher the limbs were cold
and rigid or cold and pinnt Irorii •» nietlicnl orsiirgicnl jHimtfof new
these conditions of the ljod\ nrc of little iirrj«)rtnnc<^ but if these facts be
obscr\c<l thc\ ninj enable n witness to spcak’wUh greater pnibaliilih h^to
the time of death this nia'N mike all tlic diflOTnie between tlir tcquiltnl jvnd
conMction of a perion clnrgetl with murder I i I

A girlSbod} was found fully dressed (it 8 ^a.fn ) I\angbn1he/trw tide and ti ink of
the rinlnes mwter n p impel of tNalertilo Dri Ige during its Vnonstfuclion \ puliM
surgeon was railed to ccrtifi the fact of dc'lUiand wits usked («) jibuntwliei^ sllc liod
died and (b) if there was (.iii.se for suspicion Ife put a bind on the hoji and
pronounced It dead four to seven dnss Ift apprert itcd thit there >ms a {irukeii
probiliK from a jiimp off the bn Igc

On arrmil at the puhl e inortuars tlic liodv was found to luve (a) an intml d
(rectal) temperoture of 4" I (uir temp WK Thames rUcr ) (6) in irks of
stmni,hngon the nrak Xhese olwcrv ilions indicated lhat death wo-s dm to violfjiec
and that tlw death )i 1 1 omirreil wstlun li«ur»rattur tiun dn\s as,suggist(d b\ tlie
poTiie surgeon It tninsjjired Ibit tlie gitl bad l>cen miinlcred b\ a sfldier on the
p irtlj constructed Imdgi fioon after cloung fime (It p rii ) the prenOus csetiiiig
nndpushwldverinto tl CTiecr Aconnetionfi rinurderfollowell substant itedplhlv
bj eJoscf timing of death (11 12 |un ) vm bluirth after iiectlsed had left a lond
public iiousa in the girl s cotnpnnv

The circumstantcs which dueflv require notice on thcbt occasions Jm e bedu
fullj described in the chapter on \\oumls In cases of siipposwl death Xrodi
poison other matters also will require iniinediatc attention these will be
foiind in dot ul m thd ehn(>lers on Poisolung '

bne of the chief piiqioscs of eotihscl when defending perspn-s thur{,td Milh
murder or manslaughter is to cnd(a\our to disroicr wimt tin meclKHiI man
engaged in the ease umittcd to do Vlibnugh sometimes the omission mas be
of no medical importance whatever set it mav be plooed befon the jurj »h
such 0 strong light that the ntciisod niav obtain the benefit of a diuiHt' hhd
seturt ne(|uittal The otuissioii nmj be (illnbulcd to prorcssioiinl i{,iinranrci
or (what IS werse) to jinifessional bias— » detcnpiriation to find proofsi of
guilt against the ‘ unliappv prisoner at the bar When tile fuels might
cnsilj be taplnmcd bs the witness s lack of capcricnciJ in dealing with cases
ol this ‘iiafure

In It \ StDiHi"' (till, llridcs m the Bath inst.) it wa.s jicld llint incchcn|'|
c\ idcncc in the form of opinions b\ medical witnesses is admissible gs e\ idcncc
if such opinions are giv cn in the exercise of profcvsmh il skill niid kiidw l(dgc
with regard to assumed fai-ts t

III

NOTFS AND REPORTS ON GASES 1
1 Notes In the onhiinrs course of practice there can be no doubt that the
more cxmipletc arc the notes winch arc kept of evtrs t-ise of 6lckn(^s or
injur) the licttcr it is for the patunt and for the nd-dicnl man In the event of
anv qncstiort w hnJi mi^ht necessitate the production of record> w hether the)'
bcktplinada) bookornoU Such notes mn) l»c nfgrrit sirvlce m rcfrohing
the mind ofb medical man when lie is callol vipon to providenports or give
evidence \\ hcrcas to a virv husv practitioner such a course niav be imprai t-*
icable It IS of tlic utmost importance that all nledicnl men slmiild luakr ris

^ 1 ir iktaiU or a nK-lliixt of r^tmwibi i. Ilte Ln»>c < f lime miirx ilmlli br I eat
Irs-f nmt nilirr data MT ] 107 rl »rq I

•(11113) _jtox 2"1 » I

6 ^ OTES AED EEPOlirs

copious notes as possible immediateU there is the 'slightest degree of suspicion
that anj case maj ultimateh become the subject of a mcdico-Iegal inquirj

this IS especjallj to be emphasisttl in the case of an accident howes-er triMul
inasmuch as legal redress is rrequentl> sougljt hj tJiose injured through
accident or bj their dependant relatives
■\Mien it becomes certain that n ease will eventuallj be the subject of legal
inqum It IS the duty of the medical man to commit to w-nting at the earliest
possible moment e\erj thing which he has observed of the case hitherto
ev erj-thing which he is then able to observe and if tlie case does not terminate
at once the details of its furthercoiirse In various parts of this work (eg in
tlie chapter on Rape oiinds etc ) special reference « ill be made to the
notes which ought to he taken The medical man s own observations must be
kept distinct from information given to him bj others he may dmw conclus
ions of value from the former but the latter must be provevl before anv
conclusions can he drawn therefrom Thej may be false

^lany w eeks may chpse before a person clmgevl w ith a crime or defemling
some claim is brought before the judge and jury dloirever clear the circuni
stances may appear to a meihcal pmolitioner at the ilatc of his cvamjnation
of the body it will require more than onhnary powers of memory to retain
for so long a period a distinct recollection of all tl e facts of a case If no notes
have been made and tbe memory be defective the case may result m favour
of the accused and the administration of justice suffer through the neglect of
the medical w itncss

At ll e trial of Harold Greenwood m 10*0 on a ctiarge of murder Vjv arsenic ti e
general practitioner attending was questioned closely by Marsluli IfulT co insel f r
the defence as follow?

M Hall at tome dll you give Mrs Greenwood’ (Tl e witness produced a
paper containing a cops of the prescription and handed it to counsel It )ui 1 been
copied from the prescnptton book )

Counsel MTien il d y ou copy this’ Last n ght t\1io di 1 v ou get it fr m?
Out of my book M here is the bookV At home \Miy did vou not bring the
book* Just be earf/i I doctor Is tl ere a bool ? It >s at liome

Tlie judge ordered Dr G to bring Iwre any bonk or j apers you liave containing
entries relating to prescnptions made out for Mrs G The court adjourned nnd on
le opening Sir Edward Marshall Hall again pressed tlie doctor

Counsel M ill y ou point out the entry in the book srhicJi v ou referred to in the
morning ‘The entry is not in it f Kept it in an old prescni lion b mk an I tl e old
book has been destroy ed I thought I liad cop e 1 it into th s book

The law relative to the admissibhtv of notes or memoranda in ev idence is
verv strict and in tnals for murder is rigorously enforced by tlie jiulges
In order to render such notes or memoranda admissible it is essential tliat
they should have been made by the witness at the time when the observ aliens
were made or as soon aftenvards as practicable ftirtbec a witness is aljoncd
to refer to such notes onlv for t)ie purpose of refreshing bis memory Though
he cannot read them audibly in tl e witness box giv ing them ns his ev ulcnct
ho may and usually docs refer to them freely If he is known to have such
notes he n ay be required to produce them He nrcti neither be afraid nor
ashamed to produce soiled or Woodstamctl notes of an autopsy Dirt does not
destroy their value and may he ot bona Jidfs — by tJie inference tliat

they were in fact made at tbe earliest moment^

•Notes d ctatwi bj a paU olog st to a secretary d inng q top-v arcaecej tabicifm lover
immedutely upon compJrl on of U e post tnortt I and s gued Tl e same princij le ay pi c*
to a clinical examinat on

^OTE^ ■i^D ItrPOJiTS

\t a trial for muitlor some a cars ago tlie judge commentetl He (his lordship) had
alwdSs found that uUen a u»tne*-s saul he had such n gtrod mernorv that he toohiio
notds thatmtncsswnseitlierverv tamorten irutrumtc Dr D said tint he found
two pieces of le ul behind the tongue whereas in fact, lie did not find tliem nt all
His partner found the pieces The^e points were not ntal to the case but thej
were at ans rate irnportaut points

At the 1! V Ilatgh trial at Lcucs \ss12cs m 1949 the Attorne\ General
commented his cross eiaminalion of the psjchiatnst called by the defence as
follow s'

Cross-examined b) the Mtornej General \ ou said when jougaae aTJuresadence
that 5 ou liad seen the prisoner fise times \ou liad examined him five times This is
notnccuratc isil’ I believe It to be accurate or I should not have said so

‘ Look at jour notes IMicn did jou see him first'* ‘ I reallj do not know the
dates— lictween the first and sivtli Julv *

Would JOU accept it from me that the first time Jou saw the prisoner was on the
first Julv? \es

lortwentv five minutes'* \es I dare sav

The seconil time on the second JuK for one hour’ \es •

And the third time on the fifth Julv for forty five minutes? \es
\ tm vasited Dnxton Pnson on two other i ccasions and discussed the case wath
Dr Matheson’ *^os

\ounevcrsaw thepnsoncr didjou’ Idonotthmkthatisquitenght lam
quite prepared to accept it and I am sorrv if I have made a mistake

I iiu not want \ou to accept anything whith is not right I want vou mereh
to be necuratc Hava; jou not imv notes of jour interviews'* I hav c got large notes
of the interview!* with the pnsoncr but I have not got notes of Uie dajs on winch I
nctuallj visited lum

I must put it to vou that vou saw him in all for two hours and ten minutes fortj
minutes longer tlinn j our evidence h is so for taken Is tlial rifcht’ I do not know
Is It about right” f luve got no idea

fins could not be described as a favourable start to a cross exammation in
w Inch tlic occiirocj of tlic medical witness notes w as to be closelv cvnmtncd
The jur\ arc bound to be nfTccteil bv such questions and the doctor quite
nccdIcssK has lus reliabilitj badlj shaken

It IS not in criminal cases onh that notes ouglit to bo made and presen ed
for in tivil cases it happens frequenUv that there is a vera long intenni
between the occurrence of an accident or on illness and the trial of the case
Vccurate records tlicn prove invaluable

Reports of a medico /egaf nature are ten frequent}} deiaarKlec) from
ilocton. and tiicbc will necessanij be basetl upon the notes, referred to MI
such reports should consist of a summarv of the relevant medical facts and
of the conclusions based upon them expressed ns far ns possible in non
tixlinical I iiigingc

Reports nctcssnnlv varj in Ihcir contents according to Uie nature of the
case The substance of a poisoning case will differ inatermllj from that of
i street accident for instance, but there are a few rules wliicli are applicable
to nil such reports, and tUev ment careful consideration

Dates Tlicse must m all eases l>e statcti verv carcfullv and m such a
manner as to leave no room for doubt and to make it unneccssnrj to refer
toedendars eg a phrase such ns Last Sntunlnv I saw Mr Tones must
never occur; it must run At 11 am on Saturtlnv, 2Ctli Jamiarj 1950 I
evamined "Mr John Tones nt No 1 Prospect Place, Kensington Careful

’ Notable Tmb T1 e Tri i1 of Jot n Ceoige Htugh (Tic \cil Buth Munler) Ed

I nril DimiKivne Hodge A Co , 1053

9 i\i) ^OMMFSTS

<]j5{mclum i»u>t hi made l)(<wecn1he<L'ite]]{K«n events tixik. jiht.c

and thc'XTntc'jA htn the Report wns Tiiatle

I Identity rhe. hex pgr, vwl vccupitiou of tlie*|>crsoti rc{K)rlccl\lpoa
shdnlti be noted nccilMtelj lormnl idejstjfintion is sometimes desiriblo '
Ihe facts should m the fmt instance he statal seruitim plainly and tcnciscJ}
(11 hngyige easily mtell(gib]e ^ non professional persons A. report should be
piade not to riisplaj [emditipn but.to pe understood If tetluucsl tcfnis are
enip!o\ ed their nicanmg sliouht 6e 'stated in parentheses

Oplnlon^s, inferences^ or comntents The facts should be stated first
{uuf the qonelusiona -suoutd be staled later lo the xeport 'pic laiigua^^ m
vvhlch tilt condogions are expresswl should lie precise and clear It must be
rf^niCmb^red that these ore inttndod to be a ooneisd siimtmrv of the nhole
report upon wliicli the decision of a magistrate orthe lenhit ofa pirj mav
ultmiateh be ha^cd ‘inch conclusions should be confincal str;ctl\ to Jht
matters svhicli are the subject of inquna aiul, base actnalls come uiuTerjthe
observation of the witness l

JRelation^to circumstanced Deiluctiorts from the facts ilestrihed shf ukl
be basett upon t le fual rfata onlj not upon circumstances unlcs.*, the reporter
IS gpecialK requirwl to ,«^press hw opinion miregard to tlvem pi cases
uhcre thev acc'Said to be relatcth Turtfier thet must be foumled ordv upon
ichnl He pn/er has hiinself Sfhi i>* obefnel ^in information dcrneif from
othec persons shbuld be made tlife basis of an Opinion m a medico legal report
onh where It IS proven or at least open to examination \ conclusion based
upon mere possdiiUtiea 13 of no vnliio as evidence ii r i

Notwithstanding the plainness sinlplicitv ondobv ions naturcof these rules
the\ are broken far too freqiientlv and it is desirahlc'to tall attention to {he
ruore oomrpoD lapses statements arp often set nut in i prljose or exaggerated
i^ngjiage’ overloadwl with teclinicnl and unintelligible terms tlie WTiler is
often not snnicientK careful to keep the facts distinct fpim | is coniineijta^
or his deductions from the facts lybereas facts are vttal as evidence the
OPinments and d«^i“<’t*ons of n witness are adonssihlc onlj in evidence at

In regard <0 tlie first of these defects too often it (s {lie practice of medical
men to use exaggerated language when ^nlmgrcfiortAor medical cases for pro-
fessional purposes Thus in the wilting of a report on an ordinarv post mortpn
fexamiiiAtihn the lining, ihthibranc Of tlie slonAcii niaj be described asTjeinp
“/ntenselv’"’ inflamed or H cal itt as * cnonnouslv distendeil Lvpre^stoiis
tfifpldvttl in tins lOos^ ntann^r 'rtiav tonvej to the legal nlmd li mcaHing
widelv^ dlffereiit from that intended bv the laporter Tbe> Create great
diflicultv in cvjdcjiee if vnthdrawn or modified a change vvhicli tlio igh
ne^-cssar^ rnav aV the sainb time place the watness in nn undesirable position
beforl^ th^ court If kdeh de4cnplions involve a compdnso'n the question at
once arises as to tlie standattl b\ winch thev tire mea'^ured find ns to fl e
opportunitv which th^ witntrss Incf of creating such a standard Vs n rule it
will be fpund that these term? hav^hcen u«.d wittiout careful eonsideratiPii
qf ftoni o habjt ac<juir«l frpm reporting rases f >r the information of medical
ipen-onlv Lav^v^rs look much more ploselv to the strict signif cation pf words
than do piost medical men flud tliex are disp^si^d al\va>s to mistrust the
judgment of <1 pep^T} vvJjo laniiot apeak or write without employing tlic

superlative degree .

‘’«nt/rVorlK-»G n I Hr f , »l f ,2 Sin

OPJS /o\iV \7S » ft

\vho frceU einpVV teLbni<raHcrins \vli<?h^vrilint: n*pf<rt^ imin
bear in nnntl tint Uicv are rcjwrlmfj^nol to h medtc-il but for Oie

infornintion niul assistance of people who inns n^viP lin\eh{nril ofttlic Urnis
used In a rcj»ort on the appeamncey in the Iwch of a min who had ^uffc^od
from chrome msnniU, the fohovrmg jMWsige fveurred ‘TJk onl> umrhij
npjienrnnce in the hrain was an alhmmmtous deposit in tlic IMns \aroIiu
nc^r the vili(ation of the locu'v hi/rer’ In ahother docimiciit the hlcslital
report ^tafed for the. infonnatioii of n coroner s jtir\ , that lh<^ *StJtcgiiinontS
ofilit-tnmvimwm refieeted ni«,Uhe«nl>nntmi\\ iicxposcilf. * h.\ en cdm.atcil
persons such ns jiid/fcs- and htipeiidinn nuipstrntcs^ do iiOt as a riilu melade
the meaning of lethnieal mcilnal fer/ns within the rtiigc of tliciP know Its! 'c
OnK r few of tliim niulcrstiiul t^e difference hMsvrcn pecnluini nmrpern
tonemn or the meaning of the words hemispiieres of the hrap) pr \nji mater
Tlie\ art not likcli to know the dilftrcnec hetween the innhn and psloriis
be the sililntion of the duodenum ifenin or eiiKiliI and mai^bc

ns rends to consider therri to lie parts hf the h\ er or iifliinrv* hliidder as the
mUitmes on one occasion a reamed jddj^ asked for an cvplaiuihon nf the
TTicinmg of the tcrili ■* nlliilcnfarx canal ” 1 sc of esertdas wortU hfcc'j.ullct,
\diLc bo\ or w iddpipc tiloids nnsimdirstnOding and adds gruilU to the cate
sMth which a jiiK can foUow the c\»den<Je TOclinicnl nitdicd hniRiuigt- is
T\uite out of place In 1i retiort which is inicixled to Infofirf onhnnrs personi
upon jdam matters, of fact but in certain nistmecivjt mi\’'he a wise precautiort
to use the strict todmicnl term ns well as the more eolloqunl one to avoid
rnisundcrslonding ^ '

Facts and eonimonts U{ion huts ns uell ns hearsai fitiiienu iiLs mil nrgu
ments arc somi turns f< imd in oomhination The facts alone art for the jurvT
the reporter s comments ufwm the facts ma\ or mas not lie nrc'nmth or
Relevant and iitilcss relevant nmnut W ncciptisl as evidence As a pult;
potlimg should be cntcrcil in a rc|>url whicli is not c<onnertctl with the
subject of iiiqiiirv and winch lias not fallen direilK under the obscrvntdm
of tlie reporter The hifmducthm rf liinrsa\ i;tntcincnts-*.i r statements
made bv persons not cillctl as vnlnessi-s-Uir nf nh'iimstaucLS which have
csime to his knowledge throudi ninmur should lx avoi Itsi ■’

At the trnl of II Ijnhl in for murder d »cus«ion arose iq no wh u shqul I mid
wlint shoiil 1 not lliul a 1 1 lec In a inf-dical n|xn1 t report w is put in m which the
police Mirgrun who IlwI hoeir i «tW»nw I to mnk« a pr ft ftinKr/rt'k tinltirilinn ofllic
l)Od\ nf the dee-eased stated iit llic liepumingoflus rrjmrt, tint the hod_\ had (xs>ii
found Hiufer circMH»s/rt«f« f>f luirpiciOTi , m a front roonu etc The jiidsa;
remarked tint tins si-as nuittcr stIiicIi was not sultnJ le fo^ incliiMon in a mediial
rcjKft Moreosir with rrftrciK-e to the «s>n Iminis llniwn th6 lirst lin I Uimt
wen iis ft tliwR

1 ‘That this ws mill (til dis-ertsed) wiis inimfcMf and timt with cilrcmc
ferocitv

T 7/ifif a snrrc ntni^lcl ad fa/vtt pher brj we >

lilt suggestion of niimkr wns an iintuipitron «vf ltic''vmn( ( of Ilie Jun
Tfu. comhision should hue lx:c»i Tueitlv that dcolh hul Inhn cnuscil bw
ccrUim specified hijuncs nitre was n«» pi^xlf ofiSWv'Ntrtime so far ns the
joti tnorlrtJl examination wint lli^ fjilts ujuift whith thi wilncts rehcd as
triddiec of a struggle w ere eomrsl^nt c«pisllv w dh the dragging of the UhIc
after diaflj Such nnllcrs are l»csl hniti^it out in tlu* form of^piestion iiml
nUswer m enurl

In a rejHirl of mi no iKsis In n ense < fjx Aoidiig it is nut in cess ir\ lluit idl
the details of the tcclimqiie shduld bt gi'cn k general statement of the

10 DEPOSITIO\S

results indicated by certain tests and processes mil be sumtient proi ided
of course that the m itness kecjis a ivnttcn record of c% er> part of tlic exainui
ation for production if required

In the case of Cook and \nn Ihilmer' an applicat on was made to Dr Rees and
Dr Ti; /or fo gn e to the jinsonct s nttomej before the trial a statement of the whole
of the details of their anaU SIS of nntimonj an 1 of slrjchniue T1 ei deeJin«l to do
this mthout nuthontj The Court of Queen s Bench was aiipealed to and Lord
Campbell decided t/iat there was no legal ground on which sucli a demand coul I Ijc
enforced Inasmuch as the medical esn Icnce against the prisoner was clear an 1
conclusise the counsel fnr llic Croxm advised tliat the> si ould concede the |>oint
although It was admitted to he m accordance with neither law nor custom I jhiii
this advace tliej acted but it is not recommended that an\ Bcienlific witness si oul 1
follow such a course in future The tCiull was that bcti re the trial 11 ese memor-
anda were placed in the hands of some chemists reta ned for the defence mtha new
to hostile cnticism

In regard to the method of search lor poisons chemists ma> dilTer ns to tlie
process which it ma> be desirable to pursue m a given case and although the
same result ina\ be reached b> various methods itisbv no means difRcult to
find one who wi]J assert that iheonU correct fochnique/shisoiiTi and that all
others are fallacious or to raise thit element of douht in tlic minds of a jiirv
which maj lead to the discrediting of sound evidence 4n anal)st must
however be prepared for questions on the steps taken to eliminate con
(ammation and mimcuse error

DEPOSITIONS OF EMDENCE

It is important that a medical witness should remember that copies of his
report and depositions eitlier before a coroner or a magistrate are placed ns
a rule in the hands of counsel ns well as of the judge and that his ei ideiice as
it IS given nt the trial is compareil word for woril vntli tliat which has been
already put on record The written depositions mav be read out m court
when discrepancies between the de|)ositions and the present evidence ma>
provide material for cross examination There is reason to believe that this
IS not gencrallv known to members of tlie medical profession and thus it
happens that either from failure of memorv want of accurate notes or care
lessness in giv mg cv idence at coroners inquests niethcal w itnesscs mav lav
themseh es open to cntieism at the cv cnlual trial

Depositions are alw avs read ov er to the witness before he signs them It is
eas> to correct am error which may have crept into the document during this
stage The doctor should see that it represents exacll / w Iiat he did sav and
permits of no ambiguitj Considerable laliludo is allowed to witnesses and
counsel to ensure their satisfaction over evidence that is to be used at trial
and the deposition should not be signed until the details are acceptable

CORONERS PROCEDURE

The procedure of coroners enquiries is often treated too hgblli bj medical
men apparentlj it is a case where famibantj breeds contempt The circum
stances in which the mquirv often takes place are not calculated to inspire
great respect for these preliminaiy proceedings nevertlieless br law and bv
custom coroners inquests hav e l>een for centuries and are still the pnmarv
tribunals m Tngland for inqiunng into and determining tlie cause of death
m cases of suspected V lolence andthevare tiereforc dcscrvmgofrespect In
all inquests vrhicli result in the coimniltal for trial of an accused jverson a
1 n V Palmer CCC Vlav IBaC

COJiO\LRS* PROCEDURE 11

medical man «l)o is giving evidence before a coroner (sometimes m the room
of a snnll inn) is s irtuilh delixtnng it before n judge of assize and tins fact
alone should induce him to guc the cxidciicc ginrdedlv, and xvjtli a due
regard to the serious results to -vkhich exaggerations or misstatements maj
ultiimteh lead

Reporting Deaths to the Coroner Medical practitioners are often in
doubt about tJieir exact jxisition in connection with the reporting of deaths
to coroners andat is ns well that thc> sluiutd know exactly what their legal
position IS —

1 lliere is no Icgallj enforceable dut5 resting on a practitioner, acting as
such to report anv death to a coroner

2 The coronet has no power to require a practitioner to report anv death
to him

0 It IS the dutv of the registrar of deaths to rejiort deaths in certain
circumstances to the coroner

J A practitioner must not do an> thing to obstruct the coroner m the
discharge of lus olllce

*> A practitioner max make a post mortem examination with the consent
of llie deceaseds relatives whether or not lie knows the luvuse of death
unless bj so doing he know inglj hinders, the coroner m carrj ing out his duties
but as soon as it comes to the knowledge of a practitioner that the coroner
has been informcxl from an> source touching the death on no account should
am examination of the bod) bemadcwithoiit mstruction from the coroner'

It must not be assumcil however, that n doctor raav leave the reporting of
some death that he knows or suspects will have to be investigated b) the
coroner to take its stricti) legal course of passage through the registrars
oilice ihis consumes time which ma) be vital to satisfnUor) autops)
conditions ma) senousl) dela) police enquiries and must inevitabU hamper
tlie smooth enitiencv of the coroner s proccduitr

In It V Shaugl netsi/ at the Hampshire Assircs in 1051 it transpired tliat a
Portsmouth pmctili incr was summoned to a liousc one morning to sec a )oung
woman he had not atteiide<l previousl) She wnsdead He left the house rctunung
toliisroilnds liavang lunch ns usual Itwusnotuntilniirt nflcnioonttiat he Informed
the ton »cr s nlHecr tif n dcitli the cause of wlJch he was unable to certify The
coroner ^ ofTicer found on a routine vasit f< r particulars tliat tlie girl w ns mg in lied
slran^lcti b> o loop of thich siring wluchlav b) her head loosened the imhce found
Vrta TTfiAVaa v.v'vS'.Vj’A’.’.v:*! W'.'jdiss *.’« s^.sa.v.Tjftri Uv v.vbaw sttyitAsvRs

During this long dtlav easily avoidable if the dottor (whether or not he laid
noluxd the pi im marks of strangling) had not procmstmnlert m reporting the case
the steanglcr had left tlic t< vm and made Uis wwj to Birmingham He wav a danger
ous man and del u in reporting tlic death JumI resulted in Ins csenpmg at large — a
sitiuUon which caused j iihhc il irm and csmsiderable police expenditure liefore he
was tnued and arrcvtcd

Mlmt is stncll) law is not alwajs good common sense Wien a doctor is
faced vitli an obscure or suspicious death it is his dutv as n citizen if not a
doctor to facilitate cnqiiir) without dela) he would he wiser to teJeplione
the coroners officer or the police without wasting time or thought on the
exact legal position

Procedure Cases which are reported to the coroner fall into Iwa? mam
categories —

1 Dentls reported Inf slainfory ohh^atton

1 Sir Boland Burrowi K C , Lancet 1{>43 2 CSt

12 conovsR^ ^Piiocrnunr

i Die Go\crnorof a Prison when thedentliofn prisoner orUor^Uil

inmate takes phce i l r 1 ) ,

(fe) Uy tho Superintendent of fo oicntal hospital of anv mental patient

/ ■'Thetliertcrtified or not (Mental arenlnientahjlp<. lOts Si No 1075)

and S H950 No 1223) j I

(c) In tile licensee of a home 9 r retreat for Imhitual dnmkanls (Habitual

Brunkitas Act. rtro S ^

' o(He»s^ered foster i^fnldren (Public ireAtlt Act

(e) by nnj person intending to remose it ^1% out oi; England (Ileino%al of
Bodies from Lngland Ucgulatlons tO-T S H A, b No 5o") ‘

{/) hy the registrar m tlie esent of unsatisfactoiN certjJjcatlon nJjcre’tJie
doctor hid noti bcert In'professidhal alfemlance during the 1 1 daj k prior
to death ^r where he has reason to behese death is d«e to unnaturat
ttttises is atteiultkl b> 'su^picidlis tite^isUnces or is from unknown
cause ' *

“Difath froni ihlnatural causes JnCludes any^ sort of nocKlenl (at an) time
prior to deatji) \iolence neglect poisoning (including therapeutic ^rnn)
siBedblcd ndiusfrmi disease drugs of addiction 'bl6od and food pbisoiimg—
togetlier amIH d^atlU bclore full recpverv fr6m an'csthc^in
2 Deail e re; orted iniestQatidn by^if hen! j n ehh ler
(jt) nil deaths Ido/a^s 1 (/l*which wdold htie fo be reiiortpl bv (ire regisfraf
* if tl doctof (adhenng itritVls id Ins legal obligations) informed the
rcgAtrrtl’ instead of t(ih toroncr direct This class^ of (Tcaih is one ill
sVhit 1 j the cort ner usualK orders nri nidopss 16 elufidnte tjie cifoum
stances of deitli ■'

(0 cases fn whitli the cause of deatii is know d to lie natural blitlsherc
medical attention isois not retent tiidn^h to satisly the 1+ day rule o5
’ wTt6re the doctor wished lo mform the coroner of some matter^ not
hUmg mto i)as\ J {f) TWse are tasCs nbcrc the cornner mal offer
en piiry permit tho doctor to issue a death eertilicate l

The coroner nioy lioid art inquest in nn\ Case that is reportedio him Ife
ml/ff do ^.0 if lie IS mfordled that tl ore U ‘n» stilhm his juTisdifction llifc bdd\
btA \ crsoii and ti'Pre is lea^ol>ahte cause t<> siWpect lint ^uth person has died
eJti;?p« or i^o uipiaturaJ dcatJi pr has died m prison or in such place

OP in Mith clrciuustances ns to rccjuire nn inquest m pursuince of an%

Statute-t

* QcigutaUy^dll iih^Dcsb U ere 1 eld b> H coroner and a pirt the corone^ i^ now
gi\en p 9 Wer tq difpensi; SMtb a jury, if le fh^qhs Ht m certain tas^ but a
i«ry must be adhere it a|»i?efirs to the coroner either before he

proceeds to liold an inquest or lO the course of nn inquest begun wathout a

jury that there is reason to suspect —

(fl) That th^ deceased came b^jlMs death b\ murder i lanslmghter or
infanticide or j ^ ^ ^ f

(ii) Tliat tile <reath ogf irr«l in prison op m ^ihIi place or in snob circ|im
stances as to r^ 9 i| re ap inquest under am \ct other than the toronei^
Act IS’i" or J

(c) That the death was causetl b\ an accident, poisoning or disease notice
pf >'hicl) « tequir«l to he<-gisco o Gosermnent dqwirlment or to
any inspeetororotherorTccrora Gosenumntdepartnicnt uiiderorm
pursuance of anv Act or o At

, ’ CoTpacrii AW, 1W7 see 3 l j { (

C01i0\l RSWRQCLUURD Id

( 1) TIml tUc.4l€aith was crfusal bj an qccident nrisifig otit of iixe iijc of -i
\tluclc mn strict or publiL highwajr’or /> v r I -i j
(e) rhnl the death (K-cqrrwi m Urcumstanccs'the continiiantLioc possible
^ ]reciirrcnce of « Inch iS prcjudicioj to the hialthior fcafetj of thelpublic
s or au> seejirtn of the pnbhc i j I i j r

In addition the coroneS His poWer to summon a jur} )m an\ othir e^se
if it appears, to lum eitlier before he proceeds to hold an inquest or in the
course of an iiulucst beglin withoub»Q |uct Itha£ there is ail) rc-isoiiitor
sunimaniiig a jury i // J i I i I i t t f

The Coroners Rules lfl53 resulted in a timely restriction of eiupiitj m
court to hou V. here and hj whal means * thd person concerned cania to
Jusdeath Questions of end habiht} arc specificall) excludcdfrnmtlicjury s
responsibilities * I [ ;/

Viess ing the B6d> \.t or before th6 first sitting of mi mcinest on a liodj
tlie coroner must viCM thcboiJv nnd if before thli bodv h is been biirietl tlie
coroner so directs Oraimjohfj oftliejurj so desires thebod^ must bb\ ieWed
bj the jurj also* ^

^bsence of [The npVmal jurisdiction a corpqpr depcnils upon t)ie

existence tni^ >ieu of a (icijd bodj wilhm the area for wluph lie i> coroner,
hut tliere are exceptions to tins B here a corop?r ins reason to belies o time
a deith has occurred in or near the area nithm uiuch he Ins jufisdiction t^nc^
tint iP'^lng to t^ie destruction pf the bodj bj fire, or othersY^se or to llie fact
that it is fvmg m a phcc irom which it cannot be recpyercft, gn inquest could
not be held |iut for the pro\ mons of the Cq^octs ( Amendment) Act, ^6 ’0, s
18 ^^he^eb^ benny report thcpicts to t|^ie Home OlTice apd tbatjDejnrtment
may order t|i^ coroner to liold on inquest subject to the absence of tlie bocY}
and tli^ consequent Jock pf yen wluehjs normallj fnnjamen^l ^ t|ie
holcliiig of an inquest j

In a similar manner by« special uqrt|ine rpgulatioii^ tb® coropcr, vn**
gisen an entirelj new jurisdiction to inquire into certain tlnt| ucre

alleged to have takyi pi iccjowing to por <?p^raliops j

Autopsy Undertheprotisionsof tlieCorbners Rules I0a3 acDronccWho
requires an autopS} must haVc ifc made nssoonaftcr the death i as reason
ablj practicable He is ‘wRised tt>iise.the Scnices of a jiathologist with
suitable qualifications ond expdnence hnd haimg aeiCss to laboratory
facilities and in the eient Of crime should consult ivatii the chief o/ficCf of
polite regarding the clioice of pathologist

rUe* desire'’ of the pathologist to avoid mabingtertain classes of autopsy^
m particular tiiose of his colleagues opcrative/anjesthetic deaths or where the
conduct of a member of liis oivii staff is likelJ''-to l>e called into question — must
mn\ liaiediie regard bj the coroner i t

Insistence on reasonqblelicilrtjes longoxezdue received special imphltsis
IMiere »-xpensi\e lihgatidn^ msumnee problems or criminal prosctoiUon
> depentl as thej inaj bn good conditions fdr sound lautopsv'aTor|{,jthen
S provision of tierv facility bccnrrtcs of pafatnount importance Many doulll
consider it. of equal importance that the doctor sutgeftii nr an osthetiat lin/Jer
(Titicism from relatives should not recaixs less ixireful attention than, those

fCOTvnewJlulw.lOjI w 20jJ~ 03 a* 1 I i

» Coroners ( Vtnci dment) Vit 19 fl sec 14

’ Defence (lluri-i! Inquests and Ilegistrsktion of Dull s) IIo^ dalioius Iftl”

S n i. O 1444 reg 3 1

” COllO^rES rilOCEDVJlF

vhose libnt> IS at stale Speaking Ecncralli llic care and skill deioteil to
autops) noiklm m eonsciiucticc of the practieo of these rules acliined a
liigh standard Tlie coroner has nide discretlonar> poners to issue certificates
of death after autopsj has shonn that an inquest is iiniieccssarj tfost cases
falhng into this eategorj consist of deatlis shoim hv autops; to he due to
natural causes or to una\ oidabte surgical/nnastlietic risks

Persons at a Medico legal Autopsy It should he niadc a rule tint no
unauthorised pereon should he present at the aniopss It hcrcas tins pr ictice
niaj lead to some injustice ormaa nound the lanit; of polite or a practition
cr at ali esents it ensures the nbscnce of on\ undesirahle piihlicjtj or am
attempt to obslnict the course of justice

^\hcn (Dr) Pnlmtr the pnsoncr tluirgetl with tlic murder In pOison of
Cook n-ns allow cd to be present nt the niitopss of lus \ itttm ht dclibenfcly
attemptol to dcstroj c\ idenee of his crime and Ind to be cjcctetp

The Coroners (\mendment) Act 19>0 s 2i (4) proiides tbit where a
person states ujwn oath before the coroner tint m lus belief the death of the
deceased w -IS c'uisedparth orentircli b\ the improj- er or Jiegbj.ent treatment
of a medical practitioner or other person lint nictlinl practitioner or other
person sInJI not be allow c<l to j>crform or assist at nnv posi niortrtfi or special
exammition made for the purposes of the in picst but he slnll haie the right
to be rcppcscnteil at such cxanimation

Sometimes a cliargc of mnlpmxis is ruse<l ngnmst a medical man m
consequence of the death of o patient Hit examimtion of the bodj ma>,
order of a coroner be placwl unuiltinglj in Ihc handsof afnentl oftlie person
eoncernctl This is not jusf either to the practitioner or to the public and tii
such c'lbcs an indei>endent and cvpcnenceil patholopst should always be
entrusted with the post mortem examination Coroners havepowcrto request
specially qualified persons to make post morieni examinations analjses etc
under the Coroners ( Vmendment) Cct 192C nnd arc specifically dircctwl to
do so by the Coroners Rules lost

Documentarj £> idenee These Coroners Rules also directed that docu
mentarj cy idcncc as to ho\r death occurrctl should not be admissible axcept
where there yyas some special reason This insistence on the doctor pafho-
lomst — and more sj etific dh the lalioratorj expert— coming personally to
gi\e esidence on the cause of dcnih nyoids tie possible misunderstanding
of the report and fcises the jiarties concerned on opportunitj of asking
questions upon it thus leading to a fuller umleistandmg of the matters at
issue

SUBPCENA

Witnesses medical and other arc summoned to give esidence and to
produce documents before all courts by writs of sub/tcetui n ! testijlcaudum
and siibpcena duces tecitm wjiieli are faradiarh known as subparuvi
Acceptance of Subpeeno Medical men occasionally attend a court, especj
ally that of a coroner w itl out a subpenia but such action is in idvisable since
a medical mans claim to lus fee depends upon lus attending an inquest m
obedience to a summons* If a medical man attends a cisil court without a
stibpcsim he should take care to obtain »» UTiiit)g from tlic person who
requests Ins attendance a satisfactory assurance in regard to his fees If

* Trial of yVm Pain cr Notable Itr tisli Tnnis Ilotlgc

* Coroners ( Xmendment) Xct, 19*6 s 23

SVJtPQNA 35

possible, nrranyenients should l>e mndc for fees to be paid m advance in civil
litigation

^^ltbollt 1 suhp(ciuj or some vvnUen assurance as suggested above a
incdieil witness is not Ijound to appear unless lie makes a promise to attend
for good wnsideration if lie fads to appear under such a promise lie innv find
himself m a sinnhr iKwition to that of the defendant m 1 eatman v Dempsey ‘

This v^as an action hrougUt bv a lutsbnnd wtui ultegnt tliat tiis wife was Insane
111 tilt date of tlie marriage and where it vns held tl at an action could l>e main
tiuiictl against a nudicnl man for failing to fultil his promise to appear nnd to give
isidenec Hit pluntifT was awardetl £50 damages ami on appeal it was Iiel 1 tliat
it was not neccssirv for the i laintiff to show tliat lie would have sneoeeded in the
I)iv< ite Court with the aid of the evidence of the medii-vl man

If conduct inonej 1ms been paid to a witness but liis attendance becomes
unnetessarv nnd he bus incurred no expense the conduct inoncj is reeov erable
bv the person who paid it, A medical witness scnetl with a rtr&pfriw for
the purpose of giv ing expert cv idcncc nnd not niertlv cv idi nee ns to the facts
of the case is cntitletl to claim compensation for loss, of time as well ns travel
ling expenses before giv mg ev idcnce *

A subpu na nmv be serv cd upon a medical (or other) w itness cither jicrsonallv
or hj post and iii either ease a reasonable sum for travelling expenses is
gcntnill) tenderc<l withit In civil eases such tender of cvjvcnscs (ustiallv one
guinea) is obhgntorv on the parlj serving the writ nnd if the tender is not
mnilc the witness nce<l not obc> the tubpetna except tinder the conditions
mentioned alwve In criminal cases it appears that at the time of service a
tender of expenses is not bound to be made but a mcshral witness would lie
well ndvistd alwa>s to olicv the <«///«*«« claiming cApenses later

Obedience to the Subpoena \Micrc a sttljcrnd is accepted nnd then
Ignored or disobc>cd tlic one who disolmvs !!> Imhle to nttaclimcnt h;^ the
eoiirt so (loutetl orto an action fordamagesbj the pnrlv serving the

AthtchmaU by tie Court IJcforc nnv writ of attnrhment can he cfTected it
must he shown dcarlj that there w is coiilompt limt the defaulter was n
inaten il and netessarv witness wtls wnnied nn<l was dul> call«I nt the
trinl If these fonnahtics nrc complicil with it is m the power of the court
to fine a defaulter or to commit him to prison until he has purged his contempt

Aetnnsfar damas’cs Ileforc such action < an succcttl it must be shown that
the nction in which the pnijKiswl witiiev* was summoned was dnl} called on
and that the witiic&s w is both molcrinl nml ncccssarv Uiit it is not necessarj
to aver that tlic witness’s absence was the sole cause of the failure of the
plamtilT s nction but there must Iw actual loss through tlic witness s breach
ofdulv to obej n tu! pirua

Glvlnft Evidence on Subpeena AH evidence (whether oral or docuimnl
an, ) falls into a categorv relating either to facts or to opinions The law deals
more scvtrilv with criminal casev than with civil actions and attaches more
1 imfKirtancc Ui facts than to opinions In science however, and m the mcdicil
^ stuntt-s pirtiiularlv it is nlwavs dilTiciitt to distinguish bctwc-cn fact nnd
i tbcorv nnd if a doctor attends to testifv to a mevbcnl or seirntific fact, he
innnot casilv avoid giving an opinion arising out of the fict

If a Ti//;pfrwi be sent to or dilivcrwl lo a incihcal nuin lus course of action
should in the first place be governed bv the nnlurt of the case (crummil or

J1 {\X)f"Han»l»an <NS)hSi
* /n r* M or'kin* 'ten a Vu/Hat 59Cjffy SI U I)

in

soulless A

di\ fl) and b} theindturp of the evideneis-^rhieh at is» or is supposnl to be m
lus pow er to e Tlie matter may be siimmanzed as foltowT.

siimmonedjvi cominttoti with a mmmal case anl has facts
tbcluding loctimmis in ftts Anttirfc^c orjposjcwjob he inust obaj iite ^ihpt^na
iegftrdless of the court to in hichlie is colled and w lietlier expenses are tfcnclercd
dr not The most coiiimon case isJ a iumraons tb a police court and magis

trates }w\e poner to copipel att^ni^n^ u d i !

Inltick A >>ierpoi» /« (an action fprmalpmMs) I^e iva«i|pimunonetU a™ mt 1 is
"nl^ta feise csjdpccjjiii the part of the plaintiff lie sfatel tliat on tl iscnme
b«orc 11 e trnl ^ soUcpor csllcd on inm and left n snip cmi ajtb Jura Lee woiiH
not hear an ai count pf the esse sVJucIi llic sthciUr.ptot qscI Jo use anti said le
Mxtuld 1 as e notlung to do v itti tl e trial “Tlic iolicitor mlonned I im that Jic
wOH|d be re<juirc<l to paj the usual peaa|{\ if fie did not uttend Ife svent to
lungstoii and. svas Avamed not to lesse uotij, the trwLwas o\et He 1 cant the
e\ idence on tl e p'lrl of the plaintiff and upon tlys and tl e med cal e\ i Icnce he
{rtVelifS opbnoli not much in fat^kib tf the parts w-ho 4irAihotie t hmi hnd not much
a^aiUsthlm lle^ndoubtedly svoidesl hfrtltercompidsioix ifaplwnringnsniHcfrhttt
uhwjlhng’ witness ^rl u ^ i- Off r c ^ j

j^TT / ere p Vjfdical man ts serti^d with a stilpt^ia i« a «t.i/ ease ip coflnrchon
tCi/Ti tch^cji jgets rirf tnov:n.^^tf hm }c shotdd ohry i!e suiitnons and give
to tTi? facts If the soticrior neglects t,o teiidcr ejgienscs nt tlie time
0 ^ setsj]}^ the subfana thp ujl;ncs.s ^hould^tteml and should len^e the
question of p^peuscs to he dealt with s^bse^j^epU\ ? r-

^ Ipart f^om the foregoing cases UitfeuKie arise tv^ere o medical man has
reccjvpd sufcpariar to atteod^jltiaU at IwQpr more, courts which are heldator
fl^xiut the same time and o^etiigncc to Ijolh orallof them;s impossible On
one occasion Taj lor was called from a civil trial wluchjiad commenced in the
4ssi2e Court it Durlmm to a cnmmil trial wJuplTtnls /)\td t6 take plaic on
thbsainedaj ntLmcoln thecivilCnsewaspostponed Tntheopmionofoneof
tbcTUDst espefjencfd judges on IhteBenbh in all cases in which thcie preserved
scpuhte stibpanas relating to trials fixed for the srtmd time tlie ci'd case
should giv e w aj to the criminal case If however the ««bpfcilas are for two
criminnl cases a witness's best course IS to attend Ihe case in which lie
^ixhpQ’na wns served upon hitii fret and to address to the jiidgi presiding
oxer the second case a letter cxplainhig IhC circumstances The clerk to ti
<*ourb max be tipprontlicd prior to tile drtV fet fof hearing and he Winy explore
the possibility of chnnging the order of cases Dual decision rerts with tl e
judge ^ j ‘

TAKItiG THE OATH '

By (he Oiths Acts of 1888 and 1909 a witness is allowed to give evident'C
without taking the iisunl oath and xrtthout kis^iWg the book Unless the
Witness objects to taking ntt/Oitb (m wloch-caseJie wav a/hnn ) Jeslould
boiswonx m theusinl wav by using the following words I swear I v Mmightv
God that tlie Ctidepcel shall give shall be the truth the wl oletnilh xml
bOthing but thetrutli X>cn if lltptofcss to have i o const lence. the taking
of the bath efTeetinllJ renders him liable to the law of -petjurv which nc\t
to the obligation of telling the truth is the object of tl c oath
^ACRrmatiou !s given as follows I 1 (mmb m full) ^ do fcoleiiinlv di d
feiiuerelv ami tnilv declare and aflirm that ilic evidence Islallgilc eU
It does not lack digmtj and it achieves the same ends
^ »3F ftodT KT

\^^ws^G^ o.\Yv,miv\ u

iljirif evidence {/f‘ .(T) I ~ ^

Evidence gi\ Cn Iwforc -a coirft^aj bfe' ftf threp kinds' 'viz , (i ) oral (u )
docnmefitnr>, {iii )Teal The fii^t hientidnid mdstbe dealt at lengthy as
it IS the most eomMon and 6flen'the'6nly form In uhicli medicil fcvidencdjs-
given f ! 1 4 n 1 u J r- i ! ) i i

In the cotoner’s eourtf it is* the eomi)i6n 'prncttccfor the coroner alone to
ask the medical witness questions bearing on thbcnife, hut hj his pcmnssion/
anj member of the jur) orimj other interesteil person ninj put’questiohs and
these sliould be ansSvCretl with fnimesS’ and tnadoiir^ ^\ith this e‘<ceph6n
ihc practice in all courts Is th^ KMtnc and ft witness uso-illy undergoes the
following exammatinfi^ nj j n ^ f i j f ■■ i

1 Txamlnalion in eliicf, bj Ih^ phJl>e<nUing or flp|iell‘mt counsel
d Cross exanmintionj by defendiAgcountcl i j

3 Re esatnioalion bv counsel c^aniiinlng m chibf * i /

4 Questions bj the president of ibe courtf or’ lij'’ Ihe. foreman or anv
member of tliejurj (througli thq/o^ciyiaji)

An accused person is atwajs ^vt hWrl^ io go in'lo, the witness Ijox to^glve
evidence on his own behalf, hut oftptjrs^ mnv not ask questions from the
Amedical vi itness must Wnr m inin^ ^hai he should not allow his tesfimonj
to be mlluenccd bv the con'^qncnces wKifh niM fojilow from lus statement
of them or their probable effect on As^to opinions fheir possible

mfluente on the result of the case should indpcc^aution m forming {hem, hul
when once formed tliej should be scaled honcstlv^ and candidlv wRhout
regard to consequences !t is well to rememher^ m regard |o each Istage of llie
examination what a great rpcdical auihoptj has s<aid * ^

To make a show and nppenf learned and ingeniotw in natural knowledge may
gaiter sandv To know facts, to vqjiraie them from supposition to arrange and
connect them to make them plain to onluiarv eaparlties and above all point
but their vUeful applKiltibiis ihdiild lie the cKTef object of ambition (\Viiliatii
Hunter) ij i

E\aminatlon-ln-chlef [Xhetorthnarj^^upe^nf procefdmR la^ crirpmal
case is ns follows After opening the case, {|ie counsel for the Crowm calls the
•jwf-nesses and examines them ncconlmg^to the yules of eudeiice— that
he brings out bj questions vhxch do not juggrs/ f/iyir orwicer^ t!ie /acts ijelev ant
to the issue to be tritdavhich are vvithin Uiqpersonal knowledge the witness
IMicn tlie examination mcliief 1ms been given, the next step is the cross

C*t'WWWVfi‘»V5W I

OrOss-'Cxamlnation In this ihe ueeond stage, the counsel for Uie accjisci}
seeks to extract from the witness by IcaHingaiuestiohs ic lAa^e tcAic/i inggr?!
the anhur tnihe s\rongestfiinn onj facts wluCU maj -appear to be favournlile
to lus elient and winch he lielievcs to be vvltlnn-thd vvitnesa-s knowledge Tl u
tlicorv of the law is that the witness is unfavourable to the side which is cross
cxnminmg him and is tlilrdbnf ‘ hoslilST Hid’njott; he has shown himself
b} toilduct or coin crsntion to be partisan in the rase/ thenlorL^PVercJj "mj]!
ht bo treated \nv thing which he Jixivalmve kaid ui the hearing ofjothtrs, oy
published m journals br eten written m privaite/letters (if the contents
transpire) with reference to the ease or the guilt Of the prisoiu f il now
brought to light although he inhj Jiirc. supiKiscd that aihat he did sn> was
m 1 ‘onridenet It is at this stage of the wnC Ihit anv exaggerations ivhieh mav
have been most fnonrnbiv rocened bv-llit. vritneSs'sown couusoinre reiluctd

•rhe ordervnlIl«r(r\-crvcdlr tW^itnrlsapi^fersfdr the di-cused (the iltTcndant) Ckms'
examinntion will thea be utidertaito by prowaiting (appellant) youasel

18 VBIVILEGB OP COV\SLL

to their true proportions Any bias bj which the mind of 'i « itness ma\ have
been influenced or nnj miperfection or confusion of memorv os to facts is
liere brought out It is in this part of his cAammation that the sncdital
uiJI be closel} questionol as to his quahfications the time duriii"
which he has been engaged m practice the uccuracv of Jus judgment his
general professional knowledge and Ins special experience with reference to
the matter in issue t?ic number of cases avhich he has seen etc Straiglit
fornard ansners should be gnen to all these questions

In dealing nath -a skilled witness whose evidence mn\ be of importance
the questions in cross examination are usually put b\ the opposing counsel
with great caution for the answers brought out maj be more acl\eRe to his
own case than those elicited in the examination m chief The most import uit
caution in cross examination is the use of the phrase I don t know If a
w^tness has once used it let him adhere to it ngiclU and not be bullied bv
cross examination into saying It might ha\e been

Re-examinatlon As a rule after cross examination the witness is re
examined b\ the counsel wlio called him TJie object of this is to clear up
or to explain any jiark of tJie c\ idence m Inch ma\ Jiai c been slnkeri or rendered
obscure by the cross examination It is sometimes unnecessary to put further
questions and if the witness has giien Ins cMiIence consistently and fairly
he nni be asked no further questions As a rule the re examination must be
confined to those matters which have arisen out of the cross examination
Questions upon new matter may render a further cross examination necessary
Questions have been raised whether a witness sJiouId volunteer evidence
where the examination in cluef and cross examination have not brought
out all that he knows of the case If what he has to state is some matter of
fact within Ins own knowledge or an opinion based on facts mthin his
knowledge he will be allowed on application to the judge to make the desired
statement

Questions by the Judge or by a Juror There are no rules to govern
such questions The judge has absolute discretion in putting auv question
as well as m allowing a juror to do so as a rule however such questions
should be simple and onlv such ns are necessary to clear up an\ small and
doubtful point aJthoughoccasionally very importantandfar reaching questions
are sometimes so put In n case of infanticide an Old Bailev judge once put
this question Then doctor you mean there was no evidence of live birth’

‘ That IS so sir came the replv whcrcujion the judge stopped the case
immediately without calling on the defence
Sucli is the general method by which oral evidence is obtained but «omc
details of procedure must be noted

PRIVILEGE OF COU^SEL

Medical men have sometimes complained of the abuse of the priv iJcge of \
counsel On this subject a high judicial authority has said The law trusts
the advocate witli a privilege m respect to the Jibertv of speech which is m
practice bounded only b\ his own sense of d«t\ and he may have to speak
upon subjects concerning the deepest interests of social life and the innermost
fwlinr»s of the soul The law also trusts him with a jicwcr of insisting upon
answers to the most painful questioning and this power again is in practice
onlv controlled bv his own view of the interests of truth ‘ It wo lUl appear
» Per Erie C J In Brmcn 186—

qVOTATIOSS FROM BOOKS 19

therefore tint almost unlimited powers of mterrogalion are entrusted b) tlie
Ia« to counsel Counsel should alnajs exercise caution in putting a question

putting the question he adopts it aUhough he maj do so to the great
damage of Itis oim case Tins seems at present to be the onlj check upon the
practice for judgesscldominterfere unless appealed to directlj bj thcuitness
No -witness is e\cr compelled to appear and testif\ to wliat he does not
know He mnj be compelled to attend in court in obedience to a subpoena
but if lie attempts to gne evidence as to tMhnical matters upon which he
IS not competent he has onh lumsdf to blame if things go uTong \ countrj
practitioner ma\ be called suddenij to a case in whidi a man is found dead
from a w ound in the throat Notwithstanding the fact that a pathologist
has also been called and has performed an autopsv which makes it desirable
tint questions on detail and on inferences to be draim should be put to
him rather than to the practitioner first called to the victim the latter is
bound oier nolens loletis to appear for the first time as a witness at a
criminal trial and mai be asked (i) to testify to the fact that the tliroat was
cut and (ii) to state his opimon (o) as to the cause of death and (b) whether
the wound was inflicted by the deceased himself or bj another person The
law assumes from his profession that the medical man made a proper exam
ination of the wound with anew to deterniming whether it was the cause of
death and whether it was or was not self inflicted It is difficult to under
stand how a medical man aUhough before this occurrence he may ne\er
base seen a case of cut tliroat could excuse himself from giving answers to
these questions both of which in\oU e purelj matters of opinion In medical
evidence facts and opinions cannot be entirely separated and if medical
practitioners w ere restricted m their endence onlj to those facts which they
observed counsel would have little upon which to cross examine

Assuming that the witness is properly prepared for the discharge of Ins
duties and that the questions put to him are answered fairlj and truly
according to Ins knowledge and experience without exaggeration or conceal
ment he has nothing to fear from severe cross examuiation A doctor mn>
alwavs rely upon the judge to protect him from counsel desiring to take
advantage of non competence

QUOTATIONS FROM BOOKS

A medical witness maj reasonablj be expected to hav e a fair knowledge of
the wTitings of professional men on the subject of inquirj and during
cross examination counsel occasionallv refer to medical works The authority
is mentioned the passage is quoted and the witness raav then be asked
v'hether he agrees VMtli or differs from the views of the author If he differs
therefrom he is gencralh asked to state his reasons In cases connected viith
medical treatment the v icws of the profession are so v arious that a hamster
lias no great diflicultj in finding n book containing opinions which differ
from those of the VMtness Standard works of recent date are so well known
to the profession that there are fewr medical men engaged in practice who
are not acquainted with and are able to explain the vievre of the writers
and vs ho arc unable to state how far such views agree wither differ from tlicir
own Tlic witness must be on hjs guard that the quotation is properl) taken
with the context, or he mav find Jumself involved in a difficultv If the
witness IS not already acquainted with the work he should always ask to
see the I ook m order that he may ascertain whether it is the current edition
and that the passage is correctly or fully quoted

2Q <■ AOMEIUCan SBGIiECJi n >

Entir^l>-’V!ritSjoiitilelibtra|emisrepnaentat}QnjLbamstermi\;\\in|itlcaUnr

with the medical factb/imiiumlmtiml the author b\ lews and iai\ as<u*ni to
theauthpTopjmon.'s »hjehite,ha*qlioted froi]i otiiei^autlionUesj ThejuMicnl
wqjpfssishpuli] taKe onre W put tlie-nmtterm the tbrrect light i

I )! J 1 ll ^ f I 1 If If 1 T ’ !

MEDICAL PRIVILEGE OR PROFESSIONAL SECREGY^ '■
Sou^e medicfttnien Iia\e claimed mpiwdegcrnat f6 t^nswet dertaim|ueshans
whi^li are put to them m b court of lawi on the ground that the matters have
come to thejr JwnQ^vIcdge through pfuati and confidential Communications
%7ltU their patients iThe lau itoncedes no special privilege of this nature to
mgmberB pf the me*liml professKm.f>«c(maii U bound to reply to anj question
ifithe nns^rer Uotdd tehd in^auv wa/to incnminate hmiself, for no min js
compellable to bp-aiWiWess hgtuust Jiimselfj' With this exception, oil ques
tioas must be #i)mered^ pro^ ided they are rele^imtio the case, and their
relevanc} )B a matter forithe decisidn-of tl\e judge Sometimes a witness
jpal>cs a frjvolous Objection orreftiseJ to /insuer no ordinary question The
only result JS to bnngtidieule iipoh himsejf , u
At art Importani trrnl nn expert ititA«3 Vast a^ked JilsUge^ Instead ofanSM'cring
tins simple question atonec) he angnh' iqlpcali^d to tlic judge to knOir sihetlier Jre
was booqd Jo p\e an ansm-ct on a matter ifhiqlu hfc asserted, could Jia\-o nothing to
do with the case 7^ judge jnfoiwid h»m tl«it» unJ«? he^liad somq •^pr> strong
reliSbhs for concealing It he liad |>cuct s^ite it. j

At a trial lor murder b) {)otsoniintbecounfeoCcrms>e3taminfltion eoumel forthe
jinsoperoshed tlie medical tntnes.> whqt remedy or pntulote he lindrmplojed when
he was first, called to attend tfie de^sed ^feappealec^ to l|i? judge toknow vhether
hewnsbDUrtdtonnswcrSucha.queslioniulliat The judge said. Ves, unless jou
IiflTe 'reason to belles'e tliit jdur antidote tolled tne'lltceased fn lliat ciscjuit ore
not bound to Aasnrrit ” lha Question was onswct«J Immediately

is thfere h n6 special drinle^ oranted lo membbrs o? the' profession! a
witness htust /ememb7?r that tUerd are no seil^ls la the case of the

Duchess of Kingston^ this of Vrlthho^dihg statement^ was claimed

by a nifedi6al Witness butw-as hot allowed b> the”eaurt In a ease m which p
wottihn WAS Indicted Ibr the hiurJer Of lierUAfaht a surgeon w'as called to

pro^e certain confessions made to him bj the woman during his nttcndance
He objected to gis mg such ev idenw on thegrpund tjiat he was then attending
her as a pnsnte patient ' Tile* Judged *juleff that this was not a sudlcient
reason to present a Uiscldsure^for the purp^M ot justice and the witness^

SMS ordered lo anjwtrt the ^uestion^^ ” n I f i J

Two SLsters ^rcre"'servants to an old lady , One of them hw^ui® pregnant,
nli^carried, lind was attended b} asurgepn The mistress «lio knew all about the
matter, retained thi'feulln hCt service, and left her d'lfcgacj at her death The ^11
was disputed bv the heir it law on tire prdahd of undue Influeticc; and at the trial
iq order to injiu^ tiw fiirl s character^ the purgtoa wtt< called and asked for wlint
illness he had attended Iier same >T»rv before Jlplienng ^Int he liad a prmlege,
he refused to answer bpt it was decided by I^ndersley, ^ » C , that he had no
privilege but was bourid to ‘tell all lie jjiew ^ ^ ^ ,

In cnminalya^es llic ?axne pom^Jja^orisep on pianv,pccasi<ms, and it lias
ev en happened th-j^ thq reply njadc }° ft question esk^ by

his jph^slclap has'^^n ^he opjy jvj^oiqcjjipoa j>hidi|A ponyicUon could be

* iSo 1922 tlie‘vtedi«>-Le^l*^re*y ‘hwcttssed s piper fn lh« subj«t by ^rd
Dawson of Peurt Lan«l on In «e

r dmdlstjl022,BnaMedimLegatnevww,l02Z a I i i

« 20 State Trials, 8 S 5 53 - klip HulT

MimcAr sunrcv vj

It Will I>c seen Uar<*forc, tliat An> sialcmcntA '‘hull an made {{»
pliN-sicnns or Mirgc-ons while thi% nre attending persons tun prnalccapacih,
although not to he volunteered m evidence must he given in nnv-^ver to
questions vvlmtcvir mai he the consequences i Ca-sc*? Of poisoning of wound
mg and of nlnirtion, us well a^ tvsc*» wluch involve ipieslinns of divorct, or
the Icgitinncv of olfspring nn\ !>e nnocled inntermlly hv the answers of i
im-<lieid nnn on matters which Imve bcxii the subject of pnvatcvommaiu
cations lie cannot vv ithhohl such cv idenee

The law of I nglnml on tins importnnl stdijcct, undouhtedl) confluts with
the law of honour sought to Ik. oliscrvetl b) medicnl men (fnun a lireach of
which more than one 1ms siifftrcd scverchl viz that mfonnation ohtamcvl
m the tonsuiting room from palunls rcl dive to their aihiients must Ik licld
to he mv lolahlv setret

InUnv case however where a mwlitil pmctitioricr isinfonucd hv npatitnt
lint a senous erinit has het n etjmniilltd il is his duty nt onc( to comimmic itc
with the police He rnav olhinvlsc npptar to condone it (see section on
aliortion)

The follow ipg case illustrates the diflieiittics m which a medical man mav
Ih pi iced hv his iKKiiImr <*utindcidml relations with his patients

\n unnmn’ietl girt gave birtti lo a male tiuld The |>hvsician succecttetl in
plailng it mil and a sum of £jfHi was imid with it Ilcf >rp fns dc illi tlie iihvsKinn
tollhissOn wfiOhUeteaksl him tn tlie |m»cti« the vrlioU circiimstunccHi lUieenst
Tlie f »tcT mother took to drink otid tin illegitlmnte « m proved himself to Im, a
‘ degenerate ’ He diserivensl from his fniur mother that hi wiis not her own i*f n
and also Hut the j hvsm m knew who his in< ther was In his cITorls to ohtnin hv
Ihrtnts tiw n mie of hU mother a fret light arose an I the von tw k wit a summons
firnsKault nguinstlhe { hvMcmitun I foster mother \t ti c hearing of this sumnl ms
the niagiatmto ditnands'd to Lx: infommt of tin name of tht motiur wluch the
j h>sieian ft fused to pve he lost his cu»e

Dr Dixon Mann has s lul \ goovlcjii/tn ohe^s Ihc Jaw nlthough he innv
have scruples in doing so, thircfon. a witness aIiouIiI not act hu private
jiulgment against authnritj vvithout verv >» arching self inijuirv, an ohstm
ntc coin ittion must not be mistaken for a sense of duLj In the majorjtj of
eases it will probahlv be compatihic with liis mosc pf dut^ if the witiicvv
Inters a protest against answering the question and then bmes to the ttijuire-
pionts of the hw

^cncreal Diseases Clinics It is clear from the rLspjimncnts ns to the
notiheaHon ot iidccVnn'is AismsiSTwriVaiiicA m i'nrt-S rd WicVefrAitlile'i'i'iVi
Art 103(1 that mcdicn! scorvev Is wot rcdogmrcil b\ law Hv that sUilulc the
medical man is compotlcil to divslox* not vmlv the fict of lllticss hut hIms
flic (.xnet nature thereof

In the ea<c of fJitnirr i (lomer* Hie question waV raserl iis to the ohhgiti in of n
iikhIicuI pmctilloiKT to ghr cvWet»c« of ficta whkh Inve cume In his kmiwleilge
while ntf ending a jntunt at ii venerrni «hsea«cs thnic He rejiort of theoive sfinwi
Hut It was nt the patient s own in-stancc and on licr behalf Hut Hu phj^inin
wlio had attended lier wns to pvr evi tnuT ns to her state of lieslUi Thr

plivskbndrcw the ittenllon of Hh* Judge to the \ t nereal Diwnvcs Hegiihtlons if
JiiH Igih IfiKI whkh requiTeil uTI infomnlkm ncqmreilliv n mrillmTirraHitiomr
in tlie courts of hiv duties nt n vroerrul diseases rlinic to lie reganled as utrleth
ct nildcntial but the hnmetl judge ruled that the wiUic>«was neverlhck^^s Ijoijii I
In Lni to answer tin qucsjllon? jmt lolitm

In the nrcumslanecs thci i ase wav not one m wluth imv question of the
vlolaltniiofproriSsiuiinlrrmfideiK^artsvt. Iiiri^'anl hn\rt.viJr to the \ et mill
i I J MOTJ.IUltKk

22 MnniCAL SFCRLCY

Diseases HeRulalmns the Ministrv of IKaUlj hns l>ccii aihisct! that the
obligation avhich the Kegulations imjwse on tlie inctJie il pnctitionrr js m.t
to disclose to third parlies nn> facts uhith his examination of the patient
nia\ ha%e brought to light It tvouW seem that a ihstlosurc at the express
request of the patient and m the patient’s own interests would not he conimrs
to an> principle of medical ethics ^

The \enereal Diseases Itegulations do not purport to, and mdc«l cannot,
override the general law of Lngland. which rc([mres a witness m a court of
justice to answer all such questions as the judge mav hold to bt rtUvanl to
the issue before the court

Certificates of illness Verj much depends upon whether the pmehtioner
IS acting as a niethcal njfictr or onlv as a medieal man In the fomier ease.
It IS, as a rule, a term of his ap|>omtmetit that lie will give such certiflc*ites
when acting for his cmplovcrs, fiirlhcrmorc, those for whom tlic ecrlificntes
arc given know also that lhe> will be given and read, and, therefore, a mohe
man is m tht*se cases, bound to complete a certificate ucciiraleh and pits isclv,
stating the exact nature of the disease Tlic foregoing statement answers
the follow mg inquiry and man) others of a similar nature w hith appear from
time to time in the medical press

‘An engine dmer came to consult me about nn onlinon calnrrlnl ojititlnlml t
but m addition to this I fiiuiwl une<|ujl Anoh Itol>erl«on piipiN absence of knee
jerks and other slight svmptoms of tabes, and po*iSibK earl> (» P I , tremulous
tongue nervousness and some exeitabihl), etc Apart from this lie was quite well
and nhlc to do bis work Uould I be justifloti m njiorting him to the niilMii)
eompan) to prevent his working ashchinesclfdid notscenn) reason wliv he should
not do so^

Some workmen’s clubs will not give sick pa) wlicii mcnpncitv anses from
venerea! disease In such eases the mcihcal officer must not in his certificate
suppress the facts, tlicre can be no question here of professional secreev
In private practice, manv cases of diffieultv mn\ arise which require groat
meets of juifgmenf, of w hich the foWowiog is an examfiic
A cliild hod inten>litml keratitis and n meihcnl man was nqucslctl to give a
certificitc stating Hint ttie child could not attend schiwl The rcrlinciitc nqmrtsl
the nature of the illness to tw staled He nfuveil to do thiv but gave a gtniml
rertifitaite to the effect thil the child wws not ht to attend school As IJiH wns
deemed lasulTicicnt bv the school nuthoriliea, the mother was Bununnnnl Hk
medical man appeared ns a vnlnes*: for her in court but he still refuse*! to state
tJjc nature of the illness and said llwt the eliiW hail an nffcetinn of the ejes Hiis
action on the part of the school anlliontles was expensive to the ritcpivcrs

Certificates of meapacit) to attend to public iluties such as anm or jurj
serv Kc, are often giv cn far too rendilv A medical mail should remember tint
in regard to such matters the «loctors reputation for hoIU^l> must not be
forgotten He is in a position of tnist and rcsponsihihU and should act
nccorthngl)

In this connection it shoiiUl lie rcmcmlHrcv! that a rcrfificafc given bv a
moiical man in rcsjHmsc to the request of a private patient mav jiossilil) lic
used III juduin! proeecthngs and the pliwician ma) be callnl iq>ou to swe-ar
as to Its eorrectnevs IIis position wxwW he verj uncnviibJc if JicJi-mI sulisv'-
qiicnth to admit that the certificate was not correct

111 rogaw! to the pmpnctv of inserting in such a private certificate the
precise catjsaljoii (v cncrenl, tmumatic, etc )ot some svmplomatic disease such
as arthritis, each case must lie judged on its merits bv Urn practitioner’s
standard of conscience and dut) . On Uie one liand, it has to be remembered

^mnCAL f

smpecteU just at the time when the discovery ^vl^ odd Id hi.? conhisioA
Unless the subject is cle-^r in his own mind his awwint of it mil be confused
and unsatisfaclorj Fsers man should submit lumsdf Tjjjoroush to Ihjv
test before entering tlie witness Iwv TIkI Msc should tic Mcwed from all
passible asj>ects and if an opinion has liccn formwl it should he dealt with
and criticised ds if it w ere fhatsjf an advCis.ifv As in coldrorerSi « dismitsrit
should put himsClf ns nhi6h ns possible into the jwsition 6f his antagonist
and endeaSoiir to ?ee the question ttom lliat point of \iew ^

2. Gn c DiRFCT oiwzcw to quattmu, aurf trnreer the ^uesOoii aikol

tihelher the question be asked btj y>\ttr oven or by the opposing counsel Al^dtcal
witnesses are liable to forget that direct answers are ncccssarv, and to giix
answers to questions which are floating m their own minds or which the\
think are likel> to Be^put t«5 them 'Soni? wIlncsTes ate dl>^ disposed some
times to anticipito many qucstioas h\ gi«ng one general nnswfcr Ikis
merelv creates, confusion* and themlness -wilf be told b\ cotinsCl tn keep to
thcTjuestion and that the other matlerj. wnll be dcilt-witli latter '

MosLbf the qiicstibns put bv counsel in eross'esimirnitum wdl ndnul <f
atianswer \ea‘or‘No If from the ingciUnus nr rnsiiistknl manncMn
which the question is framed the witness feels that the simple anirmative or
negative might mislead tlje- court tlicn aficr giving the answer he should
nppcil to the judge to nllow him to qnnhfx it or to add to it nnv matter
within Aw otm Inoictedge and which is ickv irtt (o the case Jllft* witness
most /emembertliat he Mkes an oitJi to stAte the truth the rrhole Inilh aud
nothing but the truth On the other hand while the oppoCing counsel is
bound not to mlroducc falsehood his kole object is mt the discos er\ rtr
ties eJopment of truth LnlefW the witness is on his guanl tie m«v find that
when the learned Counsel who hns cross ^imminetl him aildrcss<-» Iht jurv
his nflirmatives and negntnes mn\ be sshrkcd into a simpe reprcstntiug tliC
reserso of what he intended

Somcr Witnesses haven habit of nbt answering the question whicli is askwl
but one which IS hot asked In regard to this practice whulianscv nsurule

from, a lack of proper attention th the question a jiulge once said * W hen a
witms>.s does not imswcr a question but answers something cbe it Icmfs
persons accustomed to courts of justice to believe that he prefers not to
nnsw er the question but to put a different point upon counsel

Some witnesses b^in to answer before the question is compklcil or ore
concise from n fcir of saving toil iniuli whenns the answers of ollKrs ore
given m n voluble form i e , in the form ofn little Speech or lecture A witness
who istso profuse of information gencrillj sucvC(ds m siippKiUg nbumlint

nntterforo Jong and tiresome cross exumiuation

hen a professional sadness is giving ev ideiiee ns to his opmiini it is not
perjurv for him to saj it wo<sonnd-so , tvcn if (ht cniltran l>e provtsl
bv weight of counteMVidence he vrill lia've JJiiuh Jl vicar tlmt I h ev idcnvi.
IS onlv his opiniontn saving In niv view so and bo
ISo opinion should bC given for which the witness is hot prvpinu to
reasons and e\«pt bv pemimion of the rtnirl no mevliefll opinion sbotild
Ik rsprcs-sed on ficts or arxrumstaJiccs observed bv' other. A hesitating
Witness will be met with the quesUon ‘ Have vou nn> doiiht alxmt it? or
' tl as it so or not^ to which a repiv «i the afimmtiv c or nCgitiv c must Ik
givTn If the witnes'J fairh entertains ddubts about the matter at is^ui it
IS his duU to express Uiem at onct and nol to allow IhCm to Ik cvtortwl
from him piecemeal bw o sene* of quesbons

VhmoAi/hvwmcE • l>i

Witnesses lia\( inejisjojiHllv Ustifictl to Uie ^^lso^?^cI•y of ‘ imitntKphhlc \
“immistflkablc , or “undonbicd trnc^ of poison m the h^e^ and in other
orf^ns, Si 4 h terjns nitncftlly cof\\^y^to the mind of the cross evaminer that
the witness Ins sonic Inrkiiiff itoulft or susjdnon of nustake in lus mind ‘If
poisot^ lias h<-“c« discovered, tbi /slatenjeiit of the fact i> suflicienE, ami “where
the qiiantit} is knpwn )t should becKprcssctl ni figures
fl Ilniare of or tm'ohfd qne$tf(»ns4 twmetime'? couu'jel w ifl compress
two or three questions into one laorder to avoid nnswenng the last question
or that which attracts lus attention most a witness should ask for a severance
of the questions and should gn CiSeparatc replies

4 Don i nr^Hc icit// counsel Argument is not cv idence, and tlie entering
into it disturlis the order of the proceedings Arguments between counsel
and witnesses* and even between mednal fitnesses themselves, arc freely
allowed m tlie } reach courts, but m T^ngland there is no such practice Tlie
wav in winch questions nre put b) counsel m crosstcxamitiation sometimes
tends to tlie introduction of argument, but thci Witness should avoid the
tcmiitation to eptcc into it^ \\ hat he says ui sucli oircumstances is not
€\ iricnce, except in the form of answers to questions and he is there cnlj for
the purpose of stating what is relevant to the ease

Inasmuch as the juilge is present to ensure, ns far ns possible, not only
that the work of the court shall procenl with due onler and decorum but
also that justice should he <loue to all including the w itncsscs as well as the
prisoner, a luedicil witness should appeal to the judge m every ca-Sc whefC
he considers that lie has been asked an unsatisfaotorv question The judge
IS the arbiter of what is and vvhat is not fair of wliot is and what is not
evidence, of vvliat questions the witness must and wimt he need nokansv^er
j a Speak uiulflilp anti iUshnctlif Tjic jiitv must he able to heat

clearly, and some of the jurors may he making notes V judge gencrnllv takes
full notes of the mpthcal evidence, Jie has first to liear secondjv In imderslond
and thirdly to write diqvn, the replies of the witness

C fJitr 1 /our replies, as far as possible in simple non technical Itingiittget
Some observations have been ipadc above in rcgnnl to the use of teeludfnl
terms in dravying up metlicfi legal reports The uimocessarV use of technical
pbrascolog) should be avoulcd A medicd witness sliould remehibef that
when he is giving evidence he is speaking in the presence not of a medical
nssemhlv but of a jury of plain men -md women who arc probably ignorant
of the meaning of innnv medical terms

On a trial for on osiaidt which took plaie iit Asi«cs soUic vears ago a medical
witness informed the court Uiak upon exuinming ttid ptwertilor lie found him
suff«,ring from ‘ a sivcrp contusion of tlitf integument'^ under tlie left orbit, willi
great c\tra\ai-satmii pf lilootl, and e^hymoiis Jn the surrounding cellular tissue,
wlucU vvus m a tiimefietl state Tlierc was also considerable Jibrasion of the cuticle* .

^^oumcan I suppose th.it the mm liad n black cve' lli/ins? Yes’’
Fitr/gt '’Then whv not sav so at oikv? *

Jn n case pf child murder a medical watness, ^ylio was pskcil to state pimjilv the
cause of de ith, said it was .oviin^ to atelectasis and gineral engorgement yf tiio
piilmonar, ^tl'sue * , i ! n

If such liTUguagi IS employer^ b\ a medical witness with tho vuvv of
impressing Ihecourt with some ideiof lii^ learning, it wholly fuds of its effect
T. Aroit^ cxaggeralimu j lily list of eOggernted binguaga often Icadsjlo
apparent conlhct in medical testimom If n part of th< hod' w mfiamed,
it IS frorpieiitlv discnbcd by medK^I n|^n ns “niteitselj infinmwl One

20 * hWFttT EMJ)E\cn

^\jlness mn\ speak of “patches of ulcention tii the intestines whirca-s
anotlicr nia\ tlescnbe tJic same nniditiofi at “extensu e idccrifion’

A report sJiotild first be (IraHed roughI>, and then siinphfi«l bv slrikinir
out about 00 per cent of the qiiahrMn;; adjects es and adverbs

8 A « er lose your lemper. A bamstcr inn\ sometimes trv to rn vkc a vv it-
ness lose his temper, m order to tempt him while m such a condition to make
a rash or hazardous statement but the judge can be rehed upon to pul a
stop to discourtesj or bullj mg of witnesses

MEDICAL EXPERTS

As regards the value of expert opinion m the coroner's court the nmirks
on p 28 are i suiricicnt exposition of the matter The genend consensus of
opinion that onl\ experienced pathologists should perform sucli autopsies
and that thej should be adcquatelj remunerated 1ns now been siqiplciiH nted
b\ tiie Coroners Rules, 1053

In crinmial cases and particiilarlv in civil cases, the subject of cx/vert
medical opinion is of greater importance and rccpiires iniieh eonsidcration

In questions of Icgitimacv or of divorce, obstetnemns of high standing
arc consulted on both sides, m cases of iiisanitv, those plivsieians wlio have
acquired n reputation m the treatment or observation of the msant arc
chosen as w itncsses, m cases of accident and life msiimnee, surgeons of rt piitc
and distinguished phjsicinns arc sometimes summoned os exjierl witnesses
AInnj of these cases could not jw>ssibl> lie settled without this coliatcnf aid
inasmuch as the <iuesttons at issue are dctcrimnnble nnlv bj persons of
sjiecialized experience

Ihe court has power to order that no more tlinn a specified niimhtr of
expert witnesses niav he called It is scldonv that more than two ore allovrcd
in Occident cases, although as was |)omted out b\ du Parcep L 1 , in Proftor
V Pcilhs^ there should not lie a liard and fast rule, ns m some rases the
medical eviclencc must he all important os to the nature and extent of the
mfuncs sustnmeef

\\ lien m\ iled to giv c cv idence ns an expert a medical man sliould arrange
for a qunlifving fee to be paid in nn\ event n\ the taxing master docs tiot
usually allow a ven substantial fee when the fees arc faxed after the cisc
15 over

The more eoninion objections to the cx|»crt medical witness npjKar to be
the following

Jn expert vmj he biased Cockhuni C J, in comwniting cipfin tx/*crf
ev idenexj observed tliat it was m the nature of things that tliosc who gave
scientific evidence should lean slightlv to the side iijion winch thev were
giving their tcrstimonv, not from oiiv dishoni"st mleiition, nut from a
perfectlj natural and human failing ns m such c iscs a lii m was njit to look
with a keener eve on those things fnvounible to Ins own side than tJiosc
wliicli wore unfavourable

Povill C I , said “Tlie great misfortune or defect m medical tcstimoav
hitherto has been that nuxbcil men like man} other profession d nun, have
been too nmeb m the habit of making themselves partisans m cm envouring
to support the particular views of Uie parties on whose iKimir tlic> have
lieen called, and this lias l«l to conflicts of opinion winch have sometimes
npiicarcd not verv rrcditahle to the profession” This has undoubtcdlv Iwcn
done hv civil litigation

i[ltHI157TL.n 373

EXPFRT El IDES CE

27

All cvperl may act as infdical aihiaer Some barristers may obtain t!ie
services of medical men to ndvise them on the best method of cross examining
medical witnesses Such advisers do not aivvajs go into the vntness box»
and therefore cannot have their knowledge or expenente adequatelv tested

In addition to the fact that a practitioner who acts solelj as medical
adviser may liave undue weight given to his suggestions bj reason of their
being put bj Ills counsel as ascertained medical truths he escapes that
searching examination into luS competency which is mfilhblj the lot of a
metlical witness moreover, the latter is hound bj his oath to state the xcbole
truth whereas the former is obliged to impart onlj so much of the truth as
nia} suit the case of the partj for whom he appears In short his position
mav be similar to that of a hamster who is not an advocate of anv abstract
principle of justice but of the cause of liis client How far a medical man
lias a moral right to make use of his professional knowledge in order to
embarrass the testimony of those of his professional brethren who are com
pelled bj law to appear and to give evidence to the best of their abiht> on
the other side is an etlucal question which it is imnecessarj to consider here
There can be no doubt howev er, that whereas in some instances the practice
ma> work well bj preventing convictions based upon erroneous opinions it
IS liable to be abused

An erpert has little or no opporluntty for altering his opinion xchen fresh
eiidcnee xs proihiced An expert maj honestlj entertain a certam opinion
when first consulted The scientific witness who gives ev idcnce for one of the
litigants IS gcnerallv expected to support his case imder cross examination
when many views maj be suggested which may modify the witness s opinion
but even after proof of facts which ought to modify it the witness frequently
adheres to his original opimon Every witness should cscliew altogether
the notion of partisanship He should be prepared to give liis opimon frankly
and unreservedlv, regardless of results lie is there not as an advocate but
in order to inforin the court to the best of his ahihty

If after hearing all the evidence a medical witness finds the complexion
of the c ise alterecl and that he can no longer sifpport the party calling him,
it IS his duty to himself and to his profession as well as to tlic public, to
withdriw from the case No man should ever appear m court to support
that which he does not believe to be Inie

Ja' 3f>‘}3 .« JTOiiAtVrrtJ Sfie pootry ixy- nf JUi/ DvJivxl rxxUrge

battering Ins head stranj^Jing and assaulting him sexuallv ffc endeavoured to
tonc-eal the l)od> under the bed and then across tlie corridor in lus locker but with
out success finally disposing of it naked through a vvindow on to the roof where it
w IS found next morning 1 he student s guilt ^^as all too obvaous and on arrest, it
became apparent that he « as not sane m tlie medical sense Dr It D Gillespiewho
was calleil by the defence to examine the state of mind of the accused stated tliat
although there was no doubt that the nctased was schizophrenic his behaviour m
concealing the body his attitude towards the crime and his replies to questions on
his fcchn„'s about planning the nssault did not permit him (Dr GiJJespJe) to give
cvadcnce in his fav our under the ^IcNaghten Rules Ife asked Mr Birkett to reltiise
him from any such obligation and, of course counsel accepted the position

The present system leads to conjlieting medical evidence Tlie conflict of
opinion among medical witnesses anti medical experts is a frequent subject
of discussion by the public In actions which involve the rights and duties
of tlic clergy, there is seldom agreement among those who ns ecclesiastical
authorities liftve to decide upon them It is similar among inemliers of the
legal profession, and in the administration of justice generally Not only do

® i.\rEiiT BMDFsa:

harrH(c#s frciucnlK .IilTer oml p.c conflict, nj opm.ons >,,»n H.i cnmc facfa
but spccinl 3 „n)rs bonsotini; pclicfailK of mtdliKcnt men net nflin linal.lo
to nsrcc upon tlicir findings and linen to be disclmtpsl icthont a icniict.
Ilic fact tint occn^ionalh scientific emUiicc nm\ apjK-ir to be iwrijwn
iloe<. not jirstif\ tlic swccpint; dcnuiicintinn bf mcihw! or scientifit
witni^sscs ns a JkkK As Sir lushed Slcpbcti saul of tlx Hit it miv lx-
snul of nicdicind I i

“no s% stem rul<N can fuli^ emWv tWt line i f ««ulu( i Iin the . of

winch those wlio esiemse i nobW profusion si ith honour uihI erWit are aUtlninnslKsl
from those who ilisfmiee it It is piireK a fauitter of wntimenl and gooil fet-Hnr
ara it a trulj a sftd dft% for science iw «ne judge trmarlawl srhen llx* confl t of
opinion inaj lie traced to the ignoble .moth c$ pf a desire of g-nn or of notoncK, or
of nn^-thing but a desire fir tnitK

In cnif cases a is nbt qIw'i\‘ 5 easj to delermiife until the c\itleii« has
been heanl in court whether fccicntific opinion is in favour of the plamlilTor
of the defendant and herein lies the great aiK antage to 1>^ gained h) taking
the opinion of scientific experts cmplojcsl ns assessors There niav lie on
each side a portion of the tmlh which will receive nlwhrnl support vvdhoitt
an\ imputation of wrongful motive Nevertheless there art sonift simple
matters of fact in regard to which members of the medical profcssionought
not to he jn disagreement as for instance the fmehirc of ft Ixme tht fn« t of
which an N ra> pholograph enn prove lievnnd disphte or the extent of a
Msibleinjurv

The prujur duUes of crjxrU 3Ien of ocknowledgcil skill and goml [im
fcfisional expcncnce sonifetimcs forget their pn)i»cr duties as experts \n
c.Npert IS iisuall} called to-^uve an bpiiuoh on siatenienfs made bv other
witnessed, thus where certain oppeomnecs have liecn seen Jii the sUtinaeh
or hram the expert iimv be askcvl to fstnte the eonchivions to wjuth such
oppentnnees lead k genemf pmclitioncr niav describe ncfiimtelv whnt he
secs hut he mav not have tiad sulhcieut spccnlizwl exjicnence to draw a
correct conclusion Cerlam sjniploms niav Ik* dcscrdictl wiiieJi an exptrt
niav deciirc to be or not to lie consistent with poisoning* hut he iinivt take
enre that lie does not alter or distort Uic facts dcjKiscd to lj\ oilier witnesses
m ortler to fit into the case his own theories or opinions

The duty of FxperU tn Inals for tnalpraris l/fKin such tx-aisum n wjlucsv
is under a dulv . w hen rcplj mg to ipicstions bv counsel cltarlj and distmctlv
to ^talc hss opinion together with flic gniuiufs ujion whnli such opinion ts
has«I It nnv }jc harti to condemn a fcJlon pmclitiwirr Inil jt vronld be
Inrdcr still to ignore Hit* public intclrsl oml W i-ondemn oneself and one s
professn n bv rsTnctMing tbit wIdMi one knows to lie trui or bv suppressing
wJnt one hon^’^lJv }>cheies A medicnl witbrss js ilnder no dutv tohcurgiiit
in jxnnjing out or in suggesting defects, or in endeavouring to disrreilit
another practitioner in the opinion of tlic public- hut nothing shoiiM H
conccrtlMl which is relmnt to tbcrfnndation of tlit* msc m issue The M Irn
rule ‘ Do unto others as sou woiibl tint thev should d r unto von sfi mid
lie strietiv obScrvdl dpon these occasions

THE SELECTION OF MEDICAL EXPERTS
It is obv louslr impossible to exclude from li cns*. all ebnllictiiig and bad
methcal LVidcncts Inasmuch as tiUier parts mav With reason feel nggncvcl
if be IS not allowed to prtMhiec irtlcoitrt exjKrt cvidcnre m Ruj }K)rt of Ins
case Sound art.unicnt is bealUiv and tends to promote justice

I ) ^ MnmcAr,\K\/^hit7*SiK)^ •_%

ctprrts sboulJ aJwuN bo irtCn bf 'ilkTtow]^gM fepiUatlon fft fhe
profession not \oung in j-enrsortn cxprfnenec, A krge propoi'ti6h nrc pr^^r^nt
or past tc-ichcrs m medicdl srhodlsitvlioj frpm then nature of tlicir duties
nuist keep tliemsch es nbreast of the disco\ encs of ach nncmg iurditn! science,
»jid mm be c^peeteI] to be scquainterl with new ideas
Under the law rcKtiiig^Hi tlW fnrefnhd WnUnefit'of persons of unsound
nuiid s jsds to ihstitutionS nhd to patients ih nmglo core lite m tdc thmiighbut
Ihe coulitrv hj InrnsleVs ond phvsiciaiis nssocmtedbil p'iirs' the one tradicd
in the nucstigntion of low imUfiPtjs theotlj<lr m the dingnAsis of di^Oas'e
This had worked ndmirahlj In cases of alleged iinsotindnexs of tnmd the
presence of one or tnore of Hit physicians of the Hoard Of ContrOl sitting
With the judge find jur\, wdnld be Of more sAliie than the cMdcnie df a
shuncrtl ordinnrv medical men

iln regard to actions for dainagos in Tckjiectof ihjuricK caiiscil b) milwaj
atcidcnts it is tnntted h\ the Rcgnlation of UailwA 5 -!i Alt isrs k 2fi tli-it-^
wheiicxc'r tin\ pirsnd injured b^ an ^cclilcnl W ti mtlw i> idinpcnsilion

on nieoiint of the injiirj iins* judge Of the CJ nft in WWcJl ptoct^nigs to reeo\er
fiuth comlwnsation are taken oc anv person who b\ the fcolisent Df tlie pirlles c r
otherwise luis power to IK the anioimt nftonipensatif n^ maj order tJiat tliQ person
injured 1)0 esamuictUn siupc^tub qualifeilpicdiral practitioner nained intheordc^
nt t bung a witness on either bide and mas make such orlir witli rcspwt to H e eost^
ofMich etumln'ition is fit mii^ think fit"'*

Under the Arbilnitioii \c^s 1889 oiyl lOd'f the pnrliV In iv dispute nin^
select tin nrlutrafor or caClf ninj selett liis^ own arbitrator and these two
fltbitrnlori nns then agree upon an umpire in winch cast a Inbimal is
constituted which has jiower to call ssilntsses and to licar csiclcnce Tlic
pnrticuhr ads •Ullage of such a tribunal ht-s in fact tlint tlie thrcc^pcesi
dents nil of whom im\ be c\i>crls u'llow ihc wi^pcsses tq be ns tetlimcnl ns
thej wish Duping the nrbitnlio^i icthnn^ncrni-s m i\ be used which nPi,As
familiar to the tribunal as to the witnesses and tlie tribunal is nbh to decide
the issues with a rcisoiinhlc prospect of arriving at u just conclusion ^

In thi‘ Opinion of tniins this tsa salisiufors wnCjof di'sposing of rivjl casijs
111 which inedicnl ts ulciuc IS" tlic chief if not llje onlv, ccidcnce upon whi^h
the decision must dcpimd

Under flic \\ orkmcn s Compensation tets mcdicnl rcferecS

wire apiKiinled to each coiintj coiirl in I ngland and to encli Sheriffdom in
Scotland

Sect 13 of tlic lOJ) \r^ pnpndcd fpc llic appojntnieal t flcguUj qu^vlific l,mc()icil
(ini< titioncrs to Ik medical refenvs for the purpose of these Act*

Jlie I irst Sthctlulc to till 1123 Vet pir * enactcil that njodgi nrcoitntt cuiirts
mas if 1 e thinks lit nndsttuiU if hnV p-irrlT m ntVUnlunCe wiUi riifis Uf churl s<i
requires iiml Rises securits fir tlie i»ns-mcnt of the prcscnbctl fee slitnmtni w
iiieilieal referee to sit with Jifnins a*sr*R »r j i

Under the >snlionnl Insnraiirc (Industrial Injune^s) \ct* 1010 which
rcpenlctl the Uorkmens Comju nsalioh*Acts m resjicrt of nreidents date*! on
or after Jillj olh 1918. lledicAl Bo«rd4 coreusting of two or more mcclua!
j nictiliontrs were set up bs tlie Ministry to assess di«i5/t-ine«t for iKhcfit
III the cscnt of dissatisfaction wilb Hint Ilonrd s decision (he plunmnt mas
apjieal ton Mellieal Apptnl Tribunal consisting hf a ohnifmln nh<l tssti nwdiaU
pncfilinncrs Doctors m i\ also’^it luthfthe I ochl Appeal TnbuiHl sriiose
function Is pnrnarils egnccrncal 'mUi lliC workin.' intlrcsts of einplosw and
insured person d f t

I^astls, under the pronsions of Hus Att, pn Iiidustnal jlnjuries Coinnus

documentary EVIDENCE

sioner T\ho may determine legal questions which arise (together «ith a
number of Deputy Commissioners who may be barristers and a<iw*catcs of
at least ten years standing) may call for the assisbmcc of n spcciallv niialifiwl
Medical Assessor. * ‘

DOCUMENTARY EVIDENCE

Documentary' evidence in courts of law consists (infer aim) of —

1. Lellers, Affidavits, Plans, etc., etc., with which the moilical witness !m
absolutely’ nothing to do. Tlicsc are purely matters of Inn, and need no
comment here.

2. Notes and Deposition, about which suQlcient has been said sitjira.

3. Dying Declarations. In geneml medical witnesses Im\e no concern
with documentary' e^’ldence other than dying declarations Notes mndc by
medical men are not evidence, and can only lie usctl to refresh the rnemorv
of the w itness w ho made them.

Dying declarations are the statements of a person who is actually (King
and who behev’es he is dying. Very frequently', a medical man is responsible
for obtaining such statements, for example, in accidents where dcalli ensues
rapidly. In those cases which prove fatal at some more distant i*criod it is n
medical man’s duty to see that notice is given to the legal authorities in order
that proper attention (presence of witnesses, etc.) may be given to the matter;
moreov er, it is Jus duty also to mal^c a note of the mental as well ns of the
bodily (xmchtion of the patient at the time when the dy mg declaration is nntio.

The following rules apply in regard to the admissibility of dying dcclnrn*
tions;

1. They can be used only in charges of murder or manslaiighUr.

2. Tliey can be used only in triab for homicide m which the death of the
lijrson who made them Is the subject of inquiry.

3. Tliey can be accepted as evidence oniy as to tlie actual cireumstantes
of the death, and for notliing else.

4. A dying declaration may be made orally or In w’Titing. hut. If the former,
it must be written down by the person receiving it, cither at once or ns soon
afterwards as possible; and* also, if possible, it must be read over to the dying
person and signed by him; or his assent and agrceincnt must be obtained in

some way.

5. The person mahmg the dccharation must be actually' dying (inonbundiis,
not inoriturus).

G. He must believe that he is dying; but he need not bcliev c that dcntli w ill

ensue immediately.

7. He must have no hope of recovery', and must beline recovery to lie
impossible.^

Tlie fundamental principles upon winch tlic« rules are based ore as follows;
(a) It is obv ious that, inasmuch ns no cross-examination ran take pKrc on a
dying declaration, it must, if admitted as evidence at all be admitted ns it

was made; hence the law regards a dying declarntioii.with n very ieilous ami

senitinizing eye because it is an exception to the important rule tint there

must be an opportunity for cross-examination. (6) The law .i^nnies la no

one would wilhnglv leave this world witli a he on his hi>s. tint, under the
sense of impending dissolution, all interest in this world ,s removed; and
that the near contcmpHtion of death lias nt least as pow crfiil an ( ffect upon
the mind as the solemn obligation of an oatfi.

» « V. remj (1000) 2 K.U., 697 ami U. v. /IwlM. 8 Cr. A.Il , 2T.

31

D1I\G DLCLASAT10^S

Duties of a Medical Man In Regard to Dying Declarations

1 He must inform the patient as kindly os possible that he is dying
and should ask. him whether he ivishcs to make any statement To tell tlie
relatncs is not sulTlcient If the pahent dechnes to make a statement, the
medical man ma\ then urge upon him the importance and adsisabditj of
making a statement pointing out to him what use ma\ be made of it in
defending the innocent or in punishing the guilty It is impossible to lay
down an\ hard and fast rules eserj prictitioner must use his owm discretion
If the patient desires to make any statement the medical man must then —

2 Obbtaac ^e^^ carcfulh the mental condition of tiie patient Mhen
deati? takes place from iwlence, especi'illj when loss of blood or a blotr on
tlic head is leading to death delinum often supersenes or the intellect of the
d\ing person becomes confused If, therefore the medical man observes
anv wancleriiig or want of clearness m the mind of the patient, he must bear
it in mmd and should mention it m connection wath his evidence* but this
does not absolve him from the next duty, allliough it should make him parti
cularlv careful when writing his notes It is necessarv also to elicit from the
patient what is his own opinion of Ins condition — whether he hmyself believes
th it he is dv ing or whether he has some expectation of rccov erv

3 The patient’s statement should be written down immediately or at
the earliest opporlunitv after it has been made m the identical words used
bv the patient carefulh avoiding the practitioners oven interpretation of
them or anv paraphrases The longer the mterral which elapses between the
time of hearing the words and the time of writing them down the greater is
the possibility of error If possible after tlie statement has been written

(a) it should be read to the patient to ensure that it represents wliat he
desires to sav

(b) It should be stgnc<l by the patient

(c) It should be signed by any other persons present os being an aceurale

and complete account of what the patient said

In oixlcr to be admissible in cvadence the dying declaration must be a
complete statement on the face of it •

4 In no circumstances should leading questions be put and if at all
possible the questions asked ns well as the answers received should be
written down As a rule questions should be directed onlv to e\plamiiig
what may appear ambiguous or contradictorv in the statement of the patient

5 In cases of longer standing that is to say where tlie patient has been
ill for some time as a result of a cnminal assault it is the duty of the
medical attendant to inform the police Oiat tlie patient is dying and to
allow them to take the necessary steps to have anv statement which tlie
patient may wish to make taken donai signed and witnessed m due legal
form

G It IS not his duty to form a judgment on the admissibility or otherwise
of the declaration provided he has noticed the mental condition as above
he musi produce the statement just as it was made, and must Icav c it to tlie
court to decide the question of ndinissibilitv

In all cases w here a medical man pcrceiv es that the recov ery of a wounded
person is impossible, lie should take the earliest opportunity for stating this
opinion to tlie wounded person in thepresenee of others so that tlie ends of
justice mav not be defeated bv reason of the non observance of these legal
requirements

•(Unughv It \i>p«a Cases lOoO p 203)

•• /‘iVXVVBTIU l,s \{\

, ' r T'ns.l.ict » u lliJtiKd TOW llir mur I. r lit >. > I.

.m lirr il^nt l lied nejused lun, of llpimiiH V in.i},islrite . rktk ntlriilnl ler In
^nkc tier stalrmciil «ri|iiij: dmjn tl « .1 » „„ 1,. „„|i n . In t" nt

Wo\er> fimcrtifitr fill Iwf it -ihr M-n «t it sIh d s n ! tl f.

ndditlmoftfciurtle'.itpneonl sollntfliei. t Is rrn I will, ,i . li i,K «t | trsrnl
nfftlj recoterv ft wnsluW Uuil suUif. 1 atfm iitrouM not )>p Mctml inctilrn'c
n* Her objects n t<} siRiiing.tlie ^bttenu-nt witlfwit Ibp w nK ”nl i rr^Pht mi n-stitl
spnie faint Jiopc of ret-otmsyjj, ''

[ Tn Jl 1 , Vor^an^ Oif nounti vfai tcnoml/ta nniicluil fine i f iiimwf «te *r<nl/i
tins expres.se 1 b^ tbe D^ath wih caused 1 \ tlic prisoner cutting the tl nwl

of tictini \b>ut fi\c minutes Ixfore his clentlt an I wl in net mils chi i. tl e

Victim made tic 4ccLiralion {n svntin,; Iming nt ^l»e timt n« jwiMr tc» sjk »k
rhis mis iircSsetHh a itiliicsUrho san tlifr vnlim i-omes|n^„cr!ng out of a 1 at idfh
Ills lliroat iuU The declamtion iwts ailnussililc 1 I

fh /? \ 16W/* a Momjiii'wh i luiT llikei/ poiM n an 1 Vilin in the 1 1 Ini ii of tl r

phvbchin uus uhlikiJh torieoNcr fe^ieatedf) ejiruUtrd wliilc Kuffenng great | niii
‘ I ni thing U «as held Uut Ops ilpl u || ci nfJu.i>elv sli w u fiswl iin I scttl si
hcliet III ficr impend ngdcf^tji, [jj ,

Fn U .JVi/o«‘ the dettasejl asked Shall I rrtsisLr Pie Mirgisii wi I
Nq Ihc patient j,rc\\ Ixltcr |mt ^lapjetl, and tlic|| repeated |1ir <|ttrsti n
The siir^coii'thcn sai^ U flimk sou trill n»t,reitter llie iltTeased toil 1
think so too tt tt'aS lidl fluit if declamtl n mn it nftir tips coiiversiU m vns
iidmi siblC * 1

III /f \ t/ifrf Wh the dCcC I'd srl/s*t Idlstleiht U th it tl c rr sins little or
nq hope of her eceoserj and iipoiiliein'J.&^kc ! whelln r sj e un Ier»t khI ) cr {wmiIi n
rqdicd thnt (>lie did It mu field flialllierc tmA no proof of n h>lKle«rt\peetutI n
of mimediatt' denlh ivlucU v< iild iiuike het d(lF.ir8lK>n adiuhsdile

t I i!

|*^IES^^<?F COURT

In I nhlaiul mcdicai and scientific ssjtncs.ses except m spotlit tirtiim
stances are allosicd to lie present jip court niij Ip hear the vhole of tlio
e>i<lencc in tlie case In some mstaii?*^ ll;}s is pbsoluttl) neres^arj if Ihc
court requires mcdi(nl opuiipnv ft>p unless Fhcpitucvscs art. fulh ncqtiaintcd
\Mt|j the fqc Js tJic^ (UTigivpnpopjiuons ondlliev rotibi.foincIull\ nispi iiiiftd
with the facts onl> b^ being present and |>) hepring the cMtioncc m court
Jf o^clp(l 9 d the judge or counsel w|U I>c pqnipcllcil to read lo the witness
notes of llie pvidcuce before an opinion cqn be given and it inai iip{*car
sqhfcqucntl^ tliqt soinc^njiU point isonutfcd whicli if known to tJic witness
rqighkhat^ affected hjs opinion foalcnallj V ipiscarnagr orjushee mas take
plaep wh^n medical pitnpssca nre cxclujlcd^ and it i1 Usuall) wlicrc there is no
real ilcTettcii or a fnJsp defence ihti fbc right of cAeliuhiig them is cxcrcis d
The pule IP ?c-qtlnnd ^ different there medical witnesses arc ngoroasU
cxpluthd from court dpnng the hearing »»f other lanltcnl eviden x H is of
course^eisv lo innguic{}|rcipnstanrcspi.wliieli it tnight hciidiisftJjfe fhit a
medical witness to fact^ should not Ik, in court during the csidcnrc ffr tJic
other side but such (ireumstonres nrcltotjConimori j

FEES pnd ALI 0>' tOjMEDlCA! tMTNLSSfcS
The well known stnlement tliat the lalwurcr is worthy pf hi, hire nnv.
Iicriiajis, cut lK>lh WAis Ijut when KWivdvpnbon »* ki'vn to tl e nnliUHH an
rrspoasible tluties of p meilieal itrmjnthe onlinarv i sen isc t f his profession

ijLXJi nr I

»poxt,c vr

ir -^31 IjI
• . Ixrw n C tw U7

> r- t«n <? C sn.\

I *

COLRT I U S

3!

duties «hieb frequenlU iiuohe llie question of life or denth to n patient
nccorthng to tlic promptness and skill with winch such duties ore perforineil —
and m i icw aKo of the irnjiortancc of the mctltr-ol c\ idtncc m nil tiscs w here
it IS required, the lees nllowed Inw art still considtn*d !)^ mniu to he
inadequate

Ilie Oldnesses Allmvnnce Ucgiilalioiis 1918 efTeelcd boinc improicmcnts
III ci\il and crimiiiil court cases but coroners fees remain as lliev were,
iindequnlc

In the Coroner’s Court 11\ llic Coroners ( Vincndmcnt) \ct 1926 the
fees poMiblc to a IcfjalK qtnhfiial mcihcnl pmrtilioncr who has mide a
jmt Mu;r/<ni examination at the ditetlion or request of a toroncr, or who has
ottcndcrl an inquest in ohcditiicc to i coroners summons "Tl {with the
exciption st itcd below) ns follows —

(«) I or nttemling to gi\r CMdencc nl an) iii(|Ucst one and a half guineas
for cndi d i} on winch he is required to allcml

Somclimts Coroners ask, pncUliontrs to make reports m writing m order
to enable them to decide wlielbtr an inquest is ncccssarv k practitioner
IS not hpallv bound to gne such a report hut lie would be well uKised to
do so In most t uses lie w ill be paid a fee of lo» Od

(i) lor makiiie; a potl mnrtiin examiimtion of llic bodi of tlie dteeastd
and reporting the result thereof to the coroner witljoiit attending to give
eaidcnc'c at an inquest, two guineas Certam trasclimg txpciisos arc allowed
bv sihcdiiled disburscmonts timhr hnal autlionts

(c) For making a jmt mortem cxammatioii of the boih of tlic deccasetl
(mchtdmg the making of u report, if nn\ of the result thi rwif to thoeoroncr)
and for attending to gist estdcncc at an inquest on tlic l>od\ thrtx guineas
for tlic first da) and one aiul n h df guineas for caeli subserpient iliij on
whieli the prnotitioncr is rcipund to attind tra\(lliiig (xpiiises uus ]>c
claimed

I’ros id«l that no fee or remuneration shall be paid to n mctlital pnt tilioncr
for tlie puriKise of n po^i mnriem examination mstitutcsl without llic presious
(hretlion or request of tlic coroner

III cases liowcscr where a coroner in exercise of the power conferml
ujKm him b) s i2 of the loroiiers ( Viucndment) \ct 1026 nxpasts a
spexjinlls qiinlilicil person to make a j>ost vtortfm examination or a spi'cial
cxumiiialKm the foregoing provisions prescribing the fcTs juvable to mediia)
witnesses sliiill not nppU , but the fees |>a\nbU in r<-spcct of aiu sueli cxaniiri \
tion shall be such as mav be dcscnlHil bv the selndiile of fifs nllownnces
nml disbursements made b\ a local authonlv under s 25 of the Coroners
Act, lhS7. or b\ rules made b> the Scerctarv of State under the Coroners
(\mcndment) Act, l't20

In Criminal Courts Vs from Seplcmlicr lHh there has I>ccn a sub
sidKlantial improvement in tin niinwntircs ptvabk to mcdiial prictitioncrs
atteiidiiig to give professional evidinee m tlw irimitnl eourfs Cndir (he
\\itiiisscs’ Vllowaiice Ilcgul ilions 1*118 wliuh emie into tlTccl on that d itc
the ninxmmm allowance to a witness to fiet is £j per dav itresiicctire of
wbcllier the praetilioiur attends to give evidence m one or inori eases or
whether tin eourt is m the town wIkr the prulitinmr ri-stdcs or tistwinn
Wlurt, however the tniu diinng vvluch 11 k witness is ddnimd nwav from
his pnetiec does not ixei-eil four hours tiu maximum allowniirt* is £2 lbs
except m cases where he attends to give cvidiiKe m (wo or niori sj panic

COURT ms

onses In tlic latter e\cnt he mfl> be paid nllonamcs cxcccclm" m tf)e«o'»rc>
gate S.2 10s but not exceeding £5 ''on

l^c regulations also ])ro\i(lc for tlic pasment of a mgbt nllowunce to i
professional asitness >\hcre he ts necessnrilv detained nna\ from liis hoim.
o\ ernigbt for the purposes of attending court Tlic nllou met for this pijrj>ou
will be Oie exjKnses reasonably irutirred bs him for lK.nrd and IwLmi^r in,
to a maximum of £l per nigbt

The tn\elling allowances, which remain imclnnged, are as follows

(1) The third class railway fare (except wJicre otherwise dirccte*! bt the
court) MJiere return tiehcts arc nvailabje, the fare at tht return raft, onlv
will be allots etl

(2) The fare actually paid whore the ssilntss trascls h\ otlicr piililii,
comeyance

(3) I\ here no roihs ij or other public consevnntc is availuble to n person
who necess-irily trascls h\ a birerl xcbiclc, the sum ictuaJb piid for tht hire
of the s elude or an allowance at Uie rate of is (id a nine enrh ssas, sshiclicvcr
IS the less (M here tsso persons attend from one place, the maxnniimof Is ixl
per mile shall apjily unless the court is snlisftctl that the liiix of two mIikIcs
was reasonable)

(■!■) A sum not exceeding 3d per mile to a person InMlling on fwit or h\
private conveyance.

Tlie position of expert witnesses rciumns unclmugcil— > e Ihev imv be
paid such allowances as the court coiiwders reasonable Invmg ngard to tht
nature and dilTiculty of the case and the worh invoUcd

It IS the duty of the Taxing 0/hcer to “asctrtam the imount ' of lovlv to
be paid and he usually does so vntlioiit refercnct to the Court, hting guided
by instructions contained m a circtihr issuwl by the 1 Joint ODirt to nil Clerks
of the Peace, Clerks of Assize and Ckrks to Justices Tins tircular, wliitli has
no statutory force, originally stated that profostom! witness illnwinres
should tiof be paid tosalarietl oflicm who do not losercinuncrntioii by rmson
of attending Court.*

High Court and County Courts A mtmber of cither tht mcditnl or
dental profes-Sions attending ns n wiIik-.s uf fw-t tiLlier with or wilhnul
subjicena IS entitJed HI the High Court to a fit of from Js Od lo£.>5s ltd
per day In the majority of enscs n fee of £5 "s 0d„ per di\ is allow oil on
taxation to nietlical witnesses _

In the Countv Court mctbcnl men nrt treated as efptrt wiliits'cs and not
as witnesses of fact Allowances to tluni miigc from/Ct 3s oil to Lx Hs Oil
per day aceortbng tocireiimsl'lnccs> plus in cathtascnusonablc travelling and
subsisteneeexpenses ‘

Hie medical witness should remenibtr that —

(a) In crimiml rises (us m fhecuronerN ruurt) when onec lu his ncccpftd
0 s»6pcefMi, he has no option Tchalsotrer al any iniic subscquenlht lu must
attend and giv e cv idcnrc under the nbcive sc ilt of ft es

(ti) In end cases, even after hefire h/iini norii

and before he conseiils to giv4*'<tmeuco, he should insist iijkiii hiving m

» A Defenw: Sockty datlcncwl the vwU Wv c r llus instniction lit n t«l eis.. a nil n?
vsns even bv Vlr Justice Vc^hn in Lham1)er»totitrrPrct tlul ll nlm-clion-* in I nni^raj li
5 of iJw Home Oiriee ciretiUr (re il witne" f-xs lo

narrow, and the mere fart that n pratlhmfi rf letor n itj »*e inn wfs i ft “T

him to the slatm of an orJiruiry icitne^r l|r Judge /<irflerslat«lll«t il wo* {',
of Assite (m Uiis case) to assess wlut amount sliouti teistld fur lAelr/nWi'and h stofti

MPDic iL Frrs

33

fli) a^rocmrnt /i« to his ffev Ix>Ui is tn aojount nml ns to Hie person
m!io is to lie responsible for p iMiieiit After tibiii" the ontli he is subject to
the rules of tlie court niul must gne luswidcnce regardless of the prospects
of rccciMug u fee adeipnte or tnndcquile IiwsmuLh as fees arc recoverable
onlv from prmcipds unless tliere is a special ngreement to the coutrnrj, a
iiiethcil witness should take ean. in nil ctses where his nttuulnncc is rcipurctl
in a civil court to give expert evidence that there is a special ngretment m
writing hmding the solicitor who requires the ntttiuhmce to pav the foes
himself \ solicitor who servts a mlpirna is not h vble for the fees In a case
in which an actum was hrou^ht ngiiiist a solicitor for the am Mint of the fees
it wis decided that ns a ndt a solicitor is merclj the agent of iiriother
person mil if he simplv serves a inin with a suf prvnn he is not hahle for
tlic wilnesss actum for expenses is against the prmcipil This tm|ihisi?cs
the luxessitv for a special agreement

(e) Vn unrrsisfertd medical practitioner whitcvcr his diplomas maj be
IS ill cxactlv the same position ns an tiiiqinhficd quack , so far ns rc'ciivermg
fees b\ legal process is couceroed he iun\ acieept what is offered him hut
cm recover his fees onij on an agreement wah Irfirchrml m the same wav
as nnj other person

Fees \\|fe is Agent for Ifusbind While a husband and wife arc living
together it is a prcsiimpti m of fact that the wife is agent for and lias the
aulhontj of her husband to pledge his credit for necessaries supplied to
their establishment whii h arc smtctl to lus station m life V w ife has implied
nuthont} to hind her hushmd for nasoinhic eu'c-nses for medicines and
medical nttcndanLC incurred during illness hiit'^is implied nuthoriU may
he termmuted if the Imstiand gives suinciciit notice that he will no longer
be responsible for am dclits which lus wil< may mour
"1 ratvrs v Sen' wiis a i I'v ro the iiuthoritv of a wife to pledge her hiislmn I s
erecht for fees i^or her ue luihemeiit It w i\ held that I lie wife hnilcoiitrarted only
ns an agent fir her husband and tiuil in ocl on coni 1 in the i rciimstanees bo
brought onlv against him and n< I ngiinst the wife

Fees for Calls b> Police U lieu a j olive surgeon is e died from lus resi
deiiee between T p m and 3 a in a fee of g3s is paid nnd when called out
during the dnv time lor similar strvuts n fvc < f lis Tel is p ij ibli General
Or levs U MetrapnUinn Pnhec fl )5t)

Fees for Midwifery Hie fees pajnblc to njccliial jiraetitumcrs who arc
tnlfcd 111 bv miilwivcs in iiiufeniitv eases are prescribed b> Ifegulations made
b\ llic Munster of Ilcrilth under the Midwivcs \et 10 It

Fees under the Road Traffic Act lOlf s K \Vliere medical or surgical
Ireitment oi cxammntion is iinmcduitcl} rvquind ns a result of hochlj
injurv (including filal injury) to nnv person caused bj or arising nut of the
use ol a motor v chicle on a ro ul Jiid the trculmcnt or cxamiimtiou so required
IS cITceted In n rtgistercil medical practitioner the jicisoti wl o was using
the vehicle at the time ol the event out of which the bodily injury arose is
under an obhgition to pay to the prictitioncr or, where such treatment is
effetted by more than one pmilihoner to the prictitioncr by wliom it ts
first elTc-eted— a fee of 12s fd m respeet of each person m whose case sucli
treatment is effected bj liim md n sum iii respect of any distance in excess
of two miles which he must ensver iii onlcr to proceed from the place whence

» is r L R 20»

<10tOSR &.0 No OOi

MFDICAL FEFS

66

he IS summoned to the place where such trc-itmcnt is carried out h\ him and
to return to the first mentioned place equal to sixpence for c^cr\ complete
mile and an\ additional part of a mile of tliat distance

Fees for National Health Service are prescribed b> Regulations ‘

Recoverj of Fees A\ith certain exceptions (eg fellows of the Koval
College of Plnsicians) medical men con sue for their fees according to a
scale which v iries with the social position of the patients visited provided
that the fees be fair and reasonable In all professional dealings lictwccn
medical men and their patients the customs of the profession vvill lie con
sidered as imported into the contract unless excluded exprcssl) or bv imph
cation

ncntalsiandnslandanlWalrt) Jnnr, ILM^O

ciuPTinii

MEDICO-LEGAL RESPONSIBILITY IN THE
EXAMINATION OF PERSONS ALIVE OR DEAD

Examination of the Living

The \ arv mg conditions in Inch n doctor mas l>e asked toninkcnn examinn
tion of a Ii\ ing person for some medico legal purpose certification insurance
or other litigation a complaint or charge of crime abortion etc — make some
consideration of his responsibilities highiv dcsimhic

\ medical man acting in a prisate capacity or a medical ofiicer acting in
an ofilcial capncitj maj be callesl upon to examine —

(i) An adult capable of gi\ing consent

(») A child under age incapable of consent Jau

(in) \ person incapable for reasons other than that of age of gi\ mg a \ niul
consent— raentallj confused unconsc ons
The person to be exnminctl ina> be —

(a) In the custodj of the police clinrgcd with an offence or crime
(h) Not in custody but suspected 1)\ the police

(c) Neither in custodj nor eaen suspected by the police but suspected

or charged bj other persons eg employer

(d) InnciMleise eg divorce nullity chastity etc

(e) A private patient, m tlie onhnarv course of practice or m insurance

work etc

Tt IS yyorth while pointing out to medical men tlmt iiUlio igh the fait that
a y isit IS paid to a pmclitioiier implies consent to a certain nmouiit of exam
■nation it must not be concluded that such a visit entitles tl c medical man
to compel an examination more intimate than the patient desires If for
instance the phvscian considers a vaginal examination is ncecssarj m
order to complete lus duignosis and tl c patient refuses her consent he
must not insist upon such examination lie should explain the manner m
which this refusal prevents him from helping Jier and how she is wasting
her inonej and lus time by consulting him at all Bey ond such expostulation
all that is said below as to judical examinations holds good

In all cases vs here nii examination of the person is desirable it should be
made because val lable evidence bearing on the case niaj be obtained from
such examination Delay mav result m the evKlcncc disappearing — fading
or being washed awaj

Consent Two fundamental general propositions mav be made —

(1) Such an examination may be made onfj with the full and proper
consent of the person concerned if made without consent it is technicallj
an assault and niav possibly be an aggravatol or even an indetcnt
assault

(2) In ordinarj circumstances it is beyond the powers of a police officer

COXSE\ T

coroner, lawjcr. mngistmte, judge or e%cn n bencli of judges, to niaVt a
A a!i(l order for the mctlirnl e^nmiii'ilinn of nn\lxxh ‘s person ‘

liie following qinlificntions in rcgirtt In “consent ’ nro iimle on tlie auUior
Its of (leoidccl coses ntid of the dicta of judges —

(a) Consent must not lx* ohtnined In fraud nor b\ an\ iindnc moral
pressure or duress it must lie gntn frcels after n full ctplmintion of the
reasons for wliuli it is ilcsim! and of tlie consccpienees which imj rrsiilt
from .t Silatce iheniol nm contnii norisconiplmnecnceessards to lx- liken
as consent

{b) In nn\ tise in which there could possihh be am doubt llie eoasent
should be gnen in writing and in nil cases it should lie given in the presenw
of dismtercstctl witnesses as otherwise there nun lie diflieultj mprovjnr’it
(e) Uhcre the person is inrapnhlc, through age or through lark of under
standing of giving a valid consent, permission must he oblainnl fnim the
parent or guardian

(f/) Tile medical man sliould nsk himself the the questions “Hove I strong
grounds for bclicv mg tliat an examination is rcallj necessarv for clearing up
points which are v ital to the ease’ “I Ins consent bet n such tint I could make
It eonvmtuig to n jurv if I were charged with iissaidt'*’* In other worth lie
should have the support of his own coiisticnec that he is netiiig with good
reason and with valid consent

Refusal to submit to an examination is hv no means nn nduiissiou of guilt
lor instance n prisoner niav be snlTering from venereal disease, and he
umMlling that this slinuld be disclosed and vet mav lie innocent of tlic ernuc
with which he is charged If the eonvplaiimnt also has venereal disease this
coincidence is not conclusive citlicr waj Again nn imuxent woniim is just
os likelj or even more !ikel> to refuse consent, ns one who is guiltj

hurthermore n desire to he examined must not be rcgartlod at onee us n
prcxif of innocence ^fen who eomniil cniiics like njie unimtuml o/refieev
etc are frequcnflj well aware of the im|K>rtnnee of nn examination ns prinm
facte evidence in their favour should it he ncgulive, and it is ensv for n
criminal assault to be eonumlled wilhoiit h ivjngnnv trace ujxm llic nreiistal
^\hrn consent lias Ixren obtaiucal the examination slinuld imnrmblv lx
made m the presence of n tiiin! part) neglect of this prceaution his nunrd
more tlian one medical man of pxxl repute

Police Surgeons, i c medical practitioners ucling in an oflicinl lajiacilv ,
inaj lx- desired In police ofTictn. to exanime |KTsons m nistntl\ or su-pccled
In the jiolice, and Ihev arc sometimes nskesl to aid m delettivo work iii eases
where one nr several women max he guiU\

llie following IS from the rohee Onlers issued to tlie Mctro]X)htan Police
entitled —

Medical txamlnailons -Cases Involving*

Sexual Offences etc 'Irtlual •xaiuuiiition slioul t lx* mmlc nf jin^iniicn ihargcd
wall! such ofT.iuvs m rape and Slnlion OnUxr* must see tluit tlie csainui itlon H
made where n pmoiicr toiiM-iili ft K inipmctifahfc to filvt a eompfete lot of tJir
’ Hie ritlil of wiirch oflherf jjnionersanpirrnllj Maiitl’iin « diffeiriil footing

n nice l«int ni.al t <in>c if a per«ifi were wprclwl of »U>l<-n r n»}xrt» In «nv of

the mtuwl pasWa-s of the if « mclxiil num were ealleil to •»eli « nw l«-
ol lain consent from the person W'|>cctetl lu well a.n wnllen niUhonf> fmru those callinff

Hidr indc»rtcdne« to tie Coimnisaioncf of 1 ollce.
New Scotland \nnl, for th * informatkiii

medico LEGAL LXAVINATIO\S jO

offcmcs to «luch nnlcr nppltM hut it inclmles unnntiir'tl olTenccs all MnnKS
and the misdcmcancjurs under « t ** aiwl 11 , (rmunnl Ainendmcnt \cl,i8Sj,
and all cases m which the cxurnmition seems tikeh to furnish cMdence ns to the
prisoner s guilt or innocence

I'scrA prisoner to whom this order applies must be t!car1\ toM b\ the Stition
Olhccr m the presence of the olliccr in charge of the cast tluit it is j)ropo>til to
esaniinc him and that he his the right to object if he so desires Ihe exanun ilion
latest fieca?r foe made finder this order snlhout ttie pnsoners ejfirett roiisenf f>r
in the absence of consent an\ e\ iminatioii would lie nn as.s<ui!t

If a prisoner consents to the examinalioii it must he mule b\ the Divisional
Surgiain or, In his absence hv some other doctor called b\ Pohi-c but the prisoner
sliould lie told h\ the ’Station Olttecr in the yresem*c tif live oflicet m cliarge of the
case, tliat if he desires tlie attendance of u dfictor on his bch ilf an njiiHirtiiintv for
siuh nttindHiici joiid/i/ ud/i the Dn itioi^o/ Snr^nm or other doctor cnlletl hj PuUcr
will lie given

\rmn,^mcnts are to be nude for tiu examination to take pliux is s<i,in us
prai tuaibU after the {irisoiier is in t iistodv niid rt moved to ttif Station and be ft rc
he Is taken before a Miigistnite

1 verv prisoner who re<inesls ex imiiiutioii bv a private doctor is to be given
clearlv to iindirst uid that he will be rcsiamsdile for the fee of tin doitor ittendui^
nil Ins beluilf and the private doctor when called is to he mforttied that Ins
attindaiKi is rcqnesteil b\ the prisoner wlio is suUU responsible fi r his fee

1 he ulllccr in charge of the case wall make no entrv m his pocket b tok (n) of
cverv proposal for a medical examination and of the prisoner s consent or refusal
III Ills pri'scncc and (fo) of the offer m ide to the prise lu r to allow a doc ti r to attend
onhisbeliilf andiiisncccptanecorrcjectiimurthc offer Tlicctilrv will lx tnitialleil
at the time hv tlie Station Ollicer and will lx uvailible for the Court if
iiecesisir) The fac t-s will also Ix' rcconlcil in the (Iccnrrenu Ihxik bv the Station
Ollicer

llie Divisional Surgeon fiutsl m ike a scpirite ciitrv m liis j nvate memorundurn
honk luul III the burgi (ins Ilcixirt Hook of tlx result of uiv exnmmilioii uiul lie
must be fiillirmed of ffie time tiiuf pftex when be vydl he rri|nirecf to give cvidmec
before the Magistrate

ff in addition to the Uuisional Surgcuii or other doitor lulled m the first
instance h> Police the services of another dix lor ore obt iinul it the reijnest of the
Magistrvtc to nwikc a furtlwr c\ttium.ctmu the fee wall lx pud Uj Pohic

These onlcrs do not interfere with the ciistomirv jxtlico or otiiir sriirih of
prisoners clmrgcd inth fclonv with a saw I** discaivtrnig cviiii ni-c Ixirmg yn the
clurgp under another iiaragnph nordolhev mbrfere wiHi the tu»t uiurv iiractice
Os to midicil iiul

Otiicr Offences Gmdinfi rnnaplrs llic following guiiinu pniuiplcs mu.st lx
verv (iirefullv borne in ninwl

(I) A nieilical exammatum will lake place onU if cxprrsslv rcquesleil b\ u

iirisoncr (or Witb hiseoiisciit b\ rncndsl e r when Pohec diem it iieccssarv
in tlic !it,lit of till ensuing instruttions

(J) I xaminntions on beluilf of Police will oreiinarilv be mule bv n Divisional

Surgeon If a Divisional Surgeem is not u\ iilable and Hit tireuaistnixx^s
Ml n(]nire, the scrv lex's of the nearest Miitabk ehx tor should l>e ohlnmed
and refirciKxs In these mslnietiniw to u Divisuniul Surgeon sh uiUI be
read ns ceivcriiig a doitor whose services are so obtaiixd

( I) IMienevtr a reijUcst for cxainnintioii bv a privtili deetor is coinpheil wilJi
the Divisional Surgeon will be railed ini lx half of Pohix

(4) Division i1 Snrgvxms and pnv ite dixteirs will lx- sinnmoiuxl tiiinirtlialeli/ the
neex-ssitv for nuxlu-il rxumin ition arises

(3) Tfoe exflffif«afff/fJ foe either <Uk tor slitmM tike (flat its s/xm is (kissiI/Io nftec
arrival at the St itinn

(OJ An rxnmiiution bv a private elmteir will b< eomhiited ui the iircMiux* of
the Division il Su^eon eir, if he w lait Iminedlitilv avail ibh m tint of
Hit tst itum Olhtx r

(T) V prisomr will lx ns|)oiisibIe for tlie fee of a pnv ili clixtor attending at
Ins rt<|utbt and, if ixiiiMcteel will lx liabK for tin fit in resjxit of tht
tmfial evaminuUun b) u Divisional Surgeon

•10

F.XAMINATIOS 01 PIlISOS’EllS

(8) A prisoner s\ho appears to be drunk maj lie sufferiiij; from illness and/or
may Jiave stisHtnecI mjurj which is not apparent In an\ case islicrc the
slightest doubt exists, the Disisional Surgeon is to Iw smnmone*!
immediateU

General Directions as to Examinations at a Prisoner’s Request Tn tlie
ease of a prisoner m custod j for an> offence otlier than those dealt w ith under sexual
offences, in connection inth which a personal ineilical examination may bt material
to the accu'Mjd. if such examination is erpressly requested bj the prisoner or with
^ Ills consent, bj friends it s\ ill be made at the earliest moment practicable cither hs
tJie Divisional Surgeon or bj onj doctor attending on behalf of tlie accused In
the latter case the Divisional Surgeon will be called on belmU of Pohe-e
A prisoner nho requests cvammatinn b\ a private doctor is to be given clcarlv
to undcretand that he will be responsible for his fee. and tliat if guiltv he watlal-Ji
be liable for the tee in respect of the Divisional Surgeon’s f/iifiol examination He
IS to be mfomied at the time of making his request that the Magistrate w ill be asked
to order pa 3 ’inent bv lum of the Divisional Surgeon s fee if he is convicted ff lie
desires to pav tlie Dmsional Surgeon at the time, he may do so the particulars
being included m the entry m the Occurrence Book

In such eases when examination by a private doctor is requested, the Division if
Surgeon and tlie priv ate doctor are to be summoned w ithout delay , the latter being
informed that lus attendance is requested by the prisoner wlio is solely rcsponsilile
for his fee Tlie exammatton by eitlier doctor will take pluci. ns soon as piissthle
after his arrival at the Station and in no circumvianccs should an examination be
delaxed owing to the non arrivnl of tlie other doctor An examination by a prmite
doctor Mill be conducted m the presence of Hie DivisicmnJ Surgeon (if m attend nice
at the time) or the Station Ofheer If the pm ate cloetar completes his cxainmiition
liefore tlie arrival of the Daisionof Surgeon, he should be mfomied of the impending
examination by the latter in order that he may. If he so devirc» be present It the
Divutonal Surgeon completes his cxamiiulion before the artival of the private
doctor, he should be requested to wait a reason ibletim* for the examination bv IJie
private doctor If, owing to delav m ttie attendance of the private doctor or other
cause the Divisional Surgeon lus left the Station before the arrival of the private
doctor, tiic Divisional Surgeon should he recalled or the scrv iccs of aim lier Dlv isional
Surgeon secur^, and meanwhile the prisoner should lie evainmetl bv )»s ovv n doctor
m the presence of the Station Oibcer, and the doctor should bt mformcil timt the
Surgeon has again been summoned and be invited to remain in onler tliat he may,
if Jie so desires, be present at the turther examination by the Divisional Surgeon
DneU doctor will, on completion of his examiixition be asked to ecrlifv his
opinion in writing

Any fee incurred in respect of a second or further atttiJiJaiice In a Dmsional
Surgeon in consequence of a prisoner s request for examinatii n by ii private doctor
will be home by the Police Fund . r, .

Tlie oflieer in charge of the Station will evpressh enter in the Occurrence Ilock
tlie request by an accused person for a mevhcvl examination nnd the compliance
with It, and report the facts

Supplementary Directions as to Particular Cases U hen a prisoner cluir^d
witli drunkenness denies that he is drunk ami nsks to see a doctor, he is Inv aniiblv
to be told tjiat the Divisional Smgeon will be sent for, but tliat be is eiitith I to eall
m addition any doctor whom he may desire to nominate

M hen a drunken person found on licensed premises w arrested or when a police
ofheer is found drunk on licensed premises, and pmtecdmgs ore •'kclv to lx tuKcn
against the licensed person the Disnsioiul Surgeon will be c died in to examine the

prisoner or olFicer , ,

Any request tliat a hriensce s own doctor be allowed to examine a prisoner found
drunk on licensed premises w ill |>e refuswl

The servnees of tlie Divisional Sui^n will be obtuinnl at onre to rcrtiiv as to
the prisoner s condition before the cliarge is entered irrespective o/ic/ir//ifr the charge

is orisjiot.dniird.innrri/caseinwhidiapersonlvthirgvdwrth

(n) drmng attempting to drive or being in charge of n motor vehicle while
bem ' under the influence of dniik or a drug to such an extent as to iic
luca^bie of Iiaving proper control of tlie vefucJe or

MEDICO LEG iL E\43II^ATJ0^S 41

(6) being drunk ulule m olnTge tf t Unrsc or a •vehicle other than a motor
\ elude

In the case of charges under («) the attention of the doctor or doctors should
be colled to the a<tual temvs of the vliaiue and to the fict tlint thej do not allege
that the person is necevsanh drunk

In the event of i person cluir^^cil vnlh either of the ofTenees specified in (a) or
(1>) being examined at lus own rdpicst bv more tlian one priv itc doctor an equal
number of doctors, preferahh Dtvasional Surgeons is to be called on belulf of
Police In these circumstances a prisoner vnll be liable for the fee incurred for the
mitial examination bv cnrA doctor called on bclialf of Police

When a sador nuirine soldier nr airman, is in custods of Police for drunken
ness etc and he expresses a desire to be examined hj a doctor and is vnllmg to paj
lus fee a doctor mav be called to give an expression of opinion ns to his condition
evTn if he IS onlv dctamwl for the arrival of an escort Tf the doctor called is not the
Divasional Su^jeon the latter mitst also be caOeil on bclialf of Police

Special attention should be directed to the fact tint full and free consent
IS essential amone who steps outside the limits of this written document
does so at his peril whether he be n practitioner called in b\ the police or
a police surgeon ‘

The following is a flagrant instance of overstepping the bounds of dutv —

A child wa.s born In the street npparentlj from one of two women who were
passing along* the child vvns taken in bv a passing Simanlan tlie two women
went into a iiousc in a street a short distance imav Next morning the iwliec
Msited the house into which the women had gone but the women had disappeared
the police traced them to another house sent for the police surgeon and upon
finding the women requested the surgeon to examine the jounger of llicm using
the expression to her // you dont cotiseni I nholt lake you into custody T^e
police surgeon lliereupon examined her and found her a urge \ntacta

It is difTicult to sax who was the more dcserv mg of blame the police or the
police surgeon for both were violating everj principle of justice niercv and
dccencv there being nothing but circumstantial evidence (which turned out
to be misleading) to connect the woman with what at its worst was a doubt
C\l\ ctmvc, nvciTCOxcr cotv««wt gamed vinder a threat qC arrest vs rvot frea’
consent

In t!ie case of a person m custodv on a criminal charge there seems to be
an absence of unanimity of opinion among the English judges as to the
neccssitv for obtaining consent before examination medical practitioners
should take no risk over this

In a tasc of unnatural offence tricvl at the C C (. a divisional surgeon of
police was severely censured bv the judge for not cautioning tlie prisoner as
to the result ol the examination and for thus taking advantage of the
prisoner s ignorance

Reqvsests to Examine Servants \\ here a medical practitioner is called
m b\ a pnv ate person to examine a maidscrv nnt or other emploj ee of an age
at which a valid consent is possible special caution is necessarj

A. medical practitioner who is so summoned should be careful to explain
to the mistress that such examination can tike place onlv with the free
consent of the emplovec that compliance docs not mean consent and that
the result of the examination Cannot be dmdged without the consent of the
jicrson examined It must further be remembered that since e\ erv person m
employment IS now insured under the Health Vetsand has a medical attendant

* Exception to tlie fciv ing of consent a| | lie* onlv to l! e tik n„ of C nper prints I > a pol ce
ofl ccr on tLe orders of an Ins[>eclor (or I igler ranked ofTcer) from b person In custodv
charged w ih an offence before a Court of Summaiy Jurisdiction (Criminnl Justice Vet 1918J

42

r\ iTIO\ OF !iFRVA\TS

of lier or fiis own it is df^^irihlp that nn\ c‘\ninmntion of soch msHrcnl person
should lit im<lc hj the dwtor on whoM Jist she appears If |hp cnipjour
^^lshes hrri wii [invalc prat titiuiicr to make nnrvanunat ion niid Hicetiiploscp
const/its f 1 r doctor of the lOstim) jxrvon shniiW J>e mfoniicrt 7 he stn nut
shoui i Ik fold the rcison for the examination assured timt it is in her interest
f I cit ir up the siispKioii and mformeil clcarlv tint it is for her to decide
whether she will he cxaimncd or not The followitijr i isc is i warmiy toaJJ
practitioners w ho arc ( nnsuUcd in such eases

1 lioiiscniaid ret 28 wis fu Hie service of Cipliim and Mrs H , wlio si me time
before the occumnec luid liecn absent fmm home 1 our chj-s after Iheir isUirii la
consequence of some infonnition p«eti In a tfianvomin to Mn n Uic Ijffer
came to the coneliisioii HlH the mai 1 wns pregnant niul told her to pack up an 1
leave before 12 o clock ns she w is m the fimilj vni\ This the iiniil tleniid
Mrs B replied The d h tor wiU Ire here ilircetH , referring to the jiIijsk mn who
iinknouri to the msid had liecii «^nt for prcviouslv trrs B t«»l I the nialil to p> (o
her room the maul eriet! Mrs B forbade her to spe ik 1 lie maid went to her bed
room and shorflv jftermrds tlie pfysKiin ilso came there The mud ened wul
that she liad never had such Iteatmenl liefore asked him wlnt he was going to do to
her and said tint she did not insh fo be examined There mis unittc conOtcl of
exulenee lictbcen the maid nml the p1i>sician whether she ronsciitct! or not (which
might Jinxc been avoided if the exaniinalton had taken pj lec m the presence of a
third person) Tlie phs sirian examined her and found t li it there w ere no Imhcid ions
whate\Trorj»rega.uiev inspiteofthis Mrs B dismissed her.and rcfu<cdtogi\phrr
i eliaraitcr The maul hrou.ht on lelion against her master mNtfcs.s and the
ph>-sicnn The ease w ii tried at Mancliestor Assires licforc Mr Justice Pcnimn
'iiid ns the pirj could not agree llicj were disvluirged It wis retried at the
following assircs liefore "Mr rustier I indicv who withdrew from Ihp jurv llic rase
against tlic master and mistress ns he considered tliat there was no evidence ng'iirist
them of the maul s non assent upon w Inch the jiir> eoiihl n-isoinhlv net wlirrciijwn
n verdict w is found for the i hvstenn But the rs«c w i« not aHowctl to cn 1 llierc
The \ie.iUnee \ssocntion ussistel the mud in taking the i »sr to the Cniirl of
ApfwM when the ilcfind luts were reiiuircd to show const whv the vcnlict shmiM
not be set nsideiiiid a new trni onleml on the gmim 1* that the icartieil judgv nii„hl
not to h ive withdrawn the vise from the jurv, luwl th it thi verdict was against the
WTight of the evi Icmv

In the Court of \pi>c«l Brett, L J smi

r cannot conthiile Hus judgment without r\pres.-ing rnv nblorrener of Htf
whole fonduet with regard to tins unluippv girl fr mi liegtnnmg to eii 1 1 i mu t

conceive how right niindo I (Kople should Ik-vihsc thev Mipjaw— evTii if *l IhuI
lieen true tint a voting girl is in the faniilv wav immcdintelv take It inlo their
heads tluat thev are insulted U)n on earth sli uild fbev Invt sent for the doctor'
ISihrt /Ja-I .VAdbAcJiikeejo Jbe^.trf wb> not let |icrj>i> awav asqiiietlv asposxdile'
Jills idea of having servant girls e>anjme<l In dwtnrs H In inv mind nbsolntelv
WTOite. and it is coiuluct which evvijlaalj mijil to scout

Examinations In Infanticide or Concealment of Birth Mlure Ihv.
field Ixwlj of an infant his licin found and the jkiIicc are endeavouring to
find the mother it nnv be luxc^sarv, in order to e«Hmect htr wilh the hirlli
of the child to determine whelhcr she Ims been rec-cntlj deJnered Meihcal
cvaniinntion mav 5 .how Ih it the date of delucrj dms or does not torn?>[Hmd
with the (late of the hirth and death of llic iliild (i » A *jet{ion deahcig with
the Signs of Dchv ers )

Mwheal men have no right to citfont an eMUiiin ifioti of n susperletl
woman or b\ tJm its or otherwise, of indiinng her to he exniiiimd Such
ucourscof conduit launproiK-r. for il iscmlv whin a wonmn vnllinglv ixms<nls
to he ix limned tint n lucflzeal niw is justiJicrl jn making an cxnniitialioii
Whennmcdical man takes tlusaulhonli uiwnhmtsclf.aiidcmniKlsasusfK-ctcd

MEDICO lEGAL rXAMiyjTlOSb 1 i

«oman, umvillingly, or under duress, to suhniit to n pli>sic«l cvominn
tion, lie IS forcihl> e«mpelUi\R lur lo jinxluct v,h\t ims he positne proof of
her guilt 1 he miscliu.\ ous results of suelj olliciousness art ell illustrated b\
the following eases —

A surgeon and an inspector of pohec insisled \ij«>n esamminH two nnmeii i
mother and daii^,htcr, lu the ahseiicc oftlieliusbandand rutliir, m order to dettrmhie
whether cither of them li u! hcon htels delis eretl of a lIiiIi! llosiuis against tht ir
wish and as n result of an action d im iges were rccosered

In another ease tlie dead hod\ of a child had t>cen found near the pi lintifT s house
T lie defendant asurgeon went withaii insiicctor oCpohec to tiu pi initifr s wifi
and hasnnginfomied her tliat she w issuspccleilof !ui mg liad leluld told herthat
he Ind come to examine her hj tiu authont> of tlie law and tint she must sidnnit
SheTcfuseil at lint, and proposeil to send fora nmlnal nun whom she knew hut m
the end the defendmt examined her, and found tliat there w is no ground for tlie
( h irge riie jurs aw irdi d £JUt) d uimges for the u<vsnult

III Spvrer \ tlnll it w is alleged tlut Dr \iiMxiil Unit ktiiwsing that Mr Spla r
wasaway III hospital, railed at the liouseof Mrs Sparer and afler soim iimi trsalnni
111 rcfcitme to there tiring no thddreii In her iiumige foriilifv and ag-niist Ik r
wall, made an examination of her whiili <uus(d her mnih distress Mrs Simxr
pixc evidence In sUpiKirt of this idUg itu n tint stie admitted that sht li itl not told
her hiishaml until later although she allegeil tli it she Inil told cert iin women in tin.
district Slu lould not fix the date of the alkgiil ass Mill hut gnu it iipproximateK
ns bung ibimt thirteen months before the tn d

Ur Nimxmt Ifnll said that hi had snikd it a tirtim diti upon Mrs kjiirer tn
mquirL after her liusbiind whom he had M-nt into hospital taking iniidi nitenst in
tlieiase Mrs Spies rh id soiucioniersiiioii with him ub lut her i lultlli «s toiiditinn
and iLsked if it were possible for Iwr In luiir (Inldrin IIi told Iter lu could not
tcU her without in'king an examination which she then askid him to niiki ITc
dtznurrcd stating that lie could not do tins without soinei ne tisi being pnseiil to
which she objecUil strongly After Mime Inrilur is*ni« rs dion he tonstnted tn
make tlic usual examin itioii at her desire

Dr Hull was cTOs»-exandned and other witnessi's wire nlanit to hi tcinlcred
b\ the defence wlicnthejun slopped the e isc niiduicrdntw isgiiinforDr Ifall
7 lit jiolnecan ik> legu! junirr to a medical man lo null i such an t rnmina
imi in a Mispectcil to-sc, niul llic ultimate cotisenl of the woman if exlorteil
b\ threats or intiniulations will he no answer to n thargr of iinleeciit assuuil
A promise like “d will be better for sou if \oii <|o coiislitutes n thre it

In tIu lollowiiig ease tIu qiiestum of incilii il lespniiMbililv in eases of
alligid nifiiiticiile wns plnc-ed in a \rr\ iniiiful hglit

riu coroner held an inquest on the b nIv ofasbdd m u msc of alKgid infuntn ide
A suspieion arose that a \onng Lids the sister of a rh rgiin in linl liccii neenlli
dehiercel *1 wo medical gentlemen iinnrd with a STnttrn uriltr from tiu csinmcr
went lo the reeteirv where she was residing uiid requested att niltnn w with her for
the purpose of aseertnming wliether s»lic had rresnili lind a child She refused to
MS. them and subseijnentis teaik her life Hie llicdic d men In en haeonrnig to
justifs themseUes furthe part wide htliex twikintUe mvtlir Tilnd upon the written
order of a csironer

III fuel no eoniutr lias aulhoritv loonier the performniu e. of an illegal act,
wild if he ihfmUl ouike such an order, it should uol be obt\ td lu the mteresls
of lilt niiilieal profession, ami ns a giiielt iii future the following legal opinion
on the subjes t was obtained — •

* \rterehhgeiit scare hem tin. subject eif a coroner haulhontv I eiilerlaln iioilmilit
that an orelcr for the. ph\-sicd exaiiiinntKii of a worn in in a c-im of Mis|>fsled
Infunlieidi and eoiKeahntnl of birth, is grossly illegal Snehn melh-Kl of obtaining
tsidents. is eeimjdtleh at Miniriec wath our pniiesples of justus and f e in linil no
autUorilv for It ansorliere

• The practice of starching persons m custods is simpU a polnc recnl dion f. r

J:\AMI^ATlO\ or DEAD liODl 43

Jia\e been brought bj IiMng person^ thmiing portions of their anatomy,
or pathological products such isstones as luch Im\e been removed judgment
has al^vaj-s been entered for the claimant

The safe rule is that a post nortem examination maj be made ^vhenc^cr
the cause of death is knoun to l>e natural but cannot be determined m precise
terms from the general and methcal evidence If a medical man cannot give
a certificate of the cause of death the hod> vnll pass into the control of the
coroner A medical man lannot )<^tlv claim a fee for wliat he has done
VMthout official authoritv, but, on the whole, it would seem that he should
not, on the ground of professional secrecy, decline to divulge the knowledge
which lie had acquired at the mortem examination

The line of conduct which a meihcal man should pursue is as follows —

1 It is obvious that the cause of death was natural 'uul the me<lical
man desires a post mortem solely for his own professional uifonnntion he
must obtain the permission of a responsible rehtiv e or guardian before acting
if another rclativ e should object the medical man would act more wisely bj
at once desisbng but if he still persists he is acting jllegallv only when he
forces access to tJie body against the authoritv of the head of the house
wherein the body lies the post mortem examination itself is not illegal in
these circumstances

2 If there be anj doubt that the cause of death was natural, and the
medical man cannot clear up tlie point without an nutopsj ht would be
wise nluays to report tlie case to the coroner

He maj however exqilain fuUv to a resjwnsible person liis reasons for
desiring an autopsy w itli tlie result that he nn\ obtain permission to perform
It He IS then entitled to perform it because he is at tliat stage uncertain
whether it will be neccssarj to inform the coroner but if he lias made an
nutopsv under these coiulitions he must not suppress any facts which he
has acquired ami if lie finds evidence of unnatural death he is bound to
report the matter to the coroner He vnll then almost ccrtaiulj be criticized for
not reporting the case if at all obscure at the start

If permission to perform a post mortem examination is refused the doctor
should report the matter to the coroner and should not touch the bod} until
he has obtained a wTitten order from that nuthoritj or from his deputj
Certification will rest w ith the coroner

3 If the cause of death be unknown it is not illegal to perform an
autopsy with permission and if tlic cause of death is natural the doctor can
fill up the certificate without further delay IF it is «ot natural however the
wisdom of embarking on an unknown course must at once be open to question
Better never to have started tlian to wreck all chances of nn expert finding
the cause of deatlu Second post mortnns arc notonously difficult

4 Uhen once circumstances liave arisen whether before or after death
which necessitate a report to the coroner a meihcal man must on no account
touch the bodv foV the purpose of nn autopsy without the icrihen autlionty
of tlic coronen to do so is to render himself liable to be prosecuted

Tlie following case shows how an aggneved person endeavoured to make
a post jnwion illegal bv a somcwlvat frivolous use of the Anatomy Act

A Dr Carlef on practising at Vcwnliam was summoned to answer certain cliarj^s
under the Anatomy Act of 1832 It was alleged 1 Tliat lie u|>on July 2jtli I0(J4
lieing a person lawfullv qimlifcd to practise medicine unUwfulIv dil pnicti->e
anatomv without having obtained i licence in puiMiance of 2 A. 3 Will c 7"
empin'cring him to do so 2 Tliat on the same date being qualified to practise

44

^\A^II^ATIO\ or DFAI) liODl

purposes of safets to prc\ cut stueide and f r tlK «lisoo% er\ of st< Icri i n nt I

lias no analop\ to seardung u Awman s pmun In order to obt i!n evidence of mn
(•raiment of birtli.

issuin" such no order ami tlw* /n«h(^l nwri acting un Icr it woiitj
alike be lial le toheavs (Inmages in an niltoii aiuleserj surgeon acting un ler tl e
orders, of the fwhce or an\ other autliont} e, Iw in I to see Hint the order is not m
excess of their junsditUon

Hhetheranj andifsowliat cliangein tlie Kw onthcprescnlsubjeclisdesirjble
IS n matter not now m debate but the question Mlienevcr opened sviUpnnctnWa
\crs svide one

MthoiinJi no decision on this question nmj hai e been made bs the judges
iinsnuich ns the\ denounce m the sex crest fanginge the conduct of the j> dice
and of nieditnl men m putting qucstiom, to nnd tKtrncting incnmmitiiig
answers from a uoman cliatged mth child murder the\ are not Iikth to
spare a person who obtains from n woman b\ forte op intiinid ilion exidonce
of lier enmmalitx b) a compulsorj phxsical examination

Examination of males charged with rape or Indecent assault Pn
eiseh the same rules of procedure apph in these cases

In DoultoH \ Park a I-omlonj oboe surge on rcceixod asm stern rebuke frond e
ju Ige for hixingcximined one of theaixniscd while In (ustoili without luiimg first
obtained bis consent The learmsl judge ti 1 1 the witness Hint tl i ; r/soi ep wou! 1
lia\e been perfcetls justihed m knocking turn down

The danger of making examinations without the presence of a witness
IS illustrated b\ a case tried at Margate Quarter Stvsions m 1003 when n
sentence of six montbs hard hibour was awanled for assault tlicre was no
corroboration of the tObtinion> of the girl who alleged lliot the cxamiimlion
was made without consent Bv the Children and \c)ung I’erxoiis \ct IMi
s '18 the e\ idcnce of (.luldren of tender x cars must be « rrolmratcd ii\ sonic
other material esidenco

Special conditions are laid down for tlie examination of the person
under the Workmen s Compensation Acts and the National Insurance
(Industrial Injuries) Act 1946 Neither tiiese cases nor nnj eiui action
fov damages can gu e rise to au\ trouble to a practitioner wlio acts in nceord
once with the suggestions gixen above

Examination of the Dead Body

tor tlie examiiinlion of n dead Inidj or of human remains no furtlcr
authonts tlian the written order of a coroner (or the bherilT in SrnlJand) is
required or the consent m non judicial cases of tlie nearest rtfitixe or
guardian

\s to the possession of n dead bodj md perforniit g a /oj/iit rh'a
examination without consent the law rceogiurcs no propertj m a lUnd ixids
except insofar ns it belongs to the dreensed s personal representatives fortl c
jiijrjiosc of disjxjsing of it according to lavs It is a misdciiicmour (n) to j n-V cat
tlie burial of a dead bo 1> and (f ) tn neglect to hur> a dead IhhIv which one
IS lega!I> Imund to burs (eg that of a man s wife or childj proweiird ths
one is not legally Imund to incur n debt for such a { iirpost If a pisf tnortci i
examiiinlion lie hold without consent no olTcncc nt hw is ij v> facto <s ni
imttcd It IS only a moral oflVncc against the reJatnes whieli sh ml 1 «
course lie av oidcd ‘ No assault can lie committed ujion a dead IkxJv Smi I
ariy nmovnl nnd preservation of organs w no offence One or two nclion*

» 11 e I ro\1s on* of ll c \nalom> \rts of 1831. im I 18"> ctm* t be »>cIJ <■>

apply to a medlcai autopss for It i* not an anatomical dls<«tlon

iriO\ or DEAD BODY tS

Ila^e been brought bv living persons chiming portions of their anatomv,
or pathologic'il products such ns stones which have been retnoied judgment
has nl<tavs been entered fur the claim*int

The safe rule is tiiat a po^t moriem evaminntion inaj be mide whenever
the cause of death is know n to be natural but cannot be detenniucd m precise
terms from tiie general and medical evidence If a medical man cannot give
a certificate of the cause of death, the bodv vnll pass into the control of the
coroner A medical man cannot I^^ilv claim a fee for what he lias done
without official authorit>, but on the whole, it would seem that he should
not on the ground of professional secreev, decline to divulge the knowledge
which he had acquired at the porf mortem examination

The line of conduct which a mcihcal man should pursue is as follows —

1 It IS obvious that the cause of death was natural and the medical
man desires a post mortem solely for his own professional information he
must obtain the permission of n responsible rclativ c or guardian before acting*
if another relative should obj«.t the medical man would act more vvasclj by
at once desisting but if he still persists he is acting illegallj only when he
forces access to the bod> agamst the aiithoritj of the head of the house
wherein the body lies the pottmorttm examination itself is not illcgd m
tliese cireumstances

2 If there be an} doubt that the cause of death was natural, and the
medical man cannot clear up the point without an autopsj he would he
wise always to report the case to the coroner

He may however ex*plam full} to a responsible person his reasons for
desiring an autops} w itli the result that he mav obtain permission to perform
it He IS then entitled to perform it because he is at that stage uncertain
whether it will he nevessarv to inform the coroner but if he has made an
autops) under these conditions he must not suppress an} fads which he
1ms acquired and if he finds evidence of unnatural death he is liound to
report the matter to the coroner He" ill then almost certainly be cpitici7ed for
not reportmg the case if at all obscure at the start

If permission to perform a jml 7tioriein examinntion is refused the doctor
should report the matter to tlie coroner and should not touch the bodv until
he has obtained a written order from that nuthorit} or from his deput}
Certification w ill rest with the coroner

3 If the cause of death be unknown it is not illegal to perform an
autops} with permission and if the cause of deatJi is natural the doctor can
fill up the certificate Without further dela} If it is naturil however the
wisdom of envViarkmg on an unknown course must wt once be open to question
Better never to have started than to wreck nil chances of an expert finding
the cause of death Second post mortems are notoriously dilficult

4 t^hen once circumstances have arisen whether before or after death
which necessitate a report to the coroner a medical man must on no account
touch the body foV the purjxjse of an autopsy without tlie irtltcn authoritv
of the coroner; to do so is to render himself liable to be prosecuted

The following case shows how an aggrieved person endeavoured to make
a post morleni illegal bv a somewhat frivolous use of the Vnatomy \ct.

A Dr Catleton practising at Newnham was siunnioned to answer certain cluirgcs
under the Anatom} \ctofl832 ft was alleged 1 TJiat he upon Jutv 2. th 1001
being a person lawfuMv fiuafifieU to proetvse medicine unKwfutls did pracli-e
anatom} without having obtained a licenct. m pursuance of 2 A 3 t\dl I\ e 7 j
empowTnng him to do so 2 That on tlie same date, being qualifictl to prictise

^0 criiTincATiox oi diatii

iHciJicJfjp Jic d}(] e^/tminc nnnfnmicaNj H« hotU of Toftn Price wiilioul

IhciKTmi <iKnnr«liattionort»>eMirM\iiy,wjrc } IJwit »n} mfulH cim on
flimtoniv at a i lacc to w it, the house c f I mil> Price tiiere situ ite wtlioiit Ijawnn-
piveii at least c ne week s notice thereof Iwfoa the lirst receipt or posscssi m
the lociv f<r such pur|H»sc to lit Majest) s Sorrctivrj of St ite for llie Home
iJ ji irtiuoiif

Tie / i< ts «f the disc V ere shortly tlie% fohti Price liud of luirt iti<c»sc on Jiilv
-JrinniMIr M 1 Carter, roroner for llie I < rest Division of f.louc-cster rectiud

ii police report coneemm^' lus (hath On lulv ilfh Mr J W Guise uho «as
_ actitiR as the coronets «lcput\, rceetxcct a comituiniealion from Dr Carlctnn m
repH to which he sent the foHowinfj letter ‘ Dcir tiirkton t clhl not know I was
to liohl an impicst to morrow on pw»r IMic T has c Inti no mstnu turn m% sc If from
^fr CnrUr to this effect If tiowexcr I e fetU vein fain to there is nnclimht Tslmll
do so As to the necropsx if >o« r-mnot emccut the cause of dcith without one
please make it It is my pnclic-e to leivc these milters to the discretion of the
doctor” On lulj Jjtti Dr Cartelon udled at the house of the dcetascfl siw the
t)od\ and made a nrcrops> There wiis a dispute as to whelht r ujkwi tins occasion
Mailer Price a son of tlic decTased did not ask Dr Curleton wlielhct he Ind tins
nuthontj tomikcthtnctrojwx Dr Carleton mtheconrsi nf his esidc net. said Hint
he acted tipoii the xvrittccc uiilhonD Risen hv Mr Gnise The Siimnuas was
dutnissed

It IS ob\ious that the Act was i>e\cr nKont to he appheil to this olTence,
and it >s douhtful whetlier u ]ur> would ever convict
A post wortm examination max be ordered bx the coroner without rcjrnnl
to nnj wish to the contrary expressed b> the ilecciscd or b> his personal
represcntalix es Apart from this stntutorx power of the torontr to onler n
pojf morfchi examination nnx lucdicol man is iiRally mlitlcd to examine
a dead bod> if lie obtains the permission of the personal represcntatixes of
the deceased or other jicrsons liaxmg laxifid jK>s.scssion of the Ixidx, unless
the deceased shall Imxc cxpressctl n desire that tlie l)od\ should not uiuhrgu
examination or unless the surxixmj* Imsbind or x\ ifc, or other person li ix in^
possession of thi b(id> sliall require the Imdx to be interred xiithout sudi
examination Such jicrsons should he nppnstd of the mUiuled eximmation
and be Risen a reasonable time for objecting then to The near rclntixes
Jiaxe a right to object exon if the deceased during his lift dirtclcd that his
bodj should be examined after Jiis death

CERTIFICATION OF DEATH

The doctor who lias satisfied Iiimsclf that ileatli has m fact taken place
has no dutx to write nnj sort of nint to this clTeet, but lie has a dnlx, if
colled to a dead hexl} to report the fart cither b) a ccrtihcati staling the
cause of death (if lit is m a jhajIiod to gixe tins) or to the I emmer
or police (if he is not ihle to »ssm « eertificafe) Jfi eaimot mcreJv certiA
the factor death and walk nwnv, for he is’ hj xirtiieof his hnimghetn cnlleil
to the body, in the hne of “informants ’

A joung easualt) surgeon xvas callcil to the actmission dcpurlment of Ins liosjnta!
to see a man just brought m dead after coIIai>sinR m the Mnit ffe } rni umed tliC
bodx dead and returned to his otlar duties three cJ iis fjter tJu nlifites went to
the llcgtstrar to nsk wlmt was going to Itaiqxnss nolJiing h nl>et been d iiit nix ut
thebod> It wiis Indtx clccomposcil when It tvintudb cume witlim the coroner s
jurisdiction

K doctor maj find himself tmalde to fill m the details of a eertificatc lie
ma> not have anx personal or medical kmmleilge of tlie dead person Inxiiig
never ottencled professionalJx m life

Tlie coroner (or police) should lie lufomied bmaillv speaking, xxIiLncver

DISPOSAL or Dr AD 47

(o) Tliere Ins been no prr fessmiml atttndnncc m life or during the last
14 class

(6) rhe cause of death is olisciuf povsihK not naturil

(c) The cause of death ma\ be n violent or iimntiinl one — or W associated

dircctlv or indirecth with injiirv, industrial eviiosurc poisoning —
indeed an\ unnatural event,

{(}) Uhtre there have l>ecn nlUgntions of ntglcit or complaints m con
nection vsith treatment,

(e) Death IS due to (or takes pi Mt ‘ licforc full rccovcrv from ) nnicsthcsia
(/) There IS a statutorv regulation cnfciting a reiwrt to the coroner — ns

with deaths III prison menial hospitals foster children s homes etc
U hen once a ease lias been reporied to the laironcr the doctor has no further
resj)onsil)ilif\ wilii nganl to the death certificate It is the diitv of tlic
coroner to estahhsh the t mse of death

DISPOSAL OF THF DFAD

I poll the death of a person it is the diilv of an e\eriitor a survivor in the
familv or filling eitlicr, oT the local uithoritv (National Vssistnnce Vet
lots s oO) to burv or c remate the IhxIv riincral expenses r ink for pav me nls
hi fore debts ( \dmmistr itmn of 1 stales Vet I*)i3 s It) or as now in rngland
come from the death grant under the Nnlioiiul Insuranca* Vet 194fi

Vs there is no propertv in n bodv it cannot be ihsf>oscd of bj a vtill hut
in general the deceaseds wishes arc observed an expressed wish to avoid
trimaliim is a liar to tins mcthcMl of disposd (CreiTLatiou Kcgulntions lOJO)
Burl tl I or tlic purpose of imnni a death must he registered hv means of
the Notice of an fnfonnant and a medical certificate and the Ilcgistrars
dis[>os il certificate must he ivsiieit except where upon in'piest Ihccoroner
has himself ibsticil an Order for niinnl (tonmers llulcs 105))

No kmil of disposal onlcr fn»m nnv person can he put into effect until a
propel mcehenl certifie itc of the eaiisc of death or a euroners authonlv is
avaihihle

Cremation I ho t remit ion Ucgulations require* —

(rt) Ordmnrv registrition of <!oalh

(/j) Vpphi“itKin r >r Cremation (I orm \) viriliisl hv an approvcil person
(r) ^^\X 1 tmdical (ortificales one b\ the usual innhcid attendant (Fonii

B) the other confirmatorv (Forinl)

(d) Tlie Mceheal lU feree s aiilhoritv to cremate (I orm F )

(f) Itegisl ration ol t rcinatioii (1 orm (.) and Noliheitioii of Disposal thus

to the Ilcgistrar

V ermuier mav issue an authonlv (I orm F) to cremate subject to the
refirces approval hut lit has no niilhontv to request the cremation of
uiiiiicntirieil rcmauui (Cremation Rigiilalions 19 5U) and, indeetl such an
order would l>e refused hv the tiieibcal referee

( rcmatioii is so eonqilete a dcstniction of the bodv that it destrovs all
tnecs of violentc and all ixlcpt radio active poisons The medical nferre
shoulihr!. m imiKirtant re jwnsibihlv a> n final authontv for cremation
In the \\ ad Impliam east ‘ m 10 %, n nirtbeal referee luid his Mi<pWoris amuvetl b>
a curious letter signed in almost llhgible writing V I) The letter written in
aiKitliLr hail I asVnl fir rnmiti ii oiwl milled and it is niv wi h tf remsm wilh
nurv an I inv List wisti is mv nlatives shall ni t know of mv death “Die bodv lav
in un tinn*{n\trn I nursing lame and liad liccn seen bv a il >ctor onlv three hours
‘lojkess X.lOjg J* 0 lreJ 25 gl9

iS r\IIVMATIO\ t ill

iHjfore dentil Ijcm^ cerlifieil (nnd conflrraed) as<lcnd from cerebral lucinorihace
TJicrc Jiad l>ccn no nutopsi *'

The referee reiKirted the matter to the coroner Vutoj >> showeil death to lie due
to morphine poiTOnin? and the nurse (W tuldinchim) ir-Ls Inter found cuilu of
munler Ijvlium dion of tJtc mother of I R also ret enled niurphme ^

Anatomj Act V person ron\ clonntc his bod> for anatomical dissection
after dentil 1)\ the prtnisions of the Anntonij Vet J81-> and 1871— siihjat
to pnor requirements of the coroner— aiul an executor ma> also do so unlc&s
deceased or a sursuing rclntuc lia\e expressed objection Tins enables local
authorities to supph bodies for purposes of medical ecjiication A prescribed
intennl must ehpse after deith before anv such disposal is cnrrictl out and
proper burial must follon nithm two jears (Vnatomt (England A Hales)
Order, 1010, SR AO No 453]

Removal of Specimens Where the coroner Ins assumed autlioritj it is
lawful to rcrnoie and retain anj specimens pro\ide<l tins Ins his approsnl
No such nuthonts exists for nutOjisKS made mcreh with the approval of the
rclativ cs but a \ erv strict adhesion to this w ould prov c impracticable and a
reasonable diserction is probably a better guide

Stillbirths must be registered but mnv then be rctninctl together with
the registrar s <hsix>snl order should it be decidtd to prestrv e them as spcci
mens Thev must ultimntcK lie buried but no period of time is prescribed
Corneal tissues maj be used (Corneal Grafting Vet, l*ia2) unless objection
has been made to this in life or b> the near rehtiics after death

EXHUMATION PROCEDURE

\t Common Law a coroner in England nn\ order a to be disinterred
for an onquir) proMdcsl the both lies m his district If not it is iiccessarv
for him to npplj to tlie Home Sccretarv for an order under section Jo of the
Runal Vet 1837 The ShertfT ma\ grant a similar warrant in Scotland
W here suspicion lias been raisctl as to identitv or the cause of death tlie
Home Secretarv mav report the facts to the coroner and issue aulhontj for
exluimation

The bodies of two cluldren were eslmmcd b> tlie Ifalifax coroner m Janii «\ Iflal
on su I icH II of hoiiutidal poisoning Tliev liad dieil in 'Mareh, 1949 and October
lOaO Under circumstances wlucb ba I demimled the coroncfs nttentions but no
grounds for action liad nn>en at llie time Tlie death under obscure eircurastara-es of
vet a tbird cfuhi provoked more venous enquiry Analvsis shonied soncrvl to )>c
I resent in letlial quantitv but cxluinnlif n of the other two children gav c negativ e

itytaxiS fiwf-yj"!- V» riiargr was mailc for lack of sufT cient cvi Icnce Ojirunst Die
mother

During inv estigations into the tase of /? v Cfcrntir (C C C 10 »3) public nnvietv
arose tliat lus ass Kiation witli a man named Tvains (who had been executed for the
murder of lus wife and child three sears | revioaslv) might have resulteii in a mis
carnage of justice Exhumation was effected bliortlv bcfi re the tn d of Clinstic but
no new facts came to bglit

The minister and church wardens (or the superintendent) of tlie cemclerv
must of course be informed and it will be found convenient to screen off
the grave and dig to withm several inches of the coffin requiretl the dav
prior to actual exhumation

The procedure of identificntion atitopsv and the taking of samples are
set out m the section dealing with the tedimqurs of a meduo-lega! autopsv
(p 35) V coroner must issue a bunal oreler anew, for he has to dispose of
the subject of anj inquest in this wav

MI Dt( o I ra ih A VTOPs r to

Ditniif,' the uiM'stig ittons iiuth In the War ( runes Commission after the
^\ orkl \\ nr II sc\eral himflreds of IkhIics of alheil veniet men were c'chiiiiicd
for the piiri>*)H of tstnhlishm^ the ulrnfiU nut! riuisc of tltnlh iti onkr to
prepire well foumltd “wir irmit pnnccutimis TIicm n'tpitrci! ouh \\or
Olhtc autliorit\, thnii^'h tli< Mlittl (•msos (oinimssion might re intir
OtriMonnlU as m the tasc of Kmctli the jioet a retjuest is gnnlcd for
e\hiimntion for the purpovc of rccostnii" papers or ihximiciils i»oems of
ss}iii!i he hat! no eopv were Imriid nt Ili^hguto nitli liis ntft s IkxU In I'toJ
a ‘'heindcl firm obtnincti an ortkr for cxlnim itjon to < vanime n'conU thought
to !n\c been buritd willi the foumltrof the finn

I istl\, the (lismttniicnt of ImhIks nwi\ beeruiK iicecssarx for riplaimmg
a (iistrui or changing tli< Iwtis of n chitnhvnrti and tlie local nuthontx can
tnijKnxcr tins muler the Town nnd Coiintia riannmg (tluirches I’hucs <if
Hchgiotis Worship and Ihirnl (?««iiids) IlegMiations 1050
• I or a more extensive rtvuw of the subject of ihspnsal of the tlead in its
V anoiis ns}H'< Is iiit Itidmg dt lads of eixni vtioii nnd cmlnlming proeetiun the
rtnilcr will find Tlic Disjiosal of the Dead b\ Poison rial u most iisoriil
reference

Itntnssv I) inn IrrvLs mi (.omi rrs htli l>l Sutat uii i M ixurll (.oiulin
Gmst t\ ,!liU Tli^ Vre llii| ti«elU< llmni Tti Hrj nnl sm irtv Ixnioii

tiricinilb { at li'l nl III lOtJ Iv Irt ilhmi (u|m i»i ler II p lillr rju I’rr fl >{ IlspI Ic
lnL,p«lj

Poisis C J llairMis It 1 uml Marsiiam T K 1t)>) n p UiijhisiiI ef the Hmil
J nj,lish biiiver'itips l*fr«s l^ii lea

HOW TO MAKE AN AUTOPSY FOR MEDICO-I FGAL PURPOSFS
In almost everv section of this work tlitrt is in expressed or iniplnd
niLissitv for a /osliantlan eNanuimtion of l)i< l>od\, it seems dcsimhle
llitrcforc tofciM tmet for all somcdetaiKof the proetdnn forsm h inspection
in gincnil w ilh observations tut soint spnml mutters of mort fortnsie intirtst
In tlu first plate It is never too l.ttc to make iin outopsv No matter
bow far det oinjxisitioii mnv b»\i adv incitl linn is abvavs a jMissibihtv of
finding some niittrnl evidemt lurtssarv for the ends of jiistut Hones
ttttli and liiur arc prniticdlv iiidestnu tibk bv iUi*ompositioii and other
organs at turns dtraj verv slowK aiid niiv »>r tliest niav l>e U'.ifiil for
purposes of id( ntitioalion if for no titlier rtastm moriovcr tiu distoverj of
fnrugii IkxIks sikIi is frignitiits of wtnjKins biillets or utlitr objei ts niav
nlTortl a romplett elm i<i itioii of a mvsttrv Ivin fragmentarv rtin ims can
prtvvidt. much inforniation

The ixtcnnl iippiuninets of piitixfiuliou arc ofltn far in lulvnnec of the
interna! tlinriges so tint thtv offir little mditnlion for estimating what nnv
be found hj a eonijilctc inspection ccrliin ixusons smh ns arsciiie nnv
ixircist n cerliun lo<nl jirtMrvnlivt cITcet I or these reasons no one should
ever rtfiKt. to make a jmt inyrlrm ixaiuuiation on the grouml that piitn
fnrtion Is too far advaneitl

Ihe rcastms wh\ tin btalv is cxniniiicel niav ocrasion a slight difTimiei in
pnanhire but thev should iitvcr nffiml nii excuse for not txnniining it as
thoroughlv and eompletciv ns t iit uiiistniircs will allow Iinsmiirh as it n.
imjiossihle to foreset iti whnl iitievpcelfd thrci lions questions m nmrt iniv
had the Stroud bro ul nik is Never be RUilsfied with less than n com-
plete examimtion of the wlule IxkIv am! all tlu orguis etuitninetl m
it, smet It nnv Ik nlhrinri! that n hntlinil enuse of dmlli iniglit h ive existml
111 tint organ or nv itv winch the iiiethiai witness li id nce.ketc<! tt* examine

MEDICO LEGAt AUTOPSl

If a mortuir^ js •

Anhblc m -lUlops^ si, mild timer ho [icireniicil in n
duel mg I, time hut if ,l m„,t l„ performed m tlie hltcr the examiner
should sec th ,l II, ere is ample li„l,t for Ins pi,r|Kisc It ii, a i, isc preenition
ne%er to attempt imrirm cviiminhon under fwor eonditions

\s a last general nilc \^ rite down notes on the spot of c\cr\ thing uhich
IS found the fact tliat the paper geta will not dcstro\ the \ahic of

wlnt IS wnlttn but r itlier cnbiuicc it for it is so far e> idcnte of the tnifjj of
what IS ontten mz it was written while facts were still fresh m the iniml
I eiigths am! w eights slmiihl nex er Jx ;.uessed or left to the meniOr;

Instruments required Tliest-nre orslioiihllx pmuf!«nh the authon
ties of the mortuarx but ns n ) recaiitu n the following should be inchiiled
ni a big fxiheti for the purpose \t least two good kmxes {5 and 10 in ) and
a stool saw a (inir of scissors and lionc forceps together xxitli needle ami
twine for sexxing up the IkhIx In midilioii it is well to hixi a steel I q>e
probes md an e\tri pair of scissors xxith xerx fine ponds for cutting aJon-^
smaller tubes cif aiix sort also toothed forceps It is a wise preemhon to
take two or three clem wide niootlicd IwtUes of capaeitx alKut n pint
to contain portions of xisccn or their contents xonnt etc smaller liotUcs
or tubes for taking samples of hair blood niu! urme swabs cellophane
einelopes md a few microscope slides Sedes for weighing organs sJioiild he
at hand if possible If the ( ase is one of suspcctc d pi isoning still eicnt chcini
cnllx clean |ars to tike the whole of Hk xisccn should lie arnnged for
together with laluK and ndhesixe tellopliane ta}>c f sealing A nieistiring
cxliiuhr and plastic calhctcr nnx be found uschil md it is is well to take
spare rubber gloxcs and clem oxcralK m east these ossentiaU hn\e been
forgotten h\ the aufliotities

A CHfiiera is xen useful md i«vhf aluiost lie luclmlcd in the list of ncies
sancs espei iiillx xx lu n the IkkIx is that of an unknow n person or xxlien then
arc special eipcumstanecs cxinnettetl xxiih the estcrnal appcxrances The
police niitbonties lioxxexcr gciHrallx comeru Ihrmsclxfs xxilh such matters
ns taking photographs and finger pnnls

Identification The Ixwlx should Ik- ideidifu-d m the presence of the
doctor who slioiild nnkc n jioti of the lumcs and addrrssc-s of the p rsons
xxho idcntifx it tlotlnng should be rcinoxeil xiitb cirt pic«-e 1 \ piece listctl
and laid aside stpantelx not biiridlc<l together

It IS essential to tike notes on the imintsof idxnlifintiun where this is not
known not oimfting the more ohi/orrs siuh «x sox sge IiiigW pirdiiWe
weight colour of Inir tteth etc Shuns or dirt titlier on tlie clotl cs or ll c
person max be of tlie utmost imi>ortaiice for rcisons other than mere idciit
ification It is III f ict uiqwssiblc to IfC too precise in writing down all these
external det uls

Autopsx The hodx temj rmliire jM-r rectum the esteul and i>osihon of
h\ postases the coiuhlion ami extent of ng* r in irhs and tlic state of putre
faction should be noted fhese ixnnt!. max lie of great help in fixing t! e
tunc of death The wmdilum of the nalnral orifiecs-cxos nose innuth cars
meatus of tin urethra xiigina and onus — should l>c olserxcd and cliange
from the normal noted Samples of discharges should be taken on swalr, or

smcareil on slides

The next point is to make equal!' carefu! notes of the external inspection
of the whole bodj for signs of xiolcnct even of the most apparentJi triMsl

MLim 0 LtGAL AVroUS\ ol

intiirc In nnlcr lint nothing nia\ lie nmittcd, it is util to lia\c n fixed
order of ohscnalion— he id and ii«h» Inink arms legs The hod\ must be
tiinuil o\er nnd the Inch examined

lliis external evuniinlion nn\ well be noted m two divisions first those
marks whuh irt probalilv not f dal m Ihtnisehcs but which iinj throw
„unt hj,lil on those that were fatal Ihe most important art
Vbrnsions or bnnscs suggestive of violent t ni irks of finger nails
Sm ill < uts on the hands tti. niatcri il t lu^lit m the finder imds
Murks about the mouth (poisons) trauma — or neck I’etcehix
Marks suggestiv c of the use of a li\ podtniiic sj rmgt
Ihiriis iiowev er trn ml and hhslcring
Murks of powder grams or bums from firearm ehst barges
\1I tlust ntpurt cxplamlion ol their |ircsenee and tliev must la carcfulh
(onsuUred m order to decide whether tlic> suggest tint a struggle has tiiken
jihut lie iiienilier th it it nn\ be *is iin]H>rtunt to noti their absente ns their
prtseiue I he se eoml di\ ision ini Incles the more serious matters siuh is —
r raetiire d and disloiated limlis I lecratioiis niid t rushing injuries
C Ills se\ tnng iinportimt stiuclurts — throat or WTiits
Stabs or punetnred wounds
1 xtensivt burns or scalds
I irenrm wounds

\u\ iiijurv wliieti it is thiught mi^bt hive some specid bigmfieance
shouhl be pliotrigrai lied (with a se ile laid ilongsidt ) or if this is not possible
Irneed on trunspirmt reeoid piper \iiv foreign ninttci dirt h uror metallic
fragments in wounds shouhl he eartfullv preserved ihe dot tor will bo
expected to know somitlung the pathologist a/f about Mum — when how hv
whit miaiis iiillu tod tit ett ft ts imp ssible to emunirate cvcrvtlung
Ihatmiv be found but the nbovi irm itks indit ate the import inee of notii g
e \ erj thing

Ihe next point is the interior Inspection of the bod>, or the nnrtetu
as it IS uiiderslood in ordniarv eat>cs of dise isc

It IS will to ex inline the crinnl tavity Ixfore (he abdeincn or tliorax is
opuiid \ hclter timnee is iJios obtained of oliservmg the eondilion of the
Ultra cninal venous elnnncU ns regirels their lullness t efc re tliev li ivc Ind
aiij ojiportumlv of emptving thcinselvi's lliruugli i eut superior vein eiva
or jugular v eiii

lo o/)ci) tlif head tl i s< il;> is incised from < ir 1 1 ear over the vertex and
rellccltil haikwards niul forwards fn m the mtisum \nv brmsiiig of the
deeper tissues eif tlic scnlj) or elanngc tei the Ikiiic will be iioteei flic ikull
enji IS removed bj sawing nmiid tlic skull iiimirtliatelv nhinc the level of
the tars ihrougb Me wboh tliukiiess of the Ixme a ehiscl should not be
used for it mav cause anew frae lure or the txUnsuni of an existing fr le tare
llie eondition of the dura is eiliserveil after wbieh it is cut awav ind tlie
brim exposed

Vfter examining tn siln the brnm is rcinoved b\ p! i< mg the lingers under
till fnaital lobes lifting with gentle Imetioii and cntting the ttrtbral ncrve-c
at the bise Ihe knife is passed nrenitid the nltaehmenl of the tentorium
cercbtlli uid alter it is Ircc thcexmllSMit as furbelow the medulla as possible
and the hriiii removtHl

llii Mirfiue and base are examimd for Iieiunrrlm^i injur> or disc isc
uml the coiuhl-ion of the etrelmd vessels espcctnll} the circle- of \\illis
observed for the presence of nrterio stlerosis nn<l jiunnfe meurisins

MrOICO LEGAL AUTOPSl 53

saw be used it is apt to produce hceratetl wounds of the \isccri and thus
cause confusion between those produced bj tJie Molcnce before death and
those produced bj tl e saw tie differences are m general easj to detect
but tlint IS no reason wh^ matters should be neetllessl^ complicated The
condition of the thoracic and abdominal aiscera should be ascertained before
anj tiling is disturbed and an\ blood or other fluid or damage to anj organ
noted If this precaution is not observed the e\aminer is frequentlj m
doubt as to avhether anj blood or damage to organs found later is a result of
the dissection or whether it had previously existed Vir embolism is easilj
missed at this stage

After cartful dissection and exnmiimtioii of the superficial and deep tissues
of the neck the knife is passeil iroiind the inner side of the lower j iw to
separate the attachments of the tongue which is pulled down into the opening
and b\ a few strokes of the knife it is reflected together w itli the In oid bone,
pharviix larviix trachea and oesopbagiis from tl e posterior wall Tins dis
section gives a perfect view of the fauces and larjnx enabling anj patlio
logical condition to be rcadilj recognized Tlie hjoid bone is examined for
fractures noting at the same time whether the cornua are ossified or not
Tlie examiner must not be deceiveil bv the natural joints between the bodv
and the greater horns of the structure and it will often be found of service
to make an \ raj examination before attempting dissection

The tongue should be examined for teeth marks and lacerations and sliced
into sections to iscertain whether there are anv bniiscs in the deeper tissues
The asophagus larvnx and trachea are opened up and examined and
nnj ossification or fracture of the thjToid and cricoid cartileges noted

Vs a rule It IS better to remove the whole of the tlioncic organs togetl er
with tlie tongue larvnx and trachea but before this is done a ligature should
be placed iround the lower end of the asophagus to prevent the escape of
stomach contents

The liui^s are then examined and the incision alreadv made in the trachea
IS continued into the bronchi in order to detect foreign substances froth
etc Sanijilcs of this should be taken m suspected drowning

Hie external ns{ ect of the heart is examined after which the left ventricle
IS transfixed at its base and the incision earned to tlie apex Tlie condition
of the muscle and endocardium is observed and after tlie aortic valve has
been investigated from above the incision is carried up bv means of scissors
tiji- acirt-] tite cu9fv> oS ihe The xotexuaJ aspect of the

aortic valve tlie openings of the coronarj arteries and the surf ice of the
aorta an mmutelv examined the coronary arteries ire sliced at verv short
interv als and exaniined for signs of sclerosis and partial or complete occlusion
The left auricle is then opened and the state of the mitral valve observed
The right side of the heart is similarlj treated

In cases of suspected air cniliolism it is advisable to rommence with a
small incision into the right aumJe to ascertain whether the blood is frothv
and m suspected pulinonarv embolism the right ventricle and pulinonarj
arteries should first be examined these lieing explored farmto the lungs

Having (mislied the examination of the chest and its t rgans each organ of
the abdomen should lie examined m turn for the presence of disease or i ijurj
It IS advisable to open the whole length of the alimentarj canal m view of
the freqiiencj of disease which can be ascertained onlv lij complete examma
tion In cases of suspected poisoning the procedure is somewhat different
(See \ol n)

54

PO!iT VOJITFM IM1CTI0\S

Tlie utmis «itlj iLs <-o«mcrtions nncl the mrjst i>c rxaimnal far

Mg^sorinjur>,nl><.rlioii infection etc .x l)c nnmctl fmm the

pubis for this purpose

The blathUr is exnmmtd after mnosnl of jfs contents

The unne should bt tnhen for exnnimatioii for sujrir, nlhimicu M.kkI
pus alivhol. etc the presence of wlmh nm throu coiLsidemblc hf>ht on iu»
otlierwisc obscure case (Scc\oJ If)

It is well also to take a goiKl sample of blood frtini the i!miii!>cr> ot the
heart for cxanmnlmn when iirccssir> for alcolinl \olililc i».jtsoii-,, carlwii
monoxide etc

The fact that scseral <h\s base cln|tscd since death will not present tin
discos cr\ of food m the stomach prusided it hid been taken withm one or
two innirs Ixfort death sm«. the di^-sttori of foo<l ifoes not ap|H ir to rd on
to ans considerable extent iifltr dcatli We liase identifltal fan! in the
stomach twelsc months after interment and identifiable scRtlablc food
was also found in flie stomaeh <*f the ‘''rolfumi ’ m m iIur up iiiuiiunindl in
195J from bunal m peat in Iiitlnnd .MMMj sc.us jiresioiisls Tlie kind of
food present mid the st iteof itsdiRCstioii lias prosed of iin{Hirtni ccin iuMul<en
«»f crimmat trials (ti /<• “Ifoss Ixmjj Dead )

In cvaminiiiR the nbdoniinal orRuiis it is worth while to dnsv sjkxtiI
otteiUion to the fact that colour <li inges are sets fresjuinlls found m tlaoe
ssliieh he close to the liscr (kidnes stomach diKsleiiUTii etc ) owint; to
the fact that the colouring matter of bile <-isi!\ jKniipati's the tissues
riiesc (xilour chnUe'cs iiuLSt not lx inistiikrn for sirhs of miliuiimation
or of putrcficlion If mflamniati<»n be present cilhir piis ir Isinpli will l>e
found the latter leading to sticks adhesions or at least to a loss of lustre
of the pcrttonciim ilsfMtstisis mis also inisit td an incvpcnenrid
insesUgatur

Post Mortnfi digestion of the sfom uh is a eoniriKm phenomenon but per
foralion from mk h digestion is less ofli ii set n The reason w hs the stomach i5
sometimes jicrfomlctl bs nuttKligiMnm and sometunes not is not at nil clear
A prion tine would exjiott uittHligcstnm iii llmse casc-s wlicre the stoinneh
ssas health) and uctisels tligolmg sslicn ilcath t<x>k j>her hut tx(>eririua
111 the jioxi nicr/ei« room has sbossn that such i"* hv no iiii ms insnn ibis tlie
case for autcHligestion has Ik-cm set n in t iscs of huge ring disi ise anil it li li
not Iweii obsersod m mans c isesofaetidciilnl suildiii death

When aW <he organs /wst fieso ewrcftttfj exawi/«d noil wdev wiih f»>
them It must l>c remembered that tlicM notes unis fi rm the iiialinal for a
report, the nport itself must lit tanfulls drawn up m onler first facts, then
inferences if required (» idr p 5) Tins should be dune ss ith as little del ts as
is practicable

Post-mortem Infections If tbt ojKrator sbouM pmk his finger or
otherwise wouni! Inuiself during the |K.rfiortiianrt t f on nitfopss be should
at onet take xte/»s to present mfertimi lU must sttp tin null ps) imninb
ntcls. remose his pluses and Icbl the hand or mjiiml part iii wanii (not
hot) water for stsi nil niimitcs Bleethng must lx- tn« unged to wiesJi out
the svound and if this d k-s not lake |laoe fn-cls bs pheing thi hand in
warm water the arm should U swung to pnKhicc acongcsfit n and the tissues
smicr/ea! Vflir allowing (nt Weeding niid washing forfm mmuti-, tmrlim
of Kxhne mas W applied mid the finger iMmlagcil The nuiulx-r must l.c
cnrefulls watclicd for the next das or two in ofiler to take prompt slept if

run M tTfo\

(lierc«;hoiiI(I be t!ie slightest sj},^ of inreelion If lornl ors\stemic evidence of
infection docs develop ipproprmtc local measures and uicqimtc chemo
tlierap} should be instituted immcdmtch, under diixclions frvun n surgeon

PROCEDURE AT FMIUMATION
Tin. niiUiorit) for cxhnmntion Ins liccn described m the section tp IS)
dciling with the disposal of the dead In the following pages wo will set out
the practical procedure it the graveside and in the inortuirv as thev ton
cern the police oflitcrb uul the pathologist

Iirsl though some pri\ at \ is most desirable absolute secrccv is stidoin
attuned to creep into a burial plate at night and work at the disadvantage
of dirkncss is crass stupiditv News reporters art hcttir tre ited firinlv than
b\ deception and ran be left to the senior (kiIicc olluer for statements on
VI hat IS taking plate

As to who ina\ lit jircsent the distrction of that oHiier is tlic best guide
\nj doctor who has attended the subject in the list illness nnv pathologist
wlio has prcvioush made an niilopsv or who has been rtqiiasted to mike
tins one or who Ims been asked In solicitors to npresent n partv under
suspicion mav ask the senior police ollicers ptrmission to attend U1 who
1\ IV e soiue dut\ to perform (sec below ) must also be present
The. exhumation is best done soon after ilawii a suitable screen having
been erected and the coMm approached (to within 3 or t liuhcs) the dav
before

The siipcrtnlciulcnl <ir the ecu clcrv (or clmreli warden of a clmrchvnnl)
should idcntifv the hiiriat plue from the reeonls and the iindeplakcr should
he at h ind to idcnhfv tin coflin V sixion orgnivi titggrrnmv (onfirmthis
iilentiflintiou procedure and relatives nmv also nlmJifv eiliier tlie collin or
(he bodv

\s the t ilhti IS raiseil the pathologist should take samples of earth (or
water) from just above am! on each side (and litir fmin unikrncalh) the
<oflin I ibellmg raeli with <are himself Jo leave such matters toaiuone elw
IS risk) If vvalcr dniiits out of the ccJhn a sample should be eollceted
The coflin should lie taken to a mortiurv if possible before it is opinul
Ihe undertakers should then nmovi tiu lid prpftmhK on trestles ah ng
side the niltopsv table and idcntifii itmn should ag in be made In those
who pinceil tlic bodv iii the eollin ll« coromrmav now view the IhxIv A
large siUdion of jars Julies cdlopliane bigs labels and swabs should he
close to hand and as < nil step is t iken it should Ik dnlalcd li> someone
wl o repents it b w k for cluxk Jsotnnihh istoiiiucli romeiiiratv iscsscnlinl
The iklnils of the next singe that of ixanwmng the bod) arc ihelnted In
its coiuhtiou and the spetifie piirjiosc of exhumation The procedure iloes
not dilTcr in essentials from n imdieo legal nntopsv of nnv other kind

Eistlv full reports of the details euntammg nil rrlevaul dates limes
persons issisting idcntifvang < tr and of the aulopsv liiuhngs must fallow
it a reasonablv < irlv date Ihiv shntdd he isumiuinienled onlv In the
icroncr and the senior pohet ollhrr anil no infomialion tf un kind should
he giv cn to the pn ss or nnv mcml>cr of the public

Refnre leaving the luortuarv n pathologist should assure himself that his
cxauiinalinn has bctu complete nnd that he has tukin all specimens which
III n he reejuircd for later txninmation lie must ri.meml)cr that it will not
be [lossible to have an) n. exainiiuition of the remains in man) cases

CHYPTBR in

FUNCTIONS OF THE GENERAL MEDICAL COUNCIL

Tifi: GenenI "Medical Council wis origiiiall> constituted the McdicTl
Act of 1S5S It denis with the rcjtistration ol mcdiLol practitioners the
piiblicition of the liriUsh rhnrmacojxria the c\criisc of dtsciplmnrv jiowers
o\er registered medical practitioners and the st indnrd of nicdicnl education
Its discipltiinn, functions arc those \\hich ate of interest from a medico kgnl
aspect Tliose functions are set out in Sections 2<5 and 29 of the Medical tet
of 1858 Section 29 proMilcS Hint if an\ registered medical practitioner shall
be conMoted m England or Ireland of nnj felonj or misdemeanour or m
Scotland of an> crime or oirenec or shall after due inqtiirj he judged bj
the General "Medical (.ouncil to hn\c Iiccn guiltj of infamous conduct in anv
professional respect the (icncral Medical Council mn\ if tliev sec fit direct
the Registrar to erase the name of such medical practitioner from the
register

TJie definition of infamous oomluct in n professional respect was laid down
bj Ixird Justice Lopez in Ahson \ Gftierat MetUcal Council (Cl L Q B 53t) —
If it IS shown that a medical man in the pursuit of his profession has done
something with rcs|)ect to it which would be regarded ns disgraceful or
dishonourable bj liis professional brethren of good repute and compctenci
then it IS open to the Council to show that lie has been guilt) of infamous
conduct in a professional sense

The discipliiinr} functions originnllj e\crtisc<I b\ the General Medical
Council ore now b> aartue of Scitton 14 of thc^Iciheal Atl of lO.>OeNerciscd
b} the Medical Disciplinarj Committee lonsisting of tlie President of the
Council and 18 other members flic constitution of the General Medical
t ( iincil is laid down m the Atedical Act of 1858 and \ nrious other amending
statutes or orders in Council The proceihirc of the Disciphiinrj Committee
IS set out m Section 16 of the Mesheal Act of lOaO Vt ans cuqmrs before
the DiscipIinarj Committee the medical practitioner ina\ be legall) repre
sented So precise definition of infamous conduct has eccr been or could be
aVtcnTptcd T ach case is considered upon its farts and the general ptmeiples
can be deduced from the case preiioiislv quoted of Alison a Gaiernf Me heal
Council and bj a series of subsequent decisions of the Council and of the
Courts Vn appeal lies from an ortler of erasure to the Prii') Council bj
a irtue of Section 20 of the Medical \ct of 1950 In order to help mcibcal
practitioners the General "Medical Council hare issued llnnung Aotites
indicating certain kinds of conduct bj medical practitioners to which the
Council arc likelv to take exception Tlie mam points of such Notices are
as follows —

Disciplmatx jurisiUction o\cr registered medical practitioners was con ^
ferred upon the General "Medical Council by section 20 of the Medical Act
1858 which as amended bj section 18 ( 1 ) of the Medical Act 19o9 is as
follows —

Giirr (ntjniCATis

"If any rcgisieud medical jiroitihoiur shall he comieted hy any court tn the
United Kingdom or the Itcpubhc of Irelanl nf any filnny mis lem'-anonr,
crime or offence, or shall after due m/iitirybrju Igal by the General Council to hai e
beta guilty nf tnfuinous conlucl many professional respect the General ( ouncil
may, if they sec fit direct iht Registrar to erase the name of such me heal jiracli
{jonfT from the Register '

Tile Medical Disciplinary ConmuDce of the Coiiritil Jia\ e decided to adopt
the Ion" established practice of the Council b\ circulntin/j for tlu information
and {luidance of practitioners a Notice contaiumj; partieidars of judgments
and decisions of the Counid on distipliiian cu.es nliicli ncrc from time to
time brought before them

It must be tlearK understood that the particulars wbuli are giitii belon
do not lonsfitutc and arc not inltmlcd to constitute a complete timnitrition
of the professional offences nhuh ma\ entnil erasure from tlu Register and
tlint b\ issuing this \otice the (ommittee are in no naj precluded from
considering and dealing nith nn\ fonii of professioinl misconduct {ns for
example adulterv, winimitled in professional rtlationslnp) nliuli ma\ be
bruiigbl before tluin altbough it mnj not appcir to come nifluti the scope
or |ircrise ssordmp of am of the. categorus sct-iorUi »u tins Notice t ircniu
Stances mav and do arise from time to time in relation to wluib there mav
oetur questions of profcssioml eoiidiut ohielt do not come ojtliin otn of
these enlegorics In such uistiuues ns m all others the lommittce bait to
consider and judge upon the fnets brought heforc them

1 Ccrtiiicates, Notifications, Reports etc
Registered medical praetitioncrs-nre m ecrlam coses btmnd b\ hiu to giic
or may bo fitnii time to tunc onllcil mxm or rcijueslttl to gi\e ecrtificntcs
notifie itinns reports and other documents of a kinilrid iharaetcr sigiioil
by them in their profei>sionnl capaeiti for subsccjucnt use i ither in tlu Courts
or for adniinistratnc purposes

Stull dodiments include otnongolhers tcrlifie ites Notifu dions Reports
etc

(a) Under the Cets relating to births deaths or dispos d of the dead
(/i) Under tiic \ets relating to Lunars and Mcnt d 'Ircatment and Mental
Dtfieicnes and the rules made thereunder
(c) Under the 1 ac ton \cts ami llic Regulations made tliercimdir
UnAtr 'iVjc h ^tixaViT/i-i SvVs

(t) Under the Public Ilcallli Vets ami the Orders made thereunder
{/) Under the Vets niiil the Orth rs relating to the iiotilieation of inre'Ctious
eliscascs

(g) Under the 1 ainiU Vllownmes Act National Insumitt (Industrial
Injuries) \ct Naltemal Insurance Aet and National Health Ser\ ice
Vets and the RcguUtions made thereunder
(li) Under the Old Age Pensions Vets and the Ucgidatinns made lliercundi r
(i) Under the Mcrehnnt Shipping Ails
0) f’o'' procuring the issue of I oreign Olhcc pass|K>rts
{K) lor exeusmgattciulanee HI the Courts in the public ser\ ices m public
olHees oruiordiiiarx tmployimnts

(0 Unde r the National Sera ice Vtk or in comicxioii n ith persons sen ing
m Ills ijests s 1 Orel s

(»i) In eoimcMon aitb matters under the control of the Mimstn of
Pensions

d8

GMC COVEIilSG

\n\ rcgisteml nle(^lc^l praotitjoner \\lio •sliall Tic i)rti\c(l 1o tlie sntisfaction
of tlic Committee to Iia\c signed or y\cn under lus name and uuUiontj niw
such certificate notification report or document of a kindrtd ch iracter
nliicli IS untrue misleading or improper whether relating to the se\cnl
matters above specified or otlierwisc will be liable to hive lus mnie erased
from the Register

2 Unqualified or Unregistered Assistants and Covering I he
employment bv an\ rcgistercil inctlit il practitioner m tonncMon with 1 is
professional practice of an assistant who is not diilv qinlilieti or registered
and the permitting of such unqualified or unregistered person to attend
treat or perform ojicratioiis ujxni patients m respect of matters rcipiiniig
professional discretion or skill is in llic opinion of tlic Coiuniitlce in its
nitiire fraudulent and dangerous to the public health and anv registered
medical practitioner who sliall be proved to the satislnitioii of the Committee
to have so einjiloveil an imijinhlieil cr unregistered assist mt will le liable
to Inve lus name erased fre m the Register

Any registered medical practitioner who bv J is presence tiuntcniince
advice assistance or co-operation knovviiigh enables an iinquiihficd or
unregistered person whetlier described as an assistant or otherwise to
attend treat or perform anv operation uiwu a patient m respect rf any
matter recjuinng professional discretion or skill to issue or procure tl e issue of
onv certificate notification report or other doemnent of a kindred character
(ns 11 ore particiilarh specified tii paragraph 1 hereof) or c tlierwisc to engage
ill professional practice as if tliesaul iicrsoii were dulv (pialified find re|,i^tereci
VTill be liable on proof of the facts to the satisfaction ol the Comimtte to
have his name erased from the Register

Tlie foregoing jiarl of tins parvgrvph docs wot puTi>itt to lestrivt tlie
proper trammgand mstnic tion of bona fide medical students or the legitimate
emplovment of dressers nudwives dispensers siirgerv attendants ond
skilled ntechanioal or technical assistants under the immediate j ersoun!
superv isiQu of & registered medical pr icliUotw-r

3 Sale of Poisons Ihe employment for lus own profit and under cover
of his own cpialihe itioiis bv inv registered incrdicai practitioner wlio keeps
a medical hall open slioj) or other pi lee in which schcxlulcnl poisons or
prejmratioiis cajiitaiiimg scheduled {husoiis are sold to the public of issistants
who are left iii charge but are not legallv cpinhfied to sell scliediilcd poisons
to tlie public is in the opinion of the Comiuittee a practice [irofession dlv
cliscreclitable and fraught with danger to the public and any ree.istered
medical practitioner who is proved to tlu-satisfiiction ol the (-cmimittee tol ave
so uneiided will be liable to haveliis name eri-sed from the Register

4 Dangerous Drugs The camlroveiitmu by a registered medical pmcli
tioner of tlie provisions of the Dangerous Drugs lets and tl t- Itcgidatioris
mide thereunder may be the subject of crmihml prciceclm„s iind anv
conviction resulting tlierefmm mav be dealt with ns such bv the Conmuttce
in evercise of their powers under section jy of the Jltdual let IHjS Rut
any ixintrav ention of tl e \ols or the Hcgiilatioiis involving an abuse of tJie
privileges conferred tbereimder upoti registered incclieal practitioners
whetlier such contravention has been tlie subject of criminal proceedings or
not will if proved to the satisfaction of the Lomimtlee render a registered
medical practitioner liable to have lus name erased Iroin the Register

o9

GMc 4SS0CI rr/ois

5 Association nith Unqualified or Unregistered Persons Vn>
rcgistenci medic il practitioner who either b} idministermg nnaestlietics
or otherwise assists an iiiuiunlibcd or unregistered person to attend treat
or perform in operation upon nn> other person m respect of matters requiring
professional discretion or sV-iH will be InWc on proof of the facts to the
s itisfaction nf the (.Ommiltcc t« ho»c his name erased from the Ile^istcr

6 Advertising and Gintassing the practices 1>\ n registered medic \1
practitioner —

(o) Of advertising wlietlicrihrecth oriiidircith for tlie purpose of obtain
ini, patients or promoting Ins own professional advantage or for nn\ such
purpose of procunng or sanctioning or aqmcscing in the publication of
notices {oiiimendmg or directing illmtioii to the practitioner s jimfessioml
skill knowledge services or qiinlincations or deprrcntmg those of others
or of being associated with or emplovrd In those wJio procure or smcfion
such advertising or puhticalnm nn<l

(6) Of cnimssing or cmpioviiig an> agent or t mv isser for the purpose of
obtaining patients or of sanctioning or of licing o-ssot lated with oremplojed
h\ those who s'uction such cmplovinent

lire 111 the ojinuon n( the Comtniffcc contnrv to the pnlilie interest and dis
creilit ihle to the profession of Medicine and mv registered medical practi
tioner who resorts to mj such practice renders liimsclt liable on proof of
the (acts to the salisfa< tion of the Committee to li ive liis name erased fnnu
the Register

7 Association with Uncertified Momen Practising as >fidvvive8
M hereas it his been made to ippcar to the (ouncil that certain registered
medic d pnetitioncrs have from tinii to lime h\ tlieir eoiintenanoe or
assistant! orhv issuing eortifitates notificilions reports or other documents
of n kindred character inahled uiiecrlificil persons to attend women m
childbirth otlierwise than under the directum vwd person il supervision nf a
dills qinlihed an<l registerctl inedital prachtioner ns rcfiuired l»v law

\nii whereas siidi < oiidiit t is in Hit « pinion of the L ouncil and of the I om
imttee disereditahlc to the profession of Metlicuie anti nlcnliiletl to defeat
the purpose nf llie statutes made m the public mlircst for the protection
of mothers and infants

Jvotice IS herein given that iiiv registcrtil medical prnditioncr who is
proved to the satnf u tioii of the ( omimttcc to have so offended will be liable
to have Ins name erised from the Register

The Council point out thivt it mvist ^ eleatlv vuidcrslwal lint the lustauces
of professional misconduct winch are given do not eonstifute and are not
intend! d to ( onstitiite a complete list of the offc nccs w iiu h mas he punished
hv erasure from the "Mcilic"!! Register ami tint h\ issuing the Notice fhev
are in no wa\ precluded from consulcniig uul dualmg with nn> form of
jinifessional mistonduct (as for caamplc immorditv involving abuse of
professional rcl iltoiiship) whuh niav be Imiiight before tlicni although it
ma\ not vppe ir to come within the scope or precise wording of nnv of the
categories lliercin set forth Circumstances ma\ and do arise from time to
time m rcl ition to whieii there mav occur questions of professional conduct
whicJi do not come w ithm nnv of these categories In such inst uiees as m
all others the tmmcil have to consider and decide ujwn the facta brought
before tlitin

60

CMC MAU^RAXIS

MALPRAXIS, MEDICAL, SURGICAL, AND AN/ESTHETIC
RESPONSIBILITY, NEGLECT

MALPRAXIS

The qiiesfiorj of ma)pri\i? % erx n kIc hkI citnnot be discussed exinustn el\
here It is nch isnble ho\\e\ cr to (onMdcr wiint is the law upon tlie subject
and to illustnte the position bj n few eximpics

What amounts to Negligence Tlicre is no definition of negligence
applicable to c\er\ lonibmntion of (irciiimtaiKcs Negligence is not a
statutory offence though disteg vnl of tertam st itutot j pros isions lua^ he
held to ho iicghgcnic Gcneralh speaking IiabihU for both civil and crmunnl
ticgli^ence is based on tlie Common I aw of I ngland

Cad Negligence lo cnnstitute civ il negligence there must be*—

(i) A legal diitv to exercise care

(ii) failure in tlie exenisc of the lare nccessarj m the circumstances of
an\ particular case

1 breach of such diitv bv anv person resulting m injurv or damage to
another is actionable m the Civil Courts \ medical practitioner miplicdlv
indicates that lie is possessc<l of the average degree of skill and knowledge
possessed bj similar practitioners A specialist m nnj branch of medicine
or surgerv imphcdlj represents that he is jxissessed by similar specialists
Thus a medical practitioner has a diitv to exercise that degree of skill and
knowledge appropriate to lus position m his profession and also to exercise
ft reasonable degree of care A breach of such duty niav render ft medical
practitioner liable to an action for negligence

Criminal Negligence Crinunal negligence is negligence more grave than
the breach of dut\ sufTicicnt to support a oivd action for damages The
negligence must be so groat as to go bevond a mere matter of compensation
between subject and subject and show such disregard for the life and safetv
of others as to amount to a crime ogamst tbc State and conduct deserving
punishment The distinction between cnminnl and civil negligi.nce is well
set out in the judgment in 7? v Jtafeman 0'>25) C t R p K

A qualified assistant or locum tenens is personallv responsible for
anv negligence winch mav be proved m lus prictice he docs not mv oh e lus
principal The matter is more comphcolcd where unqualified assistants
^students nurses etc ) are conccrncvl If the principal superintends the
alleged negligent act of tlie assistant he is liable but if in lus absence the
subordinate omits to take some precaution in a matter -which is within or
m acting goes bejxuid the scope of bis speedie emplojment or directions
the pnncipd will not be liable A principal is not jointlv liable for lus assis
taut s criminal acts unless be aiithonrcs them or co operates in their execu
tion

Who may sue for Damages for Negligence If a man einplojs a
phjsician or a surgeon to attend to lus wife or child and bj reason of negh
gence on the part of the phvsician or surgeon the patient siifrcrs injunr the
man can sue the phj-sician or siHgeon for damages for breach of contract
Apart altogether from the dulj owed bj the plijsician or surgeon to treat
the patient with care and skill under tlie implied terms of the contract
between him and the man who employed lnm the phvsician or surgeon owes
a dutj to the patient to take cure bj reason merclj of the subsistence of the

\j<.ijat\CL

01

rclntionsfiip of nt«liciil prnctiluner nnd pnlicjil njicl m rcspctt of nn\
hrtnch of tins the [ntirnt c tn sue in iort for (liimnges for ncKli;:cnrc *

Neftllj^cnce bj Omission Ifa mcdtcil pnttilioner after hu mg nctunlK
undertaken the trcntmeiit of a pititnl wiikedU ncglertslum and tlic patient
dies m consctpitiKc of such nej^ket the prnetitioiur will be guilts of nnn
slaughter [see U \ Itatemnn {utpm) ]

The most frequent case's arc tho-^c where dam igcs an cl iinu'el for ficnnancnl
disatnlilv or elisfiguremeut auel ocensHneaUs seulv a chuu is unde lu orelcr
to justifs a re fus il to pas fees for ineiluni Ircaliiicnt

A *[ihM>iemii who holds hintsilf out ns liiising sjietifll knowledge and skill
in the troilmcnt of partieiilar discises is iKntml to hnng to the disdni^c
of his dut\ not nierch the ns crage degree of skill pc sscssed hj general prneli
tioncrs Ivut that spen ia\ dcgT« of skill and knowledge possessed hs phssimns
who art spceinlists in the trcnlnicnt of such <Iim isc in the light of the present
state of scientifie knowledge llic tpie'sltoii sshen n phs*siemn bceonirs a
spieiahst IS not one of I iw but oncoffnet )>riniAnIs for lus own dctcrmmalion
but wlicn he holds linnselfoiit IIS n spccnbst it becomes hiv diits to use tint
degree of skill sshieh such n pnuliltonc r should possess *

in Vnicnrn the ndc appe irs to be tint a phssieinn nr surgeon sslicn
cniplosed ui bis profussiond < ipieils is required to cseriisc that degree of
knowledge skill and care onhninls csimetl bv jilissjcmns and surgeons
jirnctising in smular loeahtics

In n ease where tlie plualirr under the dirwlion of the defendant assisted
in dressing n wound of her tiiLsband iiud Ixs ime infet Ini with tiie |>nisou b\ reasun
of slight scmlthes on tier fingers the dcfeudanl wlio knew of the dinger was
found guilts of mgligtncT In assuring her that there wis none since he was not
jiisUfiid in assuming that her hands wen frci from hiidt wniimN In anntlier
estnmrilinars e-isc it was held that n phasuim is under no nlhg'ation while n
Iierson Is lus patient to tell her < r her hushind tlut a fniguieiit of a needle broken
in n surgieul oiiemtiou w is left in her ImmIv but it is his diit\ to tell her so wlien
dischnrgmg her as Ins patient from Ins <“»rc

'Ihesc principles are still gciiirnlh recognized in Ilie I iighsli tourts
In ^forns \ M iHsI/wri/ U / Uf* n surgcstii wai> sueil f ir d im iges for neglige nee
In an ojicratHm fi r the rrm i\ d < f tla prostate gl u»1 \n« r tlir ojwmtion the

patient ninnlned In h>spttd anti wws nIUndrd h\ the resident In spilal slnlT
I he tn itnu nt iin ob ed llie insertion of liilies Into the hlad k r and the frequent
repliccment Ihireof \u \ ms phoingtwph nseaJed tlut a i»ortioii of a liiljc
WHS III the patient s bladder The Court lul I tlut tl t s tid porti in had not lieen
lift thtre hj the surgeon and tlut the dintnae * f res t/ <ti (nqittlnr di I n it,ap|il\
t«j the finding of a tul»r whuli laid lieen kfl In the l»odv ipcr an ojK-ration

Errors In Medical Dhgnosls Of the cirnrs in diagnosis ninde hj
practitioners in onlimrv medical work the I iw knows acr\ little for it is am
rarrla that Ihri result m hligalioii Sime the notiliintion of infectious
diseases Ims hcctmu eompulsora scxcral eases of nUeged ncglif,cni‘c in rcgnnl
to the diagnosis of these diseases hiiae l»eru brought into court either b\
aggne V cd \ iclinis of the error or In the autlmnUc-s resjwmsihle for reeonhng
iHitifieatnms

The rcni irks of the nngistntc in Uie following cose seem fnirlj nrcuralela
to represent the \ lew ashich courts, nre liktla to take of such c esev

'Sllini: N t “Tl /i/ima S/q/wnt Hirer too
>Iw\ilt \\ M in-a In Sfo.t fii Trents hi lore HOC Mrttnne l>.t Kntli
SinijMn Uiiltcrwwtii Ixmlea
’ (1107) 4 \!ll~ !l -iJt

MOIIGlXCi: 03

Thoiiins ^NeljsUr, a collier, siictl Dr C llnimhnrj for «l^^mKC^ for alleged
unskilful trcalinonl

The plaintiff was n pitman eiiiplosctl at tlic Sil\crhill Colhcrv at TcNcrsal
On ^\o^ulllle^ ifU* I*** ’net Milii an accident wherein he RUbtninetl an injur\ to Ills
left mil Ifc thcrcupnii eniisiilted the dcfendtiit «lio w is ineelu il ofliccr to the
sick chilj of nhich the pluntifl was a mcnihir \ccordmg to the plaintiffs case
the dcftiuhiit afttr eMinnning the nnn snid tint no honts were broken an 1
mcreh presmbed bithin" and piiiiting with hnIiir to redutt the swellmg fii
the following January the plaintifT consiiltcil a Kmp cleaner at a tuighbouring
collitrv who.lud a rcpnlatinn ns n hoiiesittcr lit also cnnsulUd inothir
honcsetter tccording to the pltmtiffs cast neitlicr of these boiicsetlcn> wouhl
undertake his ease as entli said that the tlbow was dislocited and tluit as the
injiirs w Ls of old standing he (snitd not do iiivthmg with it In the end about
a \cir after tlic leiulent the phintitf wint to tluniig Cross Ifospital where
Mr thirles Cihhs ptrfnrnicd ui o|)emlion Ifu iiegligiiitt nlUged was in allowing
tht pi niiti^ to go ahont for si\ weeks with a hroktii arm

The di fondant s ml tint when the plinilifT tame to lam lit tompi lined of a
swelling in tlu left inn Ifi hid him iinaldt to tomplitt tin diignosis at the
tune owing lo this Jhe pluntiff nexer told him tluit lit had hern to tin hone
setters and nextr tuniiiHimd of Improper trealmtiit

In the opinion of the judge a count r% doctor was not c\{Ktte<l to luxe so nineh
skill as tlie surgeon of a Londnii hospital He xxns t 'qieitid to hiixe reason iblt skill
ind to tvcrcise rtasoinble can. m the treatment of his piticiits Jhe import int
<|nestifm for Ihein to determine, xx is whether the deftndint had rtshieetl tlu
chsliie-ition Hurt wix a tlifrcremc ottpinion lu. to the swtMing hut tlu dottois
nil ngreetl tliat the Hwelhiig ni ide a di ignosts dilht itU Du pi iintiff s ml th it the
dtfcuclint told huu there was uu ihslocatioii but the dcftndanl demed tins Ihc
txideiiee wus Hut the pluntiff cume up diit> to sta th< doctor Uie anu w u
nut Lirl} 111 funuarx after the I ipse of sudi a long tinii as Hi it resetting liul
b«ome unpoSsiblt In strious t uses it w is the diitx of a iniiiitrj doctor tosend
his pitK tits to II hoxpit il I fere the defend iiit s.iid lie h id st nt him hut the question
wus xxhether he lud sent him carl) enough
Ihejurj awarded Hit plaudit ki> dnni igts
A east of soiiu wlmt siinil ir iiatuic occtirrul snnu. x< irs ago
In a bicxtU aoeident a mm siistnimdv among other lujurus dam ige. to lu&
shoulder llic iiusluat iiuui usbcrled tlut he esaniined the shoulder eirrfull)
and failed to detect any dislocation until some time after the neudent The
xxitncsses for the jiatient stated tlut the esaimimtion w is < inless luixing been
mule with the ennt still on Two ciniwiit siirgctins gixt exidciue that If the
dud salion had Ihpji present at lirsi it xx« iild luxt hetn deleeted l>\ tlie nudieul
111 III, and also tint it might h tvx ocs iirml soim linu suhxsjnentlx to the leeident,
The p itieiil lost las c-isc

So fir JUi the courts arc eoiiccmctl the results ore dete riiimcd hj Hit general
print ipies nlrc ulv cnuiuiited le bj cxitleiuq ns t« eaic aiul nxerage skilt
In txcrx ease wlure Hit re is (hlliciiUx in diugiiosts anil in extrx case where
Hip patient Ins siistuiual some xioltmc xxliieli might possiblx haxi tausetl
frutim or^isloention, the praetifioiierxxlio docs not have an X rax evammn
tioii mule exposes himself to uiinttpssirx risk "Mortoxcr if tliert is anx
doubt about the ilngiiosis iii siitli n east the praetitioner should hive a
eoiisultation with n siirgual eolltagiu or if tint is not dcsirtd seiitl the ease
to hospil xl

For further rem irks on the X r»xs npplietl to sueli poiuhtams iii!r below,
p 00

Refusal to Continue in Attenelance A dissatisfied patunt will semu times
allege that refusil to eoiitmue m attiiul met eonstitules neghgniee Ihe
qiicsliim must arise oeensionnllx whether the jiractifiomr is under a diitx
tocontiiiiu witliac ne after he Ins seen the patient once Continued attend
nnee maj, m some cases, prove xerx irksome, espeeiall) if the patient lives

Ct ^EGIIGE^cr

it a distnncc and is not a regular p itieiit Tlic follow mg Scottish seems
to mdicite tint, although a medical man is not bound to continue iltciwlain c,
damages niaj sometimes he iwinlccl against him

The practitioner as the neareal mrtlical min liad been called m to attend a
labourer who Imd sustained a fracture of tlie lihia just aboso- the nnklu
Upon examination the pnctitioner found tliat ttie nnin was not in a fit state to
Imxe the leg set and for several reasons he ad\a«ed that lie would better at
the Eihntiurgh Infinnan sue miles off Having done up Uic pitient s leg so as to
guard it against the dangers of travelling lie gent lum to hospital intimating at
the same time that he vsoiild have nothing more to do with tlie casd He was'not
the regular attendant of the patient nor vsas lie the surgeon for the mill at wluch
the patient had been working Further the practitioner never entered the patient s
name in lus l>ooks nor did he ask am fee f< r vslmt he luad done After seeing the
patient the practitioner vias himself laid up with inllucn/a for a month when he
ogam savi the patient who liad never been moved to the liospital Bv that time
the mischief had been done and as the result of an ojieration vrhicli was then foiml
neccssarj one leg v\as shorter tlian the other *

Lord Adam who charged the jurv m nn action brought for negligence
against the practitioner, said that the cose turned altogether on the question
whether the practitioner had undertaken to give his contimious ptofessinnal
attendance to the patient He remarked also ‘ Jlecausc a do tor attends a
man iii an emergencj, it does not follow that he is Ixiund to go on with the
case Unless It IS jvroved that besides doing what he did lie also unilcrtook
to treat the pursuer is lus jialient the obligation ceiscd In spite of tins
vcr\ explicit direction tliejurv aw irde<l the patient £50 damages Vltliougli
the jurv decided m favour of the pitient the direction of the learned judge
in the above case represents an lecurolc statement of the law, md it cor
responds with the ittitiide tikcii up hj \mtrican courts

In heller v Zatcis^ a plivsician gave Iiis scrMcc* j,rutmlouslj ® patient who
knew tliot he was going awiv It was held tint he vns responsible onlv for such
treatment as he had administered pcrsonall} and tliat he eould not he held liable
for anj negligence or woiiit of skill on^tlic pirt of a phjsicim who was called in
subsequently

Errors of Commission TIic gcncrat rufe npplicibfe in such cases is
' the practitioner must take sHflicient care over the case and give it proper
attention This rule applies in cases where diagnosis has been incomplete
or inaccurate and vvrong Irealiiicnt iii tonsccpicncc bus been applied, for
instance —

In Xustraha a surgeon was sued for negligent and unskilful treatment of a
fractured elbow joint Ihe alleged want of skill cooMsteil in the arm having
kept in rigid splints for twelve dajs before passive motion vwis commenced
surgeon stated that he kept the splints on lieciuse the joint was too infi lined to he
moved and tliat the bov could not move Ins arm through an angle or 4,> degrees
Several medical men gave evadence for tlie surgeon und stated tliat there wiw no
evidence of an> malpractice or m^ligcnee Nevertheless the jurv awarded the
plaintiff £i00 damages

Charges of manslaughter have been brought against medical pnctitmners
in cases of midwiferv In some instances poss m smaingement Jias been
prm ed the uterus and es en pirts of the ,, seen ho> e been tenl au as . uml
in such cases convictions have followed’ It is wcH known lowever, la

> DnI nrd J 180-t 1 "Sj
* bo \rk 5*8

»Sce/f V Balfman supra In this c

-see <c V jjuifTfinn suviu ,,ii the greater jwriton of tlic uterus rrat
removed m extracting the placenta and tlie t La 1 hr niptured as well os the
rectum The phjsicun was eonvKted of inai»l»Ofeh‘«r in the Central Criminal

rectum The phjsician
Court, but tins conviction was

MlGLlGEKCn—OPLR iTIONS Co

much clifTerence of opinion exists among the most eminent practitioners of
muluifery respecting llie treatment to be pursued in difficult cases

Negligence in Operations It is onlj on rare occasions tliat a recognized
surgeon is charged uith negligence m the performance of an operation
GenenI practitioners should, of course, be careful not to undertake operations
winch are bcjoiid their skill

\llegations of negligence an, mode most frequentlj in cases where the
surgeon has cither exceeded the limit of a permitted operation or has left
instrumenti or other foreign bodies in a wound

Exceeding the Limits of o permitted Operation If during an operation
an unforeseen extension is seen to lie inc\ itablc, e g , the compulsory amputa
tion of the leg when bj mishap the popliteal arterj is damaged during an
arthrectomv, proof tliat such was m tlic opinion of tlie surgeon honestly
necessary for the life or health of the patient would be sufficient to exonerate
him

In an unreported case the plaintiff, who was n nurse, alleged that she had
expressly forbidden the removal of both ovaries, although she had consented
to the removal of one Tlie surgeon s contentions vverc —

1 The operation liad been left to his discretion, bascvl upon the result of
Ills exploration

2 Tile double ovariotom> was necessaiv at least m order to prolong tlic
nurse s life, if not to enable Iier to escape imminent danger

S The operation was not the cause of her sterilitj, ns she was necessarily
alrcadv sterile from her c>sts

The JUT} decided m fav our of ttic surgeon, and added that, in their opinion,
“an action ought never to have been brought’ This decision was upheld
b\ the Co irt of Appeal

Several practical points are presented bv this case

1 It IS advasable to have a definite understanding, m writing if possible,
fls to tiie scope an<l possible results of one’s operalire treatment, and it is
preferable to hav e it statcvl cleariy th it the matter is left to one s discretion
to act when one has gamed full mfonnation This is particularly important
where a series of operations or examinations under an aii'csthetic is required

2 If one s patient is * under and one secs tliat one must exceed the
limits of one s permission, one should consult with the nearest relative at
hand or else be able to rcK on the extreme nccessitj of the case before
proceeding

3 It should always be remembered that one is ojierntmg upon a possible
plaintiff

Foreign Bodies left In the ^\ouod or Abdominal Cavlt> Since the
•^outh \iricnn case of Van liyA. v J cans (1924) * tlie English Court of Appeal
in 1939, in Mohm v Osborne, ^ has considere<l tlic dutj of a surgeon m coses
where a foreign bodv lias been left in the wound after an operation The
patients mother brought an action for damages against the surgeon who
pirformcd an operation for tlie removal of a duodenal ulcer A swoib which
had been used bj the surgeon to pack off adjacent organs was left m the
patient s bodv , witli the result that he died three months later It was held
that there was no general rule of lawr which required a surgeon at tlie end of

V VrfI med J 1033, 1, 1027
< (1039) 2 K. U 14

ArcncrAC^iiot/ADs o

IS a considerable proportion of light of shorter ^^avelengths e g 3 000 2 OOO

AU

The bodj IS unaccustomed to light of this nature and therefore unless
the radiation is properly controlled, there is great danger of injiitj to the
patient

The use of this light Iiom ea er for the treatment of \ anous local and s\ stcinic
diseases has reached a stage where the control of such treatment is pissing
from the hands of specialists into the hands of the untrained and unqualified
It IS to be expected therefore that bums and other injuries \\ ill become more
common An old man who was in the habit of gismg himself an artificial
sunbath went to sleep under tlie n>s for an hour and ten minutes Vs a
result there were sea ere burns and general disturbances from winch the man
nearlj died

In Anderson nr I nielle \ Glnsg to Koyal InJirmarij (suprn) a woman under
treatment bj ultra \iolet light was placed m the light room and ordered to
walk about until she was tol 1 to come out She rtm lined there for 45 minutes
and ns nobods came to her she walkcil i ul herself Vs a result of the prolonged
exposure (the usual time for n lirst exi>osurc was ten inimitcs) she was bndlj
burned and brought an action for damages against the institution The case
came before the Court of Session and the House of Lords and judgment was
gnen in fas our of the hospital

Negligence In Promoting Drug Habits The ease of Forsythe v Lnxo^
should be regarded bv all mcilicd men who ha\c dealings with patients
addicted to drug taking as a warning agimst doing anything wluch could
possihlv he made the basis of an accusation that thc> were lending their aid
to a tontmuHiite of the habit (See also Dangerous Dmgs m\ol II)

Negligence In Gases of Criminal Wounding Inastnucli as on the death
of the a ictim within a year and a day after the wounding* the ass ulant must
bo charged with murder or manslaiigliler the question of medical negligence
maj assume great importance for it ina\ he alleged that deutli would not
lia\c occurred if the case had not been treatcil impropcrlv by a medical man

In these circumstances the question mnj arise as to how far tlie treatment
Rggraiftted the effects of the siolence and the court tnaj haie to decide
from the evidence of a medical walness as to the degree of criminality which
attaches to a prisoner If, for instance an ignorant person removes a clot
wbAfiJj. sedfifJL up thn exUrettuAv of a. blood % cssel and as a result
fatal bleeding ensues or deatli is causcil by unnecessarily interfering with a
penetrating wound of the cliest or oMonicn it would not be just to hold the
aggressor responsible for homicide

A serious responsibility rests tijKin practitioners who undertake the treat
ment of cases of criminal wounding -Vna desntion from common practice,
therefore should be made only with tlie greatest caution Upon these oecas
ions e\cr\ matter connected with the surgical treatment will be the subject
of rigorous inquiry and professional criticism In tlie case of a sc\ ere lacerated
wound in the hand or foot it may be alleged that tlie wounded person would
not lm\ e died if amputation had been performed at once V practitioner may
be able to justify himself by showing cither tlial the injury w as too slight to

> jAincet iao'» I G8(i

* This Tcfers to tl e Law of EnElnnl under Scots I aw tl c se of Ume I elwcea U e
mfl ction of an injury and li e leatli of the victim docs not alter tl c respons bil t\ of tl e
assailant if it can be si own U at tl e death was undoubtedly due to tl e injury

y NEGLIGENCE~^rOUNDS

equire imputation, oc thit the health of or other circumstances connected
/With the deceased n ould not alion of its being performed w itli an> reasonable
/ hope of success On the other hand, if the practitioner performed amputation
and the patient died, then it might be urged that the operation nas uniust
iFiible and that it Iiad caused death Here the surgeon is bound to siiow that
the operation was necessirj, according to the ordinarj rules of practice
The treatment of ses ere incised woiuuh, of the throat, v hen the wmdjiipe js
ini oI\ ed, sometimes places a practitioner in an embitrassing position If tlie
wound is left open, death mav take phee from bleeding if it is prematurelj
closed blood ma> be effused into the svindpipe and cause death bj suffocation
Lord Hale dreu a sery nice distinction between death resulting from a
wound rendered mortal b> improper treatment and death resulting from
improper treatment, irrespectne of the wound In most loscs such a dis
tinction could scarcely be cstablisheil except upon specuhtne grounds, and
in no case probahlj, would there be anv unanimitj in the opinions of meilical
watnesses In slight and unimportant wounds it might not be diflicult to
distinguish between the effects resulting from improper treatment and those
connected with the wound but there can be few cases of se\ere injury to the
person wherein a distinction of Hus nature could safely be made The proba
bility IS, that no jurv would convict of murder if the medical CMdcnce sliowed
that the wounding was not orjginaUv mortal but became so on)} through
unskilful or improper medical treatment In such a case it would be impossible
to ascribe death to the wounding or to its usual or probable consequences
If death had been caused by the wounding it is immaterial that m more
fa\ourabIe circumstances, and with more shtlful ircalmeiU a mortal result
might have been n\ erted

The true distinction in all such cases is, that if the death is occasioned ba
grossly erroneous medical treatment, the assailant wall not be guilt> of
felonious homicide but if deatli is the result of lack merels of that higher
degree of skill which is normallj aaailable only m great towns, tlie assailant
will be responsible because he wilfullj expos^ the deceased to a risk from
which he has practically no means of escaping
If the wounding had not been likeh to produce death but, through unskilful
treatment, death ensued that would not be felonious homicide

During a quarrel a man received a bite on the Ihuinb Ife went to a quack’
who applied some irritating ointment, which led to se\cre innammation and this
rendered amputation of tlie arm necessary lie died from the cfTccts of tJic opera
lioa Medurd evidence yvosgiyen that the Injurj causcii by the bile yyas slight, and
would probably have healed but for Improper treatment On this ewdence tlie
biter yvas acquitted

^Vhe^e, owing to improper trealment of the injured part, an operation
became necessary, and resulted fatallj, the assailant would probable not
be gmltj of murder Much discussion has arisen on this question, nnd manv
theoretical cases hay e been enunciated e g TMiat if the fatal condition yvas
not propter, but merely noticed post, the alleged injury (c g , an aneurysm
first noticed after a bloyv may be mistaken for an abscess and ms} be opened
with fatal result)? ,

Tlianks to the increase m skill on the iwirt of medical practitioners nnd the
increase in the number of hospitals m Great Britain, eases of improper
treatment are becoming verj rare, but tliej are allowed to remain m this
yvork because tbej are still important in places where such facilities may be
lacking

XFGIiai'\CJ-—fIOSPlTILS

For Bti intcrcslinir case of dealh iinHci-nnanTstliclie nflcr cnmiml MOimd
injj, tide p 74 In flic pirnpnph refemng to Molcnl deaths there are aUo
some further obscr\ttions on the subject

Gratuitous Treatment Wlitu o mcflinl practitioner undertakes nrallj
to treat a jntient jjmtiufouslv m iction for dnmnecs in fori will he if tlie
treatment he pneii ncplipenth fr r although no action will he for not pn mp
the treatment (there hemp no eomulemtioii for the promise) llie ! iw imjK)sc«
a tints to take rare to use such skill ns one jwisscsscs or csen proftsscs to
possess

Recovery of Fees U was loua atso’ tUst it tlie patmst ceciisev

no benefit in rou-vi^Heiifr of llie prachliottfr s xrntU uf x! ill the latter « annol
rceoscr Ins fees In t the niuunemfioii of a pru titioner wfm lins ii<;c(! due skill
and ilihperue dots not depend upon his cfTeclinp a cure In tlic ease of n
surpeon if an npiration whiih iiupht lm\c been iistfiil has bun iiiisiiieissful
lie IS ncacftheless entitled to eharpi, hut if it could not Imic been useful in
auj cient, he has no claim *

ho Is the Person Responsible R\ tin fm t of his repistnituni under
the ^Icdiea! Acts a presumption ari'Cs that i ijualified mcdien! man knows
Ins work and does it proiurlv uid he has no nreil to addiiee <\idtiiec of
pencral skill and fitness he is held jiriinn fane to bi eoinjictciit in nn% lawful
net, and the onus of proof to the conlrart lies on fht one who aikpis it
if he poses ns a specialist a prcatir tomjiettnee will l>e presumed and \et
cnnsidcmble latitnilc in the pra< lire of mu theorv or line of ta itincnt w til
be allowed Tins latter slnttmciil u haseil iijjou the Midiuil \tts of ihjR
and of 18S0 uaiUr whidi the (.ciicral Medunl (ounril u entrusted witli the
rcspniisibihlN of settinp up « stnmlanl of proliiicnii m pcneml jimfcssional
knowledpc but it cannot refuse reeopmlioii to a ihiK ijinlified prmlitioiicr
because he upholds or professes or nfuses to uphold nud praitisi artain
lines of treatment

Hospitals The lepal [>ostlioii of tin povernuip boiK of a puhlie hospiinl
ivns considered b\ tlie ( ourt of \ppoal in Gol I \ I" «<rr < t untu ( nunciP w h« re
tlic earlier decision of the tourl of \p|*enl in IJtlli/ir % S/ llarlhnlninri s
//ospitnP was res leweil It has now l»een hi Id that Ihi nbhpnlious nndi rhikin
l)\ those in control of n hospital in upiml to a pitieiit Ihtrim arc not con
fined to the prtnision of skilful imrvs or skilfiil persons siuh as radio
prnjdicrs for pump llu pntietit prrscrilH.d treatimnl The < lilipitinn which
thej undertake is tint of nursinp nr trentiiip the patient as the case mn\ Ik-
AcconhnpU Ihes will Ije liable for the iiephpent ael of a iinrsc lommilteil
whether in the course of ncfualls niirsinp the patient or while |>erfonninp
some piircK ndmlnistrntue dnt\ sin h ns sers inp Ins me ils wlinli is imrels
incidental to the pnmars task of nursinp or for the nephpent art of a skilled
person such ns a ruliopniphcr eoinmitUd in the eourse of mlministerinp
tienlincnt properK prescribed b\ a nicilicnl praclitionir

It is now cslahlishcil that tlic Hosjiital Viithonls is liable for tlie neplipcnet
of surpeons and iloctnrs cniplosetl in il (foisidi/' Ministry of IhoUh (1051)
1. R 11 IC H

•Aonn'as McituUen IVaVr 59

ssWtTsnn t tnittSt's “ Uwsv

»5S T I>.ll (latJl XT

•(1000)2 Iv II .s.a)

™ !\FGLiaE\ci:—\onsi\G // oi ; f 5

In the opinion or Greene AIR , the tnie ground on whieh n
esenpes nbilitj for the act of a nurse ulio nhcliicr in the opcratins tlicaire
or eLseiihcrc is sctmR under the mstruetioiis of a surgeon or phjsienn is not
that pro hoc lire she cesses to be the senniit of the hospiLsI h it Hi ,t she is
not guilts of negligence if she carries out the orders of the surgeon nr pin siei in
hossescr negligent those onlets nm he There is no reison on pnneiple
»b> if she carries out an order rrcglrgcntlj Hie hospital niiHionlies should
not be Inble

Some imiKirtant observ ations \\ere mide bv Wd Greene and 1)\ (m 1 1 ml
L J m the Gold case as to the position of focal nutliorjtics win pro\i k
hospital accommodation in acconlnncc «ith Part M of the I’uhlio Ilcnltli
Act, 1030

The Ifoiise of Lords held m Strar^cayi Jjfsmere \ Chyton^ tint nlirre
two nurses acting on a surgeons onlcrs negllgcntI^ administt rc<l to a
patient si\ ounces in mistake for si\ draelimf of pnril<Icli\ de m cotiscijiiciicc
whereof the patient dic<l tfie nurses alone w-erc rcspoitsillc an 1 not the
hospital authorities

Tfiere is n distinction between imtlors of profession'll skill and piircK
ministerial or idministratiie duties The governors of a hospital are not
responsible for the discharge of skillctl duties hut tlies are rcsponsililc for
the dischai;ge of admimstratitc duties Tiic i)v>tinitipn iwlnccit tJ w tao
classes of nursing duties was considcrcil b\ the House of Lunis m r/hiders n
or I aitlle v GlnsgtKc Uoyal lufinnary *

In lleigntt v Ueilmtnster Hospital* the mother of a pitient was uwanled
£2 8.0 damages for personal injunes suffered as the result of Ju r si t ping on a mat
which had been f laced on a floor in the ho pilsl covered with n phl> pol lied
tnoleum The Court of \pp«l I eld fhsl the Ifosj tal authorifles Ili I not taken
reisonable care to prevent danwgc from unusual ihii^'cr

Jsursing Homes and Nurses If the proprietors of a nursing home
sanatorium or other siniihr institution undertake to nurse or to treat paliciils
the nurse or medical pnctitioiier ssho carries nut the nursing or trcilmcnt
is the agent of the proprietors and the latter arc responsible for ctery ad
of negligence svhioh the nurse or medical practitioner ni »v commit

In IiJilsej \ MursfaW the House of LonIs licl I tliat a patient m a niU rmtv
Jwme was entitled to recover damages for ne^.hgeni-c on tJ r p irl of llie piverni u
l>odv of the 1 ome on the grounl that the staff of ttic home afltr an ciitlrraV
of pucnwral fever had admilteil patients before havaiig ascert unwl whether an)
of the staff were carriing infection of puerperal fever

In P<rcflly Streailam Manor Nwraing ffowic* the Ifouhcof I onls In IDJjrestnn I
» judgment for £3 477 damages awanled against a nursing home hi rc-spet I ol
ncpl geiice m the treatment received bj a mameit woman in connection with an
operation for livstcrectomv performed while she was a patient in the home

Phjsicians and suigeons are not responsible for the negligent nets cl
nurses whom thev have good reason for liehcving to he cMujx-fcnl un css
thej arc present at the performance of the act coiupl iine 1 t f ni are a i c
to exercise control It is alwaj-s n question of fact wlictl cr a particular
dutj properh falls nithm the scope of a nurse having rc„ rd to the j rntticc
in the institution concerned and in the profession gcncnllv
« fiirvj \\ N an

»//«/ OTC/ J JUS3 1 "C"

*(ll>30)3iTl.ll. sot
*110371 \C. AT
•rAcTiwr* March 1st 1033

M.GLIGFKCE-~DE\TJSTIiY 71

Contrlbutorj Negligence b> Patient Of the cases of contniMcmous
responsihilitj i e , cases m %thKli the practitioner seeks to tlirow the onus
Tipoti the patient, because tlie latter did not follow instructions, and tlius
caused tlie injurs or delased rccoserj. it would seem that natural justice
would not suffer a practitioner to be held responsible for a patient’s dis
obedience of instructions given solelj for lits own benefit

The actu il errors of practitioners fall imtiirnlly under one of two headings,
v 17 omission or tomnnsion but it is obvious that m some cases very definite
lines of treatment often in opposite directions, have to be pursued on the
basis of diagnosis the two cannot therefore 1x5 altogether separated in practice

Denfaf Cases Dentists are not mfrequcntlj proceeded against directfy
(or bv a counter claim set up against a bill) for negligence in breaking off
a portion of the jaw in tooth extraction but such cases as the following arc
verj unusual —

A claim for damages was brought against a consulting dental surgeon at the
t nrdiff Infirm irv for alleged unskilful evtractioii of a tooth Tlie tooth m ijuc stioii
was an ii| per canine and it was alleged tlial unneccssarv force was used with
the result tint the bioth was ft reed Upw irds into the cavitv of the check, itid
he< utie embcddeil in the cheek hone and the cartilage of the nose just below the
lachrjnnl duct It appeared that the tooth was not extracted but tlmt the
ftireejis slipping over the conical part of tlic tooth forced it up under the skin
near the corner of the e>e Swelling and pam followed and the patient was seen
li\ severil medical men who at first faded to diagnose the iinhiue condition
uid were moreover misled bj the statement of the patient that the tooth iud l>ecn
extneted The use of tlie Rbntgen ra\s liowcver clcarlj demnnstrated the con
clition and the tooth was removed b> n simple skin Incision The evidence of the
four meilitnl men who cxammeil the patient was against there huviiit, been aiij
ncgligciue in the attempted extraction although it appears tint the dentist m
fjiicstion h id not asccrtauied whether the tooth was out or not

Iht judge held tint if there was no negligence in the operation profier it was
irnm itcrnl that there was f ulurc to fiml the tootla The claim filled

In another CISC a woman went ton dentist to liavc n tooth extracted h\ the
dentists painless process The operation wxs not successful for broken
puces of the tooth were left m the patient’s jiw It wns held that n cause
nf actum i« tarl laj against the dentist in respett of the breach of his dutj
to use proper skill in the pricticeof Ins profession irres[>ecti\e of the contract
to perform the operation b\ a painless process •

If n dentist acts m conjunttion with a meihcal practitioner it is no part
<5/ tiic A iiiit} Uf i)fe ffetanti hc-iitk vsvf tk's j.xiln'ni it is not

negligent for a iiiedual man to allow the exlraclum of mimv teeth to he made
without making a preliimnarj blood test (llarren \ Grng', ami Uarren \
Wlnte*)

NEGLIGENCE IN AN/ESTHESIA
Tilt giv mg of am kind of anasthelic is n task calling for special knowledge
and expentnte for obviousK no aiicstlietic tail be free from danger V
rcgistcretl prutitiontr, therefore who administers an amestlictic assumes a
rcsponsihihtj that nia\ in the event of disaster, be asscssetl with ns much
tan as that of the surgeon lie must exercise due caution at each step taken
during anasthcsia— im/d full recnery fmm Us effects The latter dulj is
often overlooked with disastrous results

> fj^ards V 1/a//an (1008) 1 K It 1002
* L/iiicct 1035, 1 800

EGLIGL^ C I^A \ AJiTlJl SI A

AtliiltU ffncjeirs lieilth\ c\rrpt for rpoimn'r tonsdMi? owratcl uiK>n
tiiHlcr ucmlnUa! trr IJ (Knonm) etl»l chlon.le «i..l tlhcr (l.'tw pT

both lonsiU Iwi.R ,h-5scctc.l ana\ 11 m tltroit }u<l lictn i »ck«l nii<J atw-slh«ia
u. mm.stcr^UA ,ntn. trache.l tube ntmlmR t,„j>caml to Ime l>«i, ronlroSlI
Mfit ti t le < h.M w returne,! to th^ wanl at li :«» m It w as wmforhibJc m'lJJ
nlwiit J .’(I j> ni «l cn a rise in respimtion an<l pnKc nite was notol It was iwli
ashen f,re\ ninl an<i\ic nlien the U S was calletl at 1 00 p in . iimi ijid o„{e ,,f
restoratHc fiicnsiires at MO pm *

\utof)s\ rcsealed a triikle of htoml jnto tlic i.!otli> sn<l widcsprcnij nhstnuli .a
f»r tiu hroiKlual tree b> Inluileil blioci It liad not Iwen anticipntea ami nu aethc
me isures (apart from bcin^ plawl prone) IikI been taken to asert it

t\jthin a period of three innntlH in SepUmlwr lOlO two fit subjects of J7 and M
who had luid c\< isinn of knee t-irld lKe^^llft the oi>oritine theatre lit but in cluarRc
onJi of (a) u hospital {Kirfcr or (A) n pupil nurse who liad to negotiate a (ifl and a
esinsiderabto len„dh of corridor Itcfire ams il it tlie ward 1 nch was seen to bt
t\ inosed on iKing liftctl from the Indies to the lieil and caeli wa> foui d in fact to
Ik. de id

The coroner to whom nil deaths ‘liefore full recovers from nimtlicsn

or oltcn all deaths within 2t hours of administration of an anestlittic — are
reported in i\ order an nntopsv h\ mi indcptiidcnt pathologist Init is uiilikclj
to liold an iiKpitst milcss there has lieen some avoidahic mishap or serious
niisjiidgincnt The risks taken l>\ the llioiucK, t irdiovastiilar and nctiro
logical surgeon arc so groat m inmiem times that it would he ijuitc unfair
to isk that all dintlis not stricth due to nitnral rausc« sliotihl I>c discussed
nfc pKjtiests (Irefore a piihho that <mmot possibh appreente tht taJwical
ilctails and dithcultics of the procedures undirlakcn)

^\ lien the c tiisc of death nnv rciisonabU l»c regimled as one of tlie nccepU*d
risks of the pnKcilurc umlcrtakcn is hi fat cmlxiIiMn during the frai lure
iiml manipulation of hones for orthopedic piiriHisc* pulmonary tttlenia
following release ot the shunt in Blalock s ojHriilioii for pulinonnrv stenosis
or rellex cardiai arrest during mitral vaUnloloniy— then the coroner is
empowered to dispense with an incpiest When an amtstliclist endeavours to
prevewt vomit from foiihng the airw ns m a case of inlostinil ohslnation
bvit fids It IS not to l>c suggcstcil that death cnrwn/ from any laek of due care
and sKtll 1 Ins' IS the opemtiv c phnsc it HtU siatiitorj hm king hut li is fur
sofiic j ears, gamed hv usage siilhc icnt obi ions merit to justify its eontiniiniii i
In 'xotlrtiid the rnn-unlor l-isrnl mnv he satisfied with a r(|x>rt given to
him bv flu pulue Mirgcuii or other medical oHiccr npj>oint«l hv luiiv after

siuh ollicer (ns consulted the siirgcuii aiiasthctist rurrsiug staff tti Jfhe
IS unable to decide the in.ater Iroin sutli consuUatiou j nsl pinrlm ciamma
tiori will he ordered In the Shenff In I nglami an autopsy is routine jiro
cedurc in all such dcatlis

I he anrsthefist should be parlieiilarlv careful alxHit tlie follow mg iMimls —

1 Ohtaimiig written consent to IIk. jHvecdure

2 Making » tliimal CNamiintion of the patient to dceidi /ir /miiniT the

siiitahility of the subject for the proceduri
J (hcikmg the drugs tei Ix givm bottlesiif tliiwl and the np|>aritus to
Ih used himself ,, ,

I lakmg jnstaulioiis to pnvciit hn. nnd isplosion ts|)ctia1l) vvlitii
elcctn) eaiitcrv is Iicmg used

5 Never n lading \igilann. for a moment until the patunt is fullv enough
reeov eretl from the cITeeLs of amwtlieiia to lx. kft s iM) to the care of

the nursing sfafT

11 101« l.r,„on(«™™r. Ml. 1 J | IxmJ™ Jl*'”''!!

Er,Lian\ch~A vj stiii si a tj

Some exmoples of the tli^i-istcis tint iiiav Httcml fiiliire to exrrcisp enre
o\er the^c j>nint>i ina\ l)c listed

In 1051 a ]iatk<r wns a\^Qr<!rti £MHI diiuises for iirji^nn ipninst the North
^\pst MelrojKilifati Ilcgioml Ifo^pitnl Ihianl lie Imd been a|iente<l njmn hr a
duodenal ulcer dunn;' the (>{ter itinii, liatl liud fii- h ft imn stnip)wd i»lKi\e the
liead for mjertion of a rehvnnt \ hmeliiil jdivus lesion rnsneil. mil hticalion
foIIo>\-ed upon the nllrpition tint this xs Kilur to nmles.s Jlxntion < f the arm

In October 10 >1. a unman a^jetl "3, wlinlud liccn admitted for nidanl in isloidri
toiin u-ns found fit for opcmtion and indiucd hv thloiicntone niul lln\c«lil The
noTfithetist MmpiMiiRo\>(;en llmniRhnn iiKuliled nihlicr hmilhin^ hip and face
piece, con trolhnp IheMiKe of thef»\spcn esluideron the nn rsthetu Imllei with one
hand ulun there uas an explosmit It nppcnnd to lx in th< fuipieer hr sms
thmsMi to the lloor an<l then, uisn lire on the f miles The p it lent s ejchsla'S were
sinped and cm lids hniised and the nose |ie<liiip Init respinitn o utn m.untaliHd hs
intmlruhcil lulie (some liruisinp of the inl ile niid pharvns liemp noticed) and ns
the pulse svus powl the Mirpeon minpleltil tlie o|h mtinn One hour and tin inmntrs
later the patient colhpsed and \crj sliorlh nfterwnnls ih«l rxlrnsuc splitthip of
the rrsophipus anti eirdia uas found iit autnpsv The tsplosion sens nscnl>etl to
static electncits

A 18 \i ir old min uns ojh. rated uiam for jHrf<irile<l iieptit tiher Iltirlnp the in
duetmn of nna^thcsi i nn oxspcn cslinder heeuiiieeinjits nn<l a suppis ims tumes! on
from a spare islinder lilted h^ a tlieatre nit rial int at the < n<i of thr presioiis < isc
After a fi-ss minutes the pitiont * eolotir ssns nolieetl In Ik so h h1 UliI estrstlilnp
evcenl nil it ISIS thought to Ik ovspcii ssn\ shut off lh< )> ititnl s eolniir sstirseiinl
uiid lie diet! dicjils csnnnsed a f<ss nunutesliler ) he « slmihrss is found loeont'iiti
nitrmis iiMdc and tlic an i-stlietisl i v «seil hinmif hs s ismp f look it for pmntetl
tint sshen I nsktd for o\spsn f ssould ^.cl It

At nil inquest at ttsstinmster in !fHi it ssns ndmittnl Ihd a four sc in Id iliil 1
hid Iicen pisen <• 1pm of pcntotluit in Kl e< of ssutc r misrd ssith Jil ic ofsiirpioal
spirit (ill error for saline) per m turn in prepinilion for n tonsdlrctniiis '1 lie hloml
nicoliol ssns JOO mp per <snt sshtn nu is«r»sl hours liter ( 1 i*ir cent of lids
nutlAl ilcnlud) nntl death took pi ict on tlie fnllossinp d is some J lit urs iftrr tins
prase error liitl iKwrn'l

"Mr lusliic llnTlcl olts(r\<d at Ihe ‘Soils Xssires m lull in upjHirtummp
responsibilitN lo tin Jitn in n ease in ssJiidi an ermr of jtitipiiKid in pismp
nn ntucitlictic hail been alleccsl * I’rofissioml inin and i-spcnills slmlorv
oiipht to ohserse a proper slamliinl of profession il c m Ui ncldsil ‘it
ssoultl be undesirable niitl mdeed dis.islrs>us if doitors fietd svilb the
nccessilj of innkiiip decisions nnd (iikiiip responsdnlities sstn to bast llicir
coiiragt sappeil bs feebnp lint if tins innds a mistake lias ran tlic risk of
bcinp fotintl puiU\ of ncpbpenct

In rneb of ibe lascs qiiotnl nlKise litoseser Ibircssis an climeiit of cirt
lessness md a fniliin to exenisr lint cart and jilerliioss sslnrb a pilunt has
a ripbt to i\pect of nn nni*stbclisf ami ssliiib jiistdied tlie sistl blipation
ubicb ensued Lscii ssbcii unsuccessful sueb nvil ailunis (Hcasiim inucli
ssorrs nnd CNpcnsc ssbicb is nsniilalilc if rt isonible ran is cxentsid

1 sen sslun rt isoiuible tart iscMreisctl cxrtssist reattunis lo ana'sHirsi i
tnnj ortur, for rxnniplt s'bcii intmstiums birliituritc's irc mbnuusti rr«l
rapiills nnd ssitbout Ibe txperitnad rnulmii llial niipbl folloss fnuii Inii^
pmcticc

In Tuls, 11131, Mr Ju'Ikt Oliser assnnlctl a phdiilifl £1 ns qs t)! dimvii in
nsjKKt of the dr sth of her husUmd ssho hid dissl almost Imnirth itrls ujwn liemp
Risen HI ml thiopentone follinmp pus and ovspeu l.\ inisk (nhiih had to Ik*
ahindoned 111 onler to tlrcss bnow of IIm fice) The nrupstlietM qu it lV«l tnlv tiro
>ears, sms rthcsctl of Inhddj hj llw* jud^ on the pnmn Is tint the if.Hpfial

^ AK I^STIIFSI t A\D CHIMi:

Board vas rcspoasd/le for Ifje mon^ian otsome rmsnr.'.r.ft .

E‘=r;^rU!;5 rrXr^,2r"' '—"• !«

AN/ESTHESIA AND CRIMINAL CHARGES
Mhere anTsthetic/operntnc protcdurcN nrc ronccniol \mI\i nscs „f
bounding and death ensue:, through some nushap the charge nm\ W stciwl
up_saj from felonious sNounding to mansla>ighter-«hntc\tr the ments or
tauits of the procedures undertaLen

In R T Ilughts a iiiim l,rou|;lit into the london lIo.pilnl hlc one ewnm-
blcei me trom a punetured itoun.l in the left fotenmi The Io 4 1 f UoihI mil iiiileej
111 the home stitsetm to he so senom ns to neeeisitate ennfiil eMiniin lliun of the
wound under an an^thctic During the return to consciousness IhejnticHtsoinitcsl
and choked himself \nlh the contents of hii stnmacli,

\t the inquest a s-crdict of nunstaughter agnmst the iLssaihnt vns returim!
and at the subsequent trial the judge said

‘This case is remarkaWe in that it goes a step furtlier tiun nnv previous rave
w here a vrounded man has died from tlie effects of a neccss.ir> opcmlion

ffere it vras not the op^ntion but the an esthetic vWuch nccctcnteil the man s
dealli Now liad not the man misinformed the niia>lhctist ns tn the lime of his
last meal which there is no doubt he did the an esthetic would liavc home muhneir
to life

TJiereforc it «- 8 s the dead man « own ftiistike tlLit mused fits dcnlh ond t/c
prisoner could not be held responsible for such a tnis stntemcnt
Ifughes was found gudtj of feloniously wounding Mitli intent to do gnevoiLs
harm

A somewhat sunitar case occurred at the Liverpool tssizes when ii miin ntid a
woman were cliarged with the maashughter of a man with whom the male prisoner
was fighting The blow which caused tlie death vvns ilchvrn’d bv the female
prisoner Death was caused m rather a strange wny Tlie female prisoner struih
the deceased man on the eye with the neck of n broken bolllt The eyesight was
destroved and the «i ebrou wascut fn the«rcumvtinccs it was ihe/ncil neirssnn
to perform nn operation upon the man and for tint piir|iosc an niui-sthetic was
administered brom lits apjiearancc ami condition the man MCinid tn hivi been
a proper subject for an nnaisthetic During the course of tiie ojienhon however
lie appeared to be in a fainting condition and he ultimntclv died from thendmiiiistra
tion of Oie onarsthetJC In n wav wlucli the doctors were unable to neemint fir
The judge saul that in a case of this kind it might be contended inlh murh pi lusl
bihty tliat tlie personwliostruck the blow in the first mstince andtierchy rcnkitsl
tfic operation necessary w as liable for the consequences Wut it wa.s not dcsirabJe
III a ease of this kind to let the case rest upon >ueb a pnnci[ k and therch re If the
grand jurv found a prtviafaete case against the woman he (his lonl hip) wmil I Live o
bill drawn efiarging her with wounding tftc man wit/i rnfenC fo ffr> grreif Wdi
hann leav ing Ins death an open question Tlie grand jurv ndopteil lus lorddiip s
suggestion and the prisoners were tnei! for unlawful wounding

The practice is for the Crown to procecil wdh the graver chirgL, but for
the Judge to indicate to the Jurv that a senes of unfortun ile roiisequeiiccs
of accused s act can hardly have licen foreseen nml hartllv therefore
reasonably ascribed to the unlawful act of wounding for Uic piirjiose of
assessing ‘ guilt’ ami punishment It is vetnnother instance of tl c iIifTtrcnec
between stnet law and practice in which the sense of fnimcss privaiK

NEGLECT PARENTS AND OTIirilS
If a grown up person is under a dutv to take enre of iiiiol(i(r sticli as i
parent of a child or chooses to iinilertaki. the ihargt if « human l>cmg
liclpless either from mfanev siinplicitv lunnov or othir mfimiitv. such
IHrson IS bound to discharge the duly or evecutc the f ' jrge without rcckic"

^EGLFCT

75

negligence If a person who is m chir^ of a helpless creature lets it die
reckless negligence that person is gwiltj of minslauglitcr Alere negligence
mil not do There must be negligence so great ns to satisfy a jury that the
accused nas reckless!) careless as to whetiierthe person m charge died or not
There are a number of cases on tins subject, of winch the following may
userullj be consulted —

R \ aiorby (1881) 8 Q B D p 571 (Neglect to provide medical help)

R \ Chailotte Smith (1805) L C. p 007 (Neglect to pro\ ide food and
lodging)

R \ Chaltauay (1922) 17 C A R
R \ Bonmman 28 C A R
R V SiniorL R (1890)1 Q B p 283
The Appeal Court in Oakley v Jackson (1914 1 K B 210) made it clear that
the real test was the reasonableness of the decision in the particular
circumstance not the medical necessitj of any procedure winch is refused
The parent or guardian must seek or make a\ailable the medical attention
whiih IS nectssarj but there is no obligation to consent to operation Tlie
case was one in which a father refused to agree to the removal of adenoids
m a daughter aged 13 jears

The Children and Aoung Persons •\ct 1033 facilitates prosecution for
neglect in cases where a parent or other person liaMng charge of children
fails to provide medical aid ^

In 1041 a labourer was cliarged at Glamorgan with failing to provide adequate
medical aUentiun for liis son aged 0 fhe boj liod surfered for some months i^m
tuberculosis oft! e knee and liad been in a hospital for treatment for 14 months inth
c( nsiderdilc improvement Ife was re admitted some months after return home
vcTj much worse and amputation vras udvased The father refused and prosecution
follow ed

At trial a jury neoepled the fathers plea that his refusal was reasonable in all
the rircumstanocs It was pleaded on his belialf that lie i ad not been told tint lus
son s life was m danger and had ont> provisional!} refused consent m the belief that
the operation vras likelv to be fata!

In IOSj i mnnnnd his wife were convicted under t!ie Cluldren an I loung Persons
Act Ipn of failing to provade adequate medical aid to a child in their ciistod}
who on medical evidence lud dietl because of its parents neglect to provide medical
Old The pircnts were members of the Peculiar People sect

In November 19 j3 the father of a girl aged six daj’s said at a Leeds inquest that
he w IS a Jehovah s itness and could not aliovr her to liave a blood tninsfusion
lieciusc it was against God s hol> law The child died after an operation for
Tec-oiislilulion of a congenital ussopliagcal nlTcsva — ilunng which the surgeon liavl
vvislieil to give blood An olhcuil of the Sect referred to Acts chapter 15 v erscs 28 and
2D vvherem the words That ye abstain from meats offered to idols and from blood
and from things strangled ’

Herbalists bonesetters chiropractors osteopatlis anti other unregistered
pnctitvonerv mnv practice tUcir jiarticular cult without hindrance, within
the limits mentioned in this chapter provided they do not pretend to be
registered medical practitioners

The position of herbalists, so far as regartls criminal respoasibihtv vvas
stated bv the Court of Criimml Appeal m R \ Burdec * In that case the
accused (a v jolmist) was interested in. herbalism and fasting as a cure for
rheumatism, and in April lOlfi lie commencetl giving advice for which he
charged fees In July, 1916 he gave ndvtce to a confirmed invalid and the

I lint med J 1041 2 832
>(10l7),flauj K D 871

QDACKLln

patient died sen ate slie I, ad abstained from fed in nccordanee with |l,e
accused s advice Them iias medical eiidence that death Mas caused by

The aeci'isT ‘‘f 7= “«= '"=«*• »>'‘t aceclcraled bi lack ontod^

The accused ^^as conMcted of manslaughter

In gnmg thcjudgnientoftljecourt Darling J said If anv person
‘r '‘r medical mai^or not professes to deal

r 1* I ‘n’5® ® ^tihitcls he IS bound to Ime compe

lent skill to perform the task that he holds himself out to perform and he is
bound to treat his patients witli tare attention niul nssiduitj

Ad\ ertisemeuts bj herbalists and other unrcgislerctl persons rclatin" to
(a) articles to be used for the treatment of Bnght s disease t itarict diabetes
epifepss or fits glaucoma locomotor ataw piralvsis or tiilicrculosis and
(ii) articles to be used for procuring the miscarriage of w< men arc prohibited
(with certain tethuical exceptions) b\ the Plianmcj and Mcilicincs Vet
Saucer Vet, 1030 contains similar pros isions relating to cancer
The legal position of oiteopalhs was consi lered m Hall \ Trotter »

In R \ Tensor (1032) the Recorder of Loiidi n said that the medical pro
fessiou liad no inonopoU of the healing art He said that osteopallis and
others had professed the heating, art in uirioiis directions mth a jerfett
right to treat patients e\or\ bit as iiiiich as nnv cpialilled doctor so liiii„
as the public kneu uithnl om thex xscredealmg In 10 1-’ mid 10 W sexera!
osteopaths xxere finwl for describing theniselxes as o^tcopatIIlc pbxsicians
and surgeons or as luampiilitixc phxsicians and surgeons conlrar) to
the Aledical Vet lSo8 There seems to be no legal objection to osteojatlis
describing themselxes us docUrs pnxidctl the) do not pretend to iic
registered medical practitioners

QUACKERY

Quackcr) must be consKlcrcd as a siibdixision of malpravis Afedieat
eMdeiiee is sntnetiincs rctiuired xxlieii n blitant quack has uxerstepped his
limits xxhere for example he has signed a xlcilii ccrtilicatc

The usual xva\ m xxliich the laxx deals with quacks is bj means of a prose
cution for obtaining mone) under the fdsc prclcnci. tint the\ are dull
registered medical practitioners Prosecutions are reportcil in the medical
press from time t > time

Tlie (losition x f (juacks xsas ssill staled bx the jii l^t- s summing up to
the jurj in the /iidiflM Oci/hit* Ca$e in 189J thus

If \ou think these ii eii dehlierxtclx iwrfonncd these opemtions vxilh
the full knoxxledge that xxhat llie> xxert. doing «as useless muiccessar)
and cniel as the skilled surgeons tell \tm xou cannot resist tliecnntiusioii
that the intention Ihcx had xsas to defraud If jou think that this is not
established then thex are entitled to be set free

Vs quacks thex had no abililx to ruse the presumption that pri nu/ffCK’

thex xxere skilled and competent Thex had to ct mmciict tleir deUiioc
ab vutto The following are classes of cases in xxh cli n tl irge of gross iieg i
gcnce has been sustained W here recklessness, slu| i lit) ornmiufest ignorance
m an essential mnllor 1ms been displaxed or xvliert some xvilful injurv luxs
been elTcctcd eg In xxax of axpcnmentalion < r !>) treatment otlienxisc
than for the patient s bcnctit or b> treatment xrhen the practitioner xras not

(le 1) JSTUn 30 lie Ugh Court lew that tie ''f 3^

notnpih tomon/p L.m« Ireatn ent wti »s serxH** ren Jrre 11 x “

nntKe onlnr^orl- nUn tfo-. v (I0-, 1> N 1.0

ciimsTiAh scII:^cE 77

in a sober condition It has been established that one may not evpenment
on a patient or rather Hint one experiments at one s pen!

Quaclver\ docs comparitivelj little harm so long as adults consult quacks
of their own free \m 11 but the matter becomes much more serious when
helpless children are consigned to tlic care of faith healers and others The
law seems utterly powerless to check tins practice

CHRISTIAN SCIENCE

Christian Science acult founded bj a Mrs Cdd) inl8S3 has a great number
of adherents It is a religion as well as a metlical cult Christian scientists
do not belie\ e in the existence m fact of pam or sickness and consider that
onlj the belief in pain reallv exis.ts They therefore treat all maladies as
phenomena curable bj faith They do not belic\c in the action of drugs or in
the tenets of orthodox medicine

There ha\e been manj cases where persons have died owing to refusal to
obtain medical ad\ ice or treatment and so far as ans individual is concerned
it is his ow n affair w hether he obtains treatment or not Tlie case is otherwise
w hen a person responsible for the health of another refuses to obtain medical
treatment and when death results owing to the lack of such treatment In
these cases the parent or gu irdian ma\ be prosecuted for neglect but the
fact that a patient died not as a result of sometliing which the Christian
Science practitioner did but as a consequence of sometliing which he did not
do mnkes it difPicult to pro\ e a charge of manslaughter or culpable homicide

In England the f llowcrs of Mrs Dld> liave long cvcrciseil a wase discretion in
the matter of procuring for tl e children under tiieir control that iDcdic.il aid a\itli
wluch thej must tliemseUes dispense if tl ej would fa tlifull) obe> the precepts
of their prophetess They lia%e in short b^ av\are that to neglect to procure
medical aid for a child might imaihe them in a serious cruninal cliarge and they
Iia\e accordinglv obtained it In Canada the\ wall now presumabh follow’ the
same course for the Court of \ppcal of Ontario lias i eld m the case of a Christian
Scientist ttiat medical aid » a necessary mtilun tlie meaning of a section oftbe
Criminal Code wluch makes a parent babic for oinitlmg to provide ncctssancs
for a child under sixteen years and tliat where death follows the omission the
parent may be comacted of manslaughter In England tmder the Prey enlion of
Cruelty to Children Vet 180^ anv person has lOg the custotly orcareofany cJuldis
guilty of a misdemeanour if he or she wilfully neglects such cluld in a manner likely
to cause such child unnecessary s iffering or injury to its 1 ealtl Tlic omiss on of anv
direct reference to medical aid hi the later Vet rendered it neccss.»r\ to Jiaie
recourse to the Court for Crovn Cases Rcscr\cd in a faith healing case where deatli
had resulted In that case* Ix)rd Russell of KiUowen LCJ pointed out that
It would be on odd re>ult if we were obbged to come to tlic conclusion that In
dealmg with such a subject as the protection of ciuldren U c law 1 ad meant to
take yvJiat may be described as a retrograde step and the court imaniraously
upheld the comiction for manslaughter In the ease before the Court of Appeal
of Ontario the indictment was under' a section of the Criminal Code of Canada
(Statutes of Canada 5.* oO Vicf c 20 s 210 subs (i)) wluch is as follows
Every one yyho as a parent guardian or liead of a family is under a legal d ity
to provide necessaries for any child under the age of SLvtcen years Is crimmallv
responsible for omitting without lawful excuse to do s> whde sueli a child remains
a member of lus or her household wl cUier such cluld is helpless or not if the death
of such child IS caused or if his life is endangered or his 1 ealth is or is hkch to be
permanently injured by sucli omission The questions raised upon this were
V' hether the term necessaries’ included medcal treitmeiit and whether the
Chief Justice of the King s Bench Division of Ontario the Hon Glenliolme
Falconbridge wJio tried the case bad rightly directed the jury that tlie evidence
of witnesses that they had been cured or bencOted by Christian science treatment
‘ U T Senior {1800J 1 Q 11 233.

nypnoTisv

liSHSSSSSHHH

determ iicd upt ii the circmnstantcs of c-ich t-«c and Mliether ^ t .
neglect to s,uj.pl> them must also depend upon tfie arcumstanees*
protect the intent «ho bel.evmg l«s cMd , S So bTS
consider me<lical aul to he necessary, although m fact it Mas neeJsarv Tnd moSh
leas e the j«r> the question ss hether in all the circumstances of the ease medicn
assistance and t^tment Mere necessaries proper to be provided for the child
luising regard to the state and condition in wlitch the evidence stiowed liim to be ’
i' tV\rTVi‘ cvidcn^ of Clinstian Science cures tlie learned Chief JusUce

held tlmt thc> Mere propcrlj cylmled fromtlie jury s cons deration upon the mam
issue IS to whether necessaries liad been provided or not and tliat os the pood faith
Of the prisoner « as not m question (he evidence could not Iiave been received at all
This enunenth sensible and sitisfactorj decision sliould result in tlie saving of an
nppreciablt numlier of cluldren from death or injury to their health at the liands
< f Cliristnn scientists and other ahsitrd but dangeroas people aUhou"}! the
section of the Code wiijcli it mlerjirets docs not go so fir ns the Bnti^h Act °w?i/eh
makes iicnal the causing of unneccssiry suffering Both the decision in
U \ Leicis the case before ilie Court of Ontiri 1 andtiiatm/f v Senior, referred
to above arc however no more titan we vvere entilleil to exjicct A senous slur
woul 1 lie cist upon mcdicil science In tlie present da> if our law courts refused
to rccognirc its aid as neecsvarj in cases of senous illness or injurj wl ere relief Is
desired or denied its power to allev late sufTcnng

Statulor> recognition is now given to Christian Science’ in England
for bv the Public Ilciltli Vet I^3C the ^bnister of JfcaltJi is empowered to
grunt exemption from the o{ierition of the \ct in respect of anj nursing
Jiome nhicli is or will be earned on in accordance with the practice and
principles of the bod> know a as the Church of Clinst Scientist

m PNOTISM

Tile pnctioe of suggestion as old ns ancient China and Eg\ pt has passed
thmiigh plnsev of auto suggestion (mesmerism — after Anton ^^eslne^ of 18th
centuri Pans) to lit [motism as first dearly defined J>\ Clmrcot It js used in
the treatment bj suggestion of mnnv conditions of ill health including states
of depression and other mental disorders It has aiso been used instead of on
an'csthelic m certain manipulative and operitive procedures and in child
birth The induction of hypnosis if in the right hands is safe enough and
cannot be considercvl improper

Unfortunatel) the bizarre elTecls which can be produced bj suggestion
lend themselves to public exhibitions which are not without their dangers

tn Dscembpr IMS a girl of IS went to a fotietj programrae at Bngton
where she took p irt in a stsge cvliibifion of hjTinotism given b> a Mr Jlaiph blater
Slater said it would be hantilvss She was easily put into a hv-pnotic state but on
being left for a in iment apjie vred to be coming round Slater ran to lier put boin

Iiands on her netk moved her liead forward and m a very comraan hng voice lou

I cr to sleep She relapsed into a deeper trance „ i.f .maWe to sit

Slattr tol 1 her her cliair was getting hotter and she woul I soon be fo *il

cnit whereupon she jumped from It Tlu^n he said ^ T .e"m! Srted tS

little babv an 1 >-ou will want >our looUier and will ctj ba 11> TI P ^ ^

frv bitterh nnd shouted Mumm> Minnmv Miu^v ^rmal thenstarteil

was going to wake up and she did so Tora week after she felt
to hav e bouts of depression often Jbirtmgbv I er^king up fwl ^ j f ^ fJuP
In the autumn of IDtO she consulted doctors and m 10 0 she un.ierwem a

’“St™ cc a„,l (.he p.je,„e of the S

lesid before Mr Justice Croom Johnson at Lewes tssizes m Mircli 39a-. and

InP^OTIS^I 70

rccullctJ m nn tin-ard of £1 000 for neglgence and £2> for assault together with
fperial damages of £107 (Ilatnifiitl \ SiMer lenes \ssizcs 10 2)

Tic lljpnotism Act, lOji subsequently made such public exhibitions
illegal

The question ulicthcr a Inpnotized subject might be tricked into dung
some inunoril or dishonest e\ cii felonious net isnn important one FricLsen^
attempting such suggestions on oO lest subj«:ts found that tlie\ awoke
rather than carrj out some repugnant act

It IS possible that hypnotism ma\ be used for psycho aniUticil methods
of extracting information yhich would be withheld by a fully conscious
and resistant subject hut it is a method upon which the law would undoubtedly
frown evndence so obtained would not be admissible

»Quote<!lnJ It Itees IfilO Modem 1 net ce in r8>cli atricMtil c e p 311 London
n lUerw rtl

CIIAPICR IV

IDENTITY

IDENTIFICATION OF LIVING PERSONS AND HUMAN REMAINS

The necessity for the ideotifiootion of mdiv iiliiaL is a rmtter of e\ cn day
occurrence throughout our criminnl and other courts, and cases of mistaken
. occur from time to time, none lias been so notonoits as that of

Adolf Beck m I003-L m nhich it was fully recognized that a mistake -was
made An account of the legal dilTiciiltics m the case appeared m a leader lu
The Ttjnet, August 19th, 1904 The points relied upon for identity seem to
hn\e consisted chiefly m the general likeness of Inir on the face, similarity
of features, etc, so far as the common witnesses were concerned On the
scientific side identity of handwriting was the thief point relied upon On the
medical side the principal fact was that Beck Ind not been circumcised and
was therefore not a Jew It is on the legal side, however, tlint the principal
interest of the case centres for the medical cndence (as'biso a perfect alibi)
seems to have been ignored or rule<l out of court The fact remains tint on
innocent man suffered penal servitude through mistaken identit>, and that
this arose not from medico legal defects, but through legal teclmicalities
and police obstinacv , and need not therefore, be gu en m detail here
The factors to be considered in connection with identification and the
questions that ma> arise in connection therewith arc verv numerous Some
can be answered only by a medical man some he more m tlie province of a
detective, while others can be attested bj on} observant witness Most of
these points have otlier important connections in legal medicine, but there
IS no link other than identity which connects them, and the} vvill, therefore
be considered here in this connection

Before mentioning any details, attention must be dtawn to a wt

probabilities in logic or evidence, it is the “law” of multlplicitj of evidence,
and may be thus stated — Supposing onevvatness or fact testifies to a certain
thing, or points to a certain conclusion, then if a second independeni witness
or fact testifies m the same direction the probability of the conclusion being
correct is more than doubled, and if a third aidcpetident person or piece of
evidence corroborates the first two, the probabihtj of the conclusion being
correct bas a jet still higher miiltipljing factor, and in ordmarv cases nmv
be accepted as a certamtv This prmciple has a wide field of application in
all medico legal questions

Identification maj be required m respect of —

(a) A living person or one recentlv dead

(b) Mutilated, decomposed, or fragnientaiy remains

(c) Skeletal remains

81

iDE^TlTi or LI\I^G PERSO\S
The means a\ailable for identification nre asiollo^s

Intellect and memorj
Education

Speech language accent
Gait

Alannerisms tics
Handwriting

Complevion Racial colour
Likeness of features
Occupation marks

Clothes jewellerj and articles in
pockets
Race

Deformities birth marts peculiar!

ties of nails etc
Injuries scars, and tittoos
Anthropometry (Bcrtillon s svstem)
Dacty lographj (the fingerprint
system)

btature, aveight
Sex

/\j!0

Teeth, dentures
Hair Blood

These can obaiousl} be used only
in relation to a person actually
In mg at the time of inquiry

Of these some can be used m the
haing or the sety recenth dead
others in those dead for a longer
lime Mam of these points ha\e
interest other than that of mere
idcntt/icntion thev mil be discussed
fully here to aaoid repetition

For identita m mutilated decomposedorfragmentarv remains Seep 197

For reconstruction of identity from skeletal remains See p lij

Intellect, Memory, and Education
These three features of personaliU require no detailed discussion for
they come within the prosmee of the ordinary intelligent witness Thev
assumed a ser\ lugh degree of importance in the cross cKamination of the
claimant to the Tichborne estates in 1872 and 1879 (see pp 107 109) The
intention of counsel was to show that the claimant was a man of
poor mental power inferior memora and slight education while the real
Roger Tichborne was a man of good mental c'lpaciti fair memory and well
etUicated

Deterioration of intellect loss of memory and acute disorientation of the
mind must of course be accepted as possible explanations for such changes
m character

Speech

Stammering stuttering and lisping are tlic most obvious peculiarities
and tnnv under certain circumstances as when people arc heird quarrelling
or in e\citc<l com ersation bci omc of importance in identification

TJie famous Charles Peace, wanted for murder *, was described m a police
notu e as

* n picture fmincr t»> trade occasionallv elcaris nnd repairs clocks and w ntches
sometimes deal in oleograpl •» cngravinjib oml pictures

lleistlun sliglith built nliout >ft Sins inlicight aged 4(1 looks ten \ ears older-
grev liair nearly while 1 card and whiskers

Two fingers of the n„ht luind bnllj mauleil In n maclunc walks vntli lus legs

IDFATJTl nmTh\o

lo rccogni 7 c a iK.rson h\ the ^oioe nionc would he a riskv nroccedm-r m n
tninunl clnr^jr tiioufrh ,l ,s often enongh icceptcd upon Ls m ?
n«|,s,ons 1 l,c Iml „ „r „ voice viloch coovUlutcv II, c La.,, I,j X '"o
Jicrlnjiv uiiconscioiibl, j, 1,15c voiixv ,le, e„& hmeU o„ ik Xc
o„d Cocc.cc of .Ke oveCooev „„d thes'e ™„, evil! ,, ”, Xc
or arcideiit or of course dclibcritcjj. ^ uwisc

Iherc ate ccrhin k.ml, of speech depen, lent „pon ncr,e diseases ce
dissciiiniatc. sclerosis linlbar p.K, „r genem! pvra|js,s „f the „,„„e unm
lilneli a nicdirnl opinion might In? asked in a court of hi, but the, belon"
loo much to the domniii of ;p;iicraJ jnedtcinc to rcrjuire further notice here’
W c must note how prosthetic dental work, dentures m particular may alter
a \oice ^

Galt and Mannerisms Tics

^\c are coustniitl\ m the habit of recojrn'zmg friends and aquaintances
h\ the iJiar icier of their gmt and from ccrtPin mannerisms Lameness or
oliicr disahihts in wnlkinR might require a medical evammnfion to elucidate
Its taust cspctiaUj if malingering were suspected Unvs of wftmg leaning
moving Iht hands niuvcinents of the IkmIj shrugging of tlie shoulders
movements of the fncnl muscles brows etc, arc often clnroctenstjc and
dillicult to disguise for anv length of time

\t tlifi (rial upon a ctiarge of murder IieM nt Umcliestcr /Ustzes m lOii (It v
jnurh of tlio (inunistantnl cvmience molved round the flanking hi
occiiscdof tlie (lead wnm m a toilet set piece in silver and enamel The min who had
iipiieared nt a jeweller a m the towm next «h> Jiad usedn ri}»e/ imein ditcusung tfie
mlc of the stolen article hut was described ns hiving TtpraUdlj Fcrpl bnti fit fnir
HiW t/ie (tft /mil The jewelli,r rcmoiiibeml him effcelinga previous safe under the
I line of \S iittam rein n led p irtlv hv llus liahit of stroking Imck the hair Lvcii
during trill iieeusod will t denving this i lentifieition eoull l>e s(^n bv the jtitj
to be triwitcdli ttrohugbicl hs hair uiUt llte Iffi I and

Handwriting

The study of cnlligrapliy can scnrcelv l»c considered one of the branehta
ot mctlml jiirispriidcucc

It IS essential bow ev cr tbit the mcdicil jiimt should have a certim know
kdge ol the scope ot this subject so tViat Vie vuis not fatt mlo the wnmon
error of issiunmg tint all Immlwnting experts arc unreliable The trouble
arises from the fact that a numlxr of people who studj mercl> the superficial
characters of wTituig are quite prepared to give an expert opinion as to the
auUienticitv or otherwise of a document and as a general rule the less tlie
knowledge of such persons the more didactic thev become in their stitements
It is this that has brought the handwriting expert into disrepute

In the examination of documents to ascertain whether two samples of
writing arc b> tlie same liand the documents must be pitientli searched
for certain peculiarities in the formation of letters the manner m which the
upstrokes and downstrokes are formed cliamcteristic methods of joining
certain letters together and so on. Tliese peculiarities are then searched for
m the second sample and if the two are by tiie same bind it is practicillv
certain that a number of the same peculiarities and chiraotenstic forms will
be found Of course these must lie m siifliaent number and suflicientlj out
of the ordinarj to exclude the possibibtj of a cbmee relationship Tjie

IDLKTITY rE4TUl{ES S-J

greater the number of nonls to be compared the greater the tlnnce of the
expert to detect sinnhritics, when, there arc onij a few wordi written it !■»
often inijKJssiblc to give an\ derision

Tlie subject has become of great importance since the examination of
documents ink etc , has passed into tlie hands of tliose ipnlilied to exaiiiii c
them and though the science can nexer attain the state of certaintj of
finger print identification, it has great possibilities The detection of forgeries
and additions to wTitings made at later dates has been made easier infra red
and ultra \ lolet photographx , but this more exact science has nothing to do
with identitx problems and xsill not be discussed here

Complexion

This IS an important identitj feature m the In ing and in the recciitlj dead
Ihe racial differences between the extremes of skin colouring are marked
enough but \ital sliades like pale florid sallow, etc, tend to disijipcir or
niter soon after death Organic changes in the skin such as freckles jumjiles
etc , are more enduring and are hkclv to be recognizable for some little tune
after dentil provided decomposition has not advanced \cr\ far In judging
the colour of the lomplexion it is most imjiortnnt that the individual alive
or dead be exammed bv ordinary da>liglil form the usual forms of artihcial
light, with a large prepoiulcrante of vellow ravs the finer shide?s of skm
colour are quite UKlistinguishablc, even deep j umdice cuuiot be appreciated
w ithout great diincult>

Von Luschan s skm colour tablets used in nnthropologv are particular!)
helpful in determining racial identity

Likeness of Features

During life the general expression of the face can be so rcadilv altered
that mistakes can easil) be made The notorious Charles Peace who was
executed in 1879 xvas so clever at disguising his features bv voluntarv move
menfs that he was said to be ab/e to converse without discovers vrifh defec
lives wlio knew him After death such vohintarj alteration is of course
impossible, but death so speedilv aUer?> expression that too much reliance
must not be placed upon this mode of identification Photographv is union
ousl) an unreliable method of identification unless minute details are con
sidered

“swkswvKvlss ’(R X Mantwi QedCatvl Xsxwca IftVtVvtvv vxoAtwwUed
that when the profile photograph of the v lelira was Hashed on the screen of the local
cinema and placed in shop wandows in efforts to identifv her even lierowi ihughtcr
of 17 failed to rcoogni/e the likeness of her ntothcr Tlurlj nine nlcntitv visits were
made to the bodv and nine people positivxlj identified the vactuii ns four diffcrciil
women of winch she was not one

Tlie details of features are more enduring and more satisfactorj as ev ulence
of idenlitv Tlie colour of the iridcs, possiblv dilTercnt m the two e\cs or
with peculiar segments in them the size of the cars and their lobes the
length of the nose, the shape of the dim lend thcmsclv cs to exact observ atiou
and measurement, ns m the Bertillon svstem, and inav lead to definite results
in identification An artist or draughtsman is however, much Iretter qualified
than a nictlical man to speak to such details Hence in bastard) cases a
medical witness must be cautious m drawing deductions from an ailcgod
likeness between the child and the putative father Vide the Slitigsbj case,
1016

84 IDENTITY' FEATURES

The identification of persons by sight alone leads to endless mistakes in
ordinary life without any particular inconvenience, but such mistakes
occasionallj occur in connection witli criminal identification nith possihlj
serious results

In 195 i the p1iotogm|ih of a man “wnntnl for interview ’ by the police in connec
lion with n murder in Kent was televised— for tlie first time in Englisli police
bistorv Scores of people s\\\ Pettit” dunng the nc*rt few da^-s, some simnl
laneously m places hundreds of miles apart lie was, m fact, alreadj Ijmg dead m
tombed out Citj premises

It IS common experience that the average truthful isitness is nbsolutcK
unreliable in the majority of cases when asked to identify a certain induiduil
whom he is supposed to li ue seen Nearly everj person has others wlio are
more or less like him, and occasionally this resemblance is so startling that it
IS impossible to recognize the difference between the two people when seen
apart A good example of such resemblance is seen in the famous Fox Twins

IDLMITl occur iTI()\

but a more remarkable case is ll at of tno men quite unknown to one another

and unrelated (Figs - and 3) who were m tic same prison at the same time

Fig 2 PhotORrarl oft' hWesl So TPC of the VS Pen tent ary
atlx'aten orth

Fir a PI olofrnpl of tVJII am West So "ftir of tl c same Pen
tenliar> He*<t o me were In pr o» at U e »an e t me Tier
I njzcr pr ntsi were of co«r«e d fferent m Innumerat 1e respects
( Ifter mu r a clUe rrortA Ptrsonal Ident fcaKon p 81)

1 ore tl e same i ai c nnil bail prirlicnll\ ll c •«in e Bcrtillon measurements
Tl cse examples serte to show the great d mger of sight rtcognition in
criminal iclcntiflc'ilion In other inst ii ecs the same iiulit idiiil ma) lie com
pletclj clianged by inotlifcilions in ll e intll <k 1 i f triii Tiling the moustache
or beard or b} shat ing as seen m 1 I

Occupation Marks^

These are of two classes (a) stains etc oF recent occupation such as
spots of paint on painters ami dccorilors dtc m dve workers grease in
engineers and mccbamcb dust of noiir m bakers and millers and so on
In the absence of stains t r marks on the clotl cs c% i Icn c of occupation
and 1 abits may be found in the dust and tUbnt m the pockets un ler the
finger nails and in the cerumen m ll e ears Alicrosct pic examination of dust
and debris is of prime inqiorlniice as an oi ! m the idcntir cation of unknown

• hora jrcnrralofi ele cr? tt l Ifct c /rhttrlir* P jaifl P f mnf f I J

80

IBENT2TY CLOTHES

Tio 4 Twoiljoto'ToplisortlffS'imep^non 7)te f nt was taUn in
November 1008 and tl e second in Decemt«r, 1000
(lifter tl i!d«r and l> m/JtvrtA J^ersorm! Jdenftjteefion )

bodies a clue to tlictr last wliereibouts or a link with a person suspected ot
crime

Apart from the aboie evidence of the social status habits etc of the
person ma} he obtained from the ^feneral condition and state of the clothing
Its obMous salue cut and finish Tlie cleanliness of the clothing and shiii
and tlio care which has been taken with the nads teetli hair etc may be
points of nluc

(tl) More permanent organic changes which may recen e brief notice here
TJiev are generally speaking of more \aluc when tlie boil> of an
unknomi person is found under suspicious circumstances than m questions
connected uifh living persons though in the latter the} may afford useful
evidence corroborative or otherwise of the tale of a prisoner The homv
handed son of toil can he thus easily distinguished from one who has not
performed much manual lahouf the callosities on a bncklajers thumb
those on n harpist s hngers are examples of more jiarlicular trades as also
arc anthracitic stigmata m coal miners In modern tradesmen there is less
tendency to tlie formation of trade marks or deformities but if an unknown
body IS being examined all marks resulting from occupation should be des
cribed and photographed

Clothes, Footwear, Jewellery and Articles In the Pockets
Tlie clothes are nearly always of value although manufactured m large
quantities of identical nature and should Ije preserv ed with the greatest care
The name of the tailor or maker on tlic tags or buttons of the cloth^ tlie
piesence of laundry marks*, dyers marks or repairs should be recorded at

for idenlily marks in this way

iDr\TiTv lucr sr

once \^ntclies frequenlK ha\c pnvate marks mside tlie cases made b\ the
natchmakeni ^^ho ha%c earned out repairs All contents of pockets, must he
rcconlcd and filed %Mth preat tare

In lOjJa man named J’ettit uTinted lit tlicpflluc m cnnncclt< u uith a murtler
in S !■ Ixindon ttas found dead in h mhe<l out Cit^ pmniscs so de< omptssed that
identitj Imd to rest mth clolKinp papers therein— nnd teeth A letter hcside tl e
bodj ttas identified ns m Ins imtinpand a card bcannp the winteit man s nam" was
found ill the jacket poiket it referred to dental treatment it Giu sHospital pitmg
n nie number from whicli\ rnj and other dental data cvacti} comparable with tliose
of tlie dead man were obtained Thej bore the name Pettit

At nil inquest held at Southwark in September, 1953 a man s bod^ re
co\ered from the Thames as as identified b>

(а) Clotliing includmp a shirt marked L254 — a Inundrj mark smiilar to

that of the landlad) whose lodger the dead man was tlinught to be

(б) Undertlothinp similarlv marked in the loilper s chest of drawers,

(c) A ke\ m the jacket pocket which fitted the lodgers door

(d) The general features of sc\ age height, hair nnd skm colouring

Iso distinguishing feature was present

A bank book ration book N I ca^ nnd ideiititj card still lay in the
vacant room they rcinaiiied unclaimed

ariiing should he gis eu against accepting laundry m irks on sm ill articles
nsesulcnccofidentitv, liandkerclnefs etc , are easily transferred or misplaced
and arc unsafe clues

In /? \ lltalh (C C C 1040) the ankles of the victim of a sa listic se\ mimler
Marjorie Gardner were found to lie tic1 with a liandkerchief embroiderr I with the
letter * K ' and laundry marked L Kearns No one connected with the case
had such a name

Race

This IS a method of identification which is not infrcqucntlv of use in seaport
towns The hair (vide under * Hair ’) the skin * black m the Negm and some
other races dark brown m Indians and some other aboriginal races yellow
in ’Mongolians the lips \arying m thickness nnd slmpe, are all useful for
identification if deconijiosition has not procccticd too far If hones alone arc
found racial identification is exlrcmch dilliciilt and should not l*c ittcmptcd
by the ordinary practitioner The help of a skilled nntliropologist sliould he
obtained in all cases *

A careful examination of skeletal remains quite frequenth tiuihlcs the
cx|)crt to arnse at fairly precise inromiatioii coutcnimg old iliscasc nml
formations nnd injuries winch oflcii lead to n jursonnl idciitificntum Cases
of this sort. Ill whuh hhiidncss motic tyc wiyilcek jiar iKsis m tlu Icgiiacc
been diagnosed, hnic been published ^

Asymmetry of the Body
Deformities and Birth-marks

Developmental stigmata arc most important nnd must he acrv tarefuliv
noted in the extcriml examination of a dead hodv ns well as in dcstni>tn„
the person of a li\ mg iinhv ulual ’'foies nawi port wine stains are all tlis
linctne marks, easily seen on liahies ind \oiing children noted ami

* Hie skin tints imy measured mote acmimtcli i»> using \ oii I iiscl an < skm
eoloi r tablets

*I<JrTnvor I C IOjO ( ikimlirn I ne}(Io| II I2S

•Sinltli s. , ia3J lolcft 12 3 4

lDE^TJT^i i^TIlROPOMETRr

remembered by nurses and mothers, nnd frequently (eg. m Arthur Orton’s
case) used as means of ufcnfification m later n ears ^vhen prolonged penods of
separation have altered the features of a child’s face beyond rccomntion
Here ne get an excellent illustration of the principle of miiltipliciti of e\ idcnce
enunciated above Thus one smaU birth mark of an\ p-irticulir shape, say
on an arm or face, is common enough, but to get tno of p-irtuiihr shapes
on particular parts of the body agreeing -with knonn marks on an individual
IS very rare, and if it were found that n corpse or hv mg individual possessed
three such peculiar marks, it would lie a practical certainty that it or he vras
the actual indniduaHiho nas previously knowm to have three such peculiar
marks Clubfoot harelip cleft palate congenital absence of limbs or parts
of them permanently split mils congenital dislocations etc etc, arc
further illustrations of deformities winch are of value m identification

A case is reported by Berk m triiccli a girt Salome ftotter, iuiil ficen sold as
a slave, but her ulcntity as the child of Cerman parents was proved after Iifteen
years by two marks resembling moles about tlie size of coffee grams on the iiivuie
of the thiglis Thev were proved to have e^sted in the child and to exist in the
same parts of the bodv of the girl ciglileen years afterwarth After much hligntioii
she was upon this evadenee pronounced to be a free v« omen

Injuries leaving Permanent Results
Ojierativc and other scars tattoo marks (ii/e below) dental extractions
nnd plastic proc«lurcs come under this head and so rlo unwiitctl or IwdJy
united fractures of liones \mpulatioiis by trauma nnd operations on joints
form perhaps the best renminmg illustration but tlicse nrc so common that
standing alone, they would be of small value Associated with other points
tJiev acquire J^crc^sc<I importance and the date of their occurrence might
be very useful as corroborative evidence
In the trial of Crippcafor the rounler of Cora Cripiicn (BcUe Llmorc)thei rtsence
of a 4 inch sear on a pieceof abdominal skin was on important factor m tlicidentih
cation of the remains as those of the missing woman It w as shown bv the cv idence
that Jlrs Cnppeii had had an operation in that part just before t?ie mamasc

ANTHROPOMETRY
(Ber/tllott'* St/s(em)

The idea of elaborating the desenptive data ordinardy to give some
picture of a wanted or missing person so as to give it more mathematical
precision was proposed bv Bertillon m 1882 nnd was soon adopted bv the
Trench Government Tliough i£ fias now become superseded by tffe more
exact data of dacty lograpln , the basis for agcncral description remains much
the same

Bertillon relied upon the following —

A Beswphtc da/a—colour of hair, eves, complexnon shape of nose,

B

C

3odf/ such as moles, stars or tattoos and deformities sue i

as hare hp shortened limb or club foot
?ody fneastiremerils — ns follows —

(a) Standing and sitting height

(b) Arm reach

(c) length and breadth of head

(d\ T^nrFth of R ear and breadth of cheek

(e) Lengtii of L foo*- I* nnddic finger, L forearm and hand to
tip of mid finger

lDn^TIT^i I i\GriirjiiNTS

80

These (lain entered on n card file topethcr with a full face and profile photo
gmi>h provided an indcv winch formed Uit basis for criminal files for many
jears

“\\ anted ’ notices and the familiar FBI posters circulated m the United
States use tlie same major identitv data Imt the ilctailed measurements
have of course become replaced In a fingerprint code

DACT\LOGRAPin
{rtitgerprtnl System)

\s long ago as the seventh centurv finger tip imprints m ink were m use
in the h ar as e\ idcnte of goo<l faith in tlic sealing of bonds or the issue
of documents The British Museum has a MS dated VD 78i hearing such
impressions being (marked) m the presence of each other * Such marks
were however not comparable with the hiii prints used for modern identi
lication consisting inerclv of lilobs of ink m u!e h\ the finger tips thej lacked
ridge patterns and cannot therefore have been of much use m ideiitifvmg
their signatures

The modern stem of <laet>logrnphj ilcpcnds upon the development bj

[From Forei lie Me<I etne , fc / ^ Sm It tmdh hdJra
I lo S FisiOeiii rists
A Vreh n I-ooj)

t Wlotl U Cotnpoaite

• Giles I« 11M7 Fill Set one t ^tud /»riJ Lnic pp O-iO

^ IDE\TITi ri\GElll>Kh\TS

I’,"'”','’' “ r’”'™ of ndgcs on Hie slun of the bills of the

pittenis Ime n nnjor design (stionn in Fig 0) nhieli cnalles them to be

n icrJetnil'"l7b ".'’"'"’'’i “"<1 » comideriible nmomil of

liner detnil of bi-ineliiiig onil toaleseeiice of ridges of island cote and delle
nrningenients perniitiing sub grouping and an unlimited quantitj of er

OT BiHler >’°'V f ‘"''■'“'“‘‘I "■'!:« The Hear? Conlat Fleek
or Bittlct siiigle-pniit sj stems refer to jioliec methods of classifjme
siieli records in such a iiaj ss to make llicni easj to refer to for the pliposet
of conipnnson * ^

Classification TW <JctnK enable fingerprints to be classified primanls
{ns m i ig G) as loops (about CT per cent) of sshieh all but some ^ per cent
arc ulmr le open out towards the ulnar border of the arm, wliorls
(about > j per cent) and arches (6 to 7 per cent) or more composite forms
co]npri'>in^ tiie ran'inmtg 1 to 2 percent. Lme tracing and counting enables
tliese nniii groups to he broken down mto sub groups and final identifica
tinn IS effected bj a stud} of ridge pnttem

In practice 1C to 20 points of fine comparison are accepted os proof of
identit} but of course an unlimited amount of detail is rfsailablc in ans
small area— cNen a small part of a single print Details of these can be
accuratcl} tekprmted for companson in modern crime file departments so
that a search of the records, a comparison and a repiv need take onl> a
few hours The details that are present at birth remain for the rest of the
indiMdital s life unalterable capable of defacement onh at the esqwnse of a
senes of new identits data the scars left when the defacing injuries heal
Palm and foot prints mas also preside similar material for companson

In April 10}'’ 21 n old pawnbroker was found suffering from lietid injuries near a
rifletl safe in tl e basement of h s shop at Shoreditch lx>ni]f>n he died seseral daj 8
later V single | dm f riiiton the safe door led to thecon>iction of two men wl oliad
phmicil a r II I of tins calibre — though possibly neser Intending murder (/? v
DnsJ rood tt Sit'erosa C C C , ItVtS)

\ safe robber) occurred m Lanarkshire in 1!) ’ and examination of the premises
resealed m me bare footprints m a film of flour on a hard floor On the s.ife two
fiiTlher prints were found and one of tlie^diowe ! clear ndge details of a great toe
\b( lit a niofitli later a well known safe blower was arrested on enclosed premises
and taken into custody lie sras cautioned and charged with the safe blowing
robbers j rmts of Ins bare feet gis'ean esact companion (from the left big toe) with
live y>s\wl Csv.ww.1 os\ live. ««i(e at tlie v«oe pouits of s m Lints srcre noted A
conviction followed*

I ootpnnts are also useil m \menron maternity hospitals as a means of identify
ing tl e babies of iiiatcrnit) cases which might be inadvertentl) nuxed

The Individuallt) of the Fingerprint The credit of iiitroducmg tlie
fingerprint to crime records undoiihtctUj lies with two rngbshmen
Dr Henrj Fatilils who first publislietl an account of the method in a let er
to Nature on October 2Stii 18SO and tohir Ujlham Hcrschel raulds was
umloubtedh aware of the importance not onl) of thd ten finger rcco s or
identification but also of the possibibt) of recognizing chance impr^sions
or identiA mg mutilated remams in this way unfortunatelj Ilersc e c attnei
a precedence for using the method of some 20 V ears and had i twou appear
submitted a report in 1877 asking that tlie method be useil as a means ol
identifving prisoners An acrimonious dispute over pnoritv achiev no
decisioiu but it appears that Faulds sliould be given priority It rernamed
•Scott P iaa3 PoleeJ 2 10"

IDF\TITl mGnitPRI\TS 91

for Sir Fnncis Galton to pro\c the indmdinlitv and permanence of the
fingerprint and to de\i<ie a classification for criminal rreo^s winch was later
simplified bj Sir Edward Ilcnrv of New Scotland lord
Iso doubt can possiblj be entertained as experience has increased but
that the finer ridge patterns cmpiiasized b\ Locanl as being so individual
are in fact so— and pcrmancntlj so

Tios G-8 Finger and fool print clues Icfl in a hospital ward b\ an mtni ler wl o smt 1 ed
a clilld from n cot and murdered it tn tlic hosp tal gro met (ft v Crjfilhi)
CourUsy of He Chief Camtime Lancashm
Fic <1 A wme/wster botlle hearing finger prints (mide
observable 1 v d isting with powder)

In U \ Griffiths'^ a child had been picked up nut of a ward an I was fminl
TTUrtlered an I moI iled in the hospital grounds Several Iingur impressions foaisii
to the hospital and mv estimating staff were foiin I on a \\ iiuliester bottle under the
cot (Fig 0) In tlie endeavour to locate tlic person responsible the \ar1 police
obtained the approval of the public in finger printing the entire m.ile population of
the town — no less tlian 4.1001) n.oonIs In tlic last few davs a man a known
epileptic was found to give an identical ptuit lie made a stateinint which further
incriminated him and on this au I other evidence was found gmltj
» Campbell C MjO Polu:eJ,2i 102

®- rjhGEBPmST TSCIlNiqVF

As a part of this enquirj all rn&Ush American atnl
l^ere also searched for this print no similar pnnt was found ^ ropenn records

Galfon estimated the chances of simthr prints from difTerent fincers as
being somelliing like 1 m 6t thousand million it -was a speculation It is
more significant to remark tint ncser jet m tlie world s enme rccords-ss
nmn\ as 320 million in Hooter’s TB I olTice at \\ashington alone— hare
two identical fingerprints been seen unliiss from the same finger

Techniques of FJniierpnnting Fingerprints nnv be impressed on to
some rehtnelv soft maternl ns mo«l led j»jpre??io;M rcqmnng onl\ suitable
lighting for photographic reproduction Hiej ma> also be rmble owing to
the contact of fingers coated uith some foreign colouring matter as in lliose
made for police records The \ast majoriU ot prints encountered in criminal
mtestigation are howeter not plainK seen until the> ln\e heen retenleil
In brushing with some contrasting coloured powder or devdopetl bv
means of some chemical like osmic acid orsiher nitrate

These latent reproductions of the ridge characters are due to the moisten
mg of the skin b\ sweat and sebum from the skm glands A smooth ilr\
surface touched finnl\ witliout sliding will reproduce a mirror image of the
print in sebum a fine powder like white lead powdered aluminium orh>drarg
c Creta (or for light coloured surf iocs lamp black or red o'side of lead) dusted
svith a soft bnish will desclop or res cal these so that tlicj mas he photo
graphed Should photograph) not lie practicable the print mas he ‘lifted
on to cellophane tape applied ssath great care and then peeled k^ntlv awa)
Cardboard and papers such as anonsmous letters into which the greasj
Sebum mas become absorbed mas be treated sritli iodine fumes silser
nitrate (reacting ssith the salts) or osmic acid (reacting witli the falls sub
stances of the skin) Treatment srilli 1 |)er rent AgNO^ drying and then
des eloping with mctol qumol (fixed bj hsposulplmte) apjiear. to be satis
factor)

\n interesting method hs which latent jmnls on paper mas he des eloped
has been described ^ The paper is sprojwl ssilh n 0 2 per cent solution of
mnhsdnn in acetone followed bs liealmgatSO C fornfew minutes Derelop
nient of a pink coloured jmnl continues for some time after rcmosal from
the os en and tlie prints attain f heir greatest distinctness a das or two after
treatment , ,

The test is due to the deposition of free ammo atuU from the skin on to Uie
surface of the paper , ,

Peehno finger pads in sictims of immersion m water or of decomposition
ma) be photographed bs transmitted light or res creed Dried skin ma)
be restored bs immersion m I per cent caustic potash

Uses of Fingerprints in Practice The principal uses to svhich finger
prints base been put are

To rncinlfltn identi/p rreorr/j (scrsice or enminaJJ

To timUfy a prml left at a seem: ofenmr-lo i^oeiate the »cne (or a
weapon) ssith a suspect

Fig 0 Illustrates tl e use ot tlie ptiut m this case of the patin
cndcnce of ivlio held tl e ireapon in cases ot slabbing and other i™'” £

Aecused a coloured man stabbed too fellon countrj men m an East lain Ion "K

f„ wl? A biife idcntiliedash,, IcK a* »oc f the mine Kiic bi, r«ht palm
print undisturbed He teas cons ictcd ot manslnilihlcr (lit Ateli CCC
»OdJn S andsonllonslen B lost \<ilire 173 413

FIKGUtPRlIsT PliACTlCE n'

In lOiO a man hrokp into the liouspora wll to-do reclu-,e m Maidenhead, bind
[ng gagging— and siirTocating— tht old ladv who tlircatened to disturb his crime
the bodj was phred in o trn\eUin^trunk where it was found upon search two daji

1 1( " rnlirgement of 132 1 on bottle coinpnn t «ilh ri^lit finger \ niit of siisi>eet
(f MfrI Ig fl)

tatcr A solitarj nngeqirmt was found on tlie li] of n jewel bos diseanlcrl m a
living room and search in llic files showe<l that it was from u C It O file man called
Itusscll lie was traced arrcste<l nnd on Ltcing liken into cusludv, found to be
wearing n scarf knitted In the old hdj he had murdered Convietion follnwerl
(/f V /fiMtelf, Heading issues)

To ide«f//»/ a missing person

The victim of the I uton Sick miinler' was idenliricd after three months
fniitless house to house visiting showing of pliotogrnplis nn I eireulilion of identity
data mdtidmR edcntu^rius jaw easts Va n dver a tag m n piece ot east oil etothing
1 Ills led loan address from v^ Inch a woman hiddisnpj>nred at uboiil the time of the
murder \ picklc jar King on a shelf Killing to a cellar bore n Rngerprmt identical
with tbit of the victim (recorded at the lime auli ps\ was made three months
previoiislj) It wis m remarkably goo I condition m spile of its ago
Fo ulenlifi/ Aiiwinii remains

A case bis been reconled’ in wlmh lui mtnilcr at lugbt disturbed by a woman
^crcimlng rlniificd his Iniui over her face but bad the lop of bis indev linger bitten
iTI Ttn I'liysJittr a man was arrested nnd loiindtohave a comp’iemciitirv linger,
mutilated by rough amputation of the lop \rcuscil Inppcncsl to slate tlml he
1 nd prtviousK liccn am stmt on n f ilMicIiirgc iiid reference In the records shosred a
right III lev fingiqinnt identicil willi tluil bitten og In tbo woman (1 ig 10)

Under the Criminal Justice Act, 10i8 am jwrson over 1 1 tears old who is
in custodv cliirgtd with nn olTuicc before n court of summary jurisdiction
ninv, on the cmler of n polite oHiccr not liclow tlic rank of Inspector have
his flngcrjirints t iken irrtspcclivc of consent In Scotland <nmmon law
assent for Hit same procedure has cxislesl for minv vnrs

riit detailed ttchnical aspects of fingerprinting nnd of the development
nnd photogmphv of 1 itcnl prints inav be further c\]>lorcd m (he following
writings on tlic subject

Bridges B C Practical ringcrjmnting Funk Wngnill Xew "iork, lOIJ

(cot linur I on p U*’)

*S!riipion K.lPtS ioficrJ 18
*'5m»h,S, JOW.rWiceJ 13,148

1 1 Qjwrrapli «rirft toiA mirV. on »nM

rOOTPKISTS

l'i« 8/ 1 i c>to„rn|!i of left t,trMk njifed ro> t fn r rill K nl IcttrCnlltl

(( llr 1-lR O)

Fio Ob

Fic 9 Btoodstained paJ n pnnt on Uade of Ln(fe («) aflrged to haw been ««d hj
accused to commit murder togetl crwilhcoinpariwnpth t (6)sJo ing fine ridge iu.irUig
from patm of suspect {R \ tMa)

{Courttsjof CommltgionerofPoliee 1 1 ihe Melropol

fio lOi Iclmtiricationof I tnnn ^ mini f r roMfcrv v (h
Motrnw I \ niMn^oftlicnn^oq nut TIkIij ofltpnit'Tr
V, IS bitten off hj a setc'immL umnan o\<r nl o»c face
tl r nmu ch|i[ ed n lumi mil kft at the kyik of the
rrime \ sinillir (nnl h\ hied in tie ermnal riiorls
on cc (I Ig IIW) *

ix

Iia lUb

»Mvcr J I , ion Cl mificntion of I ingi-qmiits US (.otenmunt

IrmlitKOnicc \\asliuiRlon

Uirrnll 1 a Jn’l ThcPingcr Fniit S\sUin nt bcolhmn nrcl tol -n

SlntKian OOicc

"iiiiIkH C I<nt( nt 1 ingcrjirinl D^tclopcr^ Police J 11^0 23 111
‘Smltli «t i&w lolreJ 13 2

U 1

% IDr\TJTi TEETH

Stature and \^clglitin Identification
If It were not that the obnoiis is so often oserlookeil one would sas that
in tl i In n^ or rccenlh ik-jd these tno points were too ob\ious to require

I II li n L^^ct mensuremenls. of both should be made and recorded where

r f ( ssible*

Ii worl s on I lnsiolog\ when the subject of growth is under thscussion
I d lev of increase ( f length and weight according to the age ore commonly
inserted but tlie\ ha\cacra little medico legal interest for the> deal onh
with ascrages and it is common knowledge that exceptions are frequent
I \idcnce from a ATitness regarding a person whom be had known some time
I cfore as to height and weight must be accepted with caution

Mioiit 1 _ in in men and J in women can safeb be subtracfetl from
an\ stature measured in footwear (Boxd and Tresor)* Further the heiglit
1 mloulitcOh diminishes dimng the dat Morant’ esfimates (his se((hng
clown tonscragi iboutO a in to 1 Dm b\ the end of the day

It I as aLo been sliown that IfanousTiers GO year old statement that the
corpse length avns as much as 2 cm more tl an the h\ing stature is m fact
true * These things must be taken into account lAhen taking statements as
to heiplit for idcntit\ purjioses

Tl e subject of estimation of stature from fragments of a body and from
I ones possesses sere great interest and will be found fully discussed under
IdenUU of Bones (p I4a)

TEETH

The tectJi iindcr natural conditions of decomposition are practically
indestructible They therefore offer o\cr on almost unlmiited time an
CTceJIent means of identification Jn mfanev and childhood the\ are fairly
regular in their deselopnicnt and appearance and tlius oflbitl also a %ery
useful criterion for the CAtiniation of agem aoungsidijecls \\emust discuss
tl e (ectli from both paints of \ieu

The Teeth as a Means of Identity

In am ease in which ulenfifs ma\ pos-sibly come into dispute the exact
details of the dentition of both jaws must be most carefulls recorded ^^e
mas enumerate the following points —

{a) Tlie number and situation of teeth present whether deciduous or

’ffiViirnnyiK

{b) The number and situation of teeth lost, including any esidence of hosv
long lost

(f) \n\ peciiharities in tl eir arrangement, c g prominent or the res erse

crooked or straiglit crowded out of place or not
(d) The condition of those left as to erosion periodontosis their colour
and cleanhness tl e presence of casities m the teeth and t/ie exact
situation of fillings

(c) The presence of supemumerars or uneruptetl teeth

(/) Hie details of brKige or crown work of inlays and of dentures

(g) The exact shape of etlenlulous jaws

M\ I ere « "lun; m»cl not hi fc tte M, w 1 1 >* esUmalrf

nip«on Ixindon B ittenrortli

’ Slornnt C M lOoO D olog’f 16 * i IVS"! 10 lia.

‘Trotnrr V un J Gk«T G C iner J phjs Anlfmp (VJ. ) ID 1-lX

ji)L\rnY rniTii oy

It IS ndMMiblc to Mihniit nil surh rn«cs to n deiihst for cNniniimtion, ntul
cspccinIK vhcncNtr iinpnvsion "iml in>ts nrt d<siral>U

The follnwinjj oUl eiisr ruonlrtl In Tu\lor vliows llml lit wa-* \trj mutli
alue to the im|>ortniicc of notitin^ llitst |wints -

fn/f > V C., ISU) it ftpjxmrrtl inciickm-c tint (lit (I(ocnM(1 rmilino

^^aKll nnolil IrisloMim in li ni Infn n (KitldlK « ilitiUil li\ the iirisnner toeomcnml
IKt iiith Inf inul Inr liiisl»nnil hut nfuitil Houcsir, she at 1 l^t foii'cnlrd nnd
Mcnl to the prisoner’s loclglnjjs In (»'*o«linjm <» 1 Mils on tin CMnin^ of \n^iist 10th,
ISSt, talvinj: with her iitml oml anoM I>nsktt,f^lIus\huh^ht m isati uslomtil to sell
laps umI t tlier nrticlts I mm tint rsTiim^iill trncis of the iIwc-ivnI nrre ! ist 1 he
testnnons of the primmer n son \ihu w is tlu ihnf ssitm-sv for tiu (nnin sunt to
pmscclearis thitthc ileeiascd hiul iH'en ssilfiills MiIT>ealMl ontla PMiini^ofhcr
nmsai h\ Ins mother (the prnontr) | I'leiiip tier InniN over tht mouth of tin
•leccascsl and prrssinj; on her tliest Ifi «lr|MiHctl lluit on tht fi tiosvin;: ini niint; In
^as^ tin de td tmds of tht old ssonitm l\ni^ m tlie iill ir of the hsiis< and on the
csxnln}; of the same das hesass Ins mother Irisi Ihehoim ssiIIim iiitthin^ I irgt an I
hrass in a sack

Noss It >Lip|>enid most hintpil iris tint on tite mne of Aiii.nsl 20t|i llitdts
following the nllcgeii murder, an old stomnn of tlw d(siription of tin su|>iKise<l
dci'ensed ss-ns found I>ing in lh< Klrint in tla immi liilc nei„hh urhood in a
ronipletcis c\h ntstetl eonditioii nnd in n most IlHhs and s<]u dut si tic On Ii> ing
questioned she htntul tfiat her ttinie ssns (nroliiu Uthh and that slii aisnnitisx
of Irrhni! Ihr lap ssns found to tie fnuliiml in tsuisi-ipienis t f isliah slit si'ns
rons-psed to the l,on1oii Ifospdat sslan she siiiiseqiuiitiv ditd uni a i* imriid
Tlic prisoner Itms, srhen appntnndeil nssirted tint lids snis Hu finiile sihoin
she was ncciisctl of lias inp nuinlett'sl Ihoce It Ik-s inu hi„h1s Imp rt ml, for the
ends of justUx, tiul the i<lentit> or non htcntils of llit ts\i> in men shmill Ik
rlenrlj cstahhslietl

Tlie e\lraonlIn m restmhluKT of nimes nnd the cm«i (siuKiUntx of tunc
nnd pbre Blnuk esrrs one m court hut Its the t xaninntion (f aliotil tiixntj
ssilttcsscs, (lie rotloiiing |ioints of liilTinnes sitn rh< itisl It tins | rosed tint
(lies MTft Itolh rnsliM-otnen hut (nndnie Walsti e-iine fn m Kdtenns Can line
^Neisli from ttaterford Tla fomat (tla nlhvd iinmhnd jurson) was eights
four } cars of ape, tall of a salUns mnipU moii ssith pns lunr and li 1 1 ( in e\tn
onlniAts cirnimstnnee for her >inrH) sers farfut iniisor let Ih The littir
Caroline ttehh («ho <lle<l in the f^otahm Ho»| i(nlj sms nhoul sists sc ips of apt
tall of stature dirk like u mul itto hut lind no front let th m nihlition to sihah
It wasdcposctl tis nniedu-d ssitness tint ttieidviot irons dies (s>rns|Kindinp to th« m
Afld !/«•» oW//rrni«/ /or a fonridmiWr timr the ssitmss hn u„ht tin skull and
Jnsi Intnrourt — fur the heals h id Ikcii |>ur|M>s4(s e\hiiin d for hist vainiiinlion hut
(he Judge, /xml Ih riifun inndd no( nilou it t • Ik* imahrced an 1 1- ltd lie ttould Ik
M itlsfled ssilU the siitness s stattmeiit res|KetMii. Hit tondilion of the j im-s

Other cirruinstantnl IHunts of diffeniiet s'xn deposid to iv» for example
that Carohne l\a1sh sms healths rlnuils ind iicnt in lar jarsm nml her fetf
ssere perfectls sound Caroline \^cIst^ svas ennsi hndds rmuntul, site ss-ns m a
dirtv and niilo mndltion her Inp sms I>r»>ki n htr/nlnen ros t red inth hiinioris
nnd excrcsecnocs and one tiK ostrlipjtcil nnotlirr riic dri'ss of Ha two ss-oimn
ssns fcomesslut slmihir Tlut of tarolmc ^^nlsh ss is jniseil to hist Is-cn soli
hj the prisoner Hoss to diffcn nl jsirsoiK, nit I nimt si cstrs arlitU w is rcprmliiixd
m court and sss-orn to hj ssitnesses The clothes of Inrohnt XliUh were pmsxd
to liase lieon burnt hs onhr of the pinsh nuthiinties Ih lit of these sioinen hid
similar huskets in tlair posstssion tiuil of liiroIiiK ^^at h luil no hd or eoscr
sshilc lint fouml on ( irohne >\tlsh liml n eoscr Ixist the hods of the latter
ssa-s taken up from (he hurnl prtmml of the Iximlon If isidtal h r the puqiose of '
identitimtion, and it sst-S sworn hj Isso of tlie prninl dauphters t f (.an line Wnhh
not to Ixs the IhxIs of their prandmolhtr

Tins ssas a sin(p.ilar case of dispiitwl idciititN fiien was a eoiiitidt^l
name, time place, ape, tKcnpilion, niicl circuiiislnmc's so cxiriordintfn ••
but for two cirtuinstunccs it is fiossible that the pnsoncr might IftVv' i
acquitted, tlie bodv of t}»c dtcciscil not Imuii,' been fniinil, allli,rt^

100 IDF^TlTi TEhTH

dissccimjr rooms m London Arere repeatedly ^cnrchcil for it, Thc^e iircum
stances y\ ere— first tint the relatncs of the det-casetl swore tint the exhumed
body was not that of the yyoman, and secondly, the incdiral pniof of

the entire obliteration of the nheolar cayitics in the ja« of the c\!iiitne<l
l)ody, proymg tint the incisor teeth mast Imye I>cen lt.st Ion" bcfirc ilcalJi
yyhilc seycml yyitnesses testified to the presence of llicsc Icclh as a stnkun
pcciiharity in the missinj? yyomnn fyen fnd the ftatures of the txliunial
l>ody been obliterated bj putrcfnclion the non idcnlily would Inye l>ccti
established by tins medical fact Uic pnsoncr yyas conyicttcl
Tailor also recorded the detaiK of the famous Pirkman case tn«I in
Boston L S A m 1850

\t the trial of Professor Mobster for the miinler of Dr Pirkman the eyhknrc
pyenby a dentist Keep estabhslicii tlie identity of tlic iimlihUil rtm ihis of tlw
ilcceaso! in spite of an attempt yvhieli I nd been matk to d«tro> tlie jnw-s by Hre lie
dcpose<l tliat about four >ears ptc\ioiisl 5 he liad msile and ftttwl for I’lirkm m setsof
irtificnl teeth in blocks for each jsw He saw Parkinnuynth those teeth In his head
for the last time, about a fortnight before liis disapjiennnce He tlien put a new-
spnn" to the teeth He rccognircsl the artificnl teeth taken from n fimuue I \
certain pccuinnfies about them, and also b> their fitting the tngind j laics iml
moulds yvlueh he retained in lus possession 1 he gi J 1 phli-s attuclietl to tl cm lewl
been melted Jn an assaj furnace, in an attempt to ilcstroy the head of the dccenscil
liiit the greater part of this gold leas reeoyered and theartlfiei il teeth to iihieh the
gold plates had Ixcn fasloneil Ind acquired u j Ink eol uir from u jHirtn n of II e
line)} diyided metallic gold sliomngtlnt lliey In ll>ren submitted lonliigliicmjK'rt
ture hut liatl not undergone fusion nltlioiigh minute parlieles if gill wTre fiisnt
into them Tlie left side of the Jowir jaw present! d n prenl juliird frregulirJly
The block corresponded to this and thus pLiced the I leulily of Iht jme* lieyonl
dispute *

The imimrlanee of the teeth as a meins of identifiiatlon i>f decrascsl jwivitis
iras wrll shoicn in the ease of t/ce Jremh IVmee finfien d in The liodj hid
been so much disfigured b> Ins assailants lliat Idcntificaliin wniill base iKrn
extremely dillietilt but tlint the Prince hid lud four small caylties m tl>e first
molar teeth filled yyitli g ild and liad met sntb a sl^ht atxidcnt from o W >«y on
the front letth which Jud made it neeessarj lofde fhim a hlile, in order to sin<x Ui
tlie enamel These conditions offonled a means of Idrntilicnlion

In/? s //ai"/i (Lewes \si.i7es 19 j 0)* llic identity of the I ist yfelim ofa senes r f
acid b itb ’ murders a Mr* Dtirind beacon restetl almost cntlrrlj mill the Ilinl
ing among the nenf-ero foil remains of intact acrylic rcvin d /ilnres TfiCse were
rccogmzctfby 1 rr Ixmdon «lcntnl surgeon sshopnxJuced records ton nfirm 1 1 is y its!
pieccofcsidcnce Thedcntilwwk Imd Included some tuiUmgup < f I ite towlilrh
sjicenl nttcnlion was drawn

In the nisc of /? s DoHin » in which the mutihlrd nin dns o? n Homari were
found 1 j monUis nfler hcrmunler tlie dental cy idenec yens of pirammmt »n|wirtn nre
The lower jaw wns missing but In «»e upper jaw- there yvrrr fiur tntb oid> ttiw
molars on the ri„lil si le (tym of which lu-wl l>ecii stopped) and the first mol-u (also
stopped) on the left side , ,

The dentist wlio liad attended Mr. D«bkin the missing wi nun gaye a « inj Irtr
retsird if her dental state winch conrspondcil m every ilctnd with the ilrntil
con hlion of the iij per jais of the mutilated remains Uefnre seeing tJ e *j>ciiinrn
lie <lrew a dental ilngrim (I ig 7 > irhicb shews this corre^fM n ! nre ns no «lr>CTi| non
can do He alno slatwt tliat m remming tlie first and mtoii 1 ) rcinoLir on llie leii
side lie had kfl a imrtion of the root nml \ my ixsmiastion ifthc
shewed these residual roots AVltenshmii tlie jaw tin ‘’‘•"‘•'‘.’11 r ’’ 'L ?„
Dobkin s jaw and tJiosc are m3 rdlings \ remarkable bit of esT kwr
idcntificnlion

» Itewrt of tnal of Pn f Webster Itoston Hi ISjO V 50
» The Tr«l of Jc 1 n George lUIgh , Votat le Truts senes yy 1

•Simpson K . lOJX Ifg JtfC II,

lU.lge

iOE J-ffOV TEETH 101

TkI? V Corringc^Maidstone Assize^ 1048)' the evidence ivas thit a girl } a 1 been
/ound after a Nc« \ ear s Kn di ce battered to death in a j nrd at l^inbn Igc \\ eI/>.
\ bite marb on her right breast slioned clear inij ressions of upper an 1 Icnver front
teeth M ith v'cll dclincd spicinj, 1 e 'ind sliape fdentical details (shoivn by super
imposing a transparent print) were gi\en b\ casts prepared from impressions taken
from accused Ife was foun I guilt>

The Teeth as a Means of Determining Age
1 VO principal metliods of tletcrmining the age from tlie teeth arc av nilablc
{a) Eruption dates for teraporm (deciduous) nnd permanent toetli
from C inontiis to 20 jears

(fc) Microscopic examination of tlie individual teeth giMug data for
estimations from 20 60 j ears

(a) Eruption dates The nlveolar eavitics winch contain the teeth are
formed about the SLxth month of mtra uterine life and at birtli the rudiments
of the w 1 ole of the teniponrj dentition and of the first permanent molars nnj
be found (by dissection or X ra\) in the jaws Trom the commencement of
eruption of the milk or deciduous teeth at about six montiis till the com
pletian of the full pirmanent dentition the teeth form a most valuable
addition to the other factors liv winch age mav be estimated The periods
of calcification and eruption (which gi'en reasonable 1 ealth are constant)
are shown in the following table

DVTES OF CALaflOVnoV AND ErUttIOS OFTIIF DECIDUOUS OH 'IlLIv TeeTO

Tank

Ca Ulnuir.

Eup

Cote fleo nn o[ Hno
Lvm rtl

Central Incisor

5 0 1 ontiis

8 months

11“ jasaw

Lateral Inc sor

8 ID

11-2

Can nc

1C *’0

Tifst Molar

!•» 1C

2 2|

Sccon I Molar

20-30

3

Hesorption of tlie roots of the milk teeth begins about tin. fourth year with
the central incisors followed by tlie lateral incisors about five the first molars
about SIX the second about se\ en and the camnes at about eight

Dates of Cai cifjcation and Erupt ov of the I uujAx-rvT Teeth

To. A

Erup M

^cjp'’ r

Central Incisor

3—4 inoatl s

6- 8 y ears

10 years

Lateral Inc sor

- 0

Canine

4-5 inontl s

11 1”

12-13

r ret U cu p d

1| years

IP-II

i--ia

Secoi 1 nici sj cl

^ Vesre

10 1

12-14

Atbrtl

0 7

0 10

Second Molar

2|-3 years

13 13

14-lC

Tlird Mohr

8 10

17 21

18 '’j

Tlie date of eruption of the wisdom teeth is very variable They do not
usually appear 1 efore the 17th year mdarc more commonly erupted 1 etween
the 21st and 24th years Ihev may never erupt, or may appear at a verv
iSmpson b 193i Jitemal PofceJ 6 312.

SC411S

101

means -we are able lo get n sltoiipcr contrast Ict^ccn the natural and the
adventitious colour of tlie part \ low poncr lens should be used in cases of
doubt

Having carefiilh noted ill the al»o\c jioints tlicn more special questions
will arise conctnimg —

A Scars

Nature and Formation of Scar When from nnv cause wimtever, a
sohilion of contmmtv in tissues (other than the simple epithelium of the sl^in)
is prodmcvl repair of the injure iiegiiis at tmee There is an increased flow
of blood to the part pouring out an exudate which coagulate^,, gluts the edges
together and aels is a scafToldmg Tor tin new rep ir tissue There is a gradual
development and growtli of new blood capill mes tOe,‘ther with numerous
nbrobl ists While tliest tells and new blootl tapilhincs arc voting the tissue
wbieli thev eoUettivilv form is known ns grimilatioii tissue, and this gninu
lation tissue tills up the vioirnd \s the lells become formed into hbrts these
fibres contract and oblitcrntt the iievth fortued cnjullaries causing a change
in colour of the scar from red to hrown iiid liiinllv wliilc The contraction of
the new filirous tissue niav distort the origma! slnj e of the granulation
tissue and tause the star lo (e tltprcsseil or to contract and dclorm the
iiearbv parts

N. scar, then is sitnph fihrous tissue eotitiiiniiig no spccniircd tissues -
tliese arc too tuglilv orgatuTcai in man to be « ip itih of repair bv a pcprodnction
of such special tissues \ scar m the skin is hbnuis tissue covered witli a few
1 ivtrs of simple epithelium th it have grown over it hut there is no pigment
laver hence nnv distinctive tnguient in a scans an ahnormnlitv proinblv due to
disease or iit aiiv rate idvcntitioiis ami not part of tlic sear proper in like
manner Uicre are no sweat or sctmccavus glmds or hair follicles in a sear
nofiiing m fact but (diruus tissue \ sear in hvir or muscle is identical, but
those m the bitiin arc formed of gim the camncctive tissue of the brain

In the resc of ]{ t Crippen* the question of sp« lalisrcl tivsues being found in an
alleged scir liocanie of s me iniporlnnec nnd it w is then pomlcal out that in
stitching up ft wounl living cpithclml eelK m»v eourcivabb be t-irned into the
depth of the wound and iti it \ srb icci ii-» or swe it gl md « r u Ji ur fulhelc might
thus lie found in a soar ^p^v impcrfett matirinl fir draiding the jjoint wns
avail ible in the ph«-c \n emtiicnt siirtcwu sliortiv nfler the trial stated th it he had
fccen siith trinsferred materials m -i scar Imt allowing fnr tins then is no doubt
about the truth of the statement th it sucJi tissues are imt ordinanlj rcprodiK-cvl hv
the processes « Inch ft rni a spar

Is a Scir the Nccessnrv Result of a Wound* \ssuniing that the term
wound implies a breurh of tfmtuiuitv affecting the sul stone c of the true skin
(cutis) then a star is nl c/ti/f prcHhucd iii the. pro<*ess of he ding blight
puneturcs or incisions and supcrfitiil wounds affecting oidv tin. riitis ni i\
ji ave no trace after n fi w weeks or inoiilhs In an even cut ninclt bv averv
sharj) inslnimeiit cspcci dlv if il is in the direction of the fibres of subjacent
muscles and the [nrts are kept iii close contiel the scar is even huenr and
sometimes so fine Its tn he scan civ iHrceptiblc if the skin is while it mnv be
vasilv overlooked

If nil txammiiig i part wlicn. nt some previous time a stab cut or burn
iinolv mg the c lit is is alUgtal to Imvc In.* ii inihctcd we tiiid no star it is fair
to assume tbat the allegation is false ami tint no wound lias hetn udlittcd
i/t \ Criitn f rt thtoler IDIll

101 SCAItS

making due alimvanee for the fact that abrasions of the cuticle, or slielit
punctures and incisions, often heal without leaving visible scars

If a microscopical section of llie spot suspected can be obtainetl it should
be possible to identif> the presence of a scar howev er siniH Uus might Ik

Time required for Scar Formation This vanes according to the
nature size and position of the wound and the vascularity of the part and
-the method of healing Full consideration of these pomts would take too
much space in a work on legal mciUcuie but the following propositions inaj
be laid down ns reasonable av era{,es w ith w inch to compare an> giv cn w ound

(j) In clean incised wounds iuch as those made bj a surgeon kept aseptic
the edges arc fimilj united m about five or si'^ dajs and a definite reddish
scar formed in something under a forfnigJit

(u) In wounds which have lieen burned or corroded or have suppurated
healing is greatlv dclaj ed and the formation of grnnuhtion tissue proceeds
verj slowlv within the wound starting from the time when the tissues have
begun to get the upper band of the microbes in the struggle for e'cistcntc the
time occupied bj this is quite indefinite from sav a week to two or three
months according to tlie size of the wound and the success of the treatment

(ijj) In small wounds on the fingers etc as ordunnh m/ficted a stab
forms m about *56 to 48 hours and if on removal of this some granulation
tissue be found or attempts at scamng it maj safel) be said that the wound
was infiictcd at least four or five days previouslj

(iv) In lai^er ragged wounds involving man^ structures caused bj /arluiioiij
vnolcnee no appreciable amount of granulation tissue will be found under a
week and no real scar for at least two or three weeks

(v) The age and health of the wounded person have material mfliienec
even on tliesc averages tliough not alwajs m the expected direction Thus
m man) old people a wound will heal quicklv , vv hilc in an apparentiv health j
person septic infection may cause much delay

Age of a Scar hen first formed a scar looks r«l or bluish and is tender
Vs its age increases it becomes smaller whiter denser more slimy and less
sensitive but there are such wide variatioas m the tune taken to produce
these clmnges that even averages arc of no use beyond tins that m about
two months or so a scar acquires those permanent characters by which its
indmduahty will be known during the life of its bearer 14 e have seen scar^
vvlucli after 35 years still became revl shmv, and angrv looking when local
irritation was applied 4\ hen once a scar has become firm and white there
are no data of a medical nature which will enable us to siy when the wound
producing it was infiicted whether two ten or even 20 years before

Relationship between the Shape and Size of the Scar and the Wound
which caused It It is obvious that there must be a broad general likeness
between a w ound and its scar Tims a straight simple incised w ound will hav e
a straight Imear scar as a rule and this will be the nearer the case the closer
the edges have been kept in apposition while it was fieaJjng ant! the more
rapidly it healed If the incision was of some length so that the skin g ipcd
or jftlie wound suppurated the scar will probably be wider and thicker m the
middle than at the ends IVounds of irregular shape and lacerated and con
tused w oiinds commonly leav e irregular scars but not ev ery little irregular! tv
of the wound is shown m the scar espccialfy if of old date owiog to the
contraction wluch tends to distort or obliterate small irregularities If there

SCAItS

105

has been definite loss of substance m a svound from sloughing the scar mil
be proportionateJ V thicker and if m era boneit may be depressed and attached
to the bone

Apart from these general features there are certain special t\ pes of scars
tint are \ erv clianctenstic amongst which may be mentioned —

Burns and Scaldi These are generally large and irregular often (in burns
especially ) show ing keloid patches or lines -V scald from boiling water can
usually be distinguished from a bum h\ tlie peculiar stippled appearance it
presents as though the ducts of tht vanous skin glands were still visible on
the surface

Surgical Operations Tliese are commonly indicated by their linear form
and situation and often suggest the reason for their occurrence— heraiotoms
amputation etc the marks of the stitches which lield them m position ma\
sometimes also be seen

are gcneral]\ thin often tissue paper like thev are some
tunes difficult to distinguish but they cannot easily be mistaken for thescirs
of wounds The elasticity of the skin the looseness or density of the cellular
tissue beneath and the tension of the muscles are conditions which will
modif\ the form of a sore as well ns the scar proceeding from it A.n expert can
seldom do more than distinguish the sears of ulcers, ansing from morbid
causes from those which ha\ e resulted from \iolencc

I flcemalion an i Small pox Scars The sears left ns a result of the application
of the pure roccuie Ivmph have an irregular honey combed appearance with
white streaks and are slightly depressed below the level of the surrounding
skin If the vaccination sore becomes infected with common pyoffenio
organisms the scar may be like that of any ulcci The scars produced by small
pox are m tlie form of deep depressions showing destruction of tlie cutis
often disfiguring the face

Ptmelwred Tlcimds Stabs bullets etc generally leave small puckered
cicatrices from winch it is> generally impossible to give evidence os to the
nature of the weapon infiicting them In wounds alleged to luivc been caused
by projectiles the exit wound should be looked for and if none is found an
X ray jihotograph of the part should be taken

It IS without other circumstantial evidence frequently very difficult or
impossible to sav how the wound of which we have only the scar to evamme
was infiicted If the person is living he niav give a description of the injury
and the date of its production consistent or inconsistent witli the appearances
presented

Removal or Alteration of a Scar No scar can be removed by excision
without leaving another scar It is thus obvious that ns regards artificial
alteration it not only can be done but is often done intentionailv when
tlie new scar would probably be less disfiguring or harmful than the original
one A person might thus get rid of an inconvenient scar by substituting
another one for it ^

Apart from such artificial procedures, jtis certnin that the scars of wounds,
involving a definite loss of tissue arc permanent and indelible and last through
life with but little clinuge On the other hand the scars of small wounds
that have healed by first intention may become so indistinct as to be most
difficult to detect If no mark of cutting can be perceived withm a few
months of the period at which a severe wound is alleged to have been mllicted
*1? V Otto I

SCARS LIIDEVCE

It js reasonable to infer (Ii it the alleg^Uon is untrue or that the circumstances
iiaie been greatlj cvnjjperatwf

Tavlor s opinion nas soUohl jn tlie follon c ise

The mclic-il is kiu^ u is to the effect lliat there \ias i uoiinJ on the nose
or he tin seculns ipparentK mflicletl bv some sliarp instrument an.l tlie bmW
nf the n isns hrt ken The weapon Lad entered half an inch ami had causeil
profuw b{eedin„ TJie nound was so deep tliat if it had entered a little hierher
up m the c\e it might haa-c causoil death Tt was assumed h\ the iiirs tliat
a UMpon must haic been used and the prisoners were coiuaeted. the one of
Mabb.n^r nnd the other aiding ami a)>e»iRg \lK>ut six months afler the aUe-nid
stabbing ami some weeks after tlie prisoners had been conneted and sentenced
to punishment tJie face of the proserutnv was evaniined ba two surfer m (one of
them a pnctitioner of twints eight sears standing) ind thc> both deposed that
thcrew isnomarkofnticatnxfKimastab of fracture of the nose or of am pera nal
injurs wlnteser fn coaseqiieiiee the medical ficts of the ruse were referred to
<^uain Guthrie Kes and Taslor The CMdcnce of the surgeons nt the trial wtis
lud before them with the statements of tltc two surgeons who subsenucnlts
examined the prosecutrix TJie\ all agreed tint if such a woumi as that desenbed
in the medical evidence had been inllicteil tlicre would Imc heen a visible scar
and a ridge of promincnrc mdicalne of the situation where the bridge of the nose
was stated to have been broken and ns no such marks could be perceived bv two
well informed surgeons thej considered it improbable cither that such n wound
os that desenbed could have been inflicted or that a weapon could have b«n used
in the assault

The question of tlie rcniov a| of scan> or mthcr w hat can be done to obviate
their results occasioinlh arises in cull cases where the amount of com-
pensation IS to he (Iclermmwl Tlius defomuties of the evelids produced b}
bur'hs ma\ be occasiotiallv relieved joints set free etc but it is generall>
held b\ the courts that ii chinianl cannot be compelled to submit lumself to on
operation to relieve another partv of am part ol the latter s responsibility
In a case where an exploxioii of gas bad resulted in severe scars of the face
causing ectropion with overflow of tears the judge ruled tint the possibility
of relief bv a phxtit operation was not to influence the jury in awarding
damages

Scars in Evidence Such Ijcing the guiding pnncijilcs upon wlucli ques
tions regarding scan* niav be determined wc have now to see how Ihev have
been cinplover! in practice FrniuK of this description are rare for the wound
must Iw made in anticipation wi onler to give the njipearancc of an old sear
It IS more hkelj that an imposter miv seek to gam tlus object h\ attnhut
mg the scats of wound's ntcidenfalVv rtccivco’ fo acfioiraiiife causes aVs a
remarkable coincidence two persons mav have scars on or about the same
part of the bodj produced bv cuts punctures, or abscesses in eariv life* and
serious mistakes mav be made m flie«c circumstances Tajlor rccorcled the
following niisoamage of justice

In 1704 a man named Lesurgues was convicted an I executed for murder
There were doubts at tlie tune as to hi- identity and strong exertions wen* matJc
to save his life Soon after his execution ttie real murderer was iJiseov ered between
whom and Lesurgucs wliohadhad no part in Uiemmi there existed a re^iblanee
m stature complexion and features Hut the most cxtraonhiiarv part of the ca«
was that Lesur^es like the real cnminil had a cicatrix or scar on the forehead
and another on the hand and tlierc is no doubt that these points of reseniblanee
which upon a projier stientirc eximination might have been proveil to bt reallv
different led to the conviction of an innocent person

On the other hand un impostor witli old scars upon his person mav make
use ot them as proofs of idcntilr Such st-iis lua) esist, lliej may be cicirh

T iTTOOS

107

prosed to be of old dnte, and thej mij I>e issigncd to cniiscs sslncli cannot
Ijc dispros ed except b\ n close itiLditnl exinimation **

At tliC second Tichbornc tmP the possibility of tlie disappearance of scirs
\vns made a matter of great imp »rl mcc ns bt iting upon idcntitj Ro„cr Tichborne
the missing Inrontt whilst on bo ml the ship /*rt«ltHC init withanaccident bs which
a fishhook passed through one eselid ami liad to be pulled tlirough ani nut
and it nas truli aJIcgr/l tlcit such a iroiiml noiih? lease « scar, and that this would
probably he indelible lie had »lso been bled an opcmtion which usunllv loaves
indelible scan. It was also certain that when a lad Roger Ind eitlier an issue
or seton on his left ann According to the prosecution it was in issue and w is
kept ojicri h\ a pi i According to the ilefcjiee it was a seton On the {kfendaiifij
arm there was the mark neither of an issut nor of a seton Moreover there w is
no sear on the ejelul such ns would hi\t lioen priMluivd 1>\ the fish liook 1 urther
Roger Imd his temporal \cm opened wIen a 30 ttn 4 man mil there was no scir
on the defendant s temj les Mthoiiph it was adiiiittcil that a venesection mirJc
might (lusippiar in the tourse of tune it is iit the hit'hcst degree impri liable tluit
several cicatrices such as Ime been described would ill disappcir i he defend int
was convicted of the attempted imp store or rather t f pcrjtirv, in swearing at the
first (ttval) trial that he v\ is the venlablc Sir llogrr Tichbornt

It ina\ be alleged m proof of identity tliat nt a former period of lile
certain operitions liul been pcrlormcd on the body of mi individual and it
niav b IV c to bi dtttrmmt.d whether siidi stars as nrc present liave betn the
result of the alleged operation If thev arc not \ isible nt the ti iie of examin i
lion the question whether thtv ma\ have faded or <lis.ippeared bv lapse of
time nnj have to bt dccidc<l Such simple questions iiiiv carry vvith tliem
momentous issues either m aciul ornermimaliuse t)iei can be answered b\
rcftrencc to the above [laragrophs and cases

Beck quotes the case of a child who lu ) heen bled in the right arm when
sixteen montlis old \Mien neirlj four vears old the chilil was lost and two
jears subsequently the godmiithcr seeing two boys i ass was struck wath the
vanoe of one of them she culUd him to her and was convinced that it vras her
lost godson The identitv was also oonsultred to be prnvxd bv tlie discovery of
a cicatrix from bleeding In the nghl arm and n cm itriv from in ibscess in the
left knee both of winch were present in tlie tost tfiil I ind also iii the one that
vras found The latter however hid U|>on liis boilv iiurks of smillpox while
no marks of this kind were on the bmlv of the former iiie child vras cl timed
bv a wadiw (Labric) and m.vm witnesses deposcil ttiat it was really her son
T/ic court ekcided in her favour chitllv on the ground Ihit the lost child vuw not
marked with the small pox It was ulniitlcil tliat this child had on the irm and
knee eic-itriees siimlir to those whicli were kn»wn to exist in the one tint was
missing The widow loibrie admitted that litr chiUI had never heen bled m the arm
A‘Avvb Ak“ .TO«/5iig’ oiUvld -had .'W’Aauib ainda^ow* Jibes .qnftr-.d.inD ind tbew vxas ji
conihet of medical opinion Three surgeons v xammeil the iic itnx and deci ired that
It laid been mule with a slurp instniment Others dtpisel tint it was not a
cicatrix from bleeding hut from the o|Knuig of an ibwess Vs the tlull had been
missing two vears it mijit luavel id sm »U jiox iii the meantime

From the medical ev idciue the case sctins to hive been wrongly decided

B Tattoo Marks

Designs eflccted by small punctured wounds untie into the tr le s'sin w ith
needles or cut m with tools dippeel m colouring matte" leave marks whith
mav or may not be indelible aecordingto the dye used and the nude m which
the operation is performed Tattoo nnrlss liav t been mad'* Use of is evidence
m many cases of idcntirication llie colours comm inly emploved are uuligo
cobalt, charcoal {gunpowder) China ink emuabar verindion and cadmium
selenide Although China inkandcharcoalare black thcelTectwhcnmtroducetl
* 7? V Castro L 11 0 Q 0 8a0

lo^i TATTOOS

into n » lute skin is to pnxiuce citlicr a blue or Miiish c< I mm! nnrb. The
foreign matter thus iiitroiliieeil raeclimicalK into these iniiiiile piiiietumi
aotinds causes mnammalion but tins soon passes i IT anil the cslmnnK
iiialter then remains pernnncnih enfninbcil mile sub I ii ee of tl c cutts or
beJoH it

\UhouRh sc in, and tattoos bein^ liable to rcj>ctition do not nlTinl con
eJusne identification data t}je\ {>rot ide further links m Hicclmm ofciidcnec
which mi\ b\ its tnultiphcit\ of ficts Itccome xirtunlh concliisno Initials
either personal or of those loved enough at the time— I I often

recording the initials of a girl friend — ind dates of campiigiis scrv icc badges
and lettered tombstone dev ices are e^pccialU iiscfu! for j lenfitv
The more colourful lewd or libidinous designs snakes biiltcrnics and the
like arc too common to have much value mdividuillv li it ini^ sometimes
be so elaliomte as to assume more sit^mneaiicc

\pirt from their value ns a means of identification tattoos oceasiomllv
form tl e basis for two important tnnbco legal questions t m Uuv ever fide
nwav complctelv’ \nd can thev be removed nrtificiallv*

Natural Disappearance of Tattoo Marks The design itself consists
of particles of insoluble pigment which linve readied and m mined fixed in
the outermost lu\cr of the tnie skin or in the deepest laser i f the cjiidcmus
m the laser that is which is never shed boihlv 1 ut which keeps on multi
plvmg to provide the more superficial lasers Hence tlic int iral | rocess of
disappearance coasists in grad tal convevanee m solution comettion of
particles into the Ivmphatic cimnnels or oonvoclion b> cells townnh the
surface* the eiroiencv or pcnnancnc> therefore de|en<Uvcrv nialcnallv on
the indcstructibditj and insolubihlv of the particles of pigment, and on their
reaching a situation to which phagocvtic cells have onlmariK but little aetess.
Ihus It 18 found that venmhon ami tiUranmnne have the hast resistir gjiowTr
against disintegration and solution while Indian ink and soot or t arbon lias e
the greatest and that the niest damblc situation is jiitt Motr Ihctp derm/r
m the lirmest lav er of the true skin Tidj goes so far as to nss( rl tliat a design
once c/Tieientlj inserted and made of carbon nevir disnpjieirs Iv nalum!
means and all authonlics agree tint ten sears is the shortest time in winch
even v crniihon or cinnabar tattoo marks con disappear * Some residual pig
ment inav still be found in the regional Ijmph glands

It must be admitted that tattoo marks arc not nccessanlv indelible but
fhev Aav e /fcvn oirreri ti? icwjsi.t Aar » mrv J.*je

of the marks has also somellung to do with the rapiihtv of divappenmnee
ThusUic> woul 1 naturallj disappear more ensdv from a place suchasfhchai f
wlicrc severe friction vrasof frequent occairrcnce than from tl e chest oriipi«:r
arms Slue observevl tattoos a 4 veors old quite as distmet ns vrhen ma Ic
Artificial Removal of Tattoo Marks Tlic application of cnistie an!
blistering llin Is to the part or the gnlvnno rnutcrj mav cn isc tl c rtiiiov-al
of tattoo marks but the process is almost bound to res It m tJ c production
of a scar Onlv surgical excision ami graft can Iw cxpectcfl to remove a
tattoo compJctclv

CO. snow siIvcrtann*leor 8 nlicvbcacidinadeintoflp.a tewjlhglvcennc
applied over the marks with a compress hive also betn suggcstcvl Treatment
of this kind must be applictl ven cauliouslv

• 1) N wr Pne « Sjc JU<I. <0 S^sl

*She SID IWS. J Imre sift/ l« W frl.

IDE\TirV 5/ V 109

On the occasion of the set'ond tml c f the clauninl of the Tichbome cstnlea the
possihilitj or the efT iceinent of tattoo innrks bt-conic o prominent question > It mu
svcll knosen Ifiatthc missing hironet had been tattoo^ along the whole length of
thcforeirm- Thecbinnnt Imd no tattoo ntarlsA nornm signs of tattooing hutal o\-c
tl e left MTisl tliere avns a large scar as if a picic of the skin 1 ad lieen cut or liurneil
out Ferguson and Holt state I that notiung would rcinoec a tattoo murk short of the
knifeoracnuteia The man Orton witssat Ito iu\*eli.ad the letters \ O tattooeil
on his ami Lvadenth a clumsj attempt Iiad been made to obliterate the imphc-iting
letters \ 0 on the wrist.

One of the most remarkable cases of idcntiltcation from a tattoo mark is the
so-called S\dncv slinrk Gise \ man called James Smith di appeared on \pnl 8th
103o and was neser seen again- On April 2’n 1 asliarkwas caught oIT tlic lieachat
Coogee and avas sold to the \quanum — wfterc after three dtas it samited up a
quantity of material ineludmg a human arm ihcann sihicU belonged to an adult
male avas m a fuirU good state of presers'ation and according to the methcal
e\ idenee liad been ses ere 1 from » dead bo<ly not bj a sliark bite but bj a clumsj
incis on Math a sliarp instrument On tlie forearm there was a tattooed design of
twxi men boxing

Sex’cral men whose arms were tattooed were missing and finally the search was
□arrowed to tw o men of w Inch James Smitli w is one Smith s w ifi and brother both
definitelj identified the arm ns tliat of Smith and linger print experts were able to
support the idcntif cation An arrest was made of an associate of Smith one
PatnekBradj who ivastr ed for murder at the C C C Svdnej in Sci temher lOJj
iruK n unique series of eointidcnccs which led to positiic ulentilication of the nuss
mg man

SE\

The identification of the sex of anj gi\cn individual is imtumllv a serj
important matter in tlic ordmarj meanings nttaclicd to tlie word identitj
and it must be considered here but as the point iias other important bearings
in legal metlicitie for w Inch there seems to be no more appropriate place of
introduction in this work than the present it will be discussed fullv once
for all m its practical relationships The sexmg of liuman remains is dealt
w ith on p 1 18

Sex mas require to be estabhslicd posilivelj in one direction or tlie other
for the following reasons —

1 For jJUrpose of simple identification in a liv ing or dead person

J For purposes of deciding whether an individual can exercise certain
ci\ il rights risen ed to one sev onij

3 For deciding questions relative to legitimacj divorce, patcniitj, and
nflihftlion

We mav consider the evidence that is available for determining sex. and
discuss its abstract value

Evidence of Sex

Tlus maj onlmanlv be divided into three categories (1) the presumptive
(2) the highlv probable and (3) the certain To tlie first tategorv belong all
such points as the features oiid general contour of the face and the presence
or absence of hair upon it the length of the Jiair on the scalp the clothes
the figure the habits and inclinations the voice and nuinj other almost
intangible mmutic of cvendnv experience To the second category belongs
the possession of vagina uterus and accessories and large breasts m the
female sex structures vvhicli arc incidental to the ncetls of the ovum for
impregnation safe protection development, and nutrition during intra and
extra uterine life and m the male sex. the |K)sscssion of prostate gland
I it \ Cattro Q U IS'S.

INTERSnXUALITY

118

\agma ceases its thrust downwards and urogenital sinus its growth upwards
the phallus enlarges and tlie urethral folds tend to fuse, clothing the a agina
Such cases usuallj undergo progressne masculimzation

O Farrell (1933)' described a ca<!e aged 19 in which there had been complaint of
attacks of priapism failure to start menstruation and ‘ nersousness ’ ovTr ‘psjcho
ph\-sical relations ’ Of nine siblings one had an identical condition and there were
tliree ‘ hermaphrodite ’ cousins Tins girl ^ras masculine m appearance with a
coarse %oice, and llea^’^ growth ot upper hp and chin liair the breasts irere Rat and
the lups narrow The penis was well formed but li> posjiadias was present and there
was an infant \ agina wath small uterus Laparotom\ rcsealed a solitarj cjstic left
oTOtj j\mputation of the penis and widening of the a agina together with endocrine
treatment, effected an excellent cure with ph>sicil and psjcluatnc improvements

U ithoul ntasaiUiuzmg adreml hyptrpjasia Tins tj-pe of anomaly is very
rare mdeetl The uretJira is small, somewhat stenosed and Williams suggests*
this tape maj be the onlj group which are not true hermapliroditcs

Intersex Males (male pseudohermaphrodites)
a testicular gonad hut the feminine erlernal genitalia The body habitus
follows female form and the intersev rareh becomes apparent until pubertv
when the restrained sex development, amenorrhoea or painful inguinal lumps
confirm the presence of active virilizing gonads Orclndectomv has usuallj
to be effected A more or less normal female role can be achieved though
intersev males do not menstruate

illiams (1032) reports the case of a ‘ boj ’ of IT operated upon for hvTwspadias
ns a clulil vv ho w ent to a bovs’ school though Icav mg earlv omng to doubts as to
his scY Ifc WHS slight flat chested and hirsute The plinllus was o little small, a
deep groove U ing under it A wade me itus in the |>erincnm rev ealed two onRees, and
eiidoscopv showed these to consist of a female tvpe of urctlira and vagini leading
to a small mobile uterus Excretion of 17 ketosteroids was 31 7 mg in 24 hours
As the' patient’s ineliiiations were nusculine a penile urethra was eonslructed

U ilh masculine external gemlaUa hut feminine uterus These are correspond-
itiglv nusculine tjpes with liodv form ind hair growth of male tv'jje One
testis ma\ he undcscended

11 till equivocal ertcrnal gtnitaha These nrc the most puzzling presenting
as hjpospadial cases with a vnrictj of male/feniale variants in the external
genitalis The female internal genitalia tend to be less pronounced and
on the whole a masculine role is natural Cvchcal bleeding does not occur,
but tlie liviio gonadism max give nse to a somewhat effeminate development
at pubertj The libido in some becomes powerfully female and a female
partner role is often sought castration rcliev cs this

Capon (1931)’ describes a* bov” of 20 captain of gimes at lus school, who strove
to liidc a finvalc breast development which became marked at the age of 15 His
interests were heterosexual and he mamed at JO — s,Uisfictonl 3 achieving inter-
course \t 20 lie noticed a bloodstained discharge coming from his hvpospadnc
urelhml orifice, and tlus liecamc cvchcal, lasting three to four days every 28 days
He bad a female tvpe body wath downy licird liair The gonads were palpable in
thehliio scrotal folds and a iKrsistentnro genital orifin. lontaincd both urethra and
vagina a uterus was present A lobular right goiuad l\ ing m the position of an ovary
was removed during a Iiemiotomy, and t^osteronc therapy was instituted

*0 rarrcll, toa." t .hnrr wed Im 104 lOOS
•VVillmms 1) I 10)J Uril tied I 1. 1_(U
•Coi>on, iV. V\ ,1951, Latuxi 1,508

11* lh,TFI{SF\UAUTY

True Hermaphrodites, possewjng both testictihr ind o^'inan tissues
hn\c been frequenth reported* V penile urcthm (nitiiout icrumuiinniim)
vagim uterus ami tubes and os o testes inn> be found Thcljods development
tends on the whole to he eflemmate *

Lo>wi.ancl DaviesClOo-il^describe agirlofl' with normal female mstJnclsond
general development but vvith stmilar genitnln to those described bv OfarreU
(v Jile supra) except that the right labiuDi majus contained a small fully dcseenilcd
mobile testis Microscopy of thisshoweilabout twiv-thirds to be welldifrerentjatcrl
tesMcuiartissueanAopolartbirdtobeovanan there was no spermatogenesis m the
testicular portion but normal Graafum follicles lay m the ovarian jKirt

Ivo known case of this kind Im Achieved parenthood though both sperma
togenesis and folhculation are common Tlie male cases require rejnir of the
hypospadias and hy sterectomv the females amputation of the phallus and
often a plastic yaginal operation Parly removal of the unuaiitetl gonad is
the best way of avoiding sccondnrv sc\ dilTiculties but reverses changes of
feeling and social upheav als that may perplex are likely to occur in untreated
cases

In 10o2 a north country doctor vrho ha 1 been registered as a female and had been
m practice as a woman doctor /or some vears registered s clunge of sejc and
announced his engagement to a woman acquaintance

To determine the Sex of a given intcrscMial a very thorough exainina
tion IS necessary both of the external genitalia md of the mtennl structures
together with microscopy of the gonad

The aboye facts of development constitute the principles vrhjcb guitl^ one
in a decision On tlie one liand in a male person the lack of union of the
cutaneous folds (hvTiospidias) and the hek of grou th of the genital eminence
(the penis) on the other liand in a female person the excess of union n / the
folds nnd the excess of growth of the clitoris constitute a guide to assessing
inter sexuality

If the local examination Icaxcs one still in doubt the other sexual char
actenstics must baye the greater yveight attached to them sucli as the
distribution of the hair m gencml the development of the breasts the sexual
instinct of the lndllldu^} menstnntion etc etc fjiongh tint mterse< be
variable is provetl hv well authenticated cases of individuals having to
clmnge their apparent sex ns a result of a medical examination even as late as
20 or 2o years of age nnd that too after scxaial connection of an inverted
character has long been indulged in {rtde supra)

J} F J Smith’ quoted a typKSl example of the diWieulty in actermtawg

sex m the living until operation

A Case of Spurtaus IlermaphrodHism Wni^pahas and hndestended Tesia
»n a Suhjecl v:bo had been bro«g/.t up as a Feninle and been married for Suleen

J ClJtCI/

\ woman fortv two vears of age was reccntlv admitted on account or a
paiofiil „nfll,Dg U» left BTOin She stolnl tl.nt a faliui-lil preload,
lifting some h<■a ^■5 furniture »licn swrirtliing wnurel ti) gull irey In
she Mt vers sick anil liaJ an aeule pain in 1 er left groin <•"
found n lender sivelfing there nlien she lav dora d got sm-iller lint m f cr n^ n
rising' the swclhne rcjri'ncd its former sue The sever" I am dM not list
and °Bhe was able to Slow lier occnirvtion but she was alwave In more or tes
pain and discomfort and the svvemng tmnvwd to t» atevvti ewtatsiws an at me

< nromvrali V T I"!- • “i , , c „ v, ,0

‘Lavcock II 'T andllavies D \ 16j3 DrU J ^ its **
»Mitorof th«tcxU>£ioJc Jm* JO 0
* Lancet ISOi* 1 "10

TLRSEWALITY H5

end of a fortnight she deemetl U adt-isable to seek medical adsice and s\enl to
the hospital 'Ihe notes state that on adnussion she svos of soniewhal masculine
ap}>earance, the breasts ssxre well dcs-clopcd hut the nipples were rudimentan,
and the areole were not m.irkcd rhere was no hair on the face and there was
but little on the pubes An osoui solid l>od> feeling pist like a te<>ticle rilhcr nhme
the usual sim omipied the left inguinal canal A sunilar but smaller swelling was
ohsersed in tlie right groin this was not tender and the patient wa» not aware of
Its e\jstence until her attention w is called to it Tlie external genitals were normal
m apiiearance, and tlie saigina ivas of nomial calibre and length but the Unger
introduced into the can il dcmonstraleil i cut tie sac No os or cer\ i\ uteri could'be
felt and a bimanual exanunation failetl to detect the presence of a uterus The
patient liad been mimed for sixteen \ear> and her husband had died inllun the
last scar she lud iiescr liecn pregnant and neither she nor her husband had an\
idea lliat she was in nnj w-a\ different from other women She began to menstruate
at the age of twelve veam at first not verj rcgularlv but from fifteen to thirty*
eight jears of age she never misswl tlic talamenial flow cverj four weeks, md it
alwavs continued for twentv four hours and no longer in the interval she liad a
constant wlute discharge \n incision was made over the left swelling the k 3L was
opened, and what were to nil a[ peirinees an urdinarv testicle and spermatic cord
vicre driwn out of the wound Mitaoseopi was not done If mitroscopv had been
jierformed it might wtII have revealeil the onhinrv testicle to contain both
ovarian and testicular tissues

A large number of similar eases are reported liotli m textbooks on eiido
cnnologv * and in manv inedu il journals (ii /< attpra) Ihcv show Iiow difiicult
questions of sex mn\ be w hen rwjuircd to be nnsw ered in connexion with civ il
rights and duties in cases where the jverson whose sc\ is to be determined is
alive and will not submit to an operation

A diverting case occurred m America and was described bv Tovlor as
follows —

At an exciting and warmlj contested election in the United States of America
in ISid almost cvervthing bearing tlic semhlam-e of the human form of the male
sex IS fitatetl to have been brougfit to the ballot l>n\ It was at this time and
under these circumstances tint Leva SM>dnm aged twentj tluw >ears a native
of Salisburj, Con , was prcsinteil hv tlic tMiigs to be nude a frecmim he was
clnllenged by the opjiosite partv, on Ibc ground that he was more n Lniale than a
male and tliat in liis phvsical organization lie partook of botJi sexes There was
a mens veneris, covered witli luair in tiu ilsuiI wav an imperforate perns subject
to erections about tivo ami ii lialf inclies in length witli corresponding dimensions
the donum of the jenis was connected bv tlic cuticle anti cellular membrane to
the puhLS leaving aliout on inch and a Juilf free or not Iwund up and towards the
pubic region llus pema liad a well formed gUns u depression m the usual place

kV/t wikWk w.v/i w.d.b. e. Tbn. sacokum. w cs. OAt

developed inasmuch as it was but half the usual size and not pendulous In the
scrotum, aud on tlie ri5.1it side of the penis there was one testicle of the size of a
common filbert walh a sperm itic toril oltacliMl In the perineum at the root
of the eorpom cavernosa, an Ojienin" existetl through which mieturition was
I>erfoniied tins ojitnhig w is ! irge enough to admit the introiluction of an ordmaiy
Ri7x:d catheter llavang found a jwnis and one testicle although impcrfecllv
dcvelojwl llarrv, without furtlier examination gave it as his opinion that tlie
person m ijucstinn was a mate cifiua* and oonsequcntlj entitled to vote an 1 enjov
all the privileges of a frecMioM On tlie morning of the election d iv Ticknor objected
to him as a female, and tliereforc not entitled to vole Ilarr> then slated to the
meeting that from an examination lie had made he lonsiderrd the jierson in
question to be mile and requesUd tliat Tirknormi„lit, with the consent of Suvdam,
retire into an adjoining room and examine lum fir luinsclf This was done,
when Tiekiior ultimatclv rune to tlie mnelusum tluit tins jierson w is rtallj a m ile
lie was acxordmglv admitted a frccwinw and his vote w is retcivtd and registered

• VV ilkins IOjO Diagnosis an 1 Treatment of Tn loenne Conditions m Chil Ihood
and Adolescence Sprinencld, Tl < mas aUo \oun,> 11 Ii loa" Onitul Vbnonnnhties
Hermaphroditism and Itelatcd VdrennI DneiLscs lloltimore Williams A VVflkios

110

SF\ l\

A few da>s after the el^ioa Barrj Iw-ml that SmcUni Imd regiilarK racaKtniatcd
a-s a '»^oman His sister informed Banj that she Ind washed /<?rS«r im for
j^rs and tlait he menstru itcd as re^larl^, but not ns profuselj, as most women
^\hcn questioned, he \er% un\nUin?lv confessed ttiat such wtis the fact Ife
a^in jammed b^ tlie Uxo phs-sicians, wlien tlic foUowins additional pirticulars
w-ere ehcitcd -^u>dam sms D\e feet two inches m height. Iight-colJurcd Lair
fair eomplevion. with a beanlless chin and decidedJi i sanguineous temperament,
narrow shoulders, nnd tiro id hips— m short, eserj wa> of a femimne fi mrc Thcr^
were well deseloped breasts, intli nipples and areolm On passing a female catheter
into Uie o^i^gi through wluch micturition was performed, and tlirough which he
stated he Juid a periodic-il hloodj discInrBC monthU , instead of traversin-T a canil
and drawnng off urine, the catheter appeared to enter immediately a }ussa-^ Mmihr
to the vagina three or four inclies in depth and in wlucti there was a considerable
plaj of Uie instrument. He slated tliat he had amoroas desires and that at tius
tune lus inclination ivas for the male se\ IIis femmme propensities such as a
fondness for gn\ colours tor pieces of calico, comparing and pLictng them together,
an aversion for l)Ochl> libour, and an inabilits to perform the same, liad been
remarked bj manj *

Sex in Matrimonial Suits, Legittmacj, Patemltj, and Affiliation
In siicli cases as these the question of the determination of a definite sex is
of coniparatn eh little importance compared with die questions is this
person ph\sicall\ incapable of procreation, whether as a fntlier or mother’
Is the malformation such as to justif> a suit for nulhtj of marriage on the
ground that the person is incapable of proper sexual intercourse’ liiuld this
person possibh be the father or mother of this clnlcl’ These questions ore
dealt mth fulh m Vol II

Such cases seldom come before the British courts, and are stiJI more seldom
reported with an> details, the indmdtiaU in question would almost without
exception be both impotent and sterile, and ^et there is no reason wh} any
of them who surnves infincy should not h\e to a mnmageablc age, and
even go through the ccremonv of marriage in ignorance of the real state of
affairs

^\Iien these beings have reached adiUt age, other questions may arise in
regard to them Tlie English law docs not allow them to select their se\, hut
determines it for them bv medical evidence Ilcmiaphroditcs were formcrlj
classified with infamous persons and it h.as Iwn a grave question m the
English courts whether describing a man ns a hermaphrodite was not such a
hbel or slander as to render it a ground for a civ jJ action In a case reported
bj Chittv, the use of this term vras held not to be actionable, unless it was
proved that it bad been attemlwl wnlli sjiccial damage A dancing master
brought an action against a person for calling him a hemiaplirodite. and it
was decided that it was not sustainable — (i) because it was asserted that
suchaimionof the sexes cannot exist m fact, and evcrvbotlv must l>e supposed
to know it, consequently the assertion couUl not be supjioscd to prejudice,
(ii) because, admitting the possibility of such a double function, the party
would be just as good and perhaps even a safer, dancing master than if only
one perfect sex had been discoverable consequently the words would not,
in legal presumption, injure him in lus profession or occupation

Re-reglstration of Cases of Sex Error. In any case m which an error
has been made about the sex of a child the parents or guardians should not
neglect to re register the birth of the child The following procedure is to be
followed m re r^istermg a cliild —

* Tius w-»« no doubt, a peiswtent urosemlaJ onftcc.

• winter J vied Se> , 1S47, H, 123.

Il)r^TITi HAIR 117

“^application for the re registration of the birtli shoulil be made to the Registrar
General accanti>.imi.d h\ tlic particulars of tlie case bj the medical iiractitioner
Mho has examined thcetuld If thtsisi>att 2 >f ictor} the Registrir would be instructed
to re register the birth on the information of one of the parents or other informant
quahfle I under tlie Births and Deaths Kcgisfration \tts Should there be no
qualiPied inform int available then the ongiial entrj would be corrected on the
authoritj of a statutory declaration inaile hj two persons cognisant of the facts
one of whom would be the meilictd prictitioner ’

HAIR

The value of the hair as a feature of identity is considerable under ordinary
curcuiustauces though it can be artificiallv altered bj dveuxg or bleaching
but man) medico legal questions inaj arise concerning it and the subject
maj be dealt with here m nil its aspects to avoid repetition One of its out
standing coutnbutions to crime detection is the link it provides between
victims of assault and either weapons found elsewhere or the person of
suspects the latter cornnionlv in sexual assaults

IIaIU vs a I VCTOIl 1*< iDENfincVTIOS

This lb a matter principallj of colour character Icngtii and distribution

Colour in its natural sLite offers but little means of positiv e identification
bejond the fact that the hair on the dead bodv is of tlie same colour as that
of the missing person The diiTerent shades of colour are indeed v erj numerous
but tbe> are nothing compared vvilli the number of individuals in the world
It mi) of course happen tint there ma) be something peculiarl) striking
m the colour of the hntr of a corpse cither in general or m some part of it
such as a lock of white liair tn the midst of n head of dark hair vvlucli m n
limited population might become of corrobonln e importance if the age and
other points of identification conformed to tliose of the iiultvulual known
to be inissmg

The colour ma) be artificially altered and medical jurist must be acquainted
with the commoner means employed for such purposes and how the) ma)
be detected Tlie means eraplo)^ arc of two broad classes (a) substances
applied to the hair which hv tlieir presence conceal the colour (6) subbtances
which alter or datroy the colour such as henna or bleaching agents
Amongst the former lampblack to obtain a black colour and flour chalk,
etc mixed with some greasv substance to obtain a white colour ma) be
used but are easily detected by washing the hair or brushing it m water
Tlie latter are a little more difficult to detect but the fact of d> e hav mg lieen
used is usually suggested hy one or two simple observations riuis (n) it will
commonly Inv e been applied to the hair of the head only the pubic and
other liair hav mg been left untoucheil (6) If it has not been applied recently
the bases of the liairs will siiow a short length of the natural colour bv growth
since the application (c) llie microscope will general) j show that the dye
lias left small spots and patches untouched tlie trunk of the hair showing
different colours* {d) The skm of the scalp or face may also show contamina
tion from the dve Bleaching substances such as chlorine and peroxide of
livdrogen used to produce flaxen locks have n tendentv to make the hair
brittle and hence may be suggested by the frayed condition Organic dyes
such as the panpheiiy lene diamines are mostly used for dy eing the hair black
or brown Lead and bismuth are occasionally used for dyeing purposes If

vBotli ultra vaoJet and infnred light are useful adjuncts to tlus procelire and to
photography of hair lief Kitk I* lOul Cnme Invest (ration Interscience 1 uhl Inc.,
New \ork

118

IDE^TIT1 JUlli

‘uJ “ 'T "■?' '“l'''*®"*' «>«ng mtnc or n.toL, dm

chlonc «Hd, nnd the resoltant liquid tested for these metuls It ,s not d.mcnil
as a rule to decide whether the hair lias or has not been d\ed

Character There are minj cliaracttrs of hair which nn\ sene as corn,
boratne points m idontits cither of a person or of a gnen indnidual hair
but thej are ni iiids those denoting the race from which the person came
The curlj short spiral hair of the Negro or Hottentot for instance is well
djlTcrentnted from the hair of anj European rice the stnight lank liair
of Alongolians and most aborigines is much coarser than Imir of sim lar
strniglitness occurring in more cnih/cd races Information derned from mere
similant} of the waj in wlmh sshiskers beard and moustache are worn is
of -verj little \alue ssithont strong corrobomtne cMdence

Length Tins gn es nothing more than a suggestion in a case of an unknown
person \ nnn nny let his hair grow, and at the present time a great many
women w ear their Inir short It ina\ be of some littleiinportanee to determine
whether the hair in question Im its natural length or whether it has been
srtifienJJi shortened h\ cutting the niicrosco|>e will easilj detect the differ
cnee If of natural length it mat/ be possible to suggest its origin— eyebrow
scalp pubes etc b\ its shape or by transserse section (Seep lii)

Distribution The distribution of tlie hair jnn\ be of a certain importance
in jdcntjfintion I or esample a quantity of Jnir m the beird region hair
in tlie ears nose and anus profust hairmess of the torso ore all suggestne
of the male The distribution of piibn hair dilTers m tlie two sexes m tiie
male the hair tends to run in a triangular manner tow ards the umbilicus m the
female it usually ternunatas along a line joining the iliac spines In supra
renal sinlism in females hiir may be found growing profuseli in masculine
sites

Can the Hair Grow after Death? It miv be accepted as a fact tiint
growth of the hair after death does not take jilace The skin shrinks after
death and hence a man who has been slmsed just previous to death might
m 24 hours appear not to hav e lK<-n sh iv cd Scorching of the skm ma\ cause
the same appearance

Hair as a Factor In Criminal Evidence

In this connection hair may assume i position of outsfamhng imjiortancc
Tlie questions tliat a medical witness must be prepared to tr\ to answer

Are ( 1 ) Is the object submitted for examination hair or some other siib

stance’ (2) If hair, is it human or from some otlicr animal’ (3) If human
from w-hat part of the both did it come* (4) Is it the hair of a certain jierson?

1 Is this Hair or something else’ In exaniming an\ blood clot or small
mass of mud from I oots or articles of like nature, the substance must be
macerated in saline to afTcit the separation of an\ fibres frtni the mass
If a boot or an\ weapon is submitteil for examination it must lie scrutinized
closely by the naked eye and with a lens eS{«x.ialJi in any of the unev ennesse!,
in general contour such as the junction of shaft and blade notches on the
blade cracks m boot nails junction of nail with leather hooks or lace lioles
etc etc Vny fibres must be carefully extracted b\ forceps after maccrnfion
and submitted to microscopy A precise ami detailed evammalion of the
cuticiilar scale pattern the cortex and medulla must be made of the whole
length of the hair, and of both extremities It may also be necessary to make

IfAlIt /A cm Mh

110

I cross sechon of tlie sii ift If onh one limns avnilnblc it must be kept m iJs
mtuml stTfc for lonipinson with other linirs slioulil tins he nrjmrwl nt u
later pirioc!

llie substance of n Imir is mnitiK eomiKKctI of n pigmented homj fibrous
nntcrinl known as tlic cortev whicli can be scpiralcd bj the action of sul
pliunc neid into long tnpcnng nbnllitcil cells the nuclei of which nnj still
be s isibh Most of tlie pigment of the Inir is found m this Ins er Tins fibrous
substance of the hair is iwcrttl b\ n User of delicate unbnented scales
tennctl the hair ciitule the form of which is of (.real value in identification
In insnv Inirs but not in all even m the same person the centre is occupiwl
bj a medulla wbicli mn\ present festures of a certain value in identification
from Its si/t relation to the cortev and the shape and size of its cells Ihcre
IS little pigment in the mcilulla but the presence of air gi\ es the iippeannec
of colour The root has the same structure as the hwlv of the hair except at
its cxtremitv which is enlarged into a knob composed niaml} of soft growing
cells fitting over a vascular papilla vvhicb projects upwards Iroin the liottom
of the follicle

The substances which are h^elv to the naked e>e to be mist »kcn for hairs
are fibres of the common stuffs for clothing— cotton hemp silk nvion and
wool Cotton presents itself under the microsiopc as n flittencd band
assuming more or less a spied form Tlie fibre of linen denv cd from (lav is of
a rectilinear form with jomtovi markings nt uiic jual distances the hhre
tapering to n point bilk being the dried secrclioii of n ghnd presents a
regular cvlmdrual fonu and there arc no markings upon the surface It Ims
a strong refracting power on light which gives to the fibrv a will defined
bouiiflarj The fibre of w<«»l is irregular lonlorfcd of iimcpnl thici nes-s
and It has pociihar mirkings of an imbricated cIiiiMcler on the surface
The tnierosoopual ilnnctcrs of thcxc fibres under itrUim cirunistnnces
an long rctnmcil so tliat thev nnv be identified after imnv tcnluries

riu wonllbii fibre fmiii the shroud of n ni« nk buried m an niu lent jinorv in the
f lurtccnth ccnlurv an I exliuincd after tlie l»ji<c of live liiinilmi >ears shnwed
mirkings litth kss ilcfineil tfiui in « recent 'simple if w-oif the fibres wen. of a
CO itser and I vtger km I

fJic fibre of linni ajiptars to tic rf|iintlv in lestnictihle hihns from the linen
iTrciucntsof a muiilinv of tlicilvmstv ofllurSlKptierd Kings tinrnllc 1 m 18 ig wnre
well prcscrvid and still tough llic oncient noil vms rotten an 1 broke into Hiiufi
fnignicnto The linen Iin 1 the elnnclers of the fibre nf mti Icrn lfs\ It vras i f u
verv o irse f ihra and w is ktronglv impregnate I with a I mwn bihiininnits in it ter
wscil m crntj-vlnung Its pn.scrs'alion was on douhl m greet put mem' to tlie
presence of this substance

Other fibres are frequcntlv found uixiii weapons lioots iiul articles of dress
Ilicsc eommonlv pnivi to be vegetable fibres from roots Icivcs md other
siibstaiut s *1 hev cannot be confounded either with h iir or with the fibres
dcscnlied nlwivt but unj fibre of velialevcr nature found m connection with
a crime ninv be of some miiwtaun, for comparison with othir fibres and
should be the subji-ct of careful and detailed cvammntion

If ft fs Hair, is it Human Hair? The hairs of animals are frequcntlv
found on wcn|>ons and clothing thev must nit be ronfoumlcd with liiiman
hair Tliev are goncnillv s{)caking toatscr nnd tliickrr and have a wider
medulla than those of n human being f»ut it is evtrcmclv dnngcn*us to give
fin opinion about the nature of a hair vv ithoiit a careful microscopic evaimna
lu n nnd after comparison w itli other known s,implc-s of hair

A dccisKn iilxiut the iinlUft. of the liair tan be arrived nt onlj after a

120 IIAIRTIPES

detailed examination of the cuticular scile pattern its cortex and medulla,
its form and size and the relatne size of its component parts as seen in
longitudinal plane and cross section Infra red photograpiiv inaj assist In
establishing these features

The cuticular scales a ary in shape and size in di/Terent species of 'inimals
and are of considerablenalue m identification Tliej aarj consiclerablv how
eser in different parts of the same hair and raa> differ eonsiderablj in the
wool and coat linir of the same nnitnal

'i’hese scales may be readilj observed on examination m the dr> state under
oblique light providing tlie hair is not too deeplv pigmented V conienicnt
method of studi mg the scale pattern isb> means of n cast V thm film of ccllu
lose acetate comcnient!) purchased as nail samish is unde on a microscope
shdemthemannertnwhichabloodfilmismade Thehair prcMouslj c eaned
ba immersion in a mixture of alcohol and ether is placed on the wet film and
allowed to remain for about ten minutes The liair is then stripped from the
film leaving an excellent impression of the scale structure which js best vieued
bj oblique light The hair is unharmed bj this procedure

The major tapes of scales rinv be classifcd mto seicrt groups shown m
Fig lo of which t\pc seven is tvpicallj human the presence of this tjpe
of hair scale however does not enable iis to assgn the hair to n human
origin but the presence of anj tjpe other than this definitely excludes a
human origin except in the case of newh liorn infants m which type six is
often found

In the examination of the cortex and meifulla the hair if pigmented must
bo bleached and Daiulson and Tailor' consider that a great deal of the
apparent colour is due to atr in the medulla which can be remo\ ed bj exposure
m n vacuum oven

In general the cortical layer in human hair is relatively broad and the
medulla relatively i arrow It is in general narrower than m other animal
hairs

ThemeduUamay be continuous interrupted or apparently absent altogether

Tlie cortex is striated longitudinally and sucli pigment ns tliere is is found
in this layer towards the cuUcular surface and is best seen in cross section *
Davidson suggests the following sfniniiy tecliiuque for the examination of
all three parts of a hair

(1) Cut mot and tip of hair

(2) Place hair in equal parts of absolute alcohol and ether

(cleansing and fat solvent reagents) 15 mm

(3) ^\ash well in distilled water

(4) Place in distilled niter m vacuum embedding oven

and exhaust at room tenqierature maintaining a

pressure of 18-30 mm mcrcun - ^

(5) Bleach m the follow mg solution

90 vol hvdrogeii peroxide diluted 1 in 3 with d stilled
w ater 50 ml

3 per cent aqueous feme cWonde I drop
Fxcessofhn ammonia added tmmediitclv before

* 15 rnin 12 hr

use

ij QieMip er Cl tOiS J SS9
> 1 or tletails of examination oi Iiairs
‘ Recent Advances in Forensic Sledicme

s e bin d S and CUister
London Oinrchill

J

IMS

UAJIt TYPr^

121

(0) Alnsh >\ell m ilistillpd water

(7) Stain m I 100 carbol fndism (7iehl >ieelscn) in dis

tiUctl water in \acmun tmlietidiiigovcn at room tern

perature and at pressure of 18-30 mill of mercury ut least 15 nun

(8) Mash in distilled water

(O) Decolorize and dclijdrate m absolute nlcobol 5-10 mm

(10) Clear in benzene and mount in Canada balsam

Fio 13 Major cuticutar scale t>ies ot Mammalian lluir Mn;jmflcd 200
diameters (Montz )

Roman numbers refer to bcflle tjTics

A hair so prepared gives three optical sections on examination, viz
(a) cuticnlar scales on upper surface of hair, (h) cuticle, cortev and cellular
structure of the medulla, (c) cuttcular scales on under surface of hair

HAIR SOVIiCF

Tlierefore in one jireparilion the cuticuhr scales
tudiiin] section of the hair can be studied

m detail and the lonji

The above e\amimt!OD iTia> enable the observer to diagnose the ormin of
a hair or at least tJie group of animals from which a hair has been derived
hut It IS nev cr possible to state that a liair belongs to a particular mdiridual
or animal No one is entitled to sa> more than that the hair appears to be
Identical in all asjiccts with the hair from a particular source

If Human, from what Part of lheBod> did It comes Comparison with

hairs, of known situation is essential ll is of no use whatever to state timt
the hair of the tvebrow and cvclns]i is stouter than tint of the head nor
that the hair of the pubes and n\ill-c is stouter than tint on tlic rest of the
bodj 'Stoutness IS tntirelj a matter of comparison

Jn examining Jnirs inicroseopiealli it mil Ik* irdl to observe whether thev
arc of the same or of dirfercnt colours or sires whether Ihev arc pointed
at one end or cut at both ends and whether thc> have still attached to them
the bulb or sheath in which thev grew Tins condition of the hair will be
found when it has been violcntlj tom from the skin Hairs which have wot
been cut are pointcil at their free extremity unless thev are taken frofii a
locahtv where there IS constant fnclion such as the aviUa or pubis m winch
case thev frequeptlv sliow a brush like appearance The microscope wilt
sometimes enable a medical jurist to slate whether a Inir has been indented
cut, or bruised at either or lioth ends the mediillar> structure frequcntlj
retains these marks of violent treatment V spermatozoon or other bodj
might possiblv ho foiinvl adltering to a hair Ml these matter? ma> help m
deciding where a Inir came from the site of a blow might, for instance be
known and n Inir on a blunt wca|>OD vrhen compared with another from
the same seat of iiijurv imv show simibntv or not But without such points
of comparison it would be foohsh tJ sircar to the locality from which a hair
carnc

Tlie following cases ilUistrale Uie aliovc matters

In /? V Cripprn some hairs fniml on a iLair curler nv.sriciate«t with tticxnutilatcit
remains were shown to he partiallv I Icavhed and corrcsp< mle<l vnth the bleached
hair of tJ e allcgwl v lotim Belle Elmore

In B V 1/ay (Reading Assizes 1920 ) it was sliowu that luirs on the coat of tlie
accused weresuuilar in diameter to tl»e hnirbofSh irthorn cattle from the herd from
which onimaK were nuiinicd

In the Coflalming (M igwam girl) mur Icr (Kingston Vssizcs 1943) a birch stake
found 400 v-ards awaj from the IkhIv— wlucJi batl been buried on a heath— was
piwluced m evadence It matched a licaw blunt bjurj on the back of the head
and nine head hairs identical w ith a Min) le taken at nutopsv from the vactun w cre
found clinging to the crushed hark near One cod

In 7? V I/erifh (C.C C 1*440) a wa ollen scarf suspected to have been used to gap
the victim of a sa listic sexual nssaiill in Noltmt IIiH Kate vras foun^ lo be stained
with group Al blood with nasal slune and with moisteneil head h iirs i icntical
with the sample taken from the dead woman

Jnl/M wltfwfi/cv Donfl/d (High Court « fJu ticiarv Ixlrnhiirgh 1J>W) Ihcsark
in which the bo<lv of a girl agctl 8 vears vras found was eNamincil for trno-s of dust
liair and fibres \ few liairs artificiallv waved wen: found to be identical v«th h urs
taken from accused s [lair brush and m a quantitv of fluff there w ere found fibres
of wool cotton linen silk and jute djed ui six different shades undvedwwiand
cotton fragments of cat and rabbit hair and bits of hum.ui hair nff rdmg on extciisiTO
basis for ermpanson with sample fluff from tie DouaJd house o less tinti

1DE^TITY 123

(lifTerent fibres 'n-ere nntcfied similar fluIT or dcbns from nei^hbounriji bou«cs
afforded no such companson

In \ Porfwjore (^^ mchestcr \ssizcs JOJl) the Mctim i\~is found muixlercd in n
Soutliampton jnmge and a discanhd I •unmerstainw! wnth blood pro\ i led a number
of ejebrou liairs ri\r> of these ncre identical %»lth samples taken from tJte dead

In R a Lccley {( C C lOkl) an auburn laiircd cinema uslicrclte wis found
stranj,le<l in a Folkestone shop jiassa^ Five black pubic hair* were found adherent
to the vnlaai and adjacent inner thighs of tlie dead j^irl and these pro\ed to be
identical snth sample liairs from the aceuse<l who ha I been arrested in London on
suspicion The\ afforded i stronR link in the esadenre nhich resulted in a con
\action for munler Vn aiijical on a point of 1 1» nhitli f IIomtsI sras successful

In R v n nlson atul 11 ife the jirisoncrs were chargetl with the munler of a
man named Knjnor He was seen goinj; into the prisoners hiusc and about t«o
hours aftcriv irds his dead body was found Khir ncro s a line of railwas below it
The medical eaadcnce showed tliat death had liccn caused bs manual stmngula
tinn No h it could be found There were marks of dr i^Ring betsrcea the cottage
and the line of riilwa\ and at one part in the soft cl i\ tl ere were the impressions
of footmirks corrcsjMimhng to the boots of the mule prisoner On searclung the
house an iron rake was found conoe iled on a shelf wath a tmderv substance consist
ing of burnt shellac and some fibres nliicli under the microscope prosed to be the
hair of some rodent animal adherent to it

\ hat similar to that svom hs the deceased md purchased at tlie same shop
sms burnt The cinders ash svas coliccicsl and siibmitteil to examination These
hals are m idc of felt cliiefls from rabbits anllurcs fur ind this is mixed with
shclbe the asli ss-as identical snth that on the rake

AGE

The eslahlislmient of the age of an imhsidnnl has so mans m«heo legal
hearings that it must l>e fulls discussed after sshicli sse rna> consider the
questions that ma> arise Inasmiuh as csen the ngc of the cirhest embrjo
mas base a hearing on tiie chastit> of a ssoman it is necessars to commence
at the time at sshich nn embrjo can be distmguislietl although the earls
products of conception base more connection ssitb esidence^ of pregnanej
and abortion tliaii ssith identits

It 18 coiisenient to discuss the csidences of age in periods

1 Tlie age of an embrso up to sesen months (tlic threshold of s labilits )

2 The age of a fcetiis between seven iiionlhs mtra uterine life and full term

3 The age of a child receiitlj born

4 The age of a child which has sursisid birth more than a dij or two

or of an adult

of Embrjo up Seven Months

First Month \t the end of the thinl svcck the diameter of nn ovaim is two
thirds of in inch the length of tlie embrso one sixth of an inch' the amnion
IS formed the embrjai shack is ctirxed and the enlargement < f itscepImUccxtrenut)
marked \t the end of the fourth sieek the „reatest diameter of the osaim is about
seven eights of an inch its weight about forts grams the Icngtli of the embrso is
about one tlurtl of an inch* thccscs thcears and tl exasccral nrchcsnrcdtstinguLsh
able Four bud like processes mark tlie commencement of the hmhs Tlie um Jilieal
x'csicle IS manifest but smaller than the emhrjo The amnion is not much distended
and separated bj an interval from tlie clion >n

Sfcond Month \t the end of the second ni mlh the ovaim is about one Inch
and tliree quarters in its greatest diameter and the embrjo Ibrte quarters of an
inch long* Tlie umbilical vesicle is verj small and lungs by i thin thread Tlie
‘ Crown rump (vertex I uttock)

’ * These ineas iren cuts (before tl e legs have iKCorae f lUy formed) are crown
rump (buttock) ineasuremcnts Tliose tl at follosv are crown heel lengths

124

POSTAL AGE

hnibs are more manifest the hand his a liuman appearance Points of ossification
^ The month and nose arJmanif^t

Tlie \\olirian bodies h ue atrophied and Uie kj(lne>s hasc appeared

Tlnrd Vontf, At tl c end of the thiwl montii the i vum is aliout four inches
long the pi leenta is formed and tJic rest of the chonon lias to a m irkcl extent
lost Its xallositj The cord has now become Imy rclatis cly to tlie foetus and alrcads
shows Its spiral twist The foetus is four to four an 1 a h df inches lon<» and wci hs
about 4 >0 prams 1 he head is sepanted from the body bs the ncch an 1 the oral
from tlie nas d ta\ it> b\ the palate and tl e mouth is closetl b\ the hps The sexual
orpans ln\c appeared but the i>cnis and clitoris are scarce!} distin'mislmble Tlie
limbs are de\eloped mcUidmp the finders and toes an I a first appearance of fomm
tlon of nails can be detected Pnmtsofossilicntion lias e iipi cared m mo»t of tl c bones
FaiiTth Month At the end of tie fourth month the ftetus is on an ascrige
about si\ inches long and w-cighs about tliree ounces The sex can now- I>c dtstmcllv
recognized The bones of the skull Imc partly ossificl but still hare \er\ wide
fontancllcs and sutuns There is a slight commencement of the formation of
down on the skin Moxements of the limbs base commenced lut these mas
houever be detected m a freshh expelled embryo csen Ijcfore tie end of the third
month \ r/tij of tt r tnoD tr s nl don cm »/ o / n«ro rnenl (fefat t$

hfth Month Iheftctusis on nn average nine to ten inches long and weighs
nearly elexcn ounces Hair has apjtcnred upon the head nnd Jinugo or down
oyer the yyhole body The skin begins to lie eoxcred yrith vcrnix caseosa Then?
IS a centre of ossification in the calcaneum

Sirth 4/onlA The fcctits i$ on nn axcrage about twclsc mcles long and
yveigUs about 24 ounces Ti e eyebroivs and eyelashes are beginning to form Sub-
cutaneous fat IS commcncuig to be deposited but only m sm ill degree go th it the
skin is still yvrmkicd There Is a yellowish material in the small intestine and there
may be a commencing apjiearance of the darker meconium in the large intestine
Tlie hair on the head is I ingerand less like down \ centre of ossification appears
in the manul num stcmi

Stztnth Month The feetus is about 14 incles long and weighsgometw-oand nhalf
to tiiree pounds Tlie cvolids arc opening and tlie pupillary membrane undergoing
atrophy Tlie skin is rcddisiU and loose but the liair thickening and darkening
Ossiiication centres arc present in tl e talus and (three) in the upper two thirds of
the sternum apiiearing hucocssiyeh from above down The testis is desccnimg
willun tJie abdomen and may li ixc rcacliel the inguinal ring

For further particulars the readeris rcfeireyl to special works on embryology ‘
The term oyum signifies the embno <««/ its membranous coienngs the
embryo is the body yvliich n. afterwartls comerted into the fcctus fcctus
is the name applied to the embryo after the thml month of gestation

One great difilculty consists in determining the nature of the supposed
oyaim or emhry o m aborted mat ter in the fiixt tivo months 3n making the
e-xammatiOTi the material should be placed in a {iisli of yvatcr and all coagula
gently washed away or remoyed b\ some blunt lustnimcnt If the embryo
cannot be found the decidua and chonon or portioas of them may be
recogmzed the former by its forming Uic outer myestment yvith its smooth
internal and rough external or uterine surface the latter by its yiUous or
shaggy appearance Betyyecn the thini and fourth months the fretus may be
commonly identified yvithout much dilTicuUv The oy tim in nianv instances
escapes first leay ing the decidua liehind hen n semi decomposed or dried
mass of blood clot etc is presented for exanumtion it is often tom emcn
to take an \ ray plate of tlie specimen If the fcctus is about the third montli
onwards the ossified ribs and limb bones yyill be seen It i' mlportant to
remember that in some states of the Mrgm decidua like structures are shccl
from the uterine mucous membrane which when examined by the microscope
are like the true decidua Both are eonstitutcyl of the innermost portion of

* See Gray s Anatomy 31st El London Longmans Own

FCETAL AGi

125

Ihe iilcniie m\icou'. rnenilminc and contain nil \ls eleincnts It requires a
Allied microscopist to ihslin!>uish placental Ussitf nth cerlainlij rviJeiicc of
this nature formed the basis of the lil>el nition hition \ Plaijfmr in which
Dr riasfair tlireu doubts on the ch*t5tit\ of tjie pHintifT
Such are the principal points we Ime for detcmnnin" the age of the
contents of the uterus m the cnrK stages of pregnancj

The points themsehes are of such n nature that while it js casv to give
approximate estimations it is quite impossible to ilnw liard and fast lines
between sa\ the second and thin! months and between the tliird and fourth
and tliese are prccisoh the cases m which lawyers will attempt in defence
of a womans chastitj to obtain an opinion when for instance the last
possible date of connection is five months and a ftctiis is born which might be
oftlirec four or five months development Tlie great variabihtv in develop
ment renders it essential for the medical w itncss to fi\ reasotiablv wide limits
and to leave the decision to other ev idence and to the jiirj
"With regard to the question of live birth in immature fatuses tide Live
Birth \ol II At seven months the foetus becomes viable that is
capable at law of a separate existence but it maj survive if bom as early
even as the fifth month

Age between Seven Months and Full Term, Nine Calendar
Months

The following description of the child lietwccn seven and nine months
corresponds verj closelv with those m most text boobs on midwifcn

Beticeai the Sinaith and Eigtth 'Stontts The child measures between 14 and 15
inches in length and weigiis from three to four i>oun(]> The sbm is tluck otamora
dccidedlv fibrous structure ntid covered with a white unctuou% vemix eascose
wluchnow first appears Fat is deposited in the cellular tissues wherebv the bod>
liccomes plump ihe skin prevaouvlv to this is of a retldwh colour and commonlv
more or less shrivelled the nails which are fUirlv hrm do not quite reach to the
extremities of the fingers the linir becomes long tluck andcoliureil ossification
advances throughout the skeleton the talus shows n centre of ossification vaUaiLas
conmventes appear m the small intestines and men mum is found occupvang the
caKnim and colon Tlie testicles m the iiinlq arc consi lered about this peno I to make
their descent towards the scrotum The time at which these organs change their
situation is probabl) subject to variation m the abdomen at the seventh andmthe
scrotum at the ninth month at llie ci{dith month tliev wall commonlv be found m
the ingmnal canals Its absence from the scrotum at birth docs not netessardv
indicate that tlie child is immature because the organ sometimes docs not reach the
scrotum untd after birth and sometimes not at all

lift-vten Ihe riglil/i and \in« tfonff s Tlieclwl lis from 15 to 10 inches m length
and vTcighs from four to five poui ds Tlie membrana? pupillares liave disappeared
Tlie quantitj of fit deposited beneath the skin is mcrexs^ and the hair and nails
are vrell dev eloped The surf icc of tlie brain is groov «1 or Rsstiretl but presents no
regular convolutions The meconium occupies almost entirely the large intestines
and the gall bladder cc ntams m me traces of a liquid resembling bile. Tlie testicles
m the male mav be foun I occupvangsome part of the inguinal canal or thej ma> be
m the scrotum Tlie left tciticle is sometimes in the scrotum while the right is
situated about the cx"temal ring A centre of ossification appears m the lower
epiphvsis of the femur

\t;il/i Month Signs of '\falimty \t the ninth month tie average length of
the bo<l\ is about IS inches and its wei^it from six to seven pounds The male
child IS gencrallv ratherlonger.andweiglLsrathermoretlian the female Consi lerable
variation in length anil weight occurs Cluldren are sometimes bom mature and
survive viluch weigh less than five jiotmds On the other hand records of the

120 rCETAL AGL

^ ■*"'* of 21 and ^2 inches also

Bj the end of the ninth month the centte of ossification in the loircr
epiph>sis of tlie femur meostircs about a quarter of an inch m diameter
Great stress js placed on the size of tins point of ossification in the lower
epipJnsjs of the thigh hone (femur) m its bearings upon the matcinls of the
fmtus Tins point nsuallj makes its appearance at the 3G^37th Meek at the
dr-58t}i Meek It IS commonU about one fourth of an inch m diameten and
nt the full period it is one-fourth to one fhird of an inch in diameter When
this point of ossification has reached this size it ma\ be confident!) atfirmed

Fio 13

(After Fdith no>d from Scomnwm in Moms Human

that the tetus has reached the full period but the size of the centre is subject
to some slight \ ariation \ centre of ossification is nsualh found m the Jicad
of the tibia and one m the cuboid bone of the fool m full terra Mcll-de\ eloped
children

kt the full term the bead of a diild forms nearh one fourth of the mJioIc
length of the boiK Tlic cellular tissue is filled with fat, so as to p\ e con
siderable plumpness to the wfiole form while the limbs arc firm hanl and
rounded, the skm is pale, the hair is thick, long and somcMhat abundant,
the nails are full) dev eloped and reach to the ends of the fingers— an «PPcar
ance, JioMev er nhicb ma> be sometimes simulated m a preniaturc child by the
shrinking of the si m after death Ossification will be found to Irnve nd\ anced

FQTALAOC 127

coij'SKlerablv throughout the skeleton The surf ice of the brain presents
eomolutmns, and tJie grej matter b^ns to show itself

The characters gi\ cn at the different stages of gestation must be regarded
as representing an aserage statciicnt * 1110 % ore it is well known, open to
numerous c\ception8 Iwins are gcuemll^ smaller and less de\cl()j)ed than
single children the n\crigc weight of n Iwm child is not often more than
sj\ pounds and i tri often l>eJmr this The safest rule to fehoH in emJcai our
uig to ilctcrnmie tlic inlr'i uterine, age of a child is to rcU upon a majontj of
the characters which it presents That thild <»nl\ can Lc rcgardcil as tiiatiire
winch presents the greater unmher of the cliaractecs fuucid at the ninth
montfi of gestation

It is consenicnt to remember that tlie length of tlie child in inches is,
during the Inter stages of pregmnex about double the mini uterine age in
montlis Hesse s rule slates that the square of the number of months gestation
gives the length of the fatus in tcntinicttcs

Conclusions Ihe following table niiiv l>c taken ns a siimmarv of the
principal facts upon which our opinion resivccting the uterine age of a thiUl
rnaj be based —

f nwuif/t

7 rmwWt

8 moiil/it

Length

About IS ifu

About 14 MIS

About ir ms

W eight

HtoSths

1 to IJ fl'S

t to 5 lbs

Skill

Hid nnd nrmk

!• a 1 e r and

scbiccous mat

Ir<I

smootl er

ter foniimj.

nu

No subetitane
ous fit

I nl Uginnins
to lie rlqwited

Child plump

bcrotuiii

1 mptj

—

Comigafnl

Testw

0 n |i H o 11 s

Ncir the Inter

Ineiiijl

Sea

RtlLscIc

Well digcreiitl
iiled

ttnl nn;;

(b Ufurc U)

Hair

I,nntigo

Soatp downy
svith hmiRO

“

Nails

_

Nemnj finger
tl,s

llmeh end of
fingers

rvehds

llmln

\dl crent

S>lvnn fissure
fomicil

Non odlicnnl
I.ye Ins lies
prc-Knt

Well fwmied

Intestine

Vtceoniiini In
email intes

tine

Meconium in
l»rpc fnlw

tine

Centres of
ossitication

nj i«“ir

At iniihruim

Astne il'is

I,nwcr epi| hysis

ami (H (“ilcis

(talus)

of ftmur

IMncentn

weight

0 to 10 OM

12 l« 18 otr

Alioiit 15 orj

0 irioii/fts

IS to so inn
a la s lbs
Copious vemts

Oenipied by
trstrs

In semtunu
(L Wfore It)

lliir on scalp
an inch lonj;
rrojcct ovTr fin
Rcre Itcacli
end of toes

CiiIkikI. upper
cpipliysis of

tibiA,

in to 18 ots

The Age of a Child recently Dorn

We have now to deal wifli a different class of age data from lliosc we have
hitherto considcrcel These liavc liccn tiitirelv dircctctl to proving either
tUit a clwUl ewwUl w eiowUl vwvt base l«cw tUc UwW wt pattiewlar parentage wr
that it was or was not capable of extra iiUnne life We hive now to con-
sider for how long it his lived and we assume tint Ihere is definite evidence

128

yhOVATAL AGL

of some duration of life Uncfer “iDfanUcidc ’ « ill be found a full dt^cuss.on
of the e\ idence bearing upon tins assumption (sec ^ ol II)

Changes tn the lungs, whether gross or microscopic, and chinges m the
total circulation will not be of much assistance, though thc> mav be of great
importance in deciding whetber Uie child \ris born alive (sec “Live llirth' )
W e have nniiilj to reh upon changes m the umbilical cord, clumgcs in weight
and stature, and the progressive dis,appca!nnce of the “fatnl" form of h uno
globiti during tlic first si\ months in endeavouring to delcrimne the age of a
new born child, and it must be admitted that none of them jiclds verv
decisive indications

Changes in the Umbilical Cord 'Ilicsearc the roost truslworth) ofnn>
data we Invc, for tlie changes are due to vital processes and arc dictated h>
conditions of atrophj and healing which pursue n fairlv' regular course
Thus wlicii the cord is lied and severed m the usual wav llie porhon left
adherent to tlie Ixidj begins to drj up in from 12 to it liours mid m about
24 hours from birth a ring of mflamniatton makes its appearance round the
site of its insertion This mniimmatorv re<jMcss must not be mistaken for
the thm red circle which is almost conslanll) present at birth About the
third or fourth dav the drvang of the coni is complete, mid the dried portion
separates from the navel about the fourth or fiflli dav, leaving a mw area
winch takes from seven to 12 davs to heal complctclv Ilcncc If a child M
found with well marked inflammation or a mw area at tlic umbilicus a verv
reasonable approMination mav be made to the lime that it lived nftir birth,
though even here the different rates at which wounds heal m licaltliv and
unhcalthv children must render tlie judgment somewhat tentative
It was formerh stated tint if a child ln<l lived two or three davs long
cnougJi, that is fortherordnppnciablv tomitj»)»jf>, no amount of soakingin
venter would cause a raUlutto aU iiUe^non m the dried parts but this stale-
ment IS much too positive Vdrieil coni swells up and except that it iiuv lie
a little darker, it is difficult to disliiiguisli from a coni which has not Iwomc
drj before soaking Children s bodies at this age art frecjiicntlv tlirown into
water, and in l>o<]ies thus recovered n dried jucce of coni suggests two or
three dajs esjiosurc to air before iinmcrsum

Weight If wc consider the extreme limits for the weights of mw bom
children and then remember that wc have iio means of knowing whit the
weight of a child was at birth it niff be seen f»m£ the ^h^otVrf( wogiVc o/ iv
child found dead is of no use in cstimatuig how long it hvcd-whcn it is
probable from other reasons that it was n few daj*s or weeks old

Tlie both ofan infant founiliannottaihdcaM! at Wifonl was tw. drv togivTtls
weight unv signillcanec The Icnglli nod llw mu of ttie lower fcnioml »»'« “I't;"
tlbuU owilication mitres sugp-stcnl it was * somewhere nlH.ul J in mths 1 1 1 xn
mother, whin tmc-xsl. said it was four months old furlher 1 ....int

important fact lliat birth was two months iircnialure To her il waw four
old. but Its development vTas lint of on infant of nlKWil ludf tint a,T Agein„ eouia
on!> be o]iproxim3tc

Hclftht. Prccisclv the same reasoning npphe-s to the length of a new Imm
child The birth length is loo variable, ami tlierrfDrc the initial basis for
comparison is not nv ailable

Tl.c following mav be token as a summarj of the npi>eannccs observable

^^0\^iTAL AGC 129

in the bodv of a child that has survived its birth for the undermentioned
periods —

1 AJ}er2i hours The skin is fiim and less red thin soon after birth
The umbilical cord is somewhat slinvelled although it remains soft and
bluish coloured from tlie point w here it is secured by a ligature to its insertion
m the skin of the abdomen The meconium mij be discharged but a green
coloured mucus is found in the large intestines The lungs may be more or
less distended with air, but it should lie remembered that though, when these
organs are fulls and perfectly thstended the inference is that the child has
probably survived some hours the converse of this proposition is not always
correct ^\ hen the lungs contain a small quantitv of nir it does not follow
that tlie clnld must have died immcflmtely after it was born *

2 From ilie secoiul to the third day The skin has a yellowish tinge the
cuticle sometimes appears cracked a change which precedes its separation
m scales The umbilical cord is brown and dry between the ligature and the
abdomen its v essels are thrombosed

3 1 rom the third to the fourth day The skin is more yellow and there is an
evident separation of the cuticle from the skm of the cliest and abdomen
fhe umbilical cord is of a brownish red colour flattened semi transparent
and twisted The skm in contact wnth the <lricd portion presents n rmg of
vascularity or redness gradually shadol off towards the abdomen The colon
is by now free from any traces of green mucus

4 From ike fourth to the sixth Jay The cuticle m v anous ports of the bodv
IS found separating m the form of minute scales or of a fine powder The
umbilical cord separates from the abdomen usually oliout the fifth day but
sometimes not until the ciglith or tenth day If the umbilical aperture is
cicatrised and healed it is probable that the child lived for three weeks to n
month after birth Ihc ductus arteriosus may be found contracted both m
length and diameter

3 From the sixth to the ticclflh day The cuticle will be found separating
from the skm of the limbs If the umbdicnl cord was small cicatrisation will
have taken place before the tenth day after birth if large o sero purulent
discharge will sometimes continue to escape from it for 2a or 30 days The
ductus arteriosus may become entirely closed during this period but this
IS open to evceptions which ar^ pointed out elsewhere The body rapidly
increases m size and weight when tlie child has enjoyed active existence and
adequate feeding

On the whole, it will be secu that the signs of survival for short periods
after birth are not very distinct and it is in some respects fortunate that great
precision m assigning the time of survivorship is rarelv demanded of medical
witnessess It is sufficient m law that a child did m fact achieve a separate
existence

It IS expected however that a medical man will be able to distinguish
between a new born child and one which has been born for several davs
evidence on this subject is occasionally required m reference to supposititious
children Those who attempt a fraud of this kind have sometimes been
compelled to substitute a child two or three days old for one just bom A
medical man called in to a woman after an nUeg^ dcU\ cry in the presence of

* See section on Cntena of V Separate Existence {\ of II)

130

AGi: I}ilA}\CY

of a nurse (perhaps an accomplice) is hoiincl lo ( xc rc isc gre it cniiltoii lit lln.
event of litigation at a subsequent date he in expected to Im abit to inform
a court ot the condition of the child when first seen b\ bun nml of the pmhnbte
date of its birth He will not be nllnwed to throw llic bhtnt. of n mistaVc
upon others Success or failure in perpetrating a fmid of tin? hind will
depend ujion the doctor s alertness

Ji \ If cri/v'ns a case of Rome diHicultj respecting ttic iilcntits of a cliild ollccnl
to Jiave J»en nmnJcral Tlic deail ota cliiM tnd surni-ect its hrrtli iras
found viTappcd m clothing and concealed ne*r a liigh roac! bj which Uie woman
charged vntti murder Itad l>een seen to pass on n certain daj ihe doctor wh»
examined the bodj thought Uiat» from its slate the rluld had Iwcn dtnd a month
and that it was smnefen days oWot ilealh lliechiM rf thencxiiNcd luiil iliMi|)]icnred
when it was about afortiught old

The defence was that the eluld whose UmIv w-as fmmd was m t Hint of the nceuwd
The cluld found as well also as Hint of the woman was male and hnl hgl t
tiair but the age created doubt and, iiion this cmloncr tlie ncriisod wts
acquitted

This case serves as n warning of the legitiinatc limits of medical tvidciici

hen the bodv of a child has been U ing pulrcfi ing for n month, it is diflicull
to suppose that it could jield evidence of so fine a jxnnt ns whether it were
10 or IS dajs old

• £stIma(ion of Age fn a Cbffd which has survived Birth for n
Longer Period

In the absence of documentarj proof, the cNtumtiou of the ngt of n linug
child can be onlj approximate until it arrives at the lime when (kntition
comnicnccs The height and weight nm offortl some little asNistniici., but it
must be remembered that there is a difrenmc m the rnpubts of growth not
onl) in cliildren of a different sex but also m those of the same srV
aodnotonl} in single birtiis but even in the case of twins. One max flourish
and grow the while other remains pun> Tht average llint is ordinnnl>
expected is that a chdd should measure about two feet 6j the end at the
first jear, and should weigh alwul 20 |»ounds, with phijiortmnale merrase
from birth upwards

Tlie following tabic and graph gives the average iiionUilv weights of
children during the first v ear of life —

At birth

1 month

2 months

3

4

5
C

lb 07
0 8
7 4
S 4
9 0
10 8

11 8

12 4

7 monlliN

lb or
Id 4

14 4

15 8
111 H

17 «

18 H

Afic from One Tear to Puberfj

hen tlie teeth commence to erupt they fon.i (see p 101) Uie moNt reliable
means for llic estiiintion of llic ajt of a cIiiW from nliout llir asc of six inontlK
topubartj.olictlicrllieclulilljclniiioorileail it n possiljlr l)\ X rar cxami
nalion to rorioboralc such oldcncc from the ossihcation of the Ikuics, f.r
rlueh purpose a table .s hem ...sertcl of the rr.nc.,e,l ,»>mU m such
ossification Tl.e figures must not be tolcn too ngi.ll) . hut only a, nnpl} me

^iCL IX CHILDHOOD 131

nn ft\emge For a review of the subject sec Bojd, J D )1053) or
jSoback, C (1944) ,

Bojd J R .IDj'J InMcnlcm Trends in rorca^ic Medicine (Cd Keith bimppon) London
IhiUcn'orth

Nohack, C , 10-M Anai Wee , 88 01

Appearance

of Points of Ossification

PofA

Hand

5Hi-6th month, mlra uterine

Calcaneus (body)

Whole hand cartila-

7th „ ,

Talus

ginous during intra-

9th

Cuboid

uterine life

1st vear, extra uterine

External ciinei

Capitate and hamate

2nd'

form (1-2)

First four metacar-
pal heads

3rd „

Internal cunei
form Tarsnl
nav icular

Triquetral (2-3)

4th „ „

Mid cuneiform

Lunate (4-5)

5th H 1,

Scaphoid (1-5)

Trapezium (5-6)
Carpal navneular

Gth „ „

Scaphoid ■!,
Trapezoid J

8th „

10th „ „

Calcaneus (cpi

Pisiform (f 9-10

phvsis) (9-10)

m t0-ll)»

Appearance af other Points of Osiifcatton
Heads of humerus ftmiir, nnd tibm
Lower cuds of radius tibn, nnd fibula
Patella,

Uvpcc cud qC ftbula great itocltantct oC femur (t-3)

Lower end of fibula Greater tubcrrle of humerus
Head of radius Lower end of ulna
Ilanii of ischium nnd pubis Olecranon
Irochlea of bumcrtis Lesser troeJianter of femur
L\tcnial condv |c of humerus
Acromion iliac crest lesser trtchanter
Tuber ischii (17 in female 19 in male) Inner clav lele 20 21

Union of Pones awl Fpxphyses
IH Ij >cars the anterior fonlanellcs should be closed
„ 4-5 , tilt greater tulfcrclc fuses with head of humerus

„ 9 „ the ilium pubes and ischium should meet in the nceta*

bulum rami of ischium and pubis fuse
, Id „ these three should be united but still separable on macera-
tion

, 15 , the coracoid should be umletl to tlic senpula

„ 10 , the olecninoii should bo iiniteil to the ulin

, Hi-17 „ the head of tht ruhus nnd the lower end of the humerus

should be joined to their rcspettiv e shafts
the intern d epHiHidjIt. should be iinitetl to the lumicnis
Uit held oT the femur should have joined tlie diapbvsis
vneeker, II , 1033. J Anai .Lmd ,tl. Its

1st )ear
2nd ,

3rd
•ttli „

5t!i ,
rth „

Slh-Oth jean*
lOth-lUh
12lh-l4lh ,
14th-lGth ,
ITth-lOth „

, 17-18

u lS-20 ,

AGE IN YOVTIl

Dy 18-20 jears
.. 20 ,,

» 25 ”

the epiphjses of the long bones of hand and foot sliould
have united to the diaph\ses
the epiphjses of the fibula should he united to the diapln
SIS Distal radius unites

the inner (secondary) epiphysis of the clavicle fuses
the crest of the ilium and the articular facets of the ribs
should be united

The female is usually a y ear or so ahead of the male in fusion dates

U all the epiphyses are found united tlie mdividiial is almost certamlv
over 25 years of age, and if the three parts of the sternum are united bv bone
he IS almost certainly 35 or cr *

As stated abo\e, these points can be investigated with almost the same
accuracy in the living as m the dead by means of X rays
There is a tendency for the epiphyseal centres to appear cirher and for
the union of epiphyses to the shnfis to take place earlier in the fein dc

Fio 14,

{After Ethtli Boyd from ScjwMmon» tn Moms' Iluinnn \mtoin' )

It has also been shot™ hi n,a„v oteeners Ihol JJi Iropical climalcs ostifi
cation lakes place earlier than m temperate zones In Ctjlon for csampic
It ebster and deSaram' hat e alioiin that ossilic centres appear and epipin stal
imion takes place at least two a cars earlier in males and Ihrte and a half t ears
■ M,10lrr.C.an,l.lc<t,n.n,,r. S tt lOSlJ Crim law. Crirn.iK t follee Vi <5 M«j
Tune and sulweri'ifnt Kmici

AGE IN ADULTS

133

earlier in females ns compnretl with standards recognized in temperate
climates Hepiiorth* and PilKi* hiAc come to the same conclusion about
ossification in India

Height and v, eight are too \ nnable to be of much use, but tlie foregoing
table" and gKijih slious tlie aieragcs with winch a giien individual mav be
compnred

Sex changes The gradual growth of hair on the pubes commencing with
a solt downv growth at about 10 to 13 is a little more relnble, showing at
least an approach to pubertv Tlie development of the breasts m girls is
variable In bovs the voice undergoes a marked change as pubertv comes on,
losing its shnll infantile treble and taking on a deeper note, tenor or bass—
“the breaking of the voice” in common speech It must be stated that tastes,
habits, and inclinations usuallv vara somewhat with age in children (com-
paring onlj members of the same sex), but some bovs of 15 are almost men
in these respects and others still cluJdren, and the same mav lie said of girls
some of whom are married at 16, while others at the same age are still school
girls

Prccocitj Cases of cvtnordinar} precocitv, although not frequent are
b) no means rare manv cases of menstruation m girls from sl\ >ears of age
are reported, with excessive development of the breasts and pubic hair

Ken* records the case of a girl ag^ six vear» ten months who began to
menstruate at the age of three and a Iialf jears She had well developed
breasts and a prominent mens veneris on which there was fine dark hair
The titerus was almost of adult size

Tumours or excessive development of the suprarenal cortex or of the
pituitarv gland vtiH, of course, result iii anomalies of sex development (see
p 112)

' Age in Adults

After the age of 25 the estimation of age becomes more uncertain, wliether
in the living or the dead It is true that common knowledge comes more or
less to our aid, enabling us to make a fair approximation to the decade wathin
which a person mav be but anv doser approximation must be made with
Xonsiderable reservation Premature ageing mav easilj be produced b\
illness, malnutrition, suffering, anxiety, or worrj, white hair often comes on
in quite joung people from grief or shock and often for no reason that can
be estimated, calcified arteries and arcus senilis (m the eve) are rarelj seen
before 40, but after that age tbev arc of little value in estimating the age
It IS diFTicult to achieve an accurac} of even five vears in estimating the
age after the full permanent dentition and fusion of all centres of ossification
have become established — that is, at about 23 to 23 vears Tlie ossification
of cartilage m the hvoid, larjnx and nbs, the fusion of the greater horns of
the h)oid to the IkkIj and of the manubrium and xv^plnsternum with the
bodv of the sternum changes in the appearince of the cartilage lining the
joints and lipping of the bones, all of which occur somewhere between 10
and GO mav be suggestive of advancing age but give no precise evidence
The gradual loss of teeth and changing slutpc of the lower jaw as it becomes
edentulous cquallj offer no data of precision

’ Ilepwortli S VI 1929 liuliau Mrd Gaz. 64, 12S
^Pillai, VI J S , 103G IithanJ tned Pet, 23, 1015
* Bnt med J , 1017 II B20

131

AOh iA JjAW

Other sources of information on adult age sucli as that suggested b\
Gustafson^ (see p 102) may give further eudence of this important matter
of age

It IS manifest that no one of the observations can be relied uixm to give a
precise age but a careful consideration of all may enable us to giv e an approxi
mation of value to the investigating authoritj

Medico legal Questions concerning Age
riie following preliminary remarks are of general application to all ages
and ha\ e a v erj special bearing on the dutj of accoucheurs

A child is not regarded bj tlie law as born until it is completely pro-
ceeded from the body of the mother’ , no mention is made of tlie severance
of the cord nor of the expulsion of the placenta neither of which has m law
anj reference to the birth of the child vvhich is concluded directlv tlie whole
of the child has left the vailva (cide Infanticide ) Wien a cliild is being
born about midnight if the presenting part be born before midnight and
the remainder after that hour the birth must be registered as Inv ing occurred
on tile daj after the commencement of the parturition

In law a child arrives at a given year of age at the first instant of the
day preceding his birthday, m the common meaning of that word and in
thus reckoning days no recount vvliatcver is tnken by tlie law of parts of a
day, thus a cluld born at H 59 on the night of May Srd 1933 is m Jaw 21
the first moment after midnight of May 1st, 10o4 It is obvious that in decid
mg cases of this sort nothing short of conclusiv e documentary proof or sworn
cv itlence of reliable w itnesses to the act of parturition will be accepted
r\ idence as to age may be demanded in the follow ing circurastanecs —

(<i) As an aid to identification

(6) In questions of criminal responsibility

(c) In questions of rape and sexual offences

(d) In connection w ith the comiietcncy of a witness

(e) In tlie making of wills etc
if) In contracting marriage

(g) 4s regards capacity for procreation (involv mg impotence legilunacj
etc )

(A) In connection witli civil employment and m protection of chiHren
(i) In connection with recruitment for military service
Age ju Identification An “approximate age is ot course an important
'mk m any chain of identify data but there are so many other points in
identity vvhich have been fully discussed that precise evidence as to age is
not of much intrinsic value bif ifsfl/’ except m very rare circumstances sucli
for instance as in cases where a baby some few days old is alleged to be t ic
new born cluld of a lying in woman

In Questions of Criminal Responsibility * Infants are iftwdcd inti
three classes according to crimtnol law

(i) Those under eiglU* years of age Tlierc is conclusive |wsiitnption tiiai
children so yoimg cannot have mens rea at all Nothing there ore ^ "
they do can make them liable to be punislietl by a criminal court, so a c n

•Gustafson G ID^ J Auer tnl Ass 4t
Kenny in Outlines of Criminal Iaw 1M3 ip oOelsei
* The 0{tc ot immunity was to »ed from seven (as at Comn o
L>} tl e CIi Idren and \ ouog 1 etsons Act 1033

Low) to eig! t

AGE 1\ LAW

13o

of si\ who VMS arrested for rrmie obt'iined damages from the arrestor But
jt IS not illegal for parents to administer domestic punishment to such children,
if thej have m fact become old enough to understand it

(ii) Bet teen ei^ht an I fourteen Children under It are presumed to be
doll incapax but this presumption can be rebutted b) cogent e\ idence th it
tlietliild knew tlintwhithevvasdoingw is wrong Tims when a child between
ei„lit and fourteen is charged with a criminal olTeiice before he can be con
vioted the jurv have to be satisfitHl —

(fl) That lie comimttetl the act or acts charged

(i) That at the time he had guiltv knowledge that he was doing wrong
(See in this connection J? v 6>me83J P 13Cand^ v Kerskaiv 18
TLB

*{m) Beltceen 14 an I 21 * A boj knows right from wrong long before he
knows how to nuke o prudent speculation or a wise will Hence at 14 an
infant comes under lull criminal respousiliilit)

Bj sec o2 of the Children and \oung Persons Act, 1033 no child under

14 can be imprisoned and no joung (>cn>on can be sent to penal servitude or
imprisonment (unless unruly) Bj sec j 3 sentence of death is not to be
pronounced or recorded ngainst a person under the age of 18

The following table gives the various dchnitions of child and joung
person as to age —

Tor registration and notification At least 2S v\ceks of intrauterine

life (Birtlis and Deaths Hegistra
tion Act, 1020)

To commence school \t least five vears (Ldiication

\ct 1944

To continue at school Till lo (Lducation Act 1044)

If blind deaf defective or epileptic V child is a child till If (Education
Vet 1944)

Bcstnctions on emplovmcnt Under 12 general prohibition Be

tween 12 and 18 on specifievl
conditions subject to bv e-laws
made bv a local nuthontj (Child
ren and 1 oung Persons Acts 1933
and 1038) lledicnl practitioners
maj give certificates os to the
probability of a child s being
injured bv bis work

Bv the Cliildron and \oiuig Persons Act 1933 Child means a person
under 14 \oung person means a jjcrson wlio Ins attained the age of 14
jears and is under 17

Age in Rape and Sexual Offences The law lias made certain dehni
tions relating to age winch are very important

(i) A bov under 14 is presumed to be Incapable of rape as a principal
in the first degree i e as the actual perpetrator of the ofTcnce and even of
committing an assault with intent to rape Whether tins (m certain cases)

15 WLSe or not is a matter with whidi medical men have nothing to do thev
have simplj to decide whether the bov is 14 or not If the registration of
birth certificate can be produced this is conciusive In the absence of such a
certificate the teeth and pubic hair are the most reliable forms of evndence

V Kenns loc at

186

JGL IN LAW

The size anti tle^ elopment of Ins se^nial organs mnj lia\e produced severe
mjurv upon the girl, and maj suggest his being over l-l, but the defence ndJ
require proof not mere probabilities

“(ti) To have connection with a girl under 13 is a felony, and consent
IS no excuse nhere the girl is under 16* UJicre the accused is a man of 23
jears of age or under, the presence of reasonable cause to believe that the
girl was over 16 jears of age shall be a valid defence on the first occasion
uponvvhichheisehargedwithsuchanoffeneef^ vr Ford) ® Inli \ Chapman^
it was decided that this defence is available Until the 24th birthday of the
accused

Competency as a Witness An infant of any age maj be sworn as a
wntness provided that such infant appears to understand the nature of the
oath Competencj depends not on age but on understanding Where an
infant is tendered as a witness it is for the judge to determine whether such
infant rcallj understands the obligation of an oath and it is the duty of tlie
judge in anj such case to take steps to ascertain the state of the infants
knowledge Tliere is a discretion in the judge to postpone the trial for an
infant to be instructed as to the nature of an oath If an infant does not
understand an oath bis ev idence may still be given if in the opinion of the
court or judge he is sufficiently intelligent to know that he is under a dutj to
speak the truth But no accused per!>on can be eonv icted of anv offence on
the sole evidence of an unsworn infant Tliere must be some sworn evidence
corroborating the evidence of the infant in some material particular impli-
cating tJie accused person

The Children and Young Persoas Act, 1033 contains special provisions
relating to the maimer in which the evidence of a child of tender jears mav
be received bj the court In this connection, see 7? v Moscimtek* and H v
MarshaU^ For a case where medical corroboration of a chdds evidence was
vei^ important, under “Wounds”

In the Making of Wills, Borrowing Money, Pledging Credit, etc
The law does not allow persons under 21 years of age the ful] power of dis
posing of propertv bj will or even by gift, nevertheless, it permits persons
to fi\ the age at which a legatee niaj assume full control of n legacy, but as
0 broad general rule no ilebt can be recovered by legal process from a person
under 21 The matter has however, but little interest for tlie medical jurist,
for in all such (and in many other) cases documentary ev idence of age w ill be j
required, and not merely meihcal evidence

In contracting Marriage TJie statutoiy- age in England is 16 for l>oth
sexes *

In Procreation, etc Before puberty, which is very variable m its onset,
a boy IS naturally sterile, though he need be by no means impotent. A girl
before puberty is not necessanlj either sterile or impotent for cases arc
recorded of girls bearing children before mcastruatioii (which ii taken as the
proof of puberty ) and the vulva and the v agun are certainly capa c, ong
before puberty , of receu ing the male organ At the other end of life there is

I Crmttnal Law Xm-niim-nt Vet W22 see also Age of Marriage Act 10.10
* (1923) 17 Cr App Cas O'!

*(1911) 23 Cr App Cas <W
*(1024) 18 Cr App Cas 37
*(1935), 18 Cr App Cas 104.

•Age of Mamage Act, 1929

1DE^TITY OF BEMAiyS 187

no kno^Ti limit, while life exists either to potenc\ or fertihu on the part of a
man and although women become stenie after the menopause the\ arc
ne\cr impotent mereU on account of age The matter ^^|1I be referred to
again in discussing impotence and stenbt>

Age m Civil Emplojment See above table under ‘ Emploj merit
The Children andiomig Persons Acts 1933 and 1038 relate totheemplov
ment of persons under the age of 18 vears Tlie Vets contain provisions
intended to dtscouroge juvenile smoking and thev prohibit among other
things tlie giv ing of intoxicating liquor to children under fiv e

IDENTirv OF MUTILATED REMAINS
A dead bodv mav be found parllv putrefied or mutilated and other parts
of it mav be discovered in localities distant from each other There is less
difficullj here in making out identitv than when bones onlj are discovercvl
for it IS not alwavs easj to saj whether certain bones belong to the same
skeleton or not So long as the soft parts are attached to them there will
usuallj be no difficult) m forming an opinion Tliose who commit murder
and thus dispose of a bod) believ e that identification must he a hopeless task
if thej deposit the dilTcrent parts tii remote places In this respect thev arc
generalh deceived for a satisfactory reconstruction maj still be forthcoming
Natunllv the first point m identification must be to determine that the
fragments are of human origin

V tin box seen Ijing in a sliaUovr Surrev ditch was found to contain a larvoix
and tnehea with lungs attached— but the tongue and I eart had t>ecn cut off II e
Police Su^eon who was calle 1 to decide whether the remo ns were human deoidcd
tl e> were ti osc of a cluld Had he measured the windpipe which vris ten incl es
long he could not have failed to appreciate tliat tius vras impossible tlie adult
human trad ea measures onlv four and half to five inchw T) e dian cter» of the
tongue and I eart siignested tl e\ were denvml from a sheejv or filf

If merelv pieces of muscle or v iscerv are found it ma> be diflicult to decide
b> onlmar) means but the prcctpilin test described on p 854 sliould enable
the examiner to arrive at a correct opinion about their origin

In II V Haigh (Lewes Asswes XOjO) tie human remains bv which identity w-ns
established after disposal of the victim m strong commercial sulphunc acid included
tlirce facetted gallstones In the core of one of these there was sulficient protein
matter to give a positive human preapitin lest.

Hav ir\g determined that the fragments arc human they must be carefuUv
inspected to ascertain whether they all belong to one botlv or whether there
are any incongruous or duplicate parts In this regard the examiner must
not be deceived by tlie fact tint certain of Uie parts arc more decomposed
than others for it is usual to find that the limbs are less putrefied than the
torso of the same bodv Tlie sex age stature and general development of
the bo<ly should be investigated and a careful search made for marks of
identification as described in our foregoing list (scars, tattoos hair etc )
The means emplov ed to separate the fragments (saw knife etc) should Le
elucidaleil and whether thev have been carefuUv disarticulated or roughU
hacked apart Tlie line of incision should be the subject of special sltidv
for it mav prove definitclv tint certain parts belong to the same body
It should be noted whetlicr nnntomical dissection Ins been carrievl out
On this Tavlor remarked — When parts of dead bodies arc found a section
of the public adopt tl e bvpotliesis that some medical student Ins resorted
to this methotl of disposing of parts of a dissected subject Tlius in the case

IDENTITY OF REMAINS

of Greenacre there -nas a disposition to refer the first portion of the miitihled
remains nhich were discovered to n vianton act of tins liml The erroiieoiis
ness of this vle^^ was pro\ed onlv bv the subsequent disco\en of the cor
responding pirts of the bod> and the detection of the murderer So tri
reference to the case of Parkman the mutilated remains were at first ties
cribed as anatomical preparations Suclianhjpothcsisis of course favourable
to the escape of criminals and is purely prejudicial to the course of jusbcc
It points out to the assassin an easj method of deceumg the public and it
shoos that if he onl^ mutilates a corpse fay removing and destrojing the
head hands and feet leaving the remainder of the body to be discovered
accidentalK he has a far belter chance of escaping detection md punishment
than b\ attempting to conceal the entire murrJered body The llaterloo
Bridge case formed no exception to tlie protection thus unmtentionalH
extended b\ public opinion to a foul act of murder Anj one acquamted with
anitomj anil the dissection of bodies would at one perceive from tlie des
cription til'll no portion of this bodv could hnv e been used for such a purpose
Medical students do not ns part of their anatomical pursuits hack and
mnngle a dead body so as to destroy muscles vessels nerves and spinal
m'lrrow (hej Im e no reason to make awaj with those parts bj wluch a bodj
ma> be identified or to bod and salt the remainder thej do not receive
corpses with their clothes for dissection nor is there nnj conceivable reison
VI hj if tlev did the) should produce cuts and stabs and stains of blood
on the inside of tlie clothes with such accuraev as to correspond to the efTeets
of wounds inflicted on a living man

The pnrts should be fitted together as accurately as possible When isolated
hits are found at difTercnt times the> should be carefulh preserved in Ivaiser
liHj, or other solution so that thej mav be rnatclied with parts found at a
later period

It should be ascertained to what treatment the parts have been subjected
forevomplc whether thev have been boiled burnt or treated with chemicals

If vital organs or large vessels are available it should be noted whether
injuries have been inflicted which might have caused death and vvhetJ er
anj injuries found were inflicted before or after death

If the head is available the teeth mav alTonl most valuable assistance in
identity care must be taken to see that teeth do not fall out

All scraps of clothing wrappings packing etc should be preservetl as thev
maj belong to tlie person who earned out the dismemberment, newspapers
may be helpful in connection with the dote of the crime

In V Itiuion CManchester Assiws 1036) fragments of a Simdaj Graphe
newspaper found m one of the four bundles of human remains in a ravine at vloflal

(on tie Edinburgh Carbsle road) were idenltfied as parts of n special slip ed tinn

soJ } only in Vorecambe nniJ Lancaster (wl ere Dr Buck IfuMoit lived) on Sej tember
1 >th 103o Fvidence was given of the delivers of a eopj of this editi n at Ur
Iluvton s Itouse on that dav The remains were those of Mrs Ruxton an i of viarj
Rogerson a nursemaid botli of whom Uveil at No - Dalton Sq lare Lancaster
mill Dr Ruvtojj ,

Mu personal articles such as jewellery watches and so on mav provide
important clues of identity

In 3950 a miimmjfled forearm ami right hand either as uls«l explosivelv blown
from the bodj was found mtlie loft of a house atBnghton There wasagol I ring
I n tl e third Lger Enfjumes rcvcaleil that in Scpfeml cr lOW
had fallen on a house on tlie opposite si le of the street killing o nurnher
one of these was a Mrs Maud Tud^ whose brother when traced b> the {vlice

IDE^TITI of RF'IIAI\S IS^)

jdeotjfial thegnW riuff a<* tlwt uorn hitbufer The records showed tliat the roof
oC the prcinises iii the loft of w hich the remains had been found had suffered damage
at the time Hxe bomb fell the two houses ficing each other across the street /
The following cises nre \crj iiistnictive on all tliese points

II t Gbeenacke

In the case of the woman Ilroxm murdered bj Greenaere in 183" the head,
trunk, and Junbs were scattered in wide!} distant parts of London The limbs >rere
not found until six weeks after the trunk and then at a considerable distance and
under \-er\ different circumstances In tlie examination of the trunk it was ob
ser\ed that the fifth cer\ical vertebra liad been sawn through leimng onlj about
the'tcnth of an inch of tluit bone Wlien the head was found it wns observed Hint
the fifth rerMcal aertebra had also been sa\rn through leavnng onl\ the posterior
spinous process On comparing the head antli tlie trunk tlies fitted exactlj even
to the continuation of a su|)crhciat cut on the skin On afterwards companng the
trunk wath tlic legs it iras ascertained that Uie cut surfares exactly corresponded
Tlic thigh bones remaining attaclied to tlie trank h ul been sawn through about an
inch below the trocliantcrs to about one half of their thickness and then broken off
When the limbs were discoxeretl six svccks afterwanls the portions of thigh bones
found exaeth corresponded in tlie marks produced bj the saw and in the portions
broken Not onh were the parts of the bod> thus prosed to belong to one and the
same wonun but the mditadu il wns further iilentilied 1)\ the peculiarits of the
absence of a uterus

IlBrcirrox ‘Trcnk Murdeu

On the occasion of a murder perpetrated at Brighton the head and subsequent!)
the bo<K of a female were found m different and distant places Tlic> were iden
lined as belonging to tlie same indtsidual ffrst from the fact that there were four
cenacol aertebrn* attached to the trunk ond three to the head andsecondlj from
the dmded aessels and cartilaginous rings of tlie trucliea exactl) corresponding
The unportance attached to this kind of anatomical esadcnce shows that when a
portion of a dead bod) is found the whole of the parts which form tl e boundarj of
the section should be AttentueU observed and nccurntel) ilescrihod

MtTKDFB OF Dr PtRhMAS
The case of Dr Tarkman for the murder of sihom
Professor W ebster was ineil and contacted at Boston
m March 1830 presents a remarkable instance
of the \alue of scienlitic esadenoe m establishing the
iilentits of ii mutilated bod) It also proses that
esennll the rennements of science mnj fail m the
attempt so to dispose of a dead bod) in a case
of murder as to prevent its identification On Nov
ember 23rd 1845 the deceased was traced to the
Ub( ratoi) of the pnsoner and from that date he was
missing A week after his disappearance there were
found concealed in the vault of o priv") lielonging to
the prisoner s laboratoT) a jiclvas (tlic lup bones) the
right tlugU (from the hip to the knee) llie left leg
(from the knee to the ankle) an 1 with tlicm certain
toweU hearing the initials of the prisoner Among
some cinders and slag connected with a furnace were
found portions of bones npparentls of the cramum
fragments of vertebral blocl^ of artificial teeth and
some gold which liad been melted On the dav
folloinng in a remote comer of tlie laboratory there
was found a tea chest containing embedded in a
quantit) of tan and covered v\ith minerals the entire
trunk of a human bod) with the left Hugh from the j.,q jg

hip to the knee When the parts were placed in Dr Parknians skeleton
apposition With the portions previously found the) restored Tliemis.singparts
corresponded, so that the) were obvious!) parts of are black

IDENTITY or REMAINS '

the same boJ\ This obser\aifon also applied to tlie remains of bones fcrnnlum
and sertebre) found m the slag of tlic furnace There sras no duphmS SI
the fragments fitted so as to form part of the same human sheleton Tlie portions
thus found resmbJed in es-erj particular the bodj of Parknian, and m no Sncle
particular were the> dissimilar from the body of the deceased Tliere were mllSfne
from these remains, when thej were placed m apposition, the head, the arms with
the hands, both feet and tlie right leg from the knee to the ankle
The parts found, which arc light in tlie engrasmg (Tig 15) were examined bv
seseral medical men Thej deposed that thej were human remams parts of one
and the same male human bods, that tlies had not undergone dissection for
anatomical purposes and liad not been submitted to nn> process of prcscrsation
further, lliat thej liad been cut and hacked in different directions without any
reference to their aintomical relations, and evidentlj b\ a jwrson onI\ partialK
acquainted with the structure of the bodj The chest « is stiti coiennl with the
muscles and sUn It was noticed that under the left nipple, between the sixth
and seventh ribs there was an opening which penetrated into tlie cnvitj fhe
opening was slightly ragged, and about 1 J incli^ m length
It seems that Parkman was t,i\l\ \cars of age and liis stature was 5 feet II
mches The portions of the bodj thus restored were tlmse of a person between
fiftj andsivtj > ears of ige, and with respect to statilre, the portioas found extend
ing from the sesenth cersical \ertebra to the outer ankle (malleolus) incasun-d
57^ inches The distance from the sole of tlie foot to the outer malleolus, mcasiireii
in another subject of the same age, was 3 mehes and the distance from the lop
of the head to the base of the sirth cemcal vertebra sris 10 inches Adding these
measurements to the missing portions the total length of the bod\ found would be
5 feet 10 J tnchos, licing within lialfan inch of the stature of Parkman lliere srerc
features of identitj about the teeth and ja\r which left no doubt that iJie nmams
svere those of the missing man Tlie defence of the jirisoncr rested upon the fact tint
the clmrge was based entirely on cireumstantnl evidence, that the identitv of the
remains had not been satisfactord} made out, and tliat no cause of death had been
prosed The jury, howeser returned a verdict of guilts, and the prisoner was
subsequently c-xeeuted*

The WsTEiiLoo Bridge Case*

A singular case mvoUang somcwliat simitar questions occurred m London m
October, 18j7, svhen tlic remams of a human being were found in a bag on one of
fhe battfesses of II afericM ScKlgtr It appeared that rttej hvl been accifknta!}}
deposited tliere the night presaouslj — the intention of the person who earned them
being no doubt to lower them into tlie riser, but bj accident thes loilgcd oii one
of the buttresses of the bridge V number of articles of clotlung sverc m the bag
with the remaias These remains were submitted to the examination of the
divisional surgeon of police and Tajlor

They found them to consist of parts of a human body, and obMousIv of the
same body There were '23 parts discovered consisting chiefly of bones with flesh
adherm" to them The flesh liad been roughlv cut from the bones apjiarenlK in
order to^remove as much of it as possible, and to destroy the identity of the bodv
The parts had b«n cut and sawn into small pieces probably to reduce their bulk and
to allow them to be packed within a small space The trunk, including part of the
chest and spine, had been cut into eight pieces the upper limbs had been cut or sawn
into SIX, and the lower lunbs into nine pieces The thigh and elbow joints were m a
strongK flexed condition The missingporlions were the head with fhegreafer part
of till spine, namely, fourteen out of it vertebne (seven cerviml and seven upper
dorsal) the hands the feet and some portions of the left side of the A

murderer intending to destroy personal identitv would in
succeed m his object by removing the liead, feet and hands The whole of
of the chest and abdomen liad also been removi^ The 2,1

onlv 38 lbs , about one eighth of the average weight of the adult body Tliere wu, no
diflvcultv m determining the sex of the deceased as a portion of the sexual organs
which had been mutilated still remained attached to the pehss fhe long were
m their full state of dev elopmenU The stature was determined by taking the length

1 ‘ Report of the Tnal of Prof Mebster . bv Dr Stone, Boston, U S , 1830
» Taylor, A S , 1837 Med. Times Gaz , 2 , 415

1DC^T1TY OF REMAINS 141

of the portions found and adding a certain number of inches for the missing shull
cemcil wrtcbm and feet The bones ha<l been sa»-n throu near the joints mill a
ftiie bone saw such as is used b\ bone boilen On the left side of tlio chest be tircen
the third and fourth ribs there vms a stab sihich luid penelratwl the caviU m a
ilircction to enter the heart, ft lia I been inflictctl on a h\ang bodv No portion of
these remains had the appearance of hiwang undergone dissection oraii\ preparation
or use for anatoimtal puiposes Thcmuscles scssels and ncrscsluid been liackcdm
all directions without an> reference to rclatise position The spinal cord liad been
Moicntlj tom out of the \erlcbrul canal The joints liad been saivn tlirough
eaidentK with great trouble at points where a scalpel would Imo; spcedilj effected
the separation of the limbs 1 urtlitr no presersatu-e of animal matter liad been
emidoj ed. Portions of the muscle skm and ligaments srerc hrow n and sodden thej
presented the apjicarance of lusang been boile I m water and soaked in a solution of
« imnoii silt llic tonclusions from the wliotc of the imcstJgation were gi\en bj
Taj lor as follows

(1) Tliat the remains were those of a person of the male sea of adult age and
of at least 5 feet 0 inches in stature (2) That the jiarts found presented no
plm.iological or pathological iietuliariticsba which thej could be i Icntificd as belong
uigtoam pirticularmdiMduaf nieoiilj fict obsers able under this hea I was that
the portions of skin remaining were lliicklj eoMred with dark liairs and tliat the
deceased was probahls a dirk liairj man (3) That the remains presented ni
appearance of disease or of nolent injurj indicte 1 during life with the exception
of a stab in the space between the third and fourth nbs on the left side of the chest
Tlus stab was m a situation to penetrate the heart and cause dealli. It liad the
features of a stab mlhcted on a perwn either linng or ooli recenth death ^4)TlLat
thtsse remains had not been dissected or used for the purposes of anntomj Ml
those p irts of the hunuci bo Ij srhicti arc useful to an anatomist liad been roughlj
ses'Cred and dcslroied bi a pervn or persons ijuite ignonint of their aDatomico)
relations The\ liad Ixien probabK cut and sairn before the rigidity of death had
ceased Ic. witlun from eighteen to 24 hours after death and in this state liad been
nartioJlv boded and subscqucntlv sailed (plnred m brine) The body of deceased
iiad not been laid out or attended to like that of n person dj ing from natural causes
whose body might helawfulK used for anatonueal purj oses (.>) Tliat the person of
whose bod> tliese renums irore a part might liase been dead for time or four weeks
prior to the date at which tliej were examined namclj on October 21st 18^7

The articles of clotlung found ssath the remains m the bag were those of a nun
and a foreigner Thej were mtieli tom and some presented the appearance of
stabs and cuts while all wxrc more or loss stained with blood some of the 8tain.s
presenting coagula V stab through the double collar of an oxcrcoat must base
been inthcted with some force, as it wras fiuml to extend through corresponding
parts of tlie undercoat and waistcoat VII these articles of clotlung liad stains of
blood on the inside andelucllj on the left side of the bodj in the parts corresponding
to tlie stab on the left side of the chest The culling and tearing of the clothing mas
have arisen from thercmosal of the clothes while tlie bodj was in a slate of ngi<lit\
in a constrained attitude Tlie slate of tlie clothes was consistent snth their liasang
Iww rnwvr in iAu tAnaassr I jtAct? n ts jwJiwiir wiw.b Jed j£> Jus dasJJj

From inquiries made bj tlie police there was reason to bel eve tliat the remains
Mere those of a Swedish sailor from a sessel then m tlie riser there ivas no clue to the
perpetrators of Uus murder

R t ■\\AINtt'BIOHT

In 187o the rcmaias of a woman ILvrrict L-sne -were conveyed into the
Borough she luivnng been murdered b> her paramour IIenux V\AiMvraGUT in
\\ hitecliajiel On September 7th 1874 the decca-sed woman went m a cab to
premises in V\ hilecliapel Hoad and was never seen again abve In Septcmlier
187o ajear later the premises wxre likelx to pass from Waiiiwright into the hand'*
of others and he resolved to remove the bodv of the woman whom he liad mur
dcred and buried to another hiding place m Southwark V few davs liefore the
prisoner cmploveil lus brother to purchase for him a spade and a pmall chopjier or
axe These articles were found on the premises after the removal of the boilv
The chopi>er liad on it putrescent anunal matter and on the spade was cla> mixed
with lime On the same daj M ainwmght purchased three vard'i of tmencan cloth

^^2 IDENTITY or IlLMAINS

nml a quantity of coni On September nth IST*; nmm omplojcdbyMHtnMTiHit
arrested the Borongl, having ,n l«s pov^ss.nn l«n «TapM m

^lar American doth and secured with similar tonl, mitaining liuman re/mnn*
upon being opened one parcel was found to contain tlie trunk, and the oilier tlic
remaining |wrtions of a thm human female, about li%e feet high and about gj
jears old The bodj, mIucK was supposed to liave been <lcad ibout a tear, hid
been recentlj and most unscientintally dissected It was in a stinking and decom
poseal state, some parts Xsere more or less mununifled whilst other parts were m a
condition tending to adipocerc The bodj was, roughly speaking, disadcd into
ten parts, as foUoAvs two arms, two hands, the legs ami feet connerteil, and left
leg including part of the patella, the Uiiglis including portions of the pehts {the
right tlugh included the patella tlie left thigh included part of the jiatcIU) the
trunk, except the front of the pelvis tlie head and neck Tlioiigli tJie woman
had been dead a j ear and buned m a grave on tlic ]iTemises, c-crtaiii parts liad been
well preserved, owing to the use of cldonnateil lime, emplovcd with the mistaken
Mew of destrojing the Iiodj, whereas it liad ncfcil as n preservative

The cause of death was obvious Tlicre were two bullets m her brain, and a
third was found in a hair pad at the back of the head There was u cut extending
from the centre of the tliroat to the angle of the lower jaw, which had severed all
the tissues, and wluch must have been innicteil with considerable force •

In tlus case Taj lor s identincation of tlic remains was based partlj on medical
facts, and parllj on the discoverj of certain articles of clothing m the grave from
which the bodj liad been removed Tlie features were not recognizable The bixlv
had been cut into ten pieces and much mangled It was decomposed but, as a
quantity of ddorviated lime had been used m the burial of if, putrefaction had been
m some degree retarded The relativcscouldonh speak gcnerallj to the slender form
and stature of the bodj , and the smallness of the binds and feet, as points in vrhich it
resembled that of Harriet Lane The bght auburn colour of the )tair, the absence
of a tooth m the upper jaw on the right side, and the presence or o scar or cicatrix
from n bum received matij j-cars before, ami still remaining on the right leg liclow
the loiec, were abo circumstances whicli strengthened their opinion Some buttons
and other articles of cloUiing found m the grave were identified bv her relatives as
similar to those which were actuallj vrom b> the deceased oo the evening of her
deatlL Tlie direct proofs were {l)Theage The age of the deceased was 24 Judging
by the wnsdom teeth, tliree of wluch liad appeared, this corresponded vvitli the age
assigned to the bod) {2)Slaliirt Itwasinferrcd, but b> no means directlyproved,
that the deceised wis 5 feet Gt inch in height The remains when put together,
represented a stature of 4 feet'll} inches This makes about an inch difference,
which was accounted for bj one of the medical witnesses ns a result of the shrinking
of the lutervertebml substance, hence tlie defccliv'e length of nn inch was consistent
with the remains being those of a pereouof Iheheight of the deceased fJ) TAe colour
of the hair This is stated to liave been slightly different, but the difference wis
consistent with the hair of the remains having been buried for a venr m the earth,
and exposed to the action of cblorinafed bmc But there are indeed so manj women
in the world with hair of a similar shade of colour that no great reliance can be
placed on a resemblance of this kind in i disputed case of identity The »ntr
riierevTasascarorcicatnxfroma burain tlienghl /eg, below the knee Oii removing
the matter on the bodv wluch concealed such superficiil marks, it was found in b
part indicated by the father of the deceased woman The ^r WM distmctlj
puckered, and presented all tlie usual marks of a scar prodiit^ bv a bum from a
red liot poker (5) The stale of the uterus Tlie misiing w oman Ind had tw o cluldren
by ainwTiglit, the last liaving b«n bom about nine months previous h"
disappearance From theix examination of the womb, the medical
Crown Bond and Larkin, came to tlie conclusion that tlie woniui whose remains
were discovered had borne a child

The Baptist Cnuecn Cellak ^Iubdep

ThecaseofJ? v C C December, 104J) has nianyfcit.i^

Mrs. Dohkm disappeared on April Ilth, 1941, during an air raid on London I our

WKSTITY OF JiEMM^’S

In lOfl l)m$^im of Klntcorti|>(icr Hwof nociic) Dolikin milrtivlxr
dentil siirywn frotn hw rreordi at Uw miuc^t of police nnicpp* m iking
cmndfie* to c*tnbU»li iJcnUt\ of Momm wlicwe mmins uliowcit llie
npi>er jnw dentition Men (a 1 ig ini' \ti \ m\ of tlir !>. ti; {«r t i
reijion sliows root) tliougttt to ia%e lx>en lefl after extmcoon (It t
i>oftkin)

I JO Iftfr l*lf(*lt>i.nij l> of ijf (icr J i»r tlelaiU fttnii kkidl of rrTn!iin< f >nn t
• wnol in I Iinrrli rrtlar to tildrh «reniiv!< IK t kin >iu« life-

oTHcfier (it *’ IMinn )

IDES TITY OF BOSSES 1 45

^ nccinfttion imrks on one bodj and evident of n bunion on the other cotres
ponded Mith comltUoas in the mi<iMnp women The finger mUs of the Noungcr
«ere hcnlchcil, as might lie found m a dnnirstic sers-ant nnt licr fingerprints
were identiral mth prints found on mans aKicles In tht house of the accused
TIic tips of the fingers and toes i f t)»e oiler Iwh Iind Ixxn rcmoied ttith the
bodies there were ncwspaiiers of tlic 1 dh Septemlier certam g-irments which Mere
identified and n portion of n sheet which was idcntic-d including a fiult in tlie
sehTilge witli a sheet found in Tluxtnrt s huu.se
The disirticulations liad been enmed out wathout damage other tiian small
cuts in the cartilages and were ohxnousK the work of a persf n with i knowledge
of nnatom\ There was c% idenct of asphvxi i m the orpins assigns! to Mrs Ruxtnn
and there was also a fracture of the li\oid bone fn the bod\ assigned to Mars
llopjrson there was a /nielure on tlie top of tliesktill hriiises < ri the arms and face
and a deep Imitsc in the tongue which sh<wr<l IeiicsK>tc infiUrition suggesting
that it had been causetl an hour or two lieforc death

Tio 17a Fio 176

llrad of the voungcr woman sfiow Skutl of t| « older worn in supenn posed

ing tl e extent of the mutilation on a life she pi ofo^riph of Mrs fi (>>

IVifessor llnash

In the house of the accused n number of human hlooilstains were found in the
bathroom and on tlie sUuf mils stair carpets and pads fragments of human tissue
w-cre found in the traps connectctl snth the druns and o suit of clothes belonging
to the accused ss-as grossly contaminated wiUi Idood
The arcus^ was found guilts of murder and condemneil to drath

Idcntlt) tshen Bones only arc Left
Wien bones a little slim> tissue and possiblj a few fragments of clothes
are all that ore left of a human being the great majoriU of points of identi
fication we hate considered arc not asailaWc but a great deal of mfomistion
mat be obtained b) enrefid and mmute t-Nornmnlion of sktlelal rem'uns
liowetcr fngmentan 'Natunill), the first question tint must lie considered
IS —

Are these Bonos Human’ To answer this question a thorougli know
ledge of human osteologv is cssenfisl The ansuers tnlJ be the more definite

immiry of soms

the more there r<Jalm<i if a compteU bone is founil or a reasonahh brm
tagment there should be no doubt on the matter W itli small froMs
the iinsner shou d be given with caution and the ndtiee of a proressional
anatomist should always be sought.

Taj lor s original remarks on tins subject w ere as follow s — The greatest
Ignorance prevails among the public on this subject The bones of horses
cows dogs and slieep are frequently mistaken for tliose of human beings
In an antiquarian collection of relics obtained from n neighbouring' Romm
castrum Taylor recorded finding the tibia ol n dog carefullj labelled and
religiously preserved as the bone of an ancient Roman The same collection
contained fragments of bones of v arious animals carnivorous and licrbtvorous
all marked as human relics This collection belonged to 'm mtiquirj, who
liad preferred adopting his own vieu of the nature of the relics to taking the
opinion of anyone aquainted with anatomy In a church in the north of
England tvv o bones from oxen were showTi as the tliigh bones of St Lawrence
They were of ancient date and greatb prized bj the sexton Lven well
informed men may be easily mistaken on such subjects Relzoni the cele-
brated trav eller brought from Egypt with his sarcoplngi a number of bones
taken from the interior of the Pyrumds which he pronounced to be the hones
of King Cephrenes and some of the Shepheitl Kings Clift examined them
after they had been submitted fo public exhibition and lie found that they
w ere the bones of oxen The osseous relics of saints as they are collected md
preserv ed m glass and cr\ stal cases m Roman Catholic countries often present
anomalies which would surprise m anatomist Supernumerary ribs and
vertebrie are not uncommon and intermixed witii them bones which certiimly
nev er appertained to a human being Most of us hav e been consulted •vbout
matters such as these for not only hymen but medicsl practitioners and
vctepinarj surgeons are often led into givmg foolish opinions about the
origin of bones It is enough to say that an expert m osteology should always
be consulted in difficult cases

It Will be m most cases ensicr to say whether a particuhr bone formed
pvrt of a liuman skeleton or not than to determine to wlnt animal it may
have belonged this is commonly all that is expected from a meilical witness

At what date after burnl or after death the precipitm test ceases to be
applicable is not known but it must be so long an interval tlint all proteins
hav e disappeared entirely

Assuming that bones afe Inimnii tl e questions tliat arise are

(1) Do they represent one or more bodies’

(2) Are thev those ol a child or adult’ — age

(3) Are thev those of a male or female’ — sex

(4) M hat was tlie stature of the person’

(5) Mint w as the ncc’

(6) How long livv c tlie bones been there?

(7) Is tlieie ev idence of the cause of death’

(8) tan the person be identifietl bv the surroundings’

(')) Identification from fnitures and other ptculmrities

(10) Ideiitific vtion of burnt or eoirodcil bodies

Do the Bones represent one or more Bodies’

Tins point though obvious must not be overlookctl In old grives tinre

will mturallv be a greater chance of multiple burials than m the eases
where a murderer has disposed of his victim Slid it is possible that two or

AGE FROM ROM'S

147

more people (gcncrnllj children) ma\ have l»een disposed of ^t the same lime
The only wav in •wlucli tlie point can be determined is h^ finding duplicate
1x)nt*s or too maiij bones to has e belonged to one indiv idiial Pol\ dact\ lisni
must not be forgotten

Age in Skeletal Remains

Me have alreads commenterl m some detail on tins under the lieading of
‘ Age in Identitj , and have shown that tlie condition of tlie teetli and of
the bones offers the most trustwortliv indications of age in the dead The
size of the bones as well “is the degree of roughness of tlie ridges for muscular
attachments, will also gue some clue to the approTimate age and develop
ment of the deceased person

liand and a foot were found in o garden in the Isle of Dogs Poplar ui the
process of burnt bj a dog A \oung local girl liad disippearcd some weeks
prevnoush after giving evidence against a gang of East End jouUls and suspicion of
foul pla\ ran high The hand how-evor was a verv large ind lieavj masculine piece
and the foot was a frodsnd verj aged female piece both lud been dissected vnlh care
as m anatomical dissection and both l»ad been fixed vnth a carbolic acid compound
wliicli still smelled strongh of phenol riv confirmed the difference m bone
•leiisitj and general texture

It was thought tliat the bones were those of a girl who might have been
murdered but mwlieat examination showed that the bones must have
belonged to two older persons There are numerous cases m which a question
of tilts kind mav become important

lien ossification is once completed it is difficult to determine the age b\
an examination of the bones Tlmt the person has reached adult age will be
iiulicatcd b\ the union of all theepipliysesto the bones b> the great firmness
and soliditv of the bones with theirrou^hsurfacesforthe insertion of muscles

[

tiG 18 Approximate time of closure of cranial sutures Tfe
inner aspect closes several vean before the outer as a nilc
Molar tooth root catoficabon is abo noted

148

SEX EROV m\ES

tlieir "''1 groies md foramma In the jaws we may

eapect to find tlie wisdom tceUi while Uie other teeth will probably he found
worn to a degree which mij help to assess the age (see p lot) riie cranial
sutures begin to be obliterated especiallj in the sagittal nnd coronal sutures
before 30 i ears The closure is first seen on the inner surface of the skull
■the basis for estimation of age from the ossification of bones and dentition
data has been set out on p 131 and p 101 respectt\el\

During the adult period Uie gradual closing of the cranial sutures ofTets
an additional means of ige apj>ro\imaUon Though hj no means constant
their periodic closure winch is shown diagrammaticallj m Tig 18 should be
helpful in tins respect Todds contributions to this studv are well worth
pcnisaU Mthough his conclusions are not ns reliable as he would suggest
we must make full use of an> mfonnation of this nature which is ar our
disposal

During the period between full dentition together with ossi/lcatiou of
tpiph>seal cartilages and Inter adult jears sesernl skeletal changc< of
interest to the medico legist occur Tlie LiHowj appearance of the facc\ of
the sjmphjsis pubis is gnuluallj lost nnd the characteristic smooth fact
de^ clops

\s age ad\ ances we mas ol>scr\e lipping of the glenoid fossa and of other
joints textural changes m the long bones— nintnlj a gradual rarefaction—
caluflcation of the costal and larj ngtal cartilages union of tht. greater I orns
of the hjxitd With the bod} of the nianubno sternal joint and sarious other
degeneralis c changes all of which make up the picture of ageing
Deiermtnation of Age from Stature In attempting to determine the age of
a aoung person s skeleton from the measurement of the stature or its estima
tion from bones (see Stature ) it must be remembered that there is a great
difference in the npidita of growth not nicrelj in children of different sexes
but m children of the same se\- Sometimes n child will be much under the
as erage stature before pubert> but wall grow rapidlj after has mg passed
this period Tlie graphs on p 132 may be refcirwl to

Sex In Skeletal Kemafns

The determination of sex from an examination of the skeleton or of lertain
detached bones can more readd} be made m subjects which ha^e passed the
age of pubert} for sexual differences m tlic skeletons are not definite until
adult age has been reached The skeleton of the female is general!} smaller
and more slender than that of the male The full grown bone of a fciuafe is
distinguished from that of n male bj its ndges depressions and processes
being less marked the shaft of n long bone is smoother and more pohsheil
while the articular surfaces and ends are smaller

If the whole skeleton is acailable there should be no difneulU m arriving
at an accurate estimation of tl e sex but obvaousl} when on!} part of the
skeleton is available tlie dilTicultv of assessment increases

The greatest difference is observed m the pelvis and it is b} an examination
of this portion of the adult skeleton when it can be obtained that tlie SC-X
mav be most satisfactoril} made out. Hiese differences are noted m cverv

textbook on anatom} and onlv n few details need be added here

The bones of the male pelvis nre more massive at 1 rougher the curve of
the iliac crest reaches a higher lev cl nnd its posterior extremity cun es down
iTodd T .1930 in Problcmsof Ageing Ed by E. V Cmvdr} Baltimore Williams
end WiUciasx

SC\ FJtOM BO\FS

149

more steeplj to its termination The pubic niigle is narrower m tJie male
tiie bodv of the pubic bone is narrower and the pubic ramus mucii wider than
in the female The great sciatic notch is much narrower in the male than m
the female and the appearance of the pre-auncular grooie in the latter is
well definerl {See Fig 19e)

(6) (c)

VeJose I siewofUesa c bone (fc) si owiDgthe renwuis of tl e pre aurcular groove
A comparal le gTOO\e n un intnet spec men (c) b set otongs de Onh an experienced
anatomist is Iikelj to recognise such small but vital deta I The groove occurs only
ui the female.

(/? V Ilaigh reproduced by rourtesv of tbe Commissioner of Police m the Metropol s

New Scotland \ard )

SEX I'ROV BOSES

The Skull ofters ^.e^enl points for sex Appreciation but m genen! it
Mjse to submit the specimen to an expert anatomist for Ins opimofi CcrCui i
racial clnmcleristics in the skull tend to obscure the sex dilTerciiccs and
unless the nee is known precise diagnosis of sex becomes \er\ difTcult

In tiie Spine the first cer\ icnl ^ ertebra offers some help m diagnosis It hns
been stated' that tl e mean breadth in the male is 83 mm and m the female
72 mm but the difference in n particular case might be so slight ns to make
this measurement of little practical n nlue

There are certain se\-ual differences in the sacrum wliicli are described m
an\ good textiiook on nnalom\

In the sternum the male bodj is genenlly nt least twice the length of the
manubrium wJuIst in the female the manubnal length is nearh alwans greater
than half the stennl Iwdj length Further tlie breadth is m rel ition to the
length narrower in tlie female

The long bones ha^ e certain se-v differences In general the joint surfaces
are greater in the male c\ en when the stature is the snme For example in
the head of the htimenis the botitidar} between male and female lies between
45 and 40 mm for the \crtnal and beUreen 41 and 42 for the transverse
measurements of the head as onginally pointed out bv Dwight* Pearson*
considered that something over 43 mm m the vertical measurement m the
male and under 44 mm in the female could be taken as safe guides In the
case of the femur Pearson considered that a vertical diameter m the head
of less than 41 5 mm indicated a female and of over 45 5 mm a mate A
btcond>]ar width of less than 72 mm or more tlian 78 mm liad a like stgni
ficance

Perfect has rcportevl a cave whicli shows tlw unportanee of attending to sex in
skeletons Two brothers lived togetlier on a firm TIic joune.®f of ll e ti o wn*
dissolute HU t irregular mills habits sotliattl ej lived unJiappilv Onenight whenUie
ground was covered with snow tl e jounger brother absconded from the house and
nextHiomin^ his footsteps were cleorl) traccdinlhesnowtoaconsiderabledistance,
liut there were no footsteps of anv otlier person Nothing was ever afterwards heard
of the mibSing brother T» e elder brother left the fann ami it passed into the hands
of a stranger During the progress of some alterations in the grounds surrounding tfic
house a skeleton vvas dug up It vris immcdiatelv conjectured that tiic one brother
had murdered tl e other an investigation was called for and an inquest \ -vs 1 eld
Perfect who was not summoned as a witness requesfeil perm ssion to examine
the bones he found that llicv rej rcsentcil a person of short stiturc and from tl e
obliteration of the sutures of the skull and tlie worn state of the croims of the teeth
he inferred tfiat ti e> must have belon*^ to in aged person Onexamin ngtlie hones
ofU e pelvis It was obvious tfiat tfev -»mfitnafe tthentfusfactwnscoramcmfcitcd
to the jurj tl e two medical men who liad given tl eir oj inlons from a luvtj exaini
nation were <ent for and one of them immediateli agreed tlmt tl e skeleton

female A heavw susj icion of fralr cide was thus removTd from an innocent man On

further inqu r\ it vvns ascertained tliat the bones liad been removed from an olu
gravel pit wliere gipsies ha 1 been accustomed toassembJc and wJ ere thej occasion
ally buried their dead

Identity from Fractures
Developmental Abnormalities or Disease
The existence of fractures and the progress which mav have been made
towards their union maj also become an important subject of mquirj
■Clawlin P and Derobert L. 1»M (kleomelne uiUmpo-medicO-fegalt \oI I
Paris BaiJliere

* P«^n K BeU*J '^1010*^ V btndv of the Long Bones of the English Skeleton
CLP

IDL^TIT\ SKELETAL DEFECTS ' 151

TJiebodx of Dr Linngstone n-as identified parth b\ means of an old fracture
of the luimeriis In general the past existence of a fnctiire is eastlj determined
bj the appearance of a knot or ndge or in some cases a thick deposit of bone
where union has taken phee moreoser the rairrow canal is likeK to be
obliterated at the point of fracture In a fractured bone whicli has united
m a cursed form it wll be obsc/\ed on making n section that the shell is
considerabh thicker on the side whicli has h id to bear the greatest weight or
pressure VII these facts trisial as thej mav appear mas in realitj be
material m a case of disputed idcntiU and unless carefulij observed at the
time V ahtable e\ idencc mav be lost

Questions of idcntiU m relation to skeletons ma\ occasionalK be solved
bj reference to certain special charitters of the hones Tliev mav bear some
developmental peculiarities such as supemumerarv fingers or toes which
if observed mav tend to tlirow some light upon the case Vn instance of
this kind IS mentioned bv Orfila

A man who had been residing in a small village in the neighbourliood of Mont
jicll er suddenh disappeared ft was some time afterwards reported tliat he liad
lieen murdered It was onlv after the lapse of more than two scars tliat the
magistrates were tirst induced to direct an investigation of the case A thorough
searcli was onlercd and the remains of a bodv clueflj tlie bones were found buried
m a garden It was of course essential to identifv tins skeleton as that of the
deceased It was well known tliat heliad suffered from ffsingular personal dcformitv
In imanq a sixth finger on ttie right hand and a sixth toe on tJie left foot Tlie I ones
vrlueh were ncarh all perfect werecarefuUv removed and put together when it was
found that those belonging to the two smaller toes of the left foot were wanting but
the metatarsal bone of the fifth toe liad p process on the outer side with a small
articulating suffice which might have formevl a stipcrnununtv joint Tlie fifth
bone of tlie mctacarinis was shorter and broader tlian the one belonging to the
opposite hand while its digital extremit) was divadcd into two parts ofwluchane
formed a smooth rounded articulating surface m theoxis of the bone w lule the other
winch presented a more flattened articular surface formed with it on angle of about
eight degrees On attempting to articulate the first pliahnx of the little finger it
httc/i evartJv the first artieuiar vrrforr and /wsentrd nn IJie outer sj 3e a liStjnct
groove the rblique direction of which coincided with the direction of this second
surface This left no doubt of the nature of the pccuhantv of structure although the
plialangcs of the sixth finger could not be diwovercd The left Iiand and the right
foot were complete in all tlieir parts Ollier corroborating circiuttstances tran^ured
with respect to marks of violence on tlie bodv and two prisoners were tried for
murder condemned and executed

Deformities of the spine whether from old injiirj or disease rickets etc
or of the limbs from fractures or bonv ankvfosisof joints ireeasifv observeif
and mav form well marked points of idcnlitv Ivcrj peculnntv should be
notevl for anv dev lation from the normal niav prov c to be v erv important in
identification

In 11)48 1 liiimnn skull was found l>mgm long grass cU sc to tlie edge of a lake m
lleigate Friorv and subsequent di^ng in the mud along the water s edge resulted
m the finding of fll further hones all human and comprising tlic greater part of an
adult female skelctomgcd about 40 and S feci finches to 5 feet 4 inches m height Ihe
fifth lumbar vertebra was sucrahzcd on its right side Ilccords of a woman « f
tJ ) feet 4 inches m height who had disappeared in a lughlv agitated state it
the heigl t of a blitz hv enemv aircraft showed tliat she had been rived f r
lumbar pain several vears previoiislv and Iiad been fuind 1 1 have the right side of
the fifth lumbar vertel ra fcacrahzcd Dental records and superimposed j h t
gr iphv (as pr letised in the Ruxlon and Dobkm cases) clinched i lentitj It seem t
liktiv that the woman luad committed sniculr

\ man suddenU disappeared Three vears afterw mis an excavation was male m
the cellar of the h nise w here he and his brother had resided and some human bones

152 ■ _ STATVBE FSOM BOh'ES

were (llSco^e^e(l The medicnl men to wliron the examination of these hones was
referred remarked tliat the bodj of the fifth lumbar %ertcbra was compressed and
thin, as it IS met with m rachitic individuals that the pehis was contmctcfl on the
left side, that the tibia and fibula of each leg presented a renurhable tursaturc,
greater, however, on the left than on the nght side, so that the left leg was half an
inch shorter tlian the nglit These facta, together with certain dental features and
other circumstances established the identity of the hones as being those of the
person who had been missing •

Stature from the Skeleton or from Single Bones

The average stature of rnglishmen is from five feet six to five feet nine
inches, or, according to Galton, five feet eight inches, about four out of one
hundred are calculated to have a stature of from sj\ feet to sivfcet three inches
In determining the stature from the measurement of the entire skeleton, it is
usual to add from an inch to an inch and a half for the thickness of the soft
parts ^\hen the bones have become entirely disarticulated thev should be
laid out in their natural order and an estimate made

In the Baptist Church Cellar Murder {R v Dohktn, C C C , 1042) the head had
been severed between skull and atlas, and the legs had been cut off, or cut and
burned awav in the region of the knees Heassembling tlie bmlv, giving due allow-
ance for the parts missing at the knees gave an estimated height of 4 feet OJ inches
Pearson s formula using the onlj intact long bone present (tlie left humerus) gave a
height of 4 feet II J inches The evadence given wrs that, in life, the vactim would
have stood about 4 feet to 5 feet 1 inch

In Ji V Chrwbe (C C C , lfl33) the statute estimations made from the four
principal long bones (f h t r ) and their separate sums (e g , f + t ) confirmed the
existence of a sj-stematic negative error’ using the Pearson formulas (R J
Harrison) The Dupertuis and Ifadden gcneril formula* an<l the Trotter and
Gleser formuls gave mean errors of 0 14 cm and 0 16 un — negligible errors A
variance ratio test showed no significant error witli the latter two metliods at the
5 per cent level The sctual height of Ruth Fuersl was 172 7im Pearson's formuLe
gave a mean of 16 j 3 cm , Dupcrfuis and Hadden 171 2 cm , Trotter and Gleser
172 7 cm The same undcr-estimation was evident in a re-c\arrunation of the
Ruxton and Rogerson statures vrhicli Ifamson* msde during the rcconstruetiom
m the Christie case

For manj )ears the authorities quoted lO connection with the estimation
of stature from isolated bones hove been HoUet* (1888), Manouvner* (1802)
or Karl Pearson* (1890) Each of these, whilst proving rcmarkablv useful
in practice — espcciallv, perhaps, the Pearson formula! — has subsequently
been shown to have defects Rollet’s material, consisting of 50 mole and 50
female French subjects from the Lvons district, was fresh — and, of course,
hnuted the sfooTj to (be fradVfioiiai’^ sAorhrr FhjmntnnrfT iJie rffemT temsh
stature vvas only five feet and the male five feet five inches "Manouvrier
excluded subjects over 60, and Pearson whilst incorporating the advantages of
regression equations as a form of analysts of tlie figures, made no allowance for
ageing All these formula: give statures as much as I to 1| iiis too short,
especiallj when practised on Frenchmen of taller phvsiqiie (as Pearson
himself found) and on other races sudi as Chinese (Stev enson*), Finns (Telkka*)

* Harrison, R J , 1933 Vlcdieal and Soenlific Investigations in the Christie Case Ed
F E Catops London Medical Fublicattons Ltd

* Rollet, E , 1888 De la mensuration des o» longs des niemhres dans ses rapports avee
’anthropologic la chinirgie et la medenne judenaire Lvons, Storck

> Manouvner, L , 1892 Mem Soc Ambnp P»m2e&er 4 SIT

* Pearson, h , 1899 Phil Trans Bay Sue ,A , 102 , idS

‘Stevenson, P H , 1020 BiirmelnKa 21,303

* Telkka, A , 1050 Aeia Anal , 9, 103

STAlhKf FROM JiO\rS

153

nml Amcruin AMiites and Neprocs (Dupcrtuss and Hadden') The latter
nuthors concluded that tlic cada\cr stature wa-s for all praetical purposes
the cquis alent of the \\\ mp stnture not ns Manouvner had supgestctl as
jmich as 2 cm greater This Ins su!>scqiicntlv been shown to be incorrect
{tide infra)

The whole subject of stature from skeletal remains has rcceivetl so much
attention m recent jears that \\c shill svliiKt again reproducing the classical
Pearson s fornuil® de\ote some attention to the recent work of both Duper
tuis and Hadden — and of Trotter and Closer these latter author s work on
the subject promises as great on imjMKt on the subject ns IvnrI Pcirson s
classKul work

Pearsons formula, for the estinmtion of living stature from drj skeletal
remiins (expressed in im ) were as follows

I rom the femur S==81 OOfl-f-l 880 P

humerus S=70 8Jt H

tihn 5=78 601+2 370 1

radius 5=89 925+8 271 U

in males

and

72 88t+l 945 F
71 475+2 754 H
74 774+2 352 T
81 224+J 343 H

jn females

The femur is measxircd — m n llcpbum osleometnc board for aceunicy—
from the head to the vtrv bottom of the inner condole if measured m th
oblique and not straight add 0 23 cm for mile and 0 83 cm for temale
the length before using the above formul'C The tibia is measured front
upper articular surface to the tip of the malleolus if measured w ith thr the
subtract 0 90 cm for the male and 087 cm for female before ipstcst
Pearson fonmil® The humerus and mdius arc measured ui tlir'^
lengtii ,,imum

Pearson s formula! for the estimation of stature ns a corpse tg meas

leiigtlis of the femur liumenis tibia (without spine) and
ured with the cartilage on and in a humid slate — were as f

I rom the femur S=8I 231+1 880 F T ^ a
humerus ls=70 7U+2 B94 H ^ 7^
tlbm S=:78 807+2 3"fl fi J

mdias S=80 4r5+3 271

uid 78 103+1 »

corrcspondmglv 72 010+2 <54 ^

TO 442

82 18J-r »

c in females

Duiiirtliis »nd IlmUltn mraljscd fiRures f X ‘‘‘f "‘.‘"f ”
mixed (Anicmnn) \\hile and Aincntan 1 ,,rtuall\ identical

conclusion that the corpse and living s/turcs nf the same kind

rrott.r and (,Icscr= n, n rao,l detailed a/ critical sludv of thc^sai^

•nu«n,a<C,\\ an 111.1 lend t lCl '^3

■Tnillrr M and C.lnrr C C . IMd imefi l*vi '""'">1’

154 STATVBB FltOM liO^ES

of mtxttl stocV Atucrimn \Mntc and ?«gro, wrrc nWt for Uii. Jir>l lipic to
coinpTrc llitf kiifrtlis of long }jon« with tlic hunen In mg siaturc- of \nicrican
niililan subjects whose height had l>otn ircordtxl on joining the tniu
Thes found that '^^ano^n^crs nnginil olisenntion of a J > cm jiicrca‘'C in
corpse (as to Iniiig) statim w us eoirctt ind using intilliple regression tfjtm
tions of slnture with the lengths of the long bones prodiued the folloinng
table's — with standard errors tliej arc undoubtcdl\ a significnnt nd\ance in
tlus important subject >

UHITB UAirS

VCUIO MALIg

5 OS Hum

+ "0 45

ir4 05

3J:6 Jliim + 6“’ 10

*4 43

3 T8 Rad

+ TOOI

i:4J2

3 42 Rad + 8UG

*4 30

3 "0 Iflna

+ 74 Oo

3 ■»« Ulna + 79 29

*4 42

2 39 Fem„

+ 6141

2:827

2 11 Fcm. + 70 35

*3d>4

3 52 Tib„

+ 78 O'*

2:3 37

2 19 Tib. + 96 O: ''

*3 78

2 69 FiU

+ 7178

2:3 29

2 19 Fib + 63

*4^3

1 S0(tein.

+ Tib.) + 63 30

2:2 99

1 ISfFem. + Tib.) + 71 04

*353

142 Feni«

+ 1 24 T»b„

0 66 Fern, + 1 62 Tib.

+ 50 69

2:2 99

+ 7013

*349

0 93 Ituni

+ 194 Tib.

090 Hum +178 Tib.

+ 6930

2:3 26

+ 71 29

■*3 49

0 2* Hum

+ 1 32 F*^-

0 89 Husv ^ 1 01 Rad + 0 38

+ 1 16 Tib. +58 57*

*299

Fcm. + 1 92 Tib. + 74 06

*3 38

WHiTf rctoiee

sino rsUAUic

3^6 Ham

+ 87 87

*445

3 08 Hum + 64 67

*4dtS

4 4 Rad

+ 54 03

*4»4

275 Rad + D4J1

*5 05

421 M\fA

+ 57 70

*430

331 Ultw. + 75 39

*483

SlTTem. +5410

*372

2 28 Pern, + 59 70

*341

200 tlh.

+ 61 53

*3 60

2 4a Tib. + 72 65

*3 70

a 03 Tib

+*59 61

*35-

2 49 Fib + 70 90

*3 80

1 J9<r«ni.

+ Tib«> + 53 20

*3 55

l^C<rcin. + Tib.) + 59 72

* 728

1 45 Fern.

+ 1 28 Tjb.

1 53 Fcm. + 0 90 Tib.

+ *3 0T

+ Tib.

*3 55

+ 5854

*3 23

1 3>> Him

108 Hum +3 79 Tib.

+ 5" '1

+ 1 r

-*-3 67

+ 6*» 80

*3 58

0 69 Hum

0 41 Hum —0 20 Rad + 3 4C

+ 1 15 Tib. + 50 l4^

*351

1 coi. + 0 86 Tib. + 5653

*3 22

iToiS^a IcTN^

>«cr an t Clescr Iw J p! jt h U top >* ■ tO )

Foetal Bones ij n meosurcinents of the stature of jO newlv born
children and thesubso hiitmea^rcmenls of the dried tyonesrcidiaut articular
carlil igcs (i e diaplii J^nUl tlie fonowinff ratifvj • o'p **ccn inltiihft<!

The following tables taken
found useful —

‘•tatore of diikt —

Kaduw
Clasacle

Lnner jtw (svmphj^i
cond>'Iar siirfafcj

0 .0
n 10

.Tidys ‘Legal ^fedicinc’, ma\ also l«

HAtr FROM 50\Jii 15.

Average Measuretnerti at djferent Ages reduced to a Scale of 100

1

A

-

H

1

t

P

rii

l|

-1

Krt
><a i

fl 12 }»iir4

IS Jl-UM

18-19 i

\<lu t

ICO 00
100 Ot)
100 00
lUO 00

I 0 00

iSSS

Sfl »4

33 71

J 7«
10 71
ao 81
31 ]3

78 00
C3 55
81 ii
43 73

31 St

18 6

17 4

18 6S

19 ao

1 "1
19 00
19 St

13 n
11 31
11 71
It 09
13 H
It Si
It IS

13 30
It ts
11 1
II 83

10 95

11 II
It 21

DO

2 nt
•*0 00

S SI

2U 11
27 51

18 SO
IS 88

I SO
31 «8
16
2- IS

IS 0
13 31
It S

It 6

It SI
IS 63
IS OJ

8 It

7 It

7 83

3 00

0 8

8 It

7 U

7 "I

6 60

7 0

6 01

Determination of Race from Skeleton
Theie nre certain racial difference^ m the skeleton chiefly in the skull and
face measurements and the relative lengllis of the upper and lower extremt
ties The question is more hkelj to anse m identits problems in seaports
tliough of course it might occur in other parts wl ere foreigners nere known
to ha\ e liN ed From the mixed nature of the population m London Liverpool
etc cases do occasionallv arise in which a decision as to race becomes verj
material

It IS inadvisable however for anyone not experienced m such matters to
give an opinion about the racial origin of i skeleton and tl c matter should
always I e referred to a competent anthropologist

How long have the Bones been Interred?

One of the first questions asked on the disinterment of bones relnte**
to the leiigtli of time during which they have remained buried in the ground
The period at which the bones beg n to undergo decomposition will depend
upon that at vvhicli the soft parts have entirely disappe irtd The common
opinion IS that the soft parts ore destroved m ordmarv graves in about ten
years but th s dcpen<ls on many factors sucli ns the kind of enlTm the
nature of the soil the temperature of the cl mate etc Bernt ment ons a case
seen by ISavier in which some fleshy parts of the bodv reni lined after an
interment of *’1 v cars In trop cal climates comj Icte destruction of the soft
parts takes place witli great rnpiditv and even in an ordinary rnghsh summer
we I ave seen tl e tissue redne^ to a slime m between six and seven davs
Tl c changes lu tl e bones are observed to commence h\ the loss of nnmial
matter so that they become lighter externally thev acquire a dark incnista
tion when in contact walh the earth Tins dark incristation is sometimes
confined to l\ic surface \nit tn some xtry awcwmt bowts tl\t osseous sheU vs
of a dark brown colour throughout TIic animal matter is never entirely
lost it exists in bones winch have been bured for many centuries and may
be made evident by di{,esting them in livdrochlonc aci I The shaft of a long
bone becomes after long bumi in a dr\ soil light n id ver\ bnttle it may he
easily broken and cut or scraped witli a knife It appears to be impossible
to assign with nn\ approach to precision the i eriod re p ired for tlie pro
cl iction f f these tl anges thev vary mth tl e age of the sul ject taking j 1 ice
more xapicUv m the skeletons of tlic young they v ary also with the nature
of the soil m w hic h tlie hones are buried iccordin„ to wiiether this is drv or
humid sandy cret4ateo is or clayey the skull and long bones and even the
perfect skeletons have lieen found in ordinary' graves quite perfect after

15C nOMS PbfttOlJOl- ISTHiWJ \T

scores of Nenrs If the bod\ Im become niutnmifictl llic I>oii« cnrtilnj>es
and dned tissues maj remain intnct for thousands of \ cars In Rtncral the
lower jaw of adults is presoned for a j,nnt Jcnf!th of turn and with it the
teeth which resist dt“Conij)Osition lonffcr than nn\ other part of the bod\
Tlie ultiniate destruction of the bone is rflectetl h\ the romplt tc disintrjmf loii
of its earths jiarts the phosphate and carfionfllc of caleiiim fnlJu jiito and
mixing with the cnrtli around

Bones owe their prcsereation to the large proportion of mineral matter
contained in them Tins is greater in the adult than in the child \ on Hdira
found the following proportions of niimrai matter per cent in recciil Iwnes
of ihfTerint ages in a woman (nf 0-) CO 8_» in a man {nt GS 07, m a
child (irt 5) CT 80, in a child of two months fi5 3J m a Ardis of sr\en
months 05 10 and in a fatus of six months 50 C2 Tht projH rtions in the
bones of anininls arc similar to those of the human adult

c can form onlv n rough opinion of the pi noil of intennent of Ijoncs 1>\
the presenee nr absence of the soft parts of marrow in the inltnor b\ the
firmness and Weight or brittleness diancss and lightness ol Iht Iwine I\rn
these criteria can scarreU be made nppliciblc to Ixmi's prfstrvtal in iliirnhli.
colTms or saults for in this state thc\ art to a great extent remosed from
all the common causes of chemical tliangc
DcsxTgK. states tlrnt tlie Iwnes of King Dap bert wrn foiin 1 m n tolcmblv
perfect state at St Denis altliough the\ luil liccn biinetl in a \aiult tirelvr hun Irtd
\cnr8 In the }ear 18G8 tlie skefeton of Uilliim Ilufus sms found in a stone enllln
at mchestcr ncarU pirfect after 780 sears bitnal The skull was in fratmenls
the \Trtcbrx were almost complete parts of the j»eh is and taeruni (showing the male
cliaraeters) the bones of tin arms the fimora and two tihix were final llic
hwTcrjaw with nine teeth t I k enamel ap| arentlj tinrhangn! was also disrosere*!
liiere were no < Lasat Ics and onl\ six nlw an I the small bones of tl e lun Is and feel
liad dLsapfienrcd

Taslor examined a jiortioii of the scapub nml rfli of n skeleton which was f un I
18 Inches lieliw the suffice in tlic sand> sod on tic lop of a i HI Tl r skeleton
whieii was lliat of a female sms perfect cxcc| ling the lower ea Is « f the til iw and
feel which were decomposes! It lind the nppearanre of liasdag liceii tlirusl > i ilrntK
Into tlie ground There srere no traces of wft part* Ihe teeth m the w|>j>er Jaw
Including the wisdom teeth were |>erfect and regul ir an 1 the ace was etinsi trrrti
to lie from 2*1 to 2S sears No hair or articles of clothing were diMsiseml On
anaUsis the l>oiies were found to contain “’2 jicr rent t f mlnerd iiuitter an ! tl e
j resence of flu innc wais deteitre! In n small qiiantitv of l»oiie mhiml It |>owdrr
Tlie ilate of interment was asslgnei! at from flfls to one hiindrril scare

Hones and teeth sshieh base liccn long Imned mas b\ ptrciilalu ii of wat« r
thmngli the soil lieeome imjiregnntrel with fimc oxide sulphati of enleumi
or carbonate of calcium and magnesium Ihrs nre heas\ of a dark brt wn
colour and gencralls contain miitli lime and iron willi lluoride of calriijm
In lOM susilcion long felt that the famous PiJtdown jaw was unthre|>oil at 1
did not lie! mg to the skull svhieh W7i» nllegrd to liase licen fiund In the >ame area
was renrinnrei hs the haling tint it Ind Iieen artifinallv reatrel with tniiiml
pigment f h it Us ftuoniie roalriil difTeml considerat I> frr m that 1 1 tJie skull an I
tKal the grinding snirfaees i f the teeth I ad Iieen artinti ills I Ic I *

In some Ixines disinlrmal mnr oiie of the plaster (juamrs of Puns
lAssaignc found licsides 06 7 of the usual mineral constihicnts 2 Tiiercent

of sulphate of calcium sritli trice* of ftme oxidi Other Ikuics of si Idirfs
killed m IHl 1 and Imnrel near the same spot* a ie1 Irel 56 1 of plunphatc ami
carlmnate «t calcium O 5 of sulphate nnil 8 2 per cent of argillaceous sanil
Tlicse Iwnes Ind Iieen bimeil for B penml of T! scars Tlies contained 15 fier
MSnnrr J *5^ I £>53 TJie I'flf Jwji ! I>w* Ion mfmllnb I fr^s

inMth\S IDL\T/r\ UY CLOTHISG V,7

cent of nnimni matter and 20 of niter Ihosp taken from the plaster quarry
contained the smic »njantitj of water, but on!^ 1 1 per cent of oremic matter

ldentU> from Articles of Clothing, Papers, Jewcllerv

1 he disco\ ery of eertain nrUclcs of clolhinfi know n to ln\ c bclonjjcd to n
missing person in association with the bones of a skeleton will sometimes
reino\ c in\ doubts that maj arise on the subject of identilx Alctal buttons,
brooches or rings arc imperishihlc, nnd should Ijc soiiglit for b\ siftmg or
washing the earth

In n \ ridtl^, the jinsoner was diargol witJi tlic imiriler of a min nnmcsl
Cf Ills The ilcecasetl li id not licen seen nli\c since Decemlicr 7tJi Ifrl > Oa Aiignsl
-f8lh 18tG some men in < leaning out n ccss|Ktol in tlie nci^^lilMiiirliood found s< me
hiimiin bones siith cejtaiii article* of (Intliing which were siijn>os«l to lie thoNO of
the nu'sing min l\ith the)>e remains there was the ordinnr) dress of a man -
iinmclj, coit lint trousers nrekerehref and two girfers one rwl nnd one while
riiese were stili around tlie hones of the legs fl**- Imnes were found to lx tliose of a
timlc htimin being from21to lOMarsofnge I neturcsoftlie skull «o tlie region of
the forcheid anil left esilirow ga\e ssidcncc of foul plis liie clothes wirt
identifltd ns tliose worn hj tlie dci-eiiseil at the tune of his disipiicirinet nn<l the
wlutc and red giricrs found round tiie hg hones wire ideutiliid bs a woninn who
made tlicm and gase them to l!ic dceeiscil

The prisoner was connected with the net of mimlcr Ii> a eJuin of ciitiinistnnces
On Deecinlwr Till he sins seen with a Inmmcr In his Imnd qiiimlling snth the
deceistd At a later period lie was seen with two men pushing Ihi dcec'iscd who
ujipcaretl to lie in a stujwfiwl nl ite into his *h«p On the mglit following he was
seen In compain with two men <arr)uigiiii nppirenlK liiiui s.)rk in the ilireeti >n
of the oessjKiol in wliicli tlie skeleton was nflerwnnis found 1 he prisoner li id made
falst statemciith n sjK'tting tlie tmnsictions lictwecn himsilf nnd lirrciseil nml tlie
watch and hoots of tlie <leetase»l were tmec*l to his jioswssion Tin. dercisctl luid
iieen i>een with the w-ntch up to within half an hour of his disnpjx amnee

lor the defence It wus contended tliat there wis not Miincieiit proof in hw
tluit the ttmams foiiml were rciU> those of the missing iimi Thi lln ling of some
iwrtioiis of the clothes of tlic min hi the rtssfiool wis not tiunieieiit to jmisT the
c(ifji«< df/ieli—tlw murder There must be i*omIisv cMilcnee tl it tlw temihis were
those of Collis patteson I ovemilcd the ohjeetinn ohsening tint tin idea
tlt\ < r the remains were altogether a siiKslion for Ihi jurv The prisoner wis
conMCtwl

But for tilt <lisco>cr> of the clothes more pnrticiilarlj of the two (IifTerent
rolourcd garters round the leg Ixincs, tlit idcnlits in this t »sr eoiihl not hi\c
been satisfai loriU cslahlislied 1 be suggestion Hint the dcccasetl might liace
WAiTi Tfirto Wit ccssjiotA Vf\ M«nc neeiAenV •wtii Yivgi\iMi\ Va tVit
had this occurred tlic wnttli nnd ImoLs wuuhl hi\c bcui found with tlie
remains, whereas these articles were traced to the possession of tlie prisoner
It IS worths of note that in tins msc the denil hunnii 1 kk 1\ m tl itlics was
reduced ncnrlv to the state of a skticton within the sliort ptriod of nine
months Tins must Ik* nscnlicil to the mlluenrt of the putreseent matters
b) winch it was surrounded 1 \cn if tJit Imds is putrefird tin tlolliing or
pi[>crs it contains nn\ gise sifal infonuitioii

Tn lUlt the jiohee nnmnl ns ' wanted f»r Intersiew m coamsilm with the
murder of a wninnii In S I Ixindon n nwincnUetl IVtllt who had «lfs.ij peaml rrw*
SIX weeks I tier a hursesnr insiiectliigliomlwd CiU premiMi owing to a coniplunt
of Murll, found a ninggot ridden IkmK curled up on its side far to*! dmmjx'seit
for dimt ideiitlflratnn The elolhing— n deeiosch tlicck j ittenusl tweed jsckel
unit gfT} trousers — w i-s identifleil ns l*i ttit s and in It wns f mn 1 a ilentsl a| jh lot
inent card lienniig a numlier whicli gasc aectis to lnwpilnl rreonls of nn r'ctmetimi
of n / « for apleni iilisress In a imn »ille<! I'rttit wimc months prts lotwls \ nis *
lind Ijcen filctl nnd the dental dctiri* rorrcsjjon let! cxnc llv

158 I{L^^A1^S WEKTITY Bi OTIlLlt DATA

A droM-ned bod\ far too decomposed for recognition was Identified at n South
ttork inquest m 1953 bj the clothing including a shirt marked L254— a laundrv
mark used bj a lodger in a South London lioarding house from mIiicIi a nnn liad
dLsappeared, a kcj m the picket pocket vliteh fitted tlie lodger s door The generd
features — sex age Iieight Jiair— corresponded mth those of the missing man
Other points of circumstantial eaidencc also demand attention— the
position of the bones when diseoacred m the ground whether lying at full
length or grouped together confusedly In bodies winch ha\ c undergone
Cliristian burial, the skeleton is found I>ing at full length usually with the
head to the west and the feet to the east and one skeleton mas be found
beloss another These points mas suggest that bones discos ered during
excnsntions or the foundations of ness buddings are in fact from bodies
interred in a burial ground Tlus inference is confirmed ss hen the Ironcs of
persons of all ages and both sexes are found m or near tlie same spot
In 1666 atAIileote near Statford on Ason tsro feet from the surface of the soil
upwards of two hundred human skeletons were found Tliej were placeil cinscis
side bj side upon their backs sntU their feet to the east and tlieir heads to the
srest and allsvcresvellpresersed There svetc soung and uld andskclefons ofboth
sexes tlie bones presenting no marks of injurj This was no doubt the site of an
ancient and long forgotten burial ground
A man named AVeekls Ball was chargwl snth the murder of a woman named
Ljdia Atlec with whom he Iiad cohabit^ Ululc in the last stage of pregnanes
she Imd suddenh disappeared on July 22nd, 1850 and was neser seen again It
was rumoured that she liad been muraered, and the prisoner who it was ollcged,
lud a strong motise for getting nd of her, was susp^ted of the act, hut no legal
proof could be obtained against him and the matter dropped On February 3nl
1804 as a labourer sins digging in a lane b> the side of a ditch near the Milage of
nmgsleod in Northamptonshire where the deceased and the accused kad h\ed, he
found a human skull and ultunatciv a skeleton hang at full length face dowTiwarris
obout20inchesbelowthesurface Theskelcton whenUidout was that of a middle*
aged female about S feet 2 inches in height It liad Ixen in the earth Irom twehx to
twenty a ears Tlienussmgwximan was far ads-anced In pregnancy hnt no fatal bones
were found. la reference to this the surgeon stated that the bones of a fcctus wm
tainetl more animal matter, and might liase been decomposed althougli he dcchnwl
to swear that wthm the period of 14 \ears the\ would base entire^ disappeared
Iso hair was found altliough souglit for andnotraccsofclothcsof any kind cnul I be
discos'ercd The ground w as again searclied for fuital bones and tlie result wus that
about 18 inches deeper in the earth the skeleton of a full groivn man was found,
foot to foot with that of the female skeleton aboie, Ijing on its back the bones
appeared to Im e been much longer mtlic ground On this discoscrj it ivassuggcstetl
Jliat the spot might liaa-e been a gipsies bunal place It bore no connection wafli the
disappearance ol Hie woman dia AHee

Anj object found wth the bones must be carefull} preseri ed and examined
it may form an important clue to identit\ — and sometimes also to the date
of burial

Tlie reconstruction of human skeletal remains found dunng an arcliacologica!
excaantion in Kent showed them to be of a girl of about 12 aTars She appeared to
liaac been seated at burial and the remains of an iron chair decorated with liroiixe
found munediateh under the bones were suUicicnt to date tlie bun d to aliout
A D 600 > . « . ,

Such matters may equallv be of more immediate interest In the (,oaaImitig
wigwam girl murder the MCtim s body had been buried aiath heather nl the time
of commencing blooming some six wecli prc\ lonsly

Can the AIaxnnr of Deatd be Lstaislished’

Indications of murder or Molent death may be obtained long after the
entire destruction of the soft parts

‘Jessup, n r,105» Areheob^ut Carltana 68,1

UnstAIh'S MODE or DFATH

Bmtwl rcljtPs tlir n«o of n xromnn whov Jmx1> -w-rvi djiintenril nHcr cloven
venrs’ hiinal It Iwlicv'etl anti that kIio liatl l)«‘n mtinlorrd, nnd licr

nltmTards Ijiinctl hv her mnnlercrs Tins wns found complctelv rciliioed
tn n Jiheloton btit nowiHiokss tlie third fourth llfth nntl MXth ccnicnl vcrtclirr
wre still held together bv a i! irk-ooltiimd m i*?. tleriv ed from the decompt sif ion
of 11k Hi sh\ parts of the neck itid this mass was Mill siirrnuniled bv sevTnl folds of
n oiml.v'hieli had been tJiipIoved astltcmeansofstningulation Proof wisthcrcbv
ohUunetl of themotlcinuhuh thcmunlerlnd been ]>cq)etrat«l A ring was fnunil on
the Ixines of one linger, which left no doubt wlmtewr of the hlcntitv of tin decetsitl

In 1023, during reconstruction of a fttctocv ml g\pt ii collection of human Ixuies
forming a complele skeleton was found at tlie f wt of a well V hiillel hole of ciitrv
lav m tin top of the skuH hut there was no evit and careful search of the remaining
hones with the help of \ ni\ rev<nlc<l the sjicnt Imllit King buried m the
m muhruun of the slirmuii Tt vecmcil hkcU tint tlic \nctlni luvd lieen shot wluUt
King down possiblj during sleep m<l tlicn dis]>ovc<l of ilown the will \ stispis t
cniiftssid to the crime which Ind, iii fact lacn effected tii tins wav >

The case of 1 ugtnc \rim iiKo furnislies an instance of the nect*ssltv for ilosdj
cxuniliiing skeletons when it is suspected Mint the Individuals have dic<I from
murderous Mohnet This man conspired vritli another to inuriUr n }>erson n imed
riarkc who siiddenlv disappe-ircil in I ehniarv, 171* In ITIS— i e thirteen vuirs
nftcr Ins disnpjKamnee — some bones were BCcideiiUillj diseovcml m a cave near tin
town when he livcfi Anun s nccomphce vvus arrested on Kiispicion and losing his
presence ofmind when* hirged with the municr he dcinisl that those were the hones
but nuntiomd the spot where the bones of tiarkc were buried A skeleton wns Uiere
found, amt a fracture nnd indentation of the tcmjiornl bone were plainly iierccptiblc
Die manner in wliich the murder wasconumUcil bv the nirompbic agreed wnlli tlic
medical CYidenci Amin who w isa man of some nbilitv argued in liK defence tint
it wus impossible to identifv ii skeleton nftern hpsc of 13 vc irs that the fracture of
tlic skull and the piece of bone l>ejtcn innards provcil notlung tlint It might InvT
hmlong m the tave whore it was found, wbkhliad l»ecn a lu'miilagc and ihercfott
11 likelv place of sepulture in ancient tunes and tlint the v inh net to the skull might
Iiave been produced m times of disorder when in scariliing for tmisim the graves
and lollliis of the dead wtri violated In spite of the ingrauitv of this dcfincc the
facts wen too Mrong agniast liini, and lie vras ronviited and eseiuled

Aram s <U fence gi\cs an imhcatiou of the fiue!>lums which ntc apt to arise
whin CMdcncc is gtten Ironi the examination of cxliiimcci Ikuics Proof of
idciititA IS csscntnl, ami inoxl c*nrcful cxnnmintmn of anj fracture so ns to
enable II tiiedicnl witness to dclcmuni vvlictlicr it was rmnt or old and
vvlietlier it was likel) to have liccn ciuscd in life or during the exhumation
must never he ncglictid

In It V Duiififil, wliat w is known as tlie ‘Moil I unii ravslerv ixcitcd verv
greil lalirest the facts wen* as ToTftows Itougnl w1io was a mnirusl msn per
Mmcicfl a Miss Ifolland to live w-ttli him at the Mixil I arm It vvns provnl m
tvidence bv a •n rvuiit llut Miss Holland left tlie bouse vvith the prisoner one dsv
la \iigusl IhOO ami was never ng-iln seen ilivx? karJous excuses were made
bj tlic prisoner to account for Iier non apjicaniijci Meanwhile the prisoner
prorccilfsl todisjxisc of her projicrtv , and was nmrsteil for forging the dead woman s
iiaine to n iiaUrv ehtijuc of n few

Iiwpilrv led the polire to believe tliat Miss Ifotland had liecn miirdirrd bv the
prisomr, nnd licr lioilv disjvoscil of bj bunal sonicwlirre mar the fannliouse
Aflir prolongctl senreh the renLilas of ii human hixlv were found biirieil In the
bank of n ditch which the prisoner liavlrntseil tube IWcil hi, uivoiv the sUc orwhvcli
he Imd had trees planted Little was found but the Imnes a ftw fragmeata of
inrscinnl attire, a ji iir of lioots and triers of intcriml orgins Imt there was enough
to convict the prisoner, who was luingnl llic main items of pnxif of identitv nml
of the nwxlc of drith wttc tlic followang* (1> jvvwtWMVs of v skvrt tht-. vras hlcwtilietl
hv the dwaaiscd s drcssmaki r. who wiis able to swrar tn a jieculinr mcmini i>ortloa
of It, the w itncss h ivaiig herself nirnded IIh* fckirt (2) a comb or liair fiistcnrr of
a p it tern which 'bss Ilnikand s m iM was tiWelo idciitlfv, (t) rt mains of laiots of ii
»«;mith.S 1»M» PM«rJ,l3,21

ICO RFMAim MODF OF DEATH

peciiliarij small si7e preciselv corre«pon Ln^j to the si/e which deceased was known
to Jnse s\-orn the\ were of French make and were distinctl> identifiable f4) the
skeleton sras tliat (a) of a noiiwn (b) of a person about Uie height of Mias IIoII mil ( 5 )
belund the position of the right eir tos found a jagged fracture of the bone mIUi
fragments carritd imrards the brain wns sulTicienlls presers cil for Professor Pepper
who performed the autopsy , to trace a -wound through it from belund fonrards and
to tbe left at tlie anterior end of whicli wound sms found a bullet ith regard to
j ros ing that tbe bullet was one which might ha\e been fired bv tbe prisoner, there
ssus some little difiicultj so long after the es-ent but there could be no doubt wliat
es er that the person whose remains were found lind been killed bj a bullet fired from
belund and the circumstantial endcnce sras sulhcient to pros e (o) that the b hIj w os
tliat of Miss Holland and (b) that the prisoner was the onl^ person srho coul 1 liave
fired the shot and (e) tlmt he had opportunity and motive for doing so

In reference to injuries found in skeletons it is of great importance to
attempt to determine whether tlic injurv had occurred during life or during
the exhumation and if during life whether it was recent or of old standing
Tlus IS difllcult m cases in nhich the injury took place shortly before death
but it any attempt at healing has taken place this ssiU still remain and will
pros e definitely tiiat the fracture was of some standing

In this connection it must be remembered that m the skull small portions
of bone not infrequentU ossify from irregular independent centres and
remain for v ariable periods of time as siinll bones separable by maceration
and disarticulation and knoim as ossa tnquetra The aperture left b\ the
separation of one of these bones miv be mistaken for a fracture produced b\
a weapon but the difference is usunllt well marked If on the one hand the
bone lias not vet united with the others the edges of the opening will be
found quite thin and as it were bevelled olT and possibly membrane miy be
found on the etlge If on the other hand it has united the then serrate
suture or line of junction w ith the other bones can linrdJv be mistaken for the
appearance of a fracture

Tlie dead bodv of a new bom iJuId wrapped in brown paper and a towel was
found m a pond The head was much decomposed and tbe scalp was cxtcnsireh
lacerated and destroved over the parietal bones wluch readilv sepanitcd The
brim v'-as flmd Two apertures iverc present on one parietal bone thei were small
and rounded an 1 it was at first doubtful vsbeUier thev lind not been wilfully pro-
duced by some perforating instrument In one situation tbe scalp was entire nii 1
uninjured hut the other wns situated iin Icr tlic lacerated portion of the scalp No
V lolence liad been used m the removal of tlie boilj from the water i he bone was
macerated and carefulU examined bv the aid of a kns The apertures were quite
regular at tlie edges wluch sirre remarkably tiun esadcntlv merging into a mem
braiious condition This CNamination left no doubt that the lioles m the bone were
not due to any mechanical snolence but to deficient ossification The spaces liad been
membranous and the membrane destroyed by decomposition

Careful search should be made for the hvoid and thyTOid bones for these
structures are often fractured in strangulation and seldom by anything else

In Ji \ Dobbin' (The Baptist Church Cellar Murder) the only evidence tliat death
was due to foul play was a fracture of the right superior cornu of the thyroid cartilage
The medical evadence for the Crown (tlmt tlus gave tlie strongest prrei^l tne
evidence of manual strangulation) was cross-examined without success Some d^
blood clot in Uie immediate vncmity showed it to have occurred m life if onlv
immediately before deatlu

Identification of Burnt Bodies

The I)ones> whicli v\e are required to examine may have undergone ealcitui

tion In several cases of murder which have occurred an attempt has been
» Tie on Diulcj Trials ^ncs HarrvDoncm. Loidon Jarrolds

101

Monr ot m itii

nndc to dispose of tlic bodj hj burning Ibis iiiclliod of disposing of a dend
bod> IS bs nu iiieniis muisinl in c»scs of alleged inf inticidc md conc-cabucnt
of birtli There is little diHiciiltj m deciding Mhcllicr a Iwiii. 1 is or Ins not
undergont lakiintion Its tbiriclcr is entirely nltcrcd Its sba[)e mas be
presers cd, but if burnt in tlic open air, it will be as hite, if in a closed fire it w ill
be black or ash grej 1 he bone is brittle easih puKcnr^ble and dissohes
in hadrocbloric acid leasing if perfecllv calcined onlj some elmrcoal but
no animal m \tter

In /Z a I arney the accused liad licen ileliaered of a clulcl avhose both liad
been burnt and onla a few remains of tlie bones of a liitman fcrtiii were found in
the ashes of o grate The act used w as cona ictetl of concealment of birtti

^ In a case bkc this in avhich an attempt bad been made to destroj the bodj
of a child ba burning it aaill of course be necessnra to baa e good evidence
that the bones are those of a hiimin feefus or child A small fragment ol
either end of ana well marked bone will suffice for identification If the jaaas
are present the number and condition of the teeth should be noted
The period of uterine life aabich the cbihl bod attained maa be roughlj
determined as also ba the presence or absence of ossification centres (see
p 131)

If the bodv has been burnt to a complete ash or powder it will of course
be* impossible to identifj the bones

the form of a bone cannot be recogni/ed all that medical eaidcnoe
can accompbsh mav he thus stated The detection of a large quantita of
phosphate of caletHin m tlie ash would suggest that bones were present and
thus distinguish the ash of hone from the ashes of other substancus The
bones might ncacrthelcss haac belonged to on nnmml and not to a human
ffctus There are no accurate means of distinguishing the ash of human from
that of aiiim il bone, or the asli of foetal from the ash of adult bones Tlie
prccipitm tost docs not operate with bone ash

In tie case of the lemomes mother ami daughter trictl lieforc the Irench
courts in ISoO the caideiiee amit to bhow that the elder )n oner (tlie mntiier)

1 urneil the hwlj of a child of which her daughter had liecn secretlj dchacrel
Some 1)01 es of a child arere rccoacred and amongst others the frontal hone llie
medic d ea idencc aras to the cfTcct that tlie bones aaerc those of a chdd wlucli liad
reached about the seaenth or eighth inontlu Lpon this corroboration tJie jura
cona ictetl the elder prisoner

In a t ISO of concealment of birth it aaus proactl hj medical caiden a tl it tlie
prisoner liad been recently dcliacretl of a cliild of not less tlian seven mmilhs
uterine oge She said tliat she liad burned the botlj to conceal htr sliame and 1 ad
hiiried tlic remains in a g-irdcn Some iKwes which had Iicen calcined were tl ere
found buried m aslics and after an exanunation of tlicm a medical man stated
tluit thea WTre ti e bones of a eluld nine nmnUis of age hut iii comparing tlicin
with the skulls of nine niontlis children in musciini collections It was admitted that
the skull of w Inch tlic jiarts lud hern found an I restored wras larger This admission
threw Rome doubt on the identity of tlie iMncs and tlic prisoner avais disclinq^al

III 18G3 a man n imed Barton a fireman em] tojed at a coal pit near \\ igan
vvas messing 1 rom the appearance of blood about the mouth of the steam furnace
iuhI tl e discoaerv of a burnevl portion of the elotl mg avairn hj the tlecciueil there
w IS reason to lielievc tluit the man liad been murdcrccl and his bo 1> Uinisl into the
fiimaec Ldwards examined the ashes of the fumacL and fc und— (1) jiortioiis of tlic
occi| ital bone of a skull (-) base of tlic skull and roots of an Inctsor and of a molar
tooth (1) jKirtions of the arches of the dorsal vertebra; (4) a portion of the lumbar
aertebre Ci) a j ortion of the head bodj and joint of the humerus ond (0) a i>orHon
of the head nnd joint of the Uugh bone Tliesc bones had been heated t > a high

102 I{rMAI\S MODE 01 DEATH

ttinitntiin Ii 1 1 dcsfrojiMl tl cjr inltni 1 strut lure I ut tl c cxttrinl f riii

wus well prc'^rxed l!e\ were ntl luttiLiit btnes ^ ehenucil 'lul mtert vroj ic tl
examimlioii of some of tJ e clinkers slmwed llmt there was 1 lootl ujiou them
the cluiracter of human I Ioo<l "niere seemed no re isonal Ic <1oiil t that Uicsc were
tl c remains of the m xs ng rruin lie s\as last seen olive nt eifelit ui Uic evening and
at four tlie following mom ng nothing else remained of hum
I tde nlso the case of Dr Parkman (p 139)

CII \PTLIl \

DEATH AND POST-MORTEM CHANGES

TitE conditions tint gi\ c proof of dc^th and the changes tint ensue iii tiie
dead bod} -will be discussed m the following order —

Immediate — mjra

Insensibilit} and loss of power to mo\e 1

Cessation of circulation >• Somatic death

Cessation of respiration J

Earlj— p 10«

^lolccular (cellular) death

Cooling

Skin changes

E^c changes ,

Blood changes — Kvpotasis
I ibrtnol}sis
Post mortem bleeding
Ccrcbnj spinal (luwl changes
Muscular changes — Rigor mortis
Freezing
Ileal coagulation
Cadn\ enc spnsms

Late — p 180
Putrefaction — ^in nr

jn water

•M

Adipocerc fonnntion
Mummification

IMMEDIATE SIGNS OP DEATH AND POST-MORTEM
CHANCES

Insensibility and Loss of Power to Moie
TIic^c signs are concomitants of death and must therefore lie noted in a
complete exposition of the higns of Death hut the\ ohiiously ma} be
found in cases where d< ath wlmh is onU ipparent and not real Thus iii the
apparentlv drowiiiil nol onl\ are tlii\ found bill [lena j fiblt heart belts
or respirators mosements are id » aliscnt for a tinu in « ascs th it iiltiiniiUlj
ni-orir enlirti} a faet edlmg for sustained cfforLs at resuscitation

riic same phcnoiiuna of insciisihilitj an I loss of power to move are

'“4 SIGM 01 DEAIIl

'Mlnos!«Im prolonged firalinsalliida lagol mhibitorr plicnomcim in cni
kpsj, trance and catalepsy i in narcosis, m electrocution and durin- llio
therapeutic use of muscle reln-sanls such os curare in fact these tno sums of
death has e bj the laity hid a vetj undue weight lliroim upon them udhoiit
attention being paid to other more certain signs

Cessation of Circulation

The cessation of this important function js often regarded as m itself
sulTicient to determine the realitj of death and right!> so if the obscnation
be made ivith sufTicient accuracj bj the stethoscope and over a su/Iicieiitl^
prolonged period

In ]J>o>0 one ofthe authors iras at iitorkinaLondonmortuatj n-hen the boil\ ofi
iioman aged 75 was brought »n stripped and laid on the table for autopsv She Ind
been found cold and apparenllj lifeless l\ing on a common some 20 minutes pre-
vaousI\ a doctor had on her arrival at hasp til got into the ambulance placed a
band on tlie clicst found it cold and had felt no puUc pronouncing her dead Some
four Or fi\c minutes after she liad lieen placed on the mortuary table she was seen to
swallow twice she was found to 1»e breathing and to liave heart heats She died
of coronaia tluaimbosis and mioeardnl infarction 2J hours later

That the heart maj beat with undiminislied aigoiir iip to the last beat
Dr F J Smith was consinced bj what he believed to be an nimoit unique
experience

He was engaged in counting tl»c heart lieils of a pneumonic patient and lul
counted some ten or elei en sounds and was tlunXing how good and satisfactOQ
tlie> were but no twelfth sound was heard* TJie patient lind actuaJK died at tl c
moment of listening Per contra he liad alsolislenM as the sounds grew feebler and
icsb frequent while the patient fainted and feU bach on the bed npftarenti} lifeless,
to return in a few seconds os the faintness passed awav

Life IS not incompatible with a temporarj suspension of heart licit but
it IS undeniable that the function must be specdilj re established or death
IS certain The limit of tolerance of suspension of heart iction will \arj with
the degree of oxj gtnation of the blood at the time of the suspension on the
general metibolic rate and on the bo<l\ temperature During operations
which are undertahen when the bodv temperature has been nrtificialK
lowered (hj'pothermia) tlie tolerance is increased

Certain brain cells are especialij susceptible to dejinvution of oxj gen and
even if death does not occur thev mij be permanentiv damaged Under
normal circumstances longer than 3 5 minutes cessation of heart beat is
incompatible with life

Tlie phenomena of hibernation in nnnv animiU can Inv e no reference to
tins condition for m these i purpose is answered bj the feeble state of exis
tence into winch tliev are thrown It is nitiiral for such immals to remain
torpid during the viinter season, or to e\ixt under a feeble exercise of the
functions of respiration md circulation but it would be an unnaturil «5on
dition for a iiuman being and inconsistent with the miintenanco of life
The auscultatorj test applied at intemls during half an hour cannot nil
to lead to a satisfactory conclusion Tav lor s statement of Boiichut s obscrv a
tions remains apposite

Boucliiil founl m an e\tensii-e senes rf rcsciircli "s cvlicr mintallv confirmed
tlinl in all ca«cs of ipiiarciit death wlietlicr ariMii foni nsph'xn »r svm'o^
there IS one commi n tliaractcrbv vvhlohtliej may l)cd 't ' ‘1*?,

and tliat is a continuance of the puJ-iatious of tlic Jicart 1 fe established the fact u
in the most perfect state of synci^ attendol with entire loss tf motion

103

siG\& or or iTJi

•%exi«ition llic conlnclions of the heart were not really It nm time su-i}yn lei lit t
siinpl> reduced m force and frcquenc% In sjncopc from h^cmorrliiKe earned to the
fullest extent and in cases m sslucli respiration was eiUicr imperceptihle nr carried
on at long intcrsnls the IkhIj at the same time Imang the aspect of a corjise he w as
enabled bj auscultation to detect the pulsations of the heart, and thus to dis
tiiiginsh apparent from real death In children Lorn in a state of api arent tk tlh
ami in ca<es ot asphyxia from ans cause in aarcotic’ poisoning m hsstcnrtil urul
epileptic coma, and in all diseases which Iia\-e been stated to resemhie aj j arcrt
death tlie living lias been casiK distingimlied from the dea 1 l>o<K In the eon
timiance of the heart s action This was feeble and took place at niters als hut it
wais alwaj-8 sulhcicnth marked to enable u profession il man to distinguish a lis mg
from a dead liodj

It IS important to define if possible, the penods at which after the entire
cessation of the heart s action a person might he pronounced dead Tlic
Jiighcst degree of bradvtardia (or slow beating heart) rciortlcd is ten or
twehc beats per minute If therefore no sound of tlie Iieart is pcrccncd
during an intcr\al of three to live minutes i period whitli is nsualK mans
times as great as that which observation warrants death nfiv be regarded
as (crtain

Tins test has lieen abjected to (1) because in certain suspensions of normal
rhjthm the heart Itself niaj like other mustles lit in a state of apparent and
not real death and (2) because the pulsations and sounds of tins organ niav
not alwajs bt appreciable to the car even when iidcd bj the stethoscope
lurther, ventricular (os distiiitt from auricular) fihrilintioii though receg
nizabic as muscle contracture does not provide a circulation

In support of tl esc objects the Mtalitv of new liorn children is eommonlv
restored wJicn no puN ition whatever could be discovered for a period of ten
to nftl'cn minutes after birth In one instance a child w as n v i\ cd after 20
Tnmutes of apparent death l>\ iiisufllation of the lungs iltliougli ditririp
that time no pulsation could lie heard or felt Niimcmus c iscs of resuscit ition
hv massage of the heart and bv other meins after the heart has stnpjud
Ijcating have Incn rcc-ordcd t Iciniiorarv stoppage during intesthesin is
common

\notlier test winch should onlv be rc-sorlcd lo in extreme cases involves
ojienmg a small arterv When this is opcricil the chameter of the blood flow
must lie noted It should be pulsatile if the heart is still lx.ating cimtmiious
like the flow from a vein if the licart lias ceiscd and the bleeding is incrolv
passiv c •

A casually oflter uncertain of lie fact of death in a ilctlioric man win was
intcnselv congested m the head and neck made aii incisii ii into the sculp to see if
active bleeding wul 1 lie otiserved The Irodv though dead hied from the turgi I
scalp so frcciv as to reijuire slitefics lo cuniroi tlie (post mortem) bleeding

Jiard s test which consists m the subcutaneous injection of a small cpianlitv
of a solution of fluorescein with bic irlMinatcof sodium maj be mentioned If
circulation is still proceeding howcverfteblj, a greenish vellow discolouration
of tlic surf ice of the Iiodv is soon produced 1 his test should onlv be applied
b\ davliglit as the colour is difiicuU to nppreaate b^ artificial light
The btatmg heart is acxrompanicd bv the pavsage of an cfectris charge
througli the <*on(Iuctuig system of the heart niul tins mi> be rccortkd b\
means of on electiwardiogrim llie clectnKnrdiogram will rcctri! anv
current ataamipanvuig the heart IkmI even wImii this heart beat is lofi wt«k
to lie palpalial or nusciiltattd so th it iftlicclcctrodisof the clt< tnx irdio{,r im
art count < t<d up to the individual and it fills to dcmoiistr »l< tin p issngc of
*\fjiin„ N tllTa Jtnt t rl f 2

mn &IG\6 01 tiLArn

mj ctirrent ittcr o per od of (lirce minufes it must be m,iip „1 that iImH,
hae occurred This nielliod tlioush suj orior to llic metlioiK dcscriLcd nboi i
IS obi loiisli not I riLliiMc la most of lliccsscs uluili conn biforc tile line-
tihoncr '

Cessation of Respiration

rins like tht cessation of the lienrt beat must be complete md contmiious
to constitute ntt} approvimatton to a test of the ^cahl^ of dcatli It mn%
ec-Lsc for n \crj short periott without deith ensuing in the follomng romh
tions none of which IS likcJ\ }M>we%er togne nse to nnv difiicnlts m'cxmntc
tion with real or apparent denlh — (n) As n putch \oluntarj act Two
minutes seems here to be the outside limit which experience show, emmt
be exceeded e\cii expert sponge duers who hnve spent tl iir lues at the
occupation cannot remain tinder water svithout artificial contrisames for
a longer time than two minutes (b) In the peculi ir condition of respiration
known as Chejne Stokes breathing tbe limit of the npnotic intcnal has
iicaer been known to exccc<l some 15 to 20 seconds In (t) the apparent!)
drownwl and (d) new bom infants the act of respiration is trequentiv absent
for long periods and doubts often occur ns to wliethcr life rcallj remains in
the bcKh It IS quite possible tliat in some of both classes suspended animation
passes into real deatii owing to the want of pcrsescrance in artificial aids
to establish uaturd breathing but the subject is more fiillv discussed else-
where (p 201 and Section on ‘ Drowning ) Ifter clectnc shocks there mav
be e%cr\ appearance of death but (x>ntinnous artificial nspiralion nine
cftuse natural breatlimg to commence after Jong jjcriods It Jns not lerj
n ueh bearing on the reahtx of death m such cases ns are here under dis
cussion in wJiicli it ma\ be laid dowai that some two mimites is tlie extreme
limit during which respiration ina) cease and \ct life he maintained Tins
docs not of course take into consideration the spceml conditions under
which an aiiTsthetist iua\ artificiall) niaintam some useful kind of \entilnlion
of the lung

Tests for lirenlhnig (1) The nioacments of respiration can bardl) be o\cr
1( oked In am person wfio exercises due care but for tlic purpose it n. nucs
sars to haae !x»th the chest ami the alKlomen exposed tn mcw (_'J 3he
stethoscope must be cnrcfuUv and continuoud) npphwl to the upper part
of the lungs in front or to the Jarenx itself he which means ctia slight
currents of air mas be detected Tins test alone is j meticalh suflicicnt hut
if doubt still remains (3J a feather ma) be held in front of the month wJieii
eccjQ the sl^ghtesl breath mas mose some of the smallest disisions of it or
(4) a piece of cold bright looking plavs mac be held there the surface of
which will be dimmed b\ the moisture deposited upon it from the breath if
e\en the slightest respiration is contmuiiig (5) \ glass of luercur) or other
bright rencctmg surface mac be placed on the chest or epigastrium and tlic
reflection of a light from it l>e focussed cm a lixed sjKit Tins iiimgc will heseiii
to inoce if resjnratorc mocements of the slightest degree art sfi/l continuifig

CARM SIGNS OP DEATH AND POST-MORTLM CHANGES
Molecular Death

\fter somatic dcatli certain tissues and celN ui the 1 wh lontmuc to list
individualK or eollcttnch for a jieriod of tun dc|Hiidiii„' to soim extent
c n the cause of death the eundition of the cells or tissiu s Iiefirt deafJi nu I
their oxegen requirements For instniuc ft r ptnods up to a-* long as two

POST MO/tTI M (Ihi\(.fS

1C*

In lilt'* \ti!iinl irj nius< Ics iim\ Im. iiihI< l« (tiiiir k I In iint Ii mn il or « Iixlnrn!

llnU tin hunt <‘4>ntitiu(s lii Ik il «r tontrul fi r n vvluU uflor
tcrtflin forms of MoUiit (Itnth docapitution is uill known In llie past
liicsc ; ost wiorfm rmiscic con|mclions lust Ijcen mistaken for \ itul iiios e
ments nnd m cases wliere these tin\e occurred nfter rapid mtcmicnt nnd
suhscMpicnt <\]umntion ihnnges in the position of tlie limlis liau liccn
flsstmud mistaktnlj to indiintc prematun. buna! Portions of «pit rtniosed
nl operation or inimcdialeh after death retain their power of rontraition
sslicn stimulated either ineciumcalK or bv drn„s or to\ins flic piipd will
react for vnrsing periods to c-ertnm drugs

N\ stem eoneluckd from his olisersattons that the suetcssicc disnpjienrniic c
of tmisctihr irntalnhls in the Iiodits of dtcapitatcd persons took place in The
following order (1) the left s ciitnclc. of tin heart (2) the stomach and intes
lines (J) llie iirinarx bliddcr {t)thi ri^ht untneJe (>)lhe»isopl jgiis (<)
the ins and (7) the \oliiiitar\ muscles ol tin l>od\

Cooling of the Dod}

\Mien life is e\tiiiguishcd the Inidv gradiialK loses the heat wlitih it
possessed at the moment of death just as might so much inert matter nrti
iiemllj raised to the sime temperature

*llic usual tcmpcrnbire of a Innllhs adult at rest is npproxmmteU t’l
(17*( ) when taken h\ tlie mouth whereas tlic trniptmlnrc of the rectum nl
the same time and uiuUr the same conditions is about 0 )°I and iii the wilia
nhout 07*1 Jconc of these tempemlures is c-oiistunl and tlicrc arc indis idii il
mid clad) snrmltons up to 1 1 5* He temperature snnes nccainlmg to
the time of dll) and will be lowest in the moniing between 2 and ( a in mid
Inchest in the aftenioon at 4 to C pm Mild tsertise mi\ nuise a s!ij.ht
rise and hcn\j exemse a rise ol greater extent winch howeser dnips to
normal m *2i»-S() minutes

Of a}} Otc < hinges f) nt occur in n dim) }fO(h 0 it of (oohiig in tiic
Icmpcnturc of its surroundings was the first to be cirarh imdcrstooil
1 h( rate of loss « f heat from a endaicr oIkss rceogmrid phssie d laws and
boenusc of this ixolnig of u IkkIs offer, one « f the most riliabk inelbo Is of
c*stinintnig the time whieli has rlipsed siner death iiji tc a period of about
2t hours

\Uliougli the nile of heat loss can thus Ihccittienlls be preeiseK defined
there arc a great mans sarinbles to consider in conneeti m with eonduelion
eoincition ind radiation these factors base to lie taken into aieoiint nnd
the imporlniiec of am one of them can oid\ be neciintelj nsst^ssed after
roiisidi r ibk pnietn nl experienet

In order to imderstaiid the procc*ss of cooling it is first netrssarc to gice
a brief onllme of the mrcliinisnis In schich the norm il IhmU tcnijumtim is
innmtnuH-d it a constant Icsel in life liidcrcertun « ireiiinstanccs these
meehaiusms ma\ l>t upset lij the inode of clcMxth nnd tl n trmjicmliire at
the time of deith is accxirdingl) raised or lowered and unless this is aecoimle I
for ermneoiis rc*si;!fs will lie obf imcd when estimating the time of iJtath
from the rite of ecKibng It is not projKisecl to diseiiss thcs« meclumisms m
great detail ns the) mn\ be c\pk red fulls in anj of the st mdnnl Icvtlxviks
on pin side g\

Sources nf /icat xn II r In ing IxJih/ Ihen isonh one source of iiiterinl lu it
in the IkkIs and tint is the proeos of nietnlMihsni In which snnous fnn!
substances are oxidired b% c'ompltx pror<?sses into more simple ehemual

irs

cooLi\G or Tut noin

sul,st„ntcs «,tl. llK |,TOl„il„nofl,„t The ,,r„<cs, Ilk,,,™ ph„ co..lm,.

niU throii Jioiit life \nd occurs in ill ti«Kucs snd » r^m-s of Jhc hnh Ifost of
tlitsc oMdition processes take phcc m the muscles md tlic li\ er The iJrocess
IS slowed to 1 inmimum during sleep or rest, but is considcrabJv actclinUd
during phNsicil exercise The heat IilK-ratetl h^ these metabolic processes
in the muscles and the internal organs is dislrihutcd round the lK)d\ b\
means of the blood t irculation

7 (iss of hat from the inittgbody Heat is lost from the bod\ mainh from
the skin and lungs ApproximateU 15 per cent is lost from the lungs 80
per cent is lost from the skin hj radiation coiucction and evaporation
and some 5 per cent is lost h\ warming otMal inspired air and ingested food
anil w ater

2/e /eat regii/altug fiiee/tonum in He Innig lo/tf The fenipcralure of the
living hcalliiv hodv is maintained at a constant lev cl bj the heat regulating
centre which is situated in the brain in the floor of the thinl ventricle This
heat regulating icntre controls the l»o<lv ttmpenture mainlv hv uicrtnsiiig
or decreasing the general metalmlH rate and h\ increasing pr decreasing
the blood Ilow through the skm and the production of sweat

Lnder a vnnet> of circumstances the heal regulating centre mav raise tlie
hodv temperature and maintain it at a higher level than normal us occurs
in a fibrde illness I nder certain <on<litions the heat regulating incclianism
mav he so stmuilated that it causes c\cossiv<lv high temperature (hvptr
pjrexn) from whitli rccoverv is ini|K>ssibtc Under other conditions the heat
regulating mechanism mav he unable to exert its normal control formstance
in severe dchvdntion (when there is no sweat available for evaporation)
after an mjettion of curare or tii certim spinal injuries where the nervous
p itliwavs have been paralv sed or severed Ociasionallv it is so overwhelmed
bv certain phenomena such as heat stroke and virulent bictcnaJ infections,
tint It loses eontrol altogether

The m-ijonts of factors vvhich upset the action of the heat regulating
centre occur in natural pathological conditions such as the. severe bacterial
or protozoal infections alrcadj mcntionciJ and m natural intn cranial
liTiiiorrhagt. where tlic centre is-slimiilatcd

The hodv temperature mav sometimes lie above normal at tlic tunc of
death lor example in deaths from violence especialK if there has been a
stnigglc and also sometimes in death from asphjxn ns in suffocation It
mav also he raised wl en death is due to head injuries involving the ngulatuig

I nAit-

\fter deaths in w Inch tlic liodv fernperitwre has been raised at the time of
death the cooling of the bodj still obe>s the same^pbjsical bws winch
apph to a person <h ing at a normal temperature but as the initial tempera
lure at the time of death w as abov e normal this possible elev ation in tempera
lure must be allowed for in the estimation of the time of death e are not
pistihed however in nssummg as a fact that an) hodv which wo are exanim
mg did have a temperature alwve normal at the time of deiitli though this
IS in fact common

In considering the rate of conhng vve must also bear in mind that the
cooling in the first hour after dcatli ma> bo refativef> slow for ns long as
there Is oxidizable carbohjdrate in the blood the residual oxvgen present

mav continue the oxidation process and evolve heat

Jnit V 7/e<7/ft(CCC. IWG) tlie nude bodv of n girl was fimdlrounl (recenllv)
gagged and dead of asplij'xia m a \otting lldl Gate 1 otel Tlie rectal tcmpcni u

COOU\(, 01 TUF Ijom

Ht no pm c>nthctla^ thcboch tvnsf uml vrns R4®1 (rooniGS'’! ) U«ns assumed
In tlic m\esti/-itinf; niilhontN tlut tl c munit r li nl t iVen plnre njnutid midm Jil
the presdmis ni^Iit fur Tlcntli had amsed at tlic I otel viMi the j.irl at about 1 •
a m — mid I'ls heard to slam a door fin lenMnf!)at abmit 1 tO n m If the tein}>cr»
lure of tilt bo<U nt the me menl of dralli was 08 1 I it would nuan tlLit the bo<h
tcmijcnturc hnd fdlen onK 14 4* in nlioiit eighteen hours The bod\ though In a
ilospd room wns nakctl and in this nse it wppcnml n Lsnimble to aswimc th it Ihc
[nitnl temperature w is mised nlKne the normn! b\ tbe net of stran^ul iti m

In 7? s t/c/Mfijfrr/ (C C C 'I!}42)apr) sIkhU lindlieen found nt 8 *10 n m on the
fnreshort of the Thames undera pnnipet of tlie newls constructed ^\^tc^^oo Ilrid^
A i>ohec surewin certified death and (after pi wing a Imnd on the bo<h) c\presse«l
llic \iiw tlial death luid ociiirrctl four tnscMnd'isspresiouslv In fai t on autops\
at the mortuirs at 12*50 pm a reel il tem|icraturc of I" I- wns jnensnreil (nir
*5S I Th imes riser 31 1 ) "MiKinstrs ss-ns seen to leave a lfX"d publu hotist with
I’cggs Iliclumls till murderetl girl at 11 pm nnd to wi!k tnw-nnN the (then)
descrte<l Italerloo Ilndge and It w is assumet! tint the murder wsuttihI ihnit
midnight the previous mnlit In this ease if tlic initnl tcmpenilUTc is plaecvl at
OS I® it wouhl mean that 31 t" of ttmiuntnre were last in abi iit 12 1 1 hours
tliat IS aliout four degrees per hour wliith in view of tin fact that the nvir w ilcr
was IkIow freezing jioint is not speeialK rapid

In a ease brought into Ciiv s Ilnspitnl at 8 10 ajn following i selueiihr street
nteident vrliete a lius had knocked ilovm and pinneil a cveiist liene-ith tlie eli i«is
proiiotineeil traumala aspliVNial eliangcs were jircNeni IJie Umjicmture at autopsv
liVT hours inter was still DO 1 Tliecasunltv ollieer ]i.ui Ixxn givTn a tem|ieratiiri of
lOQ 4 bv the njirse wlio rruade roiitiiie observations of pu1»e temjicmlurc nn I
respirations on o(lmi5«ion at 8 I » a m

In certain cases the recorded tcmpcritiirc ma\ eontmue to rise nfier
dcnlli for a period of nn liour or two riiis occurs in Ctrl nn severe Incternl
infccttotis nod after li imorrli iges into the bnin stem

Inen vse of teiiipcfiUure iflcr death has liecn referml to nn fer putrv fiction but
It cm oitur Mwo nftcrdeulli and liefore rigiddv seism Sonic of tlie rises rejiortetl
hs like and Inj loral'oMi iw tli it it mav take pi lee indej'emlentlv afpiilrefnction
n iwler h Is noticed it fts a I’ommon octurrence in a wainn climate in tin iHxlies of
jitrsons who have di«l front veil »vr fi.ver Uheit the ntiMiiium whidiisv mibfein
tliffimit IkxIivs 1ms licen atlnineil tlie bodv gwiduallv imdef>> les the cooling
j riH-evs obscrveil after dc itli In a drith fn in cpidiinir chrlen the dead J>oih
rraei cd its nm\iiitum tcmiverature of too i m alMiut nn 1 our and a Imlf *] ht'^e
t IwervatiOfis nuv serve to csphiii that in some ewptional lastanees a dead fi'i'h
nia) retain for miiiv hours a temi>erilurr as high as or higher Ih in thitwiuchii
usuillv found in the living

\ caution must lie here mserlcvl with rcparil to tlic c\att me imng of Ihe
ctKilmg of the IkkIv aiid Imw it is to lie dctcniinied It is not enarh f’
judgv of Hit coldness bv placing the hand on tht skm this is hu’ih
nous inasiiUKli ns It tltjKtitls hrslofiill iiimn tlic w innth of tlic i h<rrer>
hand— a corpse mnv feel cold to n vvnnii Iinml and wnnn to a
sctoiidlv the Uniptnitun of tht skin v>r*icoqist. is no cntenoiAfl'icf 'cud
ttiniicmturc

\mong eases oh crVT»l h\ Tavhr at (pIIv s llnspltil it was fe*arie* *^5 a
several a Jiigh tciujx raturr vv is ret iiimiI bv tlie vweri fir a 1
In two instancs-s ii tliennoincler Indii-nlrl in Hie M>cerv a tem{>era(.3r'''^^-ra
one instanci 17 and in tlie • titer 18 hours nfUr deatii tin teitijytf'**^ ^
lHm«comj»aMtivTK 1 nvflf I J nnifthesurficroftln. IkkIv rooi fn *"

ten limirs after drilli wlulc llic surf ice nf Oicablomen iud n ter

tlie Intfti IT vvas 83 I

In ill obstrvatioiis on ll« tcinjvcnliire of the dt id
or cits trii III inslruiiiiiit such as n ihtniiuiiitttr rttvr ^

1 -0 1 (or Ctntijnulc) or a Uitnnocouple, must be tnip'r

cooii\o 01 im noDi

should jj) nii c'isi s hi intrmlnred into t/ir rectum or through n puncture m
the nhd, niiml ^wlII nito the ca\itv of the abdomen and the temperature
should hr ruid uhilst the instrumtnt is m «i/« Reailmss should be wade at
>n/ n///s ni order t > obtain the rale of hll of temperature bnder no cir
<umstu((s s! iiid the temper iturc be taken m the ^nfT|na m t“i‘:es of sus
I « l< i lo il ph\

UifJj fhi'. <^ntl«n ue are now m a posituui to n)>preti'ite tlic factors which
art hkcU to mfluincc tlie cooling of the bodj Ihe principal factors imohcd
arc —

n/TIjc difference In temperature betivecn the body and the medium
In s\ hi eh it is lying Iliis is » simple physic 'll phrnomcnon The dead hod\
bclinvrs ns am other inert miss jmsscssing hent and will lose hnt until it
reaches the temperature of ilseiis ircminent obe% mg Newton sjsws of cooling
llie rate oi cooling is ])rnj>ortioiml lo the difference m tempenture between
the 1 o<l\ niul its siirrounihngs and the gnuter tlic difference between these
tilt more rapiii will be the mte of tnohiig Ibe nte of cooling gradually
slows ns the tempenture of the IkhK npproMimtes to that of its cmiron
nicnt A Jinked bods of ns crage plis sifpic «i air w ill tool lo tJie tempemtiire
<»f the air in about iO *3n hours acconlingto tht cnsiroTmiental lesel

In 7t \ Vnudi (Lewes \vsireH lf)(A)ab(Hls foumllsing in the snewr m a sard at
Ifustings it 0 Ida m si is feft eoscrc<i hs a lar}>«”hn until the nmsal of the Inscsti
Is ilmg team at 0 p in ilie roetnl temi»cmture w ns still 5 »®1 — thouj,h the m-ia had
heen shot it was sithsc<iueiilly j rose I bs evidence in stiitcnients snmcwliere
lictwccn () and H p m the pres ions nvht Death eoul 1 not h is-e tnken place as long
as JO to a liours pres musls for the mte of fill could liardly Iuist been as lillle as
J per hour nsenige during this penoil of exposure nsernight m the snoss The air
tempernture (iuriii^ the dns ladlietn to W* The explanation Inj In the nature
of the Wf (md« whi<h were such thit denth suiihl he hkeix tn he delised several
hours tlie extras isnti< n nf I to* d eonfirmod this The time of injury is not necess trtlj
the lime of death

bui/d of the cadaser The relationship of mass to surface area
A recently dend bodr in rommon ssilhany inert ohjcttatnliighertemperntiire
than its surroiiiuliiigs possesses a qiinntits of hent which must be lost before it
reatlies the tcnipernturc of its cnsironnienf

llic rate of loss of licit is proportional to tlie weight of the bods to its
surHec am thus < iiildrcn niid adults of small stnture w ill cool more rnpidly
llinii the ascrage adult afthmigh their actual hnt loss per unit of time will
be less os cr the same nngts of tcnipernturc

^Tbe physique of the deceased 1 at is a bnd eoiuluctur of bent and
therefore the greater the quantity -nnd the more general the distribution of

the body fat tbt slower wiIIIh. the rate of cxxiling \ oung women normalls
base moic suhciitancous fnl than soimg males niul there is n tendenes
therefore for the bodies of soiing svonieii to cool more slowb than tlie
bodies ol young men of similar age ssciglit and build t thni or einncia c
person on the otiier iiaiid will cool more rapidlv owing to the a scncc o
tins subcutnneous fntty layer

The ensironment of the body The emminincnt of the body exertisas
a profmind inHucnie <in the rate of nwling and this ni/JiieiKx, depem s no
onls on the iinture of the medium but also on ik solume and most men
V body m nr loses heat In couscetirii nnd radiatjon some howescr wi
be lost by conduction through the inatenil on which the body is hm^

COOLI\G 01 Tlir nOD} 171

Am tiling 'ivliich ill iiicieosc the r ite of ndntion conduction or convection
Will accclerutc cooling Ihus » IkicIj Ijing c\po<*etl in a well ventihtcd room
%\ ill cool more r ipidl> tli in one in a sealed room as the freelv circulating air
will rnpidh carrj awaj the air wormed b\ the body A bodj placed on a
metal slab will lose beat more rapidlj by conduction than one placed on n
porceloii) slab A bmlj h mg snu„h m bed or seoled in o coiTm will lose heat
much more slowK tlianone Ij mg on top of the bed or in a sealed lOom owing
to the smaller a oltime of air present around the boilj and tlie lack of moi e
ment ui the air

V naked bod\ immersed in cold water loses heat largely In cons action
and comluction conduction plasing much the more important role both
so immersed tools at about twice the rate of a bodv exposed to air and
movement of the water will tend to accelerate cooling b% carrying awa\
more rapullv the water w irmed by the body It must not be forgotten that
bodies found dead in baths i lay have become warmed thcrebv after death

llodies buried in earth will usutlly cool more rnjmlK than those in air but
more slowK than those m water However tins is b\ no means a gencnl
rule nuich ilepending on the conducting properties of the soil i hocI\ for
instance buried in dry soil will retain its heat fai longer than a similar hodv
pvjKiscd to air If a body is buried m rottmg mater/al such as a dung
heap the hodv temperature will rise or fall to that of the thiiip heap The
various factors whicli influence the toolin„ of the bodv in earth will 1 o more
fulU discussed in n later section

•'-tfovennfis on or around the body Clothing on a bodv or bedclothes
mound it substantially retard the rate of cooling irrespective of the medium
in whicii the bodv is lying (leiicrallv speaking clothing is a bad conductor
of heat tlie conducting properties ilcpcnding to some extent on the nature
oftheclothing eg wool coltonorsilk but to a greater extent on its texture
'liic more minute air spaces witliin (he clothing itself the poorer will he its
conducting properties and the slower the rate of cooling

The greater the number of layers ot clothing within certain hinits th”
slovser the rate ot cooling

In air w ater and cartli the delay m cooling is due to the sIom condiu tion
of the bodv heat tlirough the clothing Once the heat reaches the outside
medium throngli the external layers of clothn g it is then dissipated by
com cction radiation and conduction

It IS not uncommon for relatives to place hot water bottles m the beds of
persons who die at home Under these ciriumstanccs the body temperature
may reniiin raised for a considemblc period and the more advanced states
of decomposition to be des(?ribed later mav present themselv es after a period
of onl\ 1 few hours

It lias been alleged that in death from lucmorrhage the rate of cooling is
accelerated owing to the loss of blood Tins has no foundation in f ict the
onU pin sical dilTerencc created is that sonic heat has 1 cen lost m the extra
vasated blood and though there is a reduction in the total amount of heat
in the bodv no difftrciue occurs m tlic temperature

A 1 calthv man <rf 4"’ died suddeiilv from liTinoirhage \ ligature wliicli had
Ih*oii pi ICC 1 on the nxdlirv artery to control bleeding gave wav, and ohiiit f< nr
pints of lilooil were lost Four hours after death the slu uldm chest and al 1 iincn
of the deceased were (luite warm Tlie skin of tlie abdomen had a tempt nilurt of
Sl'T eight hours after death the tcmpenilurc vri« fiO^r and the arms an 1 legs
vs ere not rigid The conditions under winch tlnsbmh vs is exjxiscd sscrc fast unble

Skis CJIlSf.J^ itTI n Dk tTll
fare 'ifZ ■"

',11 1 ' .

ti I II hue of ,l™ll, „„d „crv r.rtor ronncrtion Uicrcn.tll
, M , <r. «)an<l c-.rcr,.llj ™„s„terct! In nil the rectal tcmperi

I lie tali' nni't he ncordal and nKo the tempemturc of the meLn,

11 . ninth the both IS found re,m.tmg Ihr altmclio,,, „l ,„Un«b otia to
unto at some eshnnle of the rale ofclimte oier n period of retenl hours

II ts ohMou-. th-^t when welme to consider so nnn> s-irnh!c. it js quite
inipossiblc to <le\isc nn ftrciimtc formula to define the rale of heat /oss
III tcinpmte thnntes it Im l>een sugt.cste<l that for an asera^c adult the
oicmil heit loss MI air may axen^ j 5*t per hour and m tropical clumtes
about 0 7 j I Such noures have to be used ssifli great circimisjiection and
(< oktd upon mcrcU as a iiroad gLiicnlization

III the esse of s 11 Af/r-raj (C C C 10.1) tiro g rK wrre mtirderr { on die
Tcddinglon Towp illi anil tlmnm into the riser The first bo K «ns rec< sere 1 the
nc\tniormiiguii Itl ercitaltcnyientufpfll |h3tt^/neCS I T}///iv}rtinn ^e^n[len
tiire was ( 0 l and the nsemge water temperature of the riianies aunn_r the
preceding »4 hours was 04 t ft sn< estimated bearing in njijjiJ the penwl of
miHieruoM in wnler and of cwling after nemert tfuit « me Ji In 1} degrees iimiJ f
h i\e been im appn siniate r ite of fall m lem}>enlure durinj. tl e peno 1 of hours
iinmedntel) f llnwin„ death This ga\c tlie estimate Uiiue of dealti as si mewhere
bLtweciiDpm on the previous niglit and in m onthennrningtheboh ivasfinml

I J is wide bm t wws hter sfic wn to embrace pretlv s juartli II c time (11 10 p m )
wlnn the eriine bad tioen cominilted

It imf,lit be argued that such a wide nn^e is of little use when the police
are seeking nerunoi but to set closer biriils onri onl) expose the pitlwlogist
to severe and damaging cross eMuniintioii and is unwise This cslinnte of
the time of death iiin\ however lie of the utmost value to the police in tlicir
lavostjgitions and thniigh it is subject to so nnnj vinnbles shiuld nhvavs
be attempted

Changes in the Skin

\fter death the skm imv be olwcrv ril to become piDid and w s\\ looking
owin'' to tlie fniUire of periplieml cintihUoii In some pirts as the biilv
cools it hecoincs cov cred bv lewd discolonltoiis (ciidiveni bv[>ostases) One
of the most stiikmg cluiiigcs in tlie skm is its loss of eKsticitj In the bv mg
hods if uv\ part of the stirnce Ik: compressed the skm will gndiinllj return
to its origiinl form on remov mg the pressure Tims in a doubtful case a
flatness of those jiart-S winch have been allowed to be upon an even surf ice
mav be regarded as a minor sign of rial death
Another condition of the skm of the dead which calls for notice is its
opacitj If the hand of a bv mg person is held before a strong light it will be
found to be translucent at d of a deep rsd colour the traiislucenev of Ih®
tissues allow nig of the red colour of the circulating bloo I to b seen through
tlieskm The hand ofadeadpersonisvirtuallv opaqu"' owin'’ to the opacitv of
tlie skm In appK mg this test we must remember that a lior/iv or hardened
state of the cuticle or a diseisecl condition of parts inav interfere with the
translucencv m the living subject it is alvvavs Iwtter seen in the joung and

of course in those whose hands arc Hun and debt itc

In the living light thus passing Htroiigh the skin vvill adiiallv displav the
sjiectrosc-opic appearances of blood if passed thro igh a spectroscope buch
a test fails if attempted with a dead both

I YE ClIA\Gf-S iFTFR DVATII 173

Fje Changes

(a) loss of corneal rejlu Uliis is found m all forms of decj) iiiscnstbilit} ,
cgy general amesthcsia, npoplex>, uremia, cjuJepsj, norcotic poisoning
It IS also lost after cocnuie or other lotal nii-csthcsins and cannot be considered
to be a reliable sign of death

(b) Clouding of ilie cornea This alTords stronger presumption of desth,
but as it may occur in certain diseases, such as cholera and other s\asting
conditions, before life is extinct, it is therefore unreliable

Tlie speed with nhicli the cornea becomes opaque after death is due to
desiccation, and is retarded if the lids arc closed after death If the cornea
IS kept moist with saline it wiU remain trinsparent enough to allow exanii
n^ition of the fundus for two hours or longer after death If however, the
cjelids remain open the cornea may become opaque so rapidly os to prevent
examination of the fundus within a few minutes

On exposure to air for a few hours after death the cornea develops a film
of cell debris and mucus upon winch dust steadily settles, md htcr on the
tilt corneal surface becomes wrinkled and brown

(c) riaeadilii of the eyeball The intra ocular tension falls rapidlv after
death, and the eyeballs tend to sink into the orbital fossa flirs fiaecidity is
readily appreciated by simple palpation

(d) filate of the pupil Tlie ins contains a large proportion of inuscuhr
tissue winch during life enjoys m common vvith nil muscles certain tone’
This ‘ tone” is rapidly lost after death and the ins relaxes into n condition of
equilibrium After a time the ins will contract slowly witli the onset of
rigor mortis Ihe power to react to light is soon lost after death but it must
not be forgotten that it mav already have been lost during life

The action of drugs— atropine eserinc — continues usually for a period of
on hour or somewhat longer after death Their application to an eye under
such circumstances is free from all risk and mav therefore be made when
tins form of ev ideiiee might be required to confirm the reality of death

Jso conclusion can be drawn from the size of the pupils in dcatli as to the
diameter which tlicy presented at the latest period of life This is of some
practical importance in reference to the post mortem appearances m cases
of alleged narcotic poisoning

Duniig life it IS not possible to press the piipd out of its nomni circular
shape but, within a few moments of death pressure on either suit of the
eyeball causes the pupil to become irregular

(e) Changes of cofoiir m the fundus Immcdiilelv after death the optic disc
becomes pale and has the appearance of extreme optic atrophy Tlie remain
dcr of the fundus gradually changes colour, taking on a yellow tinge which
later changes to a brownish grev or slate After an hour or so the retina
becomes almost as pilhd as the optic disc

(f) Changes m the retinal lessels After ileath tlie bloodstream m the retinal
vessels rapidly becomes segmented Tins change apjiears vvithm minutes
after death, and persists ior an hour or so, after winch the vessels are so
contracted that they ore difficult to observe through an oplithalmoscniie

Post-mortem Hypostases

The jihenomenon of post mortem hypostasis or hvadity is due to tlie fict
Uiat while the blood is liquid it obe^ the universal law of gravitation and
sinks to the lowest available part, furthermore the heavier parts of the
blood— VIZ, the red corpuscles — have a tendency to settle first. This is a

POST MORTEM IirWITY

point uf sonic importance ,n th- ,Kisil,on m mI.icI. a hnh ha.

hm (liinnfr f ic linurs dralli 'liic plicnomcnon of l.vi^,srnsis

as 5CC7. >v l u rn^xi ou insists m the aiipcanime in tlic skin of the
boch of (tisf Imiml pattJics-slfttej blue or rcfltiisli purple in c-nrlv stairre
varMi jr u bright r«i or cojiptn, or esen pn>cn uhen dciomposition lins
«(lv u,ct.I-to uhich manj diffircnl names hnse been appl.eil hmt mnrfrm
lopostascs subcntancoiis Ii\postnscs cadaveric Inidilies sinr^lntioas
vib/ces /wr/ wor/cw stams) Of these jiamcs potl ninriem h\ |K.slii 5 cs''or simiile
hj postnscs IS tlie best founded ns it is on the basis of the um\i rsnllv accepted
theorv as to tlie incthod bj uhicli thev are produtwl Ihcsc np|K imnces
}n\ e somctmich been mistaken for the cHects of \ lolenec applied during life
and serious mistakes I avc thus arisen Iiiiioccnt persons have been ncius^d
of V lolonce, and lias clicen tried on tli irges nfleru ards pros ed to l>e groundless
Cbnstison refers to two cases, in one of which two persons wircconritled and
m the other three narrowh escapeil comietion upon a mistake of Ibis kind
lI\-postascs gcnerall> commence to form witlun a few hours of death If
death has been taking place slowl} o\ern|>cnod cirl> liv-postascs mas lie
present before death has actually occurreil At first hypostases form patchv
or mottled areas, but witlun about 12 hours they are complete in their
permanent form by coalescence of the smaller areas
Ilyijostasis occurs in all deaths provid«l the Iiody remains largeli intact
In deaths from profound nnamiia or liTmorrlmgc Die hyjiosiivcs mav be
barely discernible If the body is constantly moving iLs position as after
drowning m moving water, the change may never develop It is jm|)ortant
to remember that hvpostases occur in the viscera as will as in the skin a
condition which is liable to be mistaken for congestion CK-curnng dtinng hfe,
or attributed to some pathological condition responsible for death

One of the authors was e-dled to Watford tocxanunc the bodv of n man Mivjicrted
to liave l)ecn poisonetl by IiH wife, with whom lie was on Iwd temw Ih luid died
suddenly after taking an evening meil prepirctl bv her and the phim-er 1 mml
reddening of the loops of small bovwel su^testod to the I<x-n1 pathologist that a imiMin
had been taken Tlie colour was undoubtedly due to liypostasis and further dissrr-
tion of the coronary vessels revealed a fresh coronary thrrrn!>mi9 Aimfms, ww/Je
for the sake of security, proved cntirelv ncpalise

Hvpostases may be found in the veins of the pm mater m the posterior
fossa of the skull, wiicrc Diey may be mistaken is a sign of nsphvxia or ol
meningitis From the former it is virv difiicult to distinguisli them except
by the fact tliat if the congestion be due to asplivxm it is hkcly to cause
actual turgidity of the veins and to be cquallv well marked over Die henu
sphere, m the middle and anterior fossa, ns well as the posterior In hyim
stasis there will be no observ able turgiditv, and the comhiion of fiilliiess will
be in tlie lowest fossa jxistcnor m the usual supine position of a corp'*
anterior m a prone jxjsition I rom the latter they are eiisv fo
bv Die absence m hypostasis of anv pus or stickv serum m irilhnimation
oncorliothof these will be usimllv noUccabk moreover m simple liv{«Kfavis
the pin matcrwill have a clear glistening apjicnmncc whitli will bt a wen i
inflammation has been prcsotit t ongestion without inH unimhon and smip e
by pastasis may be confused bv one whois unaecusfomrd fomakmgau ojwies

During life congestion mnv fie of two kinds (!) nctiv e or nrtcno<npdhrv
venous, which is the visible indication of infhmmVtion c r of blashuig or
flusbinfu (2) passive, which is due to a mere overnUmS either fnim

want of a suction power in front or a driving power bclund After death I ic

175

llinilSI-S A^D LIVIDITY

signs of active congestion are ltkel> to diminish and those of passnc or
simple filling of veins to increase and it is the latter which are so difiicuit
to distinguish from inllnmmation m certain Mscera
In the dependant parts of the lung hjpostnsis is liable to be mistaken for
the early st ige, of pneumonia Hie diminished resistance offered to penc
tration of tlie finger tlu-oiigh the substance of the lung is suggestive hut it
must be admitted that it is not always eas) even after nffucli experience to
disennumte between a mere hv^iostasis and a condition due to active ante
mortem liJTieitemn especially if the htlcr be combined as it so often is
with an escape of blood out of the capillaries Caution must be exercised m
expressing an optrtion in a case that is doubtful and the absence of other
distinguishing features such as a similar condition in non dependant parts
definite valvular disease of tlie heart, or definite bronchitis mav provide
assistance T. he most intense passive congestion of the lungs is seen in many
cases of brain disease Microscopic examinition should be made in any case
vv here there is the least doubt of the pathological condition

In dependent parts of the stomach and intestines hvpostasis is liable to be
mistaken for inllamniation In Die absence of definite lymph on the pen
tone'll surface or pus or actual haemorrhage the best distinguishing feature
lies in the fact that on stretclimg the viscus the continuous black lines (the
veins filled with blood) will break up into isolated lengths with gaps between
them if the condition is due to hvpostasis thev wall remain unbroken if
inflammation is present

IIypost<7ses may rcsnuble Marks of Viotmee (Bruises) Ihis is true on a
superficnl examination but there are manv definite points of distinction
which may be tabulated thus —

Brutse

^ 1 Below Uie epidermis m tlic true

bkm m small bruises or extrav^sa
tions below this m larger ones and
often much deeper still The reason
is obvious viz that the epidermis
has no blood v esscU to be ruptured

2 Cuticle probabh abraded by the
same violence that produced the
bruise In small punctures such as
flea bites tins is not observed

3 A bruise appears at the seat of and
surrounding the mjtirv liiismay or
ma\ not be a dependent part

4 Often elevated because the extra
''' V asated blood and subsequent inflani

mation swell the tissues

fi Incision shows blocKl outside the
vessels I Ins is the most ccrtiUi test
of ififrcrcncc and can he observed
even in very small bruises

Uypnsinsis

1 In tJie epidermis or m the
cutis as a simple stain or n showing
through tlic epidermis of underlying
engorged capillaries

2 Cuticle unahraded because the
hypostasis IS a mere sinking of the
blood there is no trauma

d Always in n part whicli for tlie
tunc of formation is dependent i e ,
at a place where gravity ordains it

4 Jvot elev oted because either the
blood IS still m the v cssels or at most
Im simplv soaked into and stained
the tissues

> Iiicisum shows the blood still m
its vesstK and if nnv oozing occurs
drops cm he seen issumj, fmm the
cut moutiis of the vessels

170

iiitunotAsis

6 Coloiiriimfonn TJ.ewlI U»o^m
change of colour {(,rrtn %d!oxT, etc)
prodiicccf in IjIo<x 1 exln>as,ifCTl mlo
Ining livMics does not ot^rnr m dend
tissues with the M/iJc regiiJantj

7 In a place which would oth-r
wise be the scat of a h\ fwstasis pres
sure of nn\ kind es cn simple support
(Uie s\nnkhug of n shirt or ncekuc,
garters etc,) is sufficient to ohliicjitt
the liiincn of senules and cipilhncs
and so to present their fifhng with
blood, sshitc lines or pitches of pres
sure Iwnlercd bj the dark colour of n
hs-postnsis art produerd and unrks
of flogging strangulation ett , arc
thus soinettfctcs sm\u!at«l

Sections of the pirt should be prepares! m ans rasp of doubt and niKroseojtic
examm ilion should make the dingtuisis certain

\ bods rccoscred from the Itisir Thames ssas found to hast striking cuytigrinent
of the head afiosic a linear oonstnrlmg mark Mrt omtind the neck n( idx ii( mf f
thsTnid Icsel Suspicion of slran^hng arose nn j the finding of n niimhcr of phtm
coloured ha-morrluigio areas m the soft tissues of the ntak niong the nj jicr Icsal of
this — and of protrusion of the tongue lx*t«cen the teeth— l»c»,shtencd this If »a»
plain liowever, lluit the iiiteiisits of tngorgement nml the ileep-seatwl pdifhli
sscre due to li^ht tonstrutiyn hs the collar (ssJuch hail Ixen rtm iscsl upon moms
of the j»«h) The held hanging loir miraler hod neijuirwl the more pn nimiimJ
tisadits eommoii to c is«,s of immerMon

Ihcae points are sufficient if cnrcfnllj noted to dtaMtlc whether n },i\ni
mark was due to aiolenco or not, but it must l)c ndiniltetl that feebleness of
circulation in the aged and somcliincs the effett of expoMin. to cold mas
resemble the c/Ttets of i lolence binh marks ore howenr, proetjt dJv ulno^s
found on parts such ns the car, the slims the finders or tms whin tlic
circulation IS comparitn ell poor

^\hc^ decomposition commences the Mock! shares m the process and

hs poslascs undergo some changes in conscanieiicc thc\ mns chniige in eriloiir

to toppers red to light or ohsc green, and since Vhe Wix>*\ gruViinlts Ivscs
it permeates tlie tissues causing a general disoolornlion throughnul Hcnet it
follows tiint ns putrefaction adsanecs it iK'comes progrrssucK more difl nilt
to distinguish betw cen n bruise and a Iivposfnsts for the crutaal test of finihifg
blood ndtmllc iffostd fnun the acssels into the tissues l>ccomes more diffieiilt
of appreciation Tlic difflcultv with the other corrolioralisc ti-sl» is j>efhn{>'
more ncidtnuc than practical Init it is ncstrlJicIess well to rxcriise caiiliuri
m gis ing an opinion when the !>od\ is much decomposed

hor tlie imjwrfancc of fhe distrilnitmn of the ffslt riftn Imd stains
see p 217

FibrlnoI>sls Then has in,,, a gootl deal «f contn verse alx.til the con
dilions which lead totluuhls of the bhxxl after dc dl. incyf imcnsis It has
usinlU iHxn taught th it in asjdijxii the blocxl mi « 's ‘'t ! >ii,,tr thin
normal, due, it w os supimscd to vimc < h tn^t. m t! <* nc^dil ihf v « f r i!ohi»

^ C Colour \ aricgated Hus is onU
true of bruises that are some dais
old jt js due to (Ik cftingc^ in the
IiTmoglobin produced during hft

7 If the l>od) liappens to be ion
stntted at or supported on n
bruised place, the actual surface of
contact maj be a little lighter than the
rest of the bruise, but will not l>c
wiiitc.

posi mAn)l^(. itt

Ilcccnf >\ork. lift's shown that fibnnol^sin njipenrs from whence it is not
ccrtftm fts a result of n wide \ariel\ of stimuli Ijotli jilnsnnl nnd nervous
It li'vs been assumed that rdinnoHsm mnj cause l>sis of n tilood clot when
nhsorbctl on the surfnec of the clot but docs not activcK impede clot forma
lion llcccnt work of "Mole^ liiis tlanfied the mode of nttion of these fomicnts
hut has not ndded to our knovvl«l;jc of the efletts of iisplijMn in connection
witli dev eloper! clotting

The folloninp observations obtained fnim i« iilra nnd in triarlt/o invcsli
gatioiis provide a summnrj of present knowledge* —

(1) lllood IS spontnncoubh coagulable m nil cases of sudden death where
the nulops} IS tamed out vvillim an hour or so of dentli

J 'Ihc spontaneous coagulahilitv of blood inuv disappear ns shortiv ns
one and a half hours after death

a I ihrinogcn was absent from post mortem blotid samples which had lost
tlieir power of spontaneous congulntion

4 IibnnoUsin obtained from postmortem lilootl acts onlj on fibrin nnd
not on fibrinogen

5 Fibrinolvsin acts b\ becoming absorbctl on to the clot as it is being
formtd and it is later released into solution uiicn the dot Uses It is not
effective when added to clot alrendj formed

C tibrmoijsm is prolnhlj produced bj the cndolhclml linings of the
vascular channels and bodj cavities

7 The ronccntntion of fibrinolv sin m the blood vines not increase iiftcrdcalh

8 Cadicxn infection nnd fat cmiKiIism inhibit Die jiroduction of fibrino
l>sin

It IS clear Ibftt uncoaguhblc fluid hloo<l is nonnnllv present in the limb
vessels nnd often in the heart of nnj licflilbv person who dies a Midden
niitumi or unnatural death from almost mi> cause Tlie finding of fluid
blood at nutopsv does not in ifself give nn> precise iiidiention of the eniise of
denlh

flic stimulus ntccssir) to ciuse the liberation of fibrinolvsin is not clear
hut in all eases where a lihnnoljsin was demonstrable a period of shock or

collapse ' has most probnlih cxistcvl for n short time before death it 1ms
been suggisted that the liberation of librinoivsm is due In some non spceiflc
general reaction to iiyurj*

Post-mortem Bleeding After dentil the heart having erased to heat
and the veins lH.ing more casil> distended Dmn the arteries the lilmxl remains
m the veins in a stagnant condition nnd unrkr noniinl circumstances
remains for a time in a fluid emidition In these circunisfiinics a 'em which
has been opened after ilentli nuiv bleed p lit nyfrtem ntul giv c rise to suspicion
tint the wound was prodiievsl before death /oiieh an extravasation of blood,
pOit mortem unv of mursc spread into the tissue spores or bnd^ envities
fspccmllv where those linve Iktcii loosened or stnppcil liv the prtmess of
dissection or where the dead bodv has bteii crushed or the limbs avulscd b>
ninmng inir*

A l*oli(x; 1 niet r tlirowa at nlglit fn m Ids lucvcle bj a non stop car struck 1 is
licndontjiegroimdaiullis imattvndcsl \ seroml ear ran over tlm victim soim few
Ml le It II tlH-H J Pat! II HI U 4n

•Munt \ h 10-1 In VIoif rn rrenl m lomisie Mnlfrinr 1^1 Kriifi
St |r>«n |,t I I n lUtlrrwiflU

•Sclje 11,101(1 J d It JnJucnait ,6 117

*l*ruuloo 1 , and Gordon 1 ,10^1 ^ Afr mnf. •/, 25, 3SS

MUSCIh UlA^CEi AllLlt m AiJl

178 _

”'"ld £ *” *™“’ T.,o p„„p , „!

{a) Tnjunes to the nght elbo\t n/jlit shmldft im I ?K-ad frorn \\hlch tfien- «-ns
considcnble eNtro\-asation of blood induding ll e inlmlaUm of MkmI from

_ the 7tose mjur} into the deepest rcwsses of the nr p tssa»es

(h) Crushing injuries to the middle of the trunk cnu^d bv the mssiec of n MheeJ
and resulting in injuries to the niesentm and right kldne^ nmonest other
effects None of these injuries were a«omj>flm«} hi Weryjing to nniilunrr
like the extent of the injuries in (o) "

It Avas therefore obsaoas tJi.it jJcalh (from the Jit id injtines) Juid taken nhee
before the second car liad run o\-er the b^j *

Post-mortem Changes in the Cerebrospinal Fluid
Changes in the Cvrebrospmal nuid occur rapidlv after deatli Those t hmiges
maj tonbist either of concentration or dilution of certain of the constituents
Such chaugci Jt has been suggested might be used to estimate the time since
death as the> folIo\\ s\ith a certain degree of constancj during a period of
about 15 hours These sequelae have b«ii used m Denmark as a method for
estimating the time of death’

The constituents of the cerebrospmnl fluid which hase been studied arc
Potassium
Lactic Acid

Non protein Nitrogen nnd
Ammo acids

and though the changes are well worth mvcsligating lhe> cannot vet be relied
upon to gne anj particular precision in fi\mg the )mur of death
Unfortunatelj also the presence of Hoot! in the ccrcbrospiml Him! itillu
ences the concentrations of these sulistances and this furtlicr reduces their
value

MuscoHr Changes

Except where caihvcnc spasm becomes instnntlj established (vee p 18))
the flrst elTect of death from anv came is in most cases a general relaxation
of the whole of the niuseidar system llie lower jnw drops the tvc)»L Jose
their tension the limbs arc soft ind llabbv and tlic joints are ijtiilc flojtihlc
W ithin a few hours after death and gencmlU while the IkmIj is in the act of
cooling the muscles of the cjchds ind jnw login to stifltn and rontrnit
follow ed bj similar cli inges in tbe muscles of the trunk and limbs so tliat the
whole bodj becomes rigid This peculiar condition is known under the name
of cidav cnc ngidit j or rigor mortis

JIuscuHr tissue passes through three stages in a dead bod> (] ) It is flnctid
but contractile still possessing life althougb as will lie seen hereafter
muscles contracted li> vital action in the act of dvmg do not ncccssnrih
become relaxed in death [Z) it becomes rigid and incapiblc of contraction
it is then dead as a tissue and (3) it once more relaxes never rcgainuig its
power of contractilit) subsequentlj it mav niummifj, putre/v, or ^ the
subject of adipocerous change The first stage defines the ilimition ofpo
mortem muscular irntnbihtj, the second stage that of cadaveric ngiditv, am
the third that of decav ‘

Riser Mortis After the periotl of iratsfailitr Ims posseil there IS n prnilil il
stifTcning Of tJie muscles together with a certain amount of shortLfimg o tjic

^ I icrj muscle in the bod>, voluntarv and iiiuhintarj lakes part in the
ihliounipK lOul r«» /’rtio- 51 .rtU

niGOR MORTIS

iro

process including the niuscuHlucc ot the heart aiul \cssels the pKtssnia of
the skin the crcctnr jiili. niiisrlcs (rontruction of which lends tn cutis nnsenno)
nnd the dnrfos leading to rttrnttion of the perns Ihe chemictil char ges which
take place in niustle tissue diiriig contmctioii and relaxation are not coin
pletelv understood and the senes of changes by which carholijdratc is
utilized for tl c production of cnergj is highly complicated and extensis e For
details of these changes and the part which sanotis compounds of phosphorous
especiallj adenosine trijihosphate ( \ TP ) plaj m this release of energy the
reader must consult the current thtories to be found m works on plijsiolog\
kertainl} when suH cient owgen is not available lactic ncid teniK to accumu
late m the muscles together with iiiorginic phosphates Fmally the whole
of the ATP Iweomes broken down and the tactic acid accumulation reathea
u lei el of about 0 J per cent at which point the muscle goes into an irreversible
state of contraction known as rtgor mortis In its initial phases the process
IS esscntialh similar to muscular contraction in life but is not rev ersible ^
There are in regartl to its mcdieo legal relationships several independent
points to he considered and these wc shall take m the following order

1 The differences between living contraction of a musclt and rigor vi rtis

2 The tune of onset of rigor mortis

J Tl e time ot disappearance and the circumstances mnucnciiig it
+ The order of its appearance and disappearance in difrerent muscles
1 /figor niortij in mvohmtar) muscles

(1) CoNTRvenoK c Rigor Monris

1 Contracted muscle is more or J Muscle m rigor mortis loses this
less transparent or rather translucent transluccncj and becomes opaque

2 It IS V erj clastic i e capable of
restontioM to its original form as
soon as the distorting force has ceased
to act

1 III reaction to litmus it is cither
neutral < r slight!) alkaline and nnv
reduction in this alkalinity »s verj
speedil) removed

t If the tonlracUoii be overcome
bj mechanical force the muscles
though thej iiia) remain for a tune
uncoutricted possess still their in
licrent power of contraction lire)
may then keep the limb fixeil in a
new' position or allow a return to the
old position

2 It lias lost tins elasticit), and
readil) maintains a distorted position

*1 It IS distinetl) and tor stantly
acid (until decomposition is adv anced)
own g to the development of snrto
lactic and other atid metabolites

4 If rigor mortis be ov ercome b)
mechanical forte absolute llacciditj
.corresponding in degree with the
amount of meciianicul nuvement at
once ensues and tliere is no power to
resume tlie old position nor any new
one except so far as gravitj maj
cause a new position Tins flacciditj
is permanent till decomposition de^
troys tlie muscle

(2) Tivif o> Onset or Riron Mortis
in rlis genersillv commences withi n two to fouC-Uours of death wl i!e
the bodj IS tooling but long before it" Ins reathed ti e temperature of the

'Gjortji b J04T Cl em slrv of Muscular ConliartStm tmlemc

180

IlIGOB MORTIS

surroinulings lo tlii$ gcncnl stitemcnt there ire, howeicr. numerous
e\tcptiom some of wJmh i m l>r irmrl Jiv the kcU knonn nrincinfcs of
ph> siol.,j.M mentioned nlme mIiiIc others linrdU ndmit of such satisfactory
cNpinn ihri, Its ultiiimlc onset is i mUttr conurmn,^' the muscles onK, and
IS ,ml inuUntorthemlegritj of the nenous sjstom for a division of nerves
/cufiiig to particular muscles or even the removal of the bram has not been
found to prevent its occurrence, it also occurs m amputated hmbs
In the case of/? v Meoll (Surrej <Vssizes. 19^2) a j ouiiff man was foiintl
to death in a railway booking office Wien he wns first evainined, one hour after the
crime, ngor piorfis was absent, two hours later, liowevcr it was complete Tlic
deceased Jiaj] fought the attacker vigorously before receiving a fstal wound

Thus it ii, casj to understand that it should come on slovvlj m health),
muscular subjects who have dic<l vnthout convulsions as for instance, h)
dccnpitation, bj sudden haimorrlmgc. bv judicial or even other forms of
hanging In such cases the muscles have no more than the average amount
of waste products in them, and have their usual circulation at the moment of
death, conditions favourable to the continuance of local life, of which it must
be remembered that rigor marks the end
It IS also eas) to offer, m some measure, aii cvpiaintion of whv it should
set in rapidl) in new born infants Their muscles ore engaged in aver) active
process of growtli and consequently have no large reserve of energizing
materials available for continu^ local life

^Inte nalal Rigor ^^or^^s Two cases of tius condition are reported' Jlie first
case occurred m a quavlripara, aged SJ in latiour near term vntli a hrstorv of ti
lioiirs’ luimorrhage \ersioa was performed as soon as possible, and was ntlicr
difficult ovrlng to the rigidity of ttie child Wien CNtmetcd, the lower limbs were
still slightly stiff, and the anas markesUy nevcvl and rigid The rigidity did not
return tcctal movements liad ceased for ten hours Xo attempt had been made to
hear tJie /mtal heart Tlie second case occurred m a primipani, aged 80 m hbour at
tcniL Tlie labour was slow, and the membranes ruptured early , and five hours later
tile fcrtal heart could not l»c heard The fvxtus was evlractetl by forceps later on,
and was in pronounced ngcr mortis Tliere is no doubt that rigidity does (nterfere
with delivery, m spite of statements lo the contrary Of tlie various conditions
associated with ante natal ngulity hiemorrhngc seems the commonest

^igor inor/is is thus proved to be of no value os a sign of live birth Though
of course it does not indicate the contrary

Again, It is quite in accord with our data tint all circumstances wluch
cause an exhaustion of muscles during life should indute an early occurrence
of rigidity Thus violent exercise or exertion just before tieath accelerates t!/e
onset of rigor, as is well seen m hiinlevl animals, in ov erdriv cn cattle, in cases
of poisoning by strychnine, and otlrer convulsant poisons. The bodies of
sohiiers killed m the early part of a battle become rigid slowly, while the
boilies of those who are killed after many hours of v lolent muscular exertion
become rigid almost immediately

It IS now quite clearly established that though the onset of stiffening is
likely to be observable in two to four hours after death it inav be Bcceiervtea
or delayed in a variety of circumstances

(8) When does it Disappear’

It has been suggested tint flaccidity following rigi>^
tlie action of the alkaline liquids produced by putrefaction There can be no
doubt that those circumstances at death which tend to leave a muscle full o
» Paddock C. L., 1003 Iwmt J OhiM , 48, 14.J

lilGOn MOIITIS

181

jjrocliKt'' of its <mii (lisinl(pritio» pit Mini iWt imstiible organic bodies, tend
to shorten tin durahon oi rt^trianrUs and to liisttn the onset of decomposi
tion 1 Iicst arc precisch (heromlitionswhieli ve hiucscdi, hasten tliconset
of rigor, uid from tlicst fiefs the t\cll known rule follows us u matter of
course, \i,c tlic soonei rigidjtj sets m the more qiiickiv it disappear5> and
gives wa\ to putrcfaclne processes

On the other Jiand mj osm is soluble in ncids and the s icn has been put
forward b\ llerinann tliut the disnpiwartnec of ngiditv is due to solution of
tiivosui 1)\ ctccss of and produce<f during the continuance of ngiditj

V third supposition is that in dead muscle cnTvnies nre devclopeil nluch
haic the power of dissolving mvosin b\ a process of auto digestion

Siicakmgingcner il terms rigor wortw lasts for from 1C to 2t hours in sound
muscular siilqects, it nm\ however m apparentlj normal cases last from
il to jr hours and cxccjitionallj it niav continue for several days

Ti\ a c in wlncli Tivlor was cvmsulted n stout muscwJaT man died suddenly
from an nttncfv of ajioiilew lbs IkhIv was e'clmmwl and evamincel tJirw wxeks
after lUatli ih the nmtilh of Jniiuan/ It was in a good state of preservatun and
the limbs were so rignl tint it rotjuired a greit degree of force to bend tliein

No (louht m tins case cold favoured the defennent of onset and contin
namcnfrigiditv \\ e ha\ c seen a body enter a state of ngiditv eight days
after iloath In mmitrsion m IccUiidic waters

The Iiijtiieiicr of /ttiuo^phcnr Coiililioii* tlmosphenc changes appear
to modifv (oiisiderablv the duration of tlni.sAftte I)r\ cold air will cause
\t to jiersist and thus it is that cUirmg tUt wmler season esjicuaU', m n
frost It is slow in disappearing its imaii duration bring then from 21 to 0(1
hours 11 the air is warm and saturated with hiinmhlv it soon ceases In
lh( tropics where tlic tciiipcratuic ranges between hu® ami 100*1 rigor
usuallv begins to disnjipenr in 18 Ji hours Itmpcnturc apixnrs therefore,
lo alTcPt Its duration and mtensity

Sommer found tlLit other things lieing equal 1>o<lic*s Iwnmt rigid ns qurrkly
III an iitinnsplien. of from tu (1.1 1 ns in one from 77 to Kl I but tlial the
licklie'. of strong persons c-onliimed rigid f«)r ciglit or ten days at a temperature of
from hi to 4.J I while ri},Mlitv d sapixared m fn in f mr to ms d us when they
wm rsjioscd to a teinjicratim of fnmi f> lo ftr I

llodics sunk 111 cold water soon pass info this state and retain the rigidity
for a long lime \\ alcr is a better absoiljcnt of heat than ur and tends to
retard putrcfaetion

The Injliuncc of the \ature tf Ihr Death m Ordinnn/ Disrates It bis
long been obserud that the bodies of those who art ennemted or vvho
die from debilitating diseases such as phtlitsis ly jihus or tv plitiid fever pass
rapidiv into a sf ite of rigiditv uhitli is comnionh of short clnrition lienee,
owing to want of eorrcct observation it has been crroneauislv staled that
cadaveric ngulitv did not occur in -ueb cases In reference to deaths from
epidemic eliolcn llrowri ‘'ccpinTd observed that cadaveric ngulitv appeared
late and lasted long in tiiosc patients who died qtiiekh, that is before a
pmroiind nlleratum of iiutntioii hid set in and that those muscles which
!i 111 bcTii attacked witli violent and frequent cninips became rigid verv soon
after death and remained so onlv for a short time Olluicr found that the
bodies of oliolcm piticiits were frc<iuenll\ rigid m from six to eight hours
after death while the muselcs which were the sent of (Ins ngulitv were still
warm and on making an incision into them the blood readily (lowed out.

JilGOJt VOGTlf

nnrkc I it is rm]ucnlli iilispnt in tire Imiiii^ nf lliosc iilio )mc diet! from
Riiiernlizc seplicTnin and cspccinlh lins tins I, can Oil tise seinratt
limbs 11 111! h Im a been tlie scat of purulent iiifiltralioii amongst tlic muscles
tills IS a most striking jilicnoiiienon oiling to tlie contrast betneen the rimd
and tlie ilnccid muscles “

In tins ease the duration js obsiouslj m strict accord nitli tlie condition
of the muscles in rc^rd to the amount of jsroducts of dismtcgntion still
present at the time ol death compared %Mth tlje act» it) of hcilthi eircnhtion
througli them (m/e supra)

Jujlueiice of Dcalh bp I tgbtnin^ It was at one time thought that rigor
niorhs did not occur after death from lightning hut this idea is incorrect
liigor vinrlts tna\ occur quite normalh after deaths Irom lightning or electro
cution but on the other hand owing to the \ioIeiit con\u!sions of the muscles
which occur in deatlis from these eauscs Hie rigor nm come rapid!> an<l pass
awnj with equal rapulitj

(4) Tnr Onorn rs wiuch it cpitcrs in DirrFREVr Muscles
Cada\ cnc riguhU first appears as a rule m the muscles of tlie face neeX ami
trunk it then takes place m the muscles of the ujipcr e\tremities and hsth
m the legs Shapiro* drawing attention to the j Insiochemicol nature of the
change suggests that the processmaj start at aJ^onl the same timee^ennherc.
mereij fixing the smaller muscle masses (c g of the face and jaw) before those
of the litnlxs llus suggestion howeverdoes not explain whj the small muscles
of the fingers and (ocs sliouhl he the last to stilTcn In regard to its disappear
once tlie muscles of the low cr extremities will often be found rigid wlule those
of the trunk and upper extretnitics are again m a stale of relaxation It
appears later and lasts longer in the lower extremities than m other parts of
the bod} It begins almost alwa>$ in the neck and lower jaw Sommer fonnd
onl} one exception to tins rule in cxnniimiig 200 dead hotlics From the neck
it passes m two directions upwnnli to the muscles of the face and downwartls
to the muscles of the upper extrcniitics and trunk then nttneking those of
the lower extremities In iiidinduul limbs it communlv procce<U from abo% c
downwards and it gcnerallv passes off in the same onler It alwajs sets in
increases and decreases imperceptiblj and gradualls ui which respect it
differs stnkingh from other forms of ngiditx m muscle

(o) Rigor Mortis ix IsaoLONTARa AIuscles
The insoluntnrj as well as the soluntan muscles are subject to lad irenc
rigidit} and b\ reason of either tlicir small mass or of the more speeds loss
of muscular irntabilit) it apjiears in them more rapiclh 5 he xciitrichs o
the heart common!} lose their imtabiht} within an hour after death Tic
muscle becomes rigid and remains jn that state for ten or tweUe l2<mrs
sometimes for 24 or 3G hours then again becomes rela\c«I or llaccu t a
certain period*£[rter death the heart bwimes rigid and firmh eontractex
examined when rigid it ma^ appear to be m a state of spasm and to la^ i s
walls thickened while the cavitj of the left %entriclc ma% be dcscribim ns
being much smaller than in tlie normal state This natural condition o tlie
heart after death has led to mistakes the iralls being described ax tlnckenc
and the cas dies as being diminished in size and the heart itself os being m a
» Sliapiro H A 1»»0 flril mid J 3 201

CADJVhRIC SPASM

JKJ

State of concentric hj^pertroph\ from disease On the other hand the relaxa
tion of tlie heart Mluch follows nt a later period after death has been mis
taken for and describeel as a morbid flabbiness ind flnccidiU Spasms or
par'll^ SIS cannot be inferred to has e existed when w e discos er these conditions
of the heart in the dead bod>

The point IS of importmcp Mith regarrl to deductions nnde ns to the cause
of death from tlie post Mortnn nppcarinccs of the licart and blood icsscls of
the brain llnrs it /nust not be assumed that death was caused b\ aspln \ia
because the heart is found relaxed and full of tsanotie blood nor can the
cause of death be decided from the amount of blood still within heart and
s cssels

PJfcct of Freezing \\iien a boilv is froren so rapidly after deatli that
there lias been jnsufTtcient time for acid nictabolj tes to appear in the muscles
tlie process of rigor inortis is suspended until than mg takes place W hen the
body than s ri^wr wiortM ippears with great rapidits and passes olTvcrv rapidly

EJfect of Heat All muscle protein in the body is coagul ited at tempera
tiires nho\e 65'’C Therefore when a body is subjected to temperatures
abo\c the coagulation point of the muscle protein a degree ot rigidity is
produced which it complete is far more intense than that found in ngor mortis
Changes in posture especialK of the limbs mas follow (see Section on Bums)
This heat stifTening cannot be broken down by extending the limbs as m
rigor mortis and it w ill persist until putrefaction sets in Heat stiffening may
also follow high \oltnge electric shocks such as occur when a jierson grasps a
high tension cable for sulTicient bent is often liberated at the point of contact
with the table to cause heat stiffening in the local muscles

Instantaneous Cadaveric Spasm This is a phenomenon which hes
quite outside any of the laws hitherto considered regulating ordinary ngor
mortis and set is one of the most important m legal medicine owing to the
certainty of the conclusions which max be drawn from it when it occurs
Ordinarih immcdiatelx after death the muscles enter into a state of
relaxation though tliex arc still iriatal Ic and capable of being stimulated
into contraction The point wc base now to consider is tlie undoubted fact
that this ptnol of Jiaici hltj viaif be at sent and tlmt the body may be in
staiitaneoushi stiffened in the position in xxlnch it was nt the mome it of death
\^ e svill first illustrate tins histone obscrxation b\ a few eases about which
\V5 sv-spicvais cftu he cwtestwciwcl tliat tlxe aiauaec of death, was tint as \t xs
related to hnxc been

Brinton recorded fits experienee nn tins subject during tlie \mcncin Civil yNnr
in 1862 In inanx xslio liid died instanlnneouslx from brain and heart wounds tlie
b kI\ X IS ngi 1 throughout nn I the positif n w is tint of the last moment of hfc
Ifc Jias ealle 1 tliw mstnnlanmns n„or Vfter the battle of Aiitietam he counted
within » small sjnee forty dea<l ImhIics mostlx with cJ est wounds Tliere were
some with their arms raised rigidU in the air and others wath their legs draw-n up
and lived In not \ few the Imily xvas curved forwards and fixed These attitudes
were not those of tl c rclixatiOn of death but WTre rather of a secminglx active
chirieter the muscles remain ng rigid and inflexible as the result of siasmoclic
muscular action in the 1 ist moment of life

\\funj,n II) wliilesk tmg fell thro ict of uimn I al out seven \nr Isdi-cp

111 wiis not tl tdU iinnitrstd f »r Ik. kej t his head ni d sh mid rs « ut < f tl e w itir
al i\c the nx with I is anus resting U|Km il and as the uv gv\» vv iv «n Ur 1 5s
wei{.lit hcsjirangti a fresh i«)rlitin Iltfore assist nice touhl 1 1 rci Icaxlhc s.ink
llic body w ts recovered the next dix it was fmiid at the bottom if the pond

^ c IDA I ERIC vr IS M

Ihe In”'','" i*'," 'r. ■"“■ """" »-■' «,1I retained

the iKKition in which Jic Ind rrsloJ upaa «« ice Jus Jegs were ouifc extcndwl m,!

ir muscles on the fore pirt of the thiji were \er\ much c-ontrdct«l ns if tl e\
Lnd hwii powerfiilh exerted in keeping him erect while lie wu, liancmg on tPe
1^1 " I'' of hix Jinxing nMeinpfed to ImentJre after he hi I eoi e

IrPiwcudn ” inlcnial

^ he IkkJics of persons who Ime been ilniwncil it the same time b\ a ctunnu n
ill I ident nrc frequenth found clasped in eacJi other s arms \ contracted stale of
the muscles at the time of death li.is passed mto perfect nt,idilj and thus tlie
attitude or the last act of life of the individual lias been preserved

In manj cases of undoubted smridc the weapon whetl cr ^ Istol gun or knife
Im been tountljiniilif grasped in the lund willi wliieh the fatil iround was inflicted
Qiid considcnble dilbiultv niiv lie encountered in tl c en Icavour to relea e sudi
weapon

There is no suflicieiillv pood cxplimtion of mstantinccuis stilVcnin^' and
the fact tliat it cannot rcidilj be produced e\|>criincntullj ' raises a diOicultj
in its proper imestipilion Itsocctirrentcisbv no means comnion }>uttJioiip!i
even lu a Isusj medico legal practice the comlition is found only m a few
eases ot sudden and nolcnt death the hands should nlwavs be examined for
the presence of hairs fibres or other substance strongf) gr isjicd in them

luminp to the practical aspects of the nnlter experience Ins slumn

1 lhat instantaneous stilfeninp is calms pnnf us me re hkelv to be found
when great imisculir exertion Ins been made preiioiis tn ileatl

2 I lilt It IS more likelv to apjiear iii strong and miiscnhr subjects w lietl er
thcN arc or arc not exerting themselves powcrfullj at tJic tunc of death

d Tint #K /df« death is a prevbsposiiig factor

4 Th It death due to v lofciit distiirl nnec of the nervous sistcm (npoplexv
firearm wound of the liead etc) is also a iiowerfu! clement in causation
I his mode of de ith 1 as been oxi>erimcntaIl> shown lo be t ipablc of procliiciii,
trwtantaneoifs fTgrchfv orewdnerrc ipasm

5 That drowning m cold water has similar predis})osing tendencies towards
cadaveric spasin

0 Th it it does uoi tmariubh/ occur sm Icr ctfcui istaucci if at loi/M senn i>
he most faiuurablc and oceasioinllv occurs in Iramjml dculhs when it might

not be expected

7 Tliat the condition of afTnirs produced b} it is easih distingmsliable
from that produced bj simple ngor mortis m tint an objCTt prasped b\ the
fingers is firmU gripped just as it would lie during hfe otil> that more fonc
IS rciiuired to extract it from the gnp lliaa would be neiessarv during life-
whereas if held In ngor mortis alone the object can be released ba undoing

the fingers so to speak there being no inlcnsclt tight grip

8 Tint It is the strongest and most conclusise prtof that the object so

gripped was thus gripped at the moment of death

9 Lastlv it IS for practical purposes impossible for the condition to be

imitated bj a murderer The reason for this is that if a murderer Ins a know
ledge of the above facts sidlicientlv acute to lead lum b’ trv o , I

condition he must find one of two conditions (a) the muscles aecici

case he must place the fingers round the weapon and fx them mere m
bandage or bj holding them until rigor sets in 'unl in this case there

will be evidence of the pressure applied or (6) tl e muscles still m w iic i uis

‘ Cer^ ngf >i S 1U3J Bo/ <«• Hd Biol Sper U V. ,>s Ilut a led Jt doxe of
dimtropi enol causes instantaneous ngor in rabbits

CilhlMliK SP^ISMCASIS 1<?’,

Ill must loosen tlic III null jipam tr\ lo r(ii\ (liciu i)\ prissun orwliirli stTiiiid
nr\ lixitif,' there ^'ill {it,iin he r\Kl(n<c tint l« nieiition (liat Ihc mieMCil
stilTiiunpot the musiles will not tnlw< |ilnto

The folloiMiij; (ases eolleekd b\ rnxlur are ilhistritne of tlic nlio\e con-
clusions anti of their imporlnnrc

In the i-isc of Ixiri! Uilli un Ttussell wIh» wns mtirclerwl In toiirsoisier in 1810
it Mas c hsi r\c(l that out h mil of the diecnseil tlniiK jjrasjHiI the sheet of tiie IhiI
as If in n stnit'„le n^aJnst nn nss.tsMM Ihi {KKition of flic hnn«l of the ifeetascd
funiUlicil nmoni; other einumslaiicts mok. (Mdetur n{riinst the po^suinjitinn
ofsuitiile

III It \ ! Ili^on some of the pri'^oner k liair » tsfoumt pnis[)«l in the \ ictim siniul
Tin IkhIv of tia ihitiiseil nas fmmil l>m}'«leA(l in a house with injuries that m idt
It ilcnr ttinl she must ln\-e liecii mtioleml n> her ri^ht Imiul w is fmntl a eon
si'Urahle ipiantitv if hroan hair and m the other hind some frees Iiair irrvsjied
I'l wWdh tn Hif foriiFi On ih/' innmtng fall mitifftlic ttumlcr the (iri\ontr

'sent to a luiirdft-ssir s m thi tossai nml dcsind to liase his Imir and whiskers rut
1 Ins iivm ohsersTd Ih it the luir ami whiskers hid IxHti reiTiitls rut iindestd ntls
hs sonieunc iinuctusfotniHl to Imiriiilliiif; llierr was a diffm nec lietwwn the luiir
of the whiskers an i tint of the head the formi rinsing turned gns The hamlrcsser
ssas of o[ iiitnn th it the Imir found in the lunds of the deeeasiHl was of tin same
colour and kinil ns the liair of the | nsi ner this ssilh other eorrnliomtin^ timiin
Stains s led to his consnr(ion

In It s Onrdiifr a wuimn had ihnl from scserul wounds in the timnt which
could not Ims( hi'cn silf lutlatdl and a (sitnniin table knih was found loosels in
her rt{,ht hand with tin luck of the hi ide losuirds tiu jnlinoftlK linml and the
"C ijion III the directi in of the length of the (mils Vecorihni' to the esndi net of
tIa nudicil sstinesses the princiikil woiiiiil m tlir thnnt was of such n intiirr (li it
It tsiuld not hast Iks-ii mllioled with Ha rijit luind Ihe knife it wsis nllegi d Lid
Ian 11 pi iml in the h ind after death

On this opinion th it tlurc ltn<l liecn intcrfirsmn with the Ijods nfttrdentli
Ia\lor mnirkcil On tlnsc oicaMons it mas l>r sugci-slctl that a ssenpon
alllioiL'h grasped In an ulligcii suicide to mllict the death wound m is tilhor
tfrop from (fie finnif or f»c foiiiiif fnostfs in i( ns a rrsiiff of ffie

riliiNfition of the miisdcs m ilcatli Ilin must bt ndmittid henet tlic

inert fait of a sseipon being foimti loost should not bi. tnkiii ns csnltiux of
murder imhss otlicr tircuiiislmKCs suili the mtiin of tin wound tht
fritdoni of tin hiind fmiii bloia! the i>nsition of the bods, (t( roiuur to

prose tlmt (III art was not oni orsuitidt Other < in innstniuts mas show

Ihil thessrapon 1ms bten placet! m the wrong Imiitl or that tin bliaid in irks
on it niul on tin hand do not corrrs|M)nd

The dillUiilts of thus ciidtnsotiring to mutate an act of smri It when the
rnitsim projurls nlist r\ td and toiiipirtd ssilUie npparriit Imm tin following
casi

The dterisoil m this rase a ftinalc sitss found dead in bed ssilh her thro it rut
Till nedltn! tsalriict. shossed (lint tlirwouni ssas six Inches fn ni right to hfi
extending iiiross tlie throat to a i«unl under the left cur the ii| r portion of tlic
'sniilpi|)e was srsi nd and the jugulir sun as writ ns the innscular liniiichrs of the
can || I arlirs wire dis idl'd Tlic mnlic^l witiic»ses n iisulernl tliat the wound in
the tliro it h id not liccn inthi ted bs herself It was smh a wound as a Iff I h tndnl
|K Noil won! 1 h isi intlKtcil and the hinif intiutiogit ns will ns the wcaiwin rsiift
not base c-seaiKd liein^ iinrke«.l with lil mwI It u| jicars tLit when the IkkIs was
f'Mnd flu re snis a ramr in the ngf/lumd not fiditls heft The anus sirrr f IIM
acis «s the clw'sl the right luiml rrsling on Uie left the back of the rn/' r (*ring
li'Wiinls f he licxls of the deei isisl Then was no Uwm/ no 1 / r / and* amis « r che«t
and onls i nr small sjxit on tlic razor Thru, was blooit on the undrmlf of a
pill iw and a ci rrrsjumdmg slain on !lic lx Ister hlaiwing llial this must Iiast (ktii
liihKsl os( r an 1 Hit Itei 1 j 1 io»sl i n llir clean st lc after the inllicii m i f tlir wi uri !

PUTItFI JCTiOA

All H'ecirnimsl'iiitcstoiiriirrpfJlnshowiiiL llatiiiattcmi I Iei 1 r,pn .. i .

HIc nil irt „r siiinclc niulc ll.p fncls «ere nnl, cons" ci t l" ’ ’ ''™'

priMTicr m„ connrtlcrt intli »«■ art In moral i, „ell n5 iirciimst

nml he n Is ctillsnclcd mil esecutccl inciimstuitnl csidcncc

In droisnmj! it is In no incam, .inusu.l to nml sihcn dead ho li„ „„
talscn from (lie inler soon oner tlie ntcidcnl that pieces of rone on oar
pass similar to 11, at (,«■>' ms on II e banks or needs like those Broniim at
tlie bottom of n canal or riser, are firmly pasped in the liaiids Tins latter
constitutes aerj strong proof tint the mdisidual lias f,one into the « itcr
is mg {iidi Dross nmg ) Part of a dress inns be thus found grasped in tlie
Innd tin<) s.er\ e to ^ person iccused of murder

LATE SIGNS OF DEATH AND POST-MORTEM CHANGES

Putrefaction

Tins IS tlic finnl singe m the changes following deatli Stnetiv sprnkjng
putrefaction means tlie destruction ol nitrogen contiinmg siibstnnces
brought about bj the induence of bacteria with the produeticn of foul
smelling gaseous products. In Iwclie?. openK c\po cd to the air inter and
soil etc various animals — ants hectics flics rats fish etc— assist m the
destruction of the bodj Imt this is n supplementnrs process under ordirinrj
cirtiinistinces micro organisms alone are rcsponsibk for decomposition
The breaking down of the protein comjioumis (known as putrefaction)
takes place in sta^e^ and at one and the same moment i large number of
cliernicnl substances ina\ be present in the putrcfsing mass Ol these mnuj
hate been chernicaJ/i identified such as formic acetic hitt^nc snlcnanie
palmitic lactic succinic and oxalic acids amines and ammo acids such as
Icucin and t\TOsm and \arious aromatic substances like iiulol and skatol
"^rercaptatis are formed m anairobic putrefaction \ anations m the piitn
fiictnc process depend on a series of factors manj of winch are not com
pletel> understood '

These putrefactue processes arc almost ciitirelj the result of the actisiti
of micro organisms that originate niainlj from the bowel Tie hrge bowel m
life contains a great sanely of orginisnis both ‘ci'obic and nnerohic and tf
tlio latter the most important organism in the mitintion of putreficlion

ajipcars to be the bacillus Cl M elchii

bhortli after deatJi in cases where the process of d^ing lias bmi slow or
w here death has been accompanied 1)> a bacteri<cmic condition especnl )
intestinal obstruction before death these organisms pass m increasing
numbers from the bowel into the blood \csscls and spread rapidlv throughoiit
the bod> Initially the bacteria recosered from post mortem tissues are mivcci
consisting of coliform organisms and anTrobic bacteria hut after n tunc f le
anrerobic organisms predominates* Tlie organs recen mg the srgest > oo<

supplj and those nearest the source of bactenn naturn!l> reccne mos
bacteria and normall> putrefy first The flanks of the shdomeii wi iisi a
show the earliest colour change in about 3C-48 hours

The bacteria Iibente a number of ferments or eiizvmes and ihtse lireak
down (he lanous tissues at the hodi dilTereiit eiwjmii. netn'i: on c-irbo
hidrotes fats and protein One of the most important entities is tlie /m
rtiimre produced bj Cl ttelclm This hjdroljses ll e Iccill m "hmll is rtf'™
«Bum C G

VUTRErACTlON

187

m all cell membranes jncluding blood cells and thus :s responsible for the
h enioij'sis of blood jiosi mortem

At and around*tlie normal bod\ temperature (98 4®r ) Cl M clclm nmlti
pliesfrecK The rate of multiplication lionc\er is slo>\ed as tlie temperature
falls and bclou 70®r propagation »s almost at a standstill though most of
the en7}mes or ferments produced bj tlie bacteria ^viJ] continue to net at
mucli lower temperatures esen temperatures around freezing point Thus
tlie initial spread of putrefaction is Iargel> mfluenccd bj two factors (1) the
cause of death and (J) the period of time that the internal temiienturc of
the bocl\ remains aho\e '■0''F

(1) In cases where persons die from acute intestinal obstruction there is
iisinlK a profound bacteramn before death so that when actual death occurs
the organisms from the bowel are alread\ spread throughout the bod> and
although tlie hod\ temperature nia> fall nptdlj putrefaction commences
almost immednteh This state of affairs is accelerated irhen death is due
to an infective condition caused bv gas forming organisms and in septic
'lemn

Suspicion of phosphorous poisoning was raised b> % resident medical olTiccr at a
Portsmouth hospital owing to {«) jaundice (b) recurring vomiting and (c) purjiunc
skin patches developing in a woman of 2i who Ixad been admitted for an incomplete
abortion during the afternoon on the da) ofherdcath she liad lieen ill onh 10 hours
in all when she lapsed into coma and d ed Aulops) rev ealed a h emoh vis of the blood
in circulation scantv gus formation and a rectntl) emptied uterus enlarged to
nbmit three to three and a half months gestation sire the interior of which was
rcmarkabl) drj looking the w»W crepitated and (togeti erwatli a heart blood sample)
gave a strong growth of Cl \Neldui

(2) Tlie period of time that the mtcrnal temperature of the bod\
remains above 70®r is clearlv of paramount importance os it is only
above tins temperature that the main putrefactive organisms will continue
to nuiltiplj with anj rapichtv throughout the body \nv factor which
delays the cooling of the bo<lv (see p 1C7) will tliereforc hasten putrefactive
processes

Bearing m mhul tliat environment mav considerablv alter the course of
putrcfattion we mav now describe the process as it iisuallv occurs and
consider the important points iii connection thercwitli

To facilitate reference a talile is lierc inserted of the order of discuvsion

(1 ) Colour changes external and infernal

(2) The gases of decomposition

(sj The effects of these gases

(4) Circumstances influencing the onset ami progress of decomposition

(5) Observ cd facts in the order of decomposition in the bod)

1 CoLOua Ciivvrrs is I’l ran \ction Lxtcrnall) tlicse consist in the
appear nice of a 5 ellow ish green or bnght green or topperv red discolouration
of the skin Tlie point where tins commences and the direction m which it
spreads dilTcr somewhat according to whether the body has been cxposetl
to the uir or has remained in water the rate at which it spreads and the rate
of decomposition in general varv materiallv according to cireumstanees which
will be c*onsider6d later Soon after the conmicnccincnt of putrefaction the
veins of the skin p irticulnrlv on the limbs and neck become marked as
dirk purplish red or blue linc-s due to decomposition of the Hood in them
and a soaking of tlicir coats h) the allcreil hlewel pigment (tlie bl )od becomes
alkaline with ammoniacal products) TIie> tlieii form a very striking pattern

PVTiti:rACTioh

on a l)att,j!rouml ot lighter red purple green or lihcK elm tl,. i
nptlj dcstribed as a ‘ martding of the skin " '’’""S'

Internally nuieh the same change of colour n olismahC. „
liter spleen kiilnei-tliongh shades of dark red t an mg to bla A^are
eomnioncr tints than green The hde also soaks tlircngh from the gall Halite
resLl'l’®” '' ■> Jtl'o" or greenish coLr Uilh

HieTi er "“T "'f » ■«. thi, Colour eWe

the Mseern lieeoinc softer and greasj to the touel, thej eventuall, htejk
cloMninto aunirornistinkinkinass sothal tin indni Inalmganscanno liineer
beseparatelv removed ”

n IS important to remeniher that these colour changes arc carh signs of
decomposition and that the organs Ihougluliseolourtd Hill still slioa tiiaiiv
palhologieal changes, it is therefore most nmiise to decline lo proieed nilh
an caanunation on the bU|iposition that the organs nmj be too dccomnoscd
to resent nns fncls of importance it is indeed iirscr too late to do an
a^ltoI)s^ <liininislic(l ns its-vniuc mft\ be

2 (r\«iL*> ov Pi TREi ACTIOS DuntifT putrcfaction a great iiiiinber of gnses
are faiinil jncltuling niarij organic substancc’a and compounds of sulphur
wluch smell ofTciisiich riius mc liml not onh h\ drogen sulphide ammonia
and pliosphorcttcd li\ drogen but also lllc^t«pt«^l^ md less ofTcnsne gas siiHi
as marsh i,a‘: and larlion <hox«de

Low IS reported iii 183.' on the e\tcmn! condition and appearance of
‘22 000 toHins accumulated tii the a anils of London cliun hes lie examined
the &tntc of the contents of about lOU of these including the bodies of persons
of nil ages and lolTins which had l>ecii deposited from \ sliort period to
upwards of n cciitur) He did not find therein sulplinrclted pliosphorcttcd
or larburctled iivdrogcii or nn> compound of esanogen Tlie gases wlmh
lie uiiifoniiih detected in the (oflins and the xniillb \rerc nitrogen carbonic
acid atmospheric air holding putrescent amnia! matter m suspension
Vmnionja was occasionally found in large quantities this when present
oscrenme all other odours when absent the animal matter had a smell
resembling that of putrid moist cheese He opened one leaden colfn in which
tJie coqjse Jiad been enclosed for nearly a centurv Ihe nninioniai il gas
which escaped from it fonitctl dense white lumes when brought into contact
with by drochloric acid gas It ssas so iwwcrful tl at 1 c could not remain near
it for more than a few seconds at a time ^

The same results were noticed m reference to n bodv wl icli was cxlmined aPer
sixnionllLS interment tMion tlie coffin lid rcmdstdbj the si Ic of the gnne a
/arffc quantits of fa?tid animonia escaped On tliniwing into tl e coffin si me chlori
iiatcd Imie dense while clouds of ihlon le of ammoimim were csolseil from tl c
interior of the coffin to the great alarm of some of the bjstandcTb who were nn
nwarc of the chemical changes pr«lu<cd

It would appear that the air enclosed m corTins in general lontaiiia m
oxNgen AMien tested it was not inflammable but was found in c\er>
instance to extinguish flame In leaden c*>fljm» piitrcfiition is so nimh
retarded that the remains of lK>diej» were found in them after the 1 ipse of a
century The metal is slowlv corrotled and changed tnlo wliitelcad

The chemical composition of these gases may be of little aj)] arent interest
but the points that are of importance are that they firm • eneath the skin
m hollow viscera and eventually in solid % iscera exert considerable pressure
and produce effects that are of some medico Ic^nl miportante
> Ij rr 7 med Se 18-> 0"

PVTRETACTlOh

189

3 Eifects or PnEssuRF or Tin* Gases of Putrefaction {a) Blood
Displacements ^\e have nlreacU dra\vn ittcntion to t!ie fact that after
death the arteries by Mrtiie of their elasticity empty Ihemselres into the

%eins and may thus cause ijHW/wortlemhiemorrhagefroniowoundedsurface

{^em or capillaries) ^\e ha\e here to mention the more special effects of
decomposition N^htch cause —

Post m d^m IlrprliTitt q f a t han flint mentio ned abo% e Tins

form , docs^iiot offer so much diflicnltv in dccidirm \%tietlier tlie \\CiUUd ~\v as
m dg or j ost mortem because the nsulting outpouring of hlood will slioi^ no
tr ace ot coagulation, it mil lia\p simpK soaked into the siirroutidings li ke
s o much coloured fluid

Shijltng of an Area of Hypostasis Owing to the pressure of the gas dcAcl
oped m the blood of a by postatic area this nia\ be displaced m nn\ direction
Tn\!or saw a bod\ m which the cheeks acquired a florid red colour between
the third and fourth da\s after death when rigidity liad ceased
The importance of the fact lies in this that when once putrefaction has
commenced in a dead body the inferences as to the position in wliicli the
corpse has lain since death will be materiAlIy weakened so far as the\ reh
upon the position of the In { ostases for their support

Emptying of the Heart Uhen putrefaction has commenced and tl ere is
no ojen wound from which the blood can escape the cavities ot the hcait
nnj have a portion of the blood forced out of tliem but it is not probable
that the cavities could be completely emptied by this process If th^ heart
IS found empty and at the same time contracted its emptiness could he
assigned to the effects of putrefaction the natural condition of the organ
sliortlv after death nny still persist in sjntcofdccompositioi

(&) Bloating of the Features ^\c Invc alrc'uly mentioned how death
alters the features so as to make recognition less casv ^\ith the onset of
putrefaction the features arc so blown up swollen and altered in colour
that identification becomes absolutely impossible Indeed the likene&s to
a human being is sometimes difiicult to realize when lips nose eyelids and
checks are distended into a bulbous green mass The eyes may be forced
forward almost from the sockets and the longue become blackened and forced
forward against the teeth or even protruded between them and tlius a picture
of violent death from strangulation may be so closely mutated It is iinpos
stbic to lay down an\ rules of general application to diflcreiitiatc between
Pite Sacts enip}i.7AiZC i}ie cstAton .VM'fi be J.e /Jccjd

mg that death was due to strangulation when a body is found very advanced
in decomposition

(c) Extrusion of Fluid from the Mouth Froth and other matters n av
be observed running from the mouth in manv conditions and the examiner
must be on bis guard in assuming that it is due to anV particular cause of
death It IS commonly present m death from drowning and in certain tvpes
of poisoning hut it n av also be found m any condition in v\Inch there has
been excessive fluid secretion into the lung In putrefaction froth and
stomach contents are commoiih seen issuing from the mouth and nose The
find ng of such substances Iwlow the larynx in the trachea or bronchi
liowcvcr IS likely to have happciictl iii life if only tcrinmallv

(d) Extrusion of the Foetus from the Uterus \ c isc of this kind was
seen by one ot us

190

rVTREFACT10\

M-as found to ha\e a macerated three months L£ wtb slSed^JUmbraSs
h jngcYtemal to lheyuiia nslighth saniotis laked discharge bubbled from
the ^gina and the uterus w-as found to contain the same kmd of material tcSS
uilh a partly detached placenta from uhich the cord led to the fndus ^

A similar case w as reported b\ Gordon nnd Turner* m 1953
A natise sroman who died m cluWInrth Iwfore the dehven of the Infant was
Vr* putrefaction nus then present an 1

the fcetus still attached bj the cord was found between the thighs

It has thus been established liesond doubt thatpiwt Mortgm e\tnisioii of a
fatus IS possible

It IS obsious tJiat 111 certain ctscs this condition might be used to eo\er
nnd conceal i case ot criminal nbortion The subject was brought liefore the
’Medico Legal Societs of Pans bv Penard

He was required to report on an alleged ease of de1i\TrN 30 hours after the death
of a iroman m which the question of expulsion b5 gaseous putrefaction could not
arise A j oung woman di«I under suspicious circumstances after eight da\*s illness
It was onl\ just before her dcaththallhcmedical man in attendance discovered ff at
she was pregnant and had probabiv reached the fifth month. He made no cvaimna
tion after death and when the bodv was laid out there was no unusual appearance
l\1ien raised to be pLiceil ini eo/Tln 30 hours after death a firtus fell from belWTen
the legs of the corpse On eynmioing the body the uterus was found with the
pfacenfa attached inverted and eytnidcd from the outlet

P^nnrtl after fultj considering the case as submitted to him came to the.
conclusion that after tlie death of the woman the uterus would not have
the power of e\pcUmg the fcetus and imcrtmg itself bs spontaneous mus
cular contraction ^\e emnot admit the possibility that a spontaneous
action of the afertrs after the death of the noman s?«>u)d be so powerful
as not merely to expel the foetus and placenta but further to invert nnd
prolapse the organ In tliesc rare instances it is tolerably certom that par
tuntion commenced before death In the case relited bv P<?nard the woman
had only reached the fifth montJi anti was not examined after death At
this stage of pregnanev it is improbable that the jiosi viorUm contractions
of the uterus wnthout nnj assignable cause, would have operated to expel
the cinld and micrt Me organ

(e) Floating of a Body in Water The specific gravilv of the whole Iwdv
IS onlv a little greater than tliat of water Conse<iuentlv apart from other
mechanical considerations a dead bodv will sink until siijncicnt gas develops
to make its specific gravitv less than that of water It tlieu rises an ‘
gas escapes it maj sink until it develops sufficient gas to oausc it to re oa
(ride under ‘ Drew ning )

i ClRCLVlSTAVCEi> INtXOrNCTVC TKE OSSET VXO FbOCRKSs 01
PUTREFACriOX

As we have alreadv mentioned the essential jirocesscs of putrefnclion are
dependent upon the presence of organisms and their fertnenlv >

factors which tend to accelerate or retard the propagation of these organism

iGorUonl lurner R and Fnce T 1D.»3 Vrd rnf J«r
Filmbargh tiimgsloDC

(o\r)iTio\s Arrrcuhc PUTUi 1 ACTION loi

will iiinuciKi lilt protc'>sf*r{nilrprmlioii triics»cfuc(cirj>will no« bcdcnitwitli
in more iIcItiI in llic follow inp order —

(a) IJir It inperiiliirt of Ihe «ir lo niiich fJic bodv iv exposed

(b) Tlic presence of moisture

(c) Present e of dothiiig

(d) Influence of access of nir;

(e) Tnflutnce of light»

(/) Inniicnec of the slate of tlic both
(g) Infliienct of the nature of death
(fi) Influence of immersion in water;

(t) Influence of burial in earth

(a) The Effects of Temperature of the Air PutrLfaclion is found to
protcetl most mpitlK when the bodj tempcmtiire rtmams htnclicial to the
growth of hat term (an air temperature of lietwccn 70® and 100®I ) pros idetl
of course that factors detriincnfal lo the propagation of bacterm arc not
present VMicn the organisms h\\c been tlistnbulcd alxmt the botU and
im\e alrcadj hhcrntctl their enrsmes nbtiotis putrefaction will coninitnce
although dclaj cd at anj tem[»eratiirc nliovo 50*1* \t 32®! (fretring [loint)
dccomjiosition appears to lie wholly arrested howeser certain hatteml
en^jnics will continue lo act slosslv at that temperature A dead liodv nmj
thus be prtserc cd ludcfinitcl) in refrigerators snow ire or in freezing soil

Irnian states that the ho<l% of IVincc Mcmliikof one of the fasourites of
Peter I was exhumed at llcrcsoc, in after a bunni of ^2 \cnrs m the
froren sod of Siberia Although so long a time had elapsed the bod) had
undergone but little change The hoirt and some other parts with a portion
of the gmsc eloUies sscrc remosed and sent to the descendants of the dc
ceased * A still more remarkable instance of the prcscnative power of cold
IS exhibited in the discover) in a mass of xc at the moulli of the n\er I enr
in Siberia in IHOS of the l>od\ of an ancient elephant the race of which
was extinct before the historical period *

\t high temperature le I20®I oroscr bnetcrial growth usimll) tenses
putrefaction is nrrcslctl and imiinmilKntion lakes its place ns a htc post
mortem change

Ihe clTcct of the tempernlure of the air is stnkmgh seen in the influence
of season Ihus in summer a Imd) mn\ show more putnfnctise thingi’S in
Jt hours than a similar Imilv under the same tin ironmcntal condilions will
show in 10 to 14 da)S in winter The cm ironmcntal temperature must
nlwn}s he earcfull) consulcrcd when nticmptiiig to assess the tunc or tlnlc
of death of a cadnscr

(b) The Influence of Moisture A certain degree of moisture is ncccssnrs
for the processes of pulrcfaetion The niiiiiml solids howcirr comim nl\
tnintnm sulllcient water for the cstablisliiiicnt of the process lu a hiiruiui
l»od\ weighing 150 Hr? there are aliout 100 lbs of water flic soft or^niis
differ much from each other in regard to their constituent tissue and of
htpiid cnntamcil in them and thenfote lu the degree m which thes arc prone
to putrofnction Thus the brain and the esc arc in this rcspe*ct contrasted
with the teeth Iximw Inir ami nails The fluids of the c\e arc rnpitils deit m
j>o«cil while the teeth and hair mas n.in*tin for rentunes unchniigMl

1 Tratvls in 7tbrria \ot 1 ])4CZ
■ Quart J Set , lajO 8 03

102 co\I)lTIo^ ? ArrrcTi\G pvTitt rACTio\

token from ,1.0 Curch rtoon, ot ,„ 1 Co^forf m CV m to J,Z'Z

t ^nklT' Vi '■1' ’I" to I eliiimnn Urn '»V!r rill!™

tlio old tratlitioii that the skm-* 1 1 persons who I -mI comm ttcil satnlcLC ^^cre mJltd
to the doors of the cljurrhes %>lHeh tliej had robljeiJ ^

If 'll! organic substance is dried putrefaction is arrested Dcludrnlion
oi 100(1 Stulls IS now in cscridaj use as a means of presersnlion

(c) The Presence of ClothJnft The effect of clotliing on decomposition
after niinal or immersion m water is discussed under the respective lieadmgs
but mention should be made here of the effect of clotliing on decomposition
of bodies exposed to air Clothing acts initiallv b\ hastening putrefaction
bv maintaining the bods tempemturc nliose that at which putrefactive
organisms multiptv for a longer perKwl Tight clothing dclavs piitrcfaetion
owing to the pressure producing a degree of hloodlessness m the part At a
later stage < lotlung dclaj s decomposition bj protecting tiie liodv against the
ravages of flies aiul insects Flj Inrvse not onlv hasten the decomposition of
a cadaver bj directlj attacking the soft tissues but also bv generating he it
winch niaj raise the bodj temperature to a level well above that at whicli
putrefactive organisms multiply

(d) The Influence of Access of Air Vir infliienccs decomposition
mamh bj (l) its temperature and (-*) its moisture content

Uictcria are normall) present in the air but it is unhkclv' that these bv
themselves plav an) significant part m the process of putrefaction Hies
and tlicir maggot InrvT introduce n supplementnr) process which ma> aid
decomposition

(e) The Influence of Light This has no practical inlluence on the piitrc
factiv e processes except that flies and other insects avoid those parts of tlie
bodv exposed to direct light tending to Ia> eggs in crevices like the evelids

(f) The Influence of the State of the Bod) It is not possible to state

without knowledge of all the other factors whether the state of the bodv
be it fat or emaciated has influenced the rate of putrefaction TJie car icr
stages of putrefaction are usuall) hastened when the l/od) iv fat or fla ib)
Deh)dration tends to retard flic course of decomposition throughout Us
course ,

The bodies of newborn or still Iwm infants are norniall) sterile and thus
putrefaction can onl) occur b) the invasion of the bodv b) external organisms
As the bod) of a newborn child cools rapid!) putrefactive organisms can
rarel) gam a foothold and thus it is unusual lor piUrefatUon in the sense
that It IS applied to adults to occur In a warm drj environment new horn
infants rapidly mumnuf)

Care must be exercised when examining a bod) whith has been t isincm
bered at the time of death In most instances the limbs (cvou o

putrefactive organisms and hcnie thcit decomposition wi ic sow ic
trunk liQwev er will putref) more rapid!) than normal

(g) Influence of the Nature of Death . i

y^cule Disease Tlie bodies of persons who ha\ e died from acute diseases

usual!) putrefy more readil) than tliose pcisons who have died fmm vva line

or chrome disease The reason for the liastenmg of the

IS partly the raised body temperature ot Uie time of dcatli and freq

PM cihi\ar^ iFTPE iMMritsio\ tot

also tlic c'cisldict of n Incttrimin iKforr dciMi Tn persons ihing from
nspljs-sia In sulTociticn or struigulitirii tlit f utrcfnttiM [iroctss mu be
sligbtK liaslcncd

Scplir Diseases In rtentlis fmnij>c| tic disc isesntcclcration of dctomposition
js tic rule Jliis tendcnci. is natumlh most marked m cases >\l)ert Ibe
patliogtmc organisms s\hich caused death are also instrumental m initiating
the putrcfactuc process it is a striking feature in Cl U tlclui septicTinn as
in septic abortion and in manj cases of intestinal obstruction

D flths froii Poitons (onflictin" statements base been made regarding
the process of putrefaction m tlie bodies of these who die from certain poisons
riitre njipears tn be no foundation m fact for belies ing tint an\ poison will
constaiitK icctlemtc or retard decoin])osttion Inditionallj arsenic is
bebc%ed to preserve a bodv after interment but this traditional bcluf does
not appear to Jnve anj sound basis (See Other factors influeiumg decom
position after burial )

(b) Influence of Immersion in Water Wlien a bodv is immtrscl iti
water there arise certain factors inllucncmg decomposition wbitb arc penibar
to this medium Still or running water jiolluted water ( r s.ea water alllmvc
tbcir o^n mfliienoe on subse<juent decomposition owing to their varving
baetennl and animal content silt water crustacen mav remove oil the solt
tissues in a matter of two or three da\s Owing to the better eonduetivitv
of w itcr bodies will coo! about twice as rapidl> as in nir (sec p IC*)

\fler sev eral hours immersion the skin of the palms of the bunds and sc les
of the feet becomes wrinkled and sodden If the water is well owgcn ittd
due to Its sliallowness movement or temperature ovjgcn exchange takes
place through the skin \ recovered bodv nmv appear quite pink irrespective
of tlic cause of death

Owing to the more rapid cooling of the IioiK in water mcl as for the
greater part of the \e ir the temperature of the water remains below itmos
jilieric temperature Jor the whole 24 hours decomposition jxr se tends to
proceed more slowly than in air \\ litn the water temperature is persistentlv
below 40-4 j^I the bodv mav show no appreciable decomposition after
stverni weeks immersion \t 50 TO”! it mav be exjiected alter tt rec to
live davs above tl is decomposition mo} be found in two dajs >i less accord
in„ to the temperature In the tropics for evamplc it n aj be obv lo is in
less tlian -4 houi-s

The order of the superficial apjicnrancc of the colours of dcconip isilion
IS usualh iltcred when a b dv is immcrv.cd m water thus —

1 1 aler

1 ace and neck
or sternum
Shoulders
\rms
Vbdomcn

lyCgS

In onlcr of appear
aiicc from aliov e
downwards

Mxr

Abdomen

Chest

Face

Legs

Shoulders

\rnis

riic researches on drowning made b\ t^sper and Konzlcr show that while
the lower } art of the body maj be m a tolcrnblv frt-sb condition the face
head, neck and upper part of the chest mav present a reddisli c( lour passing
into patches of a bluish green first seen on tlic temj les ears and naj c of
the neck thence spreading to the face ami nftenvards to the tl roit nn<l
chest Ihcsc changes maj be observed in the I nghsli summer when a bodv

rjt ciiA\ars irrin nnimsios

Cl lit to ten am! m \Mntcr fur n I jKn.Hl lln L. uJ of , thmriufl „
IS sttmolinies ninth (h‘.c«,loim-»J from imtrtfirlioii m|kh tiu rist c.f the IxxK i-,
111 an appnrcnfh niKJnrinrtl comhiion this is iltic to tlir fact lint the lt«n!
of a subnur/red both /lo,ts lower tliaii the rest of the IkxIv hciirt I.IxkI
gr^ifatt-s first to tlie fund and neek f inlitating bat final pnmth

Tlie skin fo\ enng the palms of the hands and the soles of ihi f« t is found
thickened white, and sodden from imbibition when the IkxK has rinnincd
sorenf {lavs in water Oning to this eniisc ccilivmoKcs reNiiltmi; fnm
violence during life are not nlwnvs nppircnt on the 1 hh 1 > at the ni urn nt it
IS removed from w iter, it is onlv when the skin has lost the gn Her |>art of
the water b) evaporation that e<a.lninoses and othtr riwrks of vahnee
begin to show themselves wiping nwav the outer cuticle will uftin reveal
tattoos and scars

Tilt inlUiento of air ujion the skin of a IkkIv vvhitli has hetn for some d i\s
submerged is {liieflv seen after its remov d from w it(r m tht f ut and clitst
In n few hours if the tcin|>cr itiirc of the ntmosplicrc lie mcxIcratiU hi^h
thcfieeinaj be found bloated and cither In id or black TIil fcnlnrcs are so
distortcil that thev cannot Ik: rceogniTetl h\ those who knew the pcivvn
during life The change (hien> occurs tn tin skin whirli 1 m comes first of »
livid brown colour nml nftcrwaitls ilmnges ton deep gnen IhcdisiHiluiin
tions are chiefls apparent n« those parts wlmh are fretl) rvjwved to the
atmosphere Thev are not commonlv found on surfaces wlmh have. Ix^n in
close contact ns m the armpits and np|>cr and lower hmhs wlurc theforincr
Imvcbecndosclv np/ihcd to the sides of the IkhIv nml the lath rhavi rtinaitud
in close proxunitv to each other 1 or the same rc'ison tlie di'cohiimlions
arc not commonlv met w itli at the Imk of llu hodv or on tliosi parts whieli
have been closolv wrapped in clothes
Clothing mllucnccs the dccom|>osition of n ImkIv in wntir insommh that
it protects the soft tissues from the rav igcs of fish i nistaeea nml « Uier sninll
iminals \\ htn a hodv sinks in water vvith n soft I>c«! (ns upjwsed to ,.riivtl
or stone) il oficn hecomes partly hanc<I in nuid < r silt Tht t vjioswl skin of
the face and hands is thin vigoroiislv attacked l>v numrmus worm' and
other nniinds living in the mml or sill Mh«n the IkkIv is rt'foverisl llu
tvposcd parts luav hi in a most advanccil stnlt of dismtegntn a ns a rrsnlt
of the nctivilv of these animals whenns tie parts protcilrvi h\ riothmg
although showing signs of decoiii|K>Mtioii eonimensumte willt the {urifKl of

immersion arc iisuallv intact

Whennlwdv isimnicrscd inwatershortlv after tht intlietionoflfteeratinis or
other injuries mvolv mg a break mcontmiutv of the skin ihr wiitif vmII nsua v
wash all the cslmv iisatcd blootf from the c<lgc« of the wound and thciv.l'rns
wounds wdltu mdisfins^iishnWe from / a7j/ wwfrwi injiines lorinstniitc i a
liodj is iinmtrsctl in w iter following n blunt head injurv with huaniti «m <
the scalp the stalp tail ration will Im indistmguishahh fn in a /"ut » ' rt i
wound However, ctrcbml contusions lareratinns ami h•»inorrM,^t•s iin rr*
Ivmg these soft tissue injuries will be unifTrctefl b\ iniiinrsion
imltvs there is an oinn fracture prestnt \t here ll e skin lius not xtti iro f

b\ a blow bruising if it has had time to form will Ik* inia re « jv iin i e
sjon although it mav not necessanfv In ohvniis when the kv v »

In warm weather a tlnck covenng of alga nmv forni ovtr fh'-

parts of the iKMh ahJsmaltmgoffllgi ,f fonnex! rap. Ih cnouji will.frr

PVJltl r icri(i\ Al FER IMMUxSlON 105

some protection to the ho(l\ from the atHcks of small animals and will seal
lip the hod\ orifices This latter phenomenon maj I e of great % ahic

‘ In the ca.se of It \ IW ilrtay the bo<l\ of one of the Mctuns'H is rccoscro 1 from
the Miter near Midsummer fi\e dijs after rape an 1 1 utrdcr tl e sigim hi I been
completely scaled h\ the alg-i and the sagiiul contents were unconti m natcl
Sf ermitozoa were re uhlj recognizable on microscoptcal e\iminntion of the vaginal
contents

The ilg L attach thcmscU et> firnilv to tl c superf cial Hj ers of the epidermis
and have to he gentU scraped off before the e\imiintion of the boclv cm
begin Tlie superf cial h\er of epidermis comes aivaj with the algu and thus
fine abrasions of the cuticle will disippenr during the tleming process

( iscoiis putrcfitlion tikes plice in bodies iimnersed in water ns well ns
in those which are exposed to iir the Ixidv nccpiires biiovanev and rises to
the surface It reijuires but a vcr\ slight generation of giscs for this clTect
to follow since tlic human liodj is onl> slightU heivicr than its hulk of
w iter

The period of time required for a bodj to rise to the surface from gaseous
putrefaction must depend on mnnj circunistnnces but prineipillj of course
on the tempcTiture of the water Usuallv in the height of the sviinmct it is
two to three dus and iii tl c spring or mitumn from the third to the fifth
daj after death from drowning (or from tie cightJi or ninth in deep sea
witer) In winter a hod\ mas not rise to the surfice for tip to si\ weeks if
the water tempenture is cold In vers deep water tl c bottf m temperature
remiins const int at JO throughout summer and winter lud in
these urcumstances gaseous putrefaction wilt be no more npid in summer
proMded the bo<i\ sinks to the bottom gcnerilK howeier the depth of
water IS insuiricient to [icrniit this state of affairs Wind affects the distri
butioii of cold and w arm w ators in deep lakes and if tl c bodv is h mg it the
windward end of the like altlough in deep witer the wind mav niter the
distrilnition of the warm la\ cr so tint the temperature of the bodv is raised
to tint in wh eh bacteria can inultiplj rapidl) The gises mav then be
liberated and tlic bodv will smk thej mav be igain generated and it will
rise The facts connected with the buovnncj of the dead hodj became of
great importance in the trial of S| cncer Cowficr* (IfO J) for tlie alleged murder
of a woman (see Drowiimg, )

\ftcr some IJ to 14 dajs tlie skm of the fingers begins to become detached
iiul ma) in two to three weeks be detached ns a kind of glove the nails
loosening lust Ihe Inir becomes easily deticliable bj mere wiping — ni
sli^htlv si ortcr periods of time

l\hen several montlis have pis^l the niiiscles become soft and discoloured
or the fattj parts mav have l>ecn converted into ndipocere Ultiinatelj the
soft parts w ill be w ished from the bones and the skeleton sep iratecl

The ciniiges due to j utrcficlion in the drovrned or apparcntlj drowned
even when c-ompantivclv slight maj as Casper justlj remarks scnouslv
ilfcet the value of the medical evidence The blood becomes decomposed
acijUires a darker colour and produces the appearance of congestion m
the bruii lungs right side of the heart and other parts ot the bod> so us
to render it difl cult to form urn elusion on deith from aj oplcxj m aspliv’cia ^
Vltcmpts li IV c been made by the ai 1 of batl s of formalin chlorine salt

Mant \ K 19 1 J fur Med f -
lanowilri lnofUistorj O rk ilc»d 10 B j 80

Uisiwr J L. IsCl II 11 ook of loim c Melc nc (Sei Sj 1 ‘'Ot ) \ol l

n^iTh 01 rniin utio\ iat

\nrict\ of insects titul nmmaK also in summer tlicst, shallow pn\cs siul
consc(\uenU\ the Iwdj ssiU lictomo wrnvctl bj the sxm

fypc nj snil The part pln\ e»l 1)\ s mous soils in aUcrny the nte of dccom
position miisl be (onsidcretl in e\cr\ case In heass cla\ soils the formation
of nihpoicrc is encoiin/fcil wliercns sands and porous soils in gcncril are
coiuiucise to miimmihcation

1 he presence of chonicah artnml the holy When i bodv is huricil in lime
<lcconiposition IS retarded and soft tissues are hrgth prcstrstti llic jirc
sirsative elTect of lone w is well illustratid in the ease it U \ I) bJ in (set
p 1 V2) \shcrc sprinkling of hmc oser the tissues preserseil tlit csidmcc ot
rnetiire of the thjroid b\ strangling during life dried bruising nroiiiid a
frartiirtd tonni was well preser\cd uid {lemiittetl mitrnscopt

Accesi of nir /o tin boily after burial I he tucessof nir In a bods after burial
prosided the hods has not become imimnuficd or toiistrtcd to iidipotcrc
considernhls acecle rates decomposition

Mass ^nnes In oases ssherc a niimhcr of hoelics arc buried in a common
grase ssithoiit coffins theise Ix>di<>s King in the centre of the grase maj be
better presers cd than those at the peripiicn

5 Oijsrusrn I \crs on rnr Usn sMiOiun n ot Pm 1 1 scijon oi tiii Pons
As ssc base ehseussed prcsiousls the rapuhli/ of dcselopimnt of dcioni
position orpulrefaction r< sts largely ssitli the st ileot the hods iit death (p ISO)
and tilt cnsironmcntal tom|)eraturc (and hiimuhtj) after death (p 187)
1 iieh of these factors, bears upon the rate of growth of the organisms
ifnd the nctisits of tlic enrvmes responsible for the gns forming hamoI\lje
and protcoUtK disintegration of tissues that toniprist Die substiiue ot
decomposition In gonernl nessborn infints decompose less rendils finii
babies who base siirsiscd some time and lean nilnlls less ripidls than tin
obese and plothorie I hose ssitli intestinal stasis or stop)>agt st irt to piitrcfs
t irtj IIS also do those whose s\ stems base nlrcade liecn insaded in their
Inst hours of life h^ iniero organisms when these are of the t) pe that initiate
piitrcfnetion so imioh the earlier eloes the jmieess start Tin etnirtinnicnlal
t( mperaturr IS ccleris paiibus thcoiiK milK sigiiifie ml fnetor m inlhieiu mg
the rale of dciclopmcnt uf piilrcfaelioii \l tempi raliires below to

to®! little ihaiigp t ikes jilaie o\tr dn\s and it li I or below the bode
ina\ remain the same as n i\ a fru/cii tareasi for weeks nr mnntbs bonii
dreing c>en well niarkid niiinnmncafion mn\ occur isjircialK in the Inuids
and feet tars and iiosi hut no putrefaction \t temperatures of 4»'’I to
the jiroecss is slow but slcadi at CO'I to 70*1 ijmte rapid at 80’J
to ahirmmglj so Those who work in the tropu*s are fanulinrwilh the

fiilmiuntiiigU rnpul dcsilo|>ment of putrefaction V boiK ina\ nlsiuhhigh
temperatures start to discolour iii the dnilka an liour or two after (hath aii<l
become badiv putrefied siithm n dn\

l{^mldl{^ IS an ndjiiMuit the IhhK mu pnmde moisture at the start hut
later the water required for the growth of orgmisius and the eonltnued action
of core mes must conic from the nir

Itwill thus be p itcnll} inipossihle lor iis to glee a gurdc to the rnpiihte
of suih iliangcs that will be applicable toescri ehmate biitweennhu down
« ertam rules and we can also set out a table of ex cuts that will pros ide a bists
for estimation i smg a fiulnr for Mih teinpenilnn rang In prwtirc ns
IS nlnioiis the seasons will thmgi this in mix location it is a pnihh in lor
e\pcricnet ofloe il conditions

ADIPOCERL ino

Bmidh sjiealvinp al)o\e70*r the mtc becomes doubled tor e\ en 15°I
rise mid bclo^s oO”! the rate Ijecomcs Inhcd lor 15®F bclo%\ 35°F Iittk
putrefaction is likeU to occur Lxpcaicncc will show howe%er that it is
impossible to be didactic, about such matters such gcncralwations as are
set out abo\e can onl\ act *vs a guide to what is well recognized to be one of
the most diilicult tasks in lorcnsic pathology— that of estimating tlie lapse of
time sinc-e death

Putrefaction inaj continue in air slater or earth until all the soft
tissues haye disappeared from the bones Wtien this occurs the bones may
undergo decakificntion and ma> tbcmsclics disappcai More usually
howescr the process of putrefaction dies awaj atalatestage and the remains
of the body undergo adipocere formation or mumnuncation or more fre
qucntl> a combination of the two

Adipoccrc Formation

Ilus substance w as first obscryed and described as aclipocire by Fourcro}
during the remoynl of yast nuniben. of iKidies Irom the Cimetiere clcs Inno
cents in Pans He gay e it this name oyi mg to its properties being intermediate
betyyccn those of lot and wax Jle considered it to be constituted of fatt>
matter and ammonia The composition of adipocere howe\ cr does not appear
to be uiutorm but is liable to yary according to the nature of the medium to
which the body has been exposed

Properties of Adipocere Taylor has guen an account of his examination
of this siihstonce ns it is found m liodics alter long interment in damp graycsi
and Ills description of its properties js here siibjomed A man died and was
buried at Boston in October 18o4 and liis )>o(ly yias exhumed for judicial
purposes in Tunc ISCi The yvbitc siibstnme into yylnch all the organs had
Jieen completely traiisformecl was unctuous to the touch and liad a jieciihar
and highly offensne odour When completcK dneii it yyus soft, yylulc
somewhat brittle \yith a fibrous structure and rnimblcd under the knife
Txafiiined bj the microscope it presented none of the usual chameters of
muscular fibre It appeared to be a confused nety\ork of fibres cemented by
a yyliite fatty looking substance without trace of organized structure It had
a disagreeable rancid odour, \ybicli y\as increased yyhen the substance yyas
hcattcl It wis in great part dissolyed l>y alcohol and the solution became
opaque on adding yiatcr to it It readily floated on yvater, forming an opaque
solution yyhen boiled and the greater part yyas dissohed but the liquid did
not become clear on filtration The solution bad n shghtl> acid reaction to
litmus piper Wlien liealed with potash it became clear and cyoheil
ammonii The substance yyas almost entirclj soluble m potash and the
solution gayc a yyliite precipitate with acids It was only partially fused at
iI2®I ^Mien heated in a close tul>e, it ga\e out an offtnsiye rancid odour
cy oly mg ammonia and traces of sulphur compoinids it readily melted an<l
b> contmmiig the heat a dense oih yapour haying an itid rciction
distilled oyer a carbonaceous residue being left m the tube W hen heated on
platinum it melted took fire and burnt yyith the bright jelloyy flonie of a
jij drocarhon

Butter and Marshall^ gave the ehcniicil composition of pig ndijoccre
as folloyys

Jioj 5jc Luiala 11)1010 llJ J M Lift 111" 29 919

200

AniPocruF

Palmitic acitl
Steant neid
Oleic acid

i H\ drow stearic acid
0 IIj drow stoanc acid
Stearin and fialoiifm
Olem

Unsaponified matter
Calcium soaps
Protein
Isii

Humus and undetemuneil

As a result of their investigations thev said tint ndij oecre was csscntnllv
composed of saturited falti adds glitcndcs Jicing prtscrit in fraa-s onl)
The} state inter aha -idijKK ere should he regarded ns the jirodiitt of
the h\ cliolvsis of fats bv w iter where the fiiiie fni tor and tjjt coiiccnlndton
of the real ting water are almost imlermilciv /.mt imd where the solnllc
product gljcercl is npulh rcinovcil It seems that hictcrml and etiAme
action and the formation of soluble soap^ plav a quilt sccomlarv part in the
dev elopmeiil of aihpocert from fats The Iinrtl w aw cl am ttr of tJic m iture
substance is largelv due to the pre emc of the two I»vdro\jst{nnc aeuls
Calcium soaps proteins etc are vanahJt incidental toinponcnts
A close csperimcntal stud} of nihpocerc formation h} one of us (ms shown
that it IS undoiibtedK foniied from pre cvisting fat whieli grndiiall} Inrdetis
ns the musciilir md otlier tissues dnapivir
The hvdrogenation of the unsatnratcil hod\ fats into satunted lirnicr
fats requires certain enzv mes winch arc lilicrated Jrom dccoiiiposing prulem
Though it is possible that an ummoniaeal soap ina} be fornicti in the rarl}
stages this is not an essential change

\Miere Adlpocere Is formed As adqioeere is a iiuvlurt of fiitlj aiids
formed from eertam thanges m ami In dmgenntiojj of j re cvnlmg IkkIv
fats It IS obvious that it will >>c formed omIv infittv parts arid if i Ik dv is
devoid of fit ndipocerc cannot lorm

The formation of liiiman adipocerc is similar to tlic hvdrogcnati m
of vegetable fats m the mamifnclurc of margarine hotli I ring diio to tlic
conversion of unsaturated fattv acids Recent worh on the ffrni'ition of
ulipoeere suggests tliat Inctcnal ciwvnits arc isseiitid for its fornintion
hen fat is coiuerteil into adipocerc it swells and remove's the viatcr nifcssarv
for its formation from its external environment and uKo from the internal
tis-siies Water is essential in the chcniicnl changes which oecur mt iiih
liecause it takes pirt in the chemical process but al o iiecaiise it removes
gl}ccrme whith is formed during livdrolvsis of the fats Some i dijHKxre innv
form even when onl> verj small quantities of vvater an. j resent but in f,eucrol
terms water or at least a moist cmjroiimcnt is essential to fncililati Uie
change . , it

Recent cNumiimtions of bodies which have been hiineil m water ii„l
cotlins for some I5(» vears have revealed Hut the Jie«h f»l has been com
nleltiv converted into ndtpcxcrc When this change is complete tlic l»od>
tinmt iins its condition for innnv >e irs It »s often jiossdile to obtain prci isc
mformalion leading to Kfcntilj cause oiid time of death in Ixalies convirlu

I crctiil

rr ’52
1 J

3 2*

0 ts
C 12

1 21
0 IG
O ffr

4 41

0 cr3

0 o7b
0 217

iDIVOLI-ML

i!01

into ndipoccrc In one of our cawr» a eoiiiplcfc exnmfmtion of the stomneh
contents «ns possible ns ssell ns full data for jdcntifi(ation iitirh t«o \cnrs
after death *

Time Required for its Formation To make an tndensonr to dcfcnimit
tills IS often of importatKc for o <lccision coiiccniing tlie time of dentil mns
\)i the tnienl point in i {riminni uisr Tlie lepal ipieslion of snnivorship
nn\ also turn on this question and in at least two cases the shortest period
rcipiirtd for its prodiiition has Ihcii the suhjwt of close scnitin\ in this
itmiKction

The follow Illy t isc is of some mlcresl as illustrating the aboic

The ilpc-ons( tl s\lio ivns in a state of msolvt n<> left his home on Njisemher Iril
and on Dee ember 1 Jtli following— i e live weeks imd four dajs ifUr Ins dcjiarlurc
—Ins bod\ «as fnuiMl llnatin'i m a mer near the j lace where he resided \ enni
mission of binkruptiv had been taken out uyiiiist him a ftw (lavs nflcr lie « is
first missed and before it was knovvai that he Imd dcstrovtd hnnself It Iki im<
therefore, import int to dcteniime wlietlier he had drouned himself (for then was
no dowtit of his liavwi,; loiwnwlUat smeutel fce/orr or «/fer tlie dvte <»C «ssiuiv 5 ; tins
commission If it could be slmwai that he was otreadv drmvncd wlun it vv vs issucil
flic commission would be void m Itw niul liis propcHv could not be sei/ci! mulcr it

I be litigation then turned upon the cpiestion whi thcr he li id drnn ned himself on
the daj of his lenviny bis iiousc or at »ome suliseipuiit time The bndv n ns found
llciiiting with the head iitid feet Mibniergrd On liehiy taken out the face vnis
oovered with a muddv slime On the dav iKifore the inquest three medic-d men
examined the hodv with a view to usecrtaiu whether iitij change had t ikcii iihev
111 It which could Justifv nn opinion os to tlie time during wlm h it had Ixcn hing
III the water The imiselcs of the buttocks were found to be ronvirtcd into a falt\
siibstancv, vers niuc h resembling suet ((idi|>oc-cre) ibc fiui was coinjih tib dis
figured br piitref iction 1 ho h nr of Hie bead was scpumti d from the scalp hv a
slight pull riip other pirts of the IhkIv were hmi and white without anv piitre
fnctive uppoaninee

A medic U wi(n(*ss fur the filiintilTs stntid it as his t pinion thit the IkmIv coni 1
not li vv c Iwc n less than « r ner f « fwhwvergcHl 1 htve or four we eks vsonld not li vs t
milliccd to produce the n( (lenrincvs met with tin ndipoceroiis state of the hCNh
enulcl not hive |>cin brought uIkuiI hi less lluii mx weeks lie ndnnttesi that he
h id met with an instanee m wliich a ImhIv Inken fn>m tlie Severn Imd a sjvcnnneeti
apfieamiKi within a shorter tune, although the rlimgt h id not ndvanied so far ns
ill this instnnex Anothc r witness Mip|>o>c<] the ImwIv must 1i i\e lierii under water
for more limn siv necks he therefore thought Hie deceased s hodv musi hivi Iiceii
bi the water during the obolo tune that lie was iiliscnt If it had liecn exposed to
Hu air it would not have iircsenlccl the np|>e iraiitrs inil vvith lit admitted he
had said the liodv wais in Muh a state that it would Iw itrii«>s,siblc to express
nn opinion Upon this cv idence. Hie jiirv were of npiinon th il tbv dcHeasod was not
abvc at tlie time Ibe coiiiinission wais taken out but Hint he Imd l*etn chad for the
whole {khckI of Ins nbsciii-e, and tlic Irnnkniptra was nceordingh muiciMsItd
ln\lor eomnicntccl on tins ns follows

Tnm<dieme nslnliw there are ulnnvs two sules to a sjieciil Hive question fin
<~isc, prime/ /urir as we have Mcn was in fuvxmr of the plilntifTs Jlie state of
Hie bcKlv supfMvrled Hus view, nlthoiigli it might luive ticcn eonteiided for the
dcfindanls that a few divs more or !•*,« would have mide no differtncc in the
results and tint dccxiisnl imgbl theirfon liave l/een alive when the iMokniplcj
was detlanci flu verdict of Hie jiirv was plivsinloginill} well founded The
gvncrnl ikHchI required for Hit pnaluelion of mliiMavn in dno'iiid IhkIics is si itid
liv most observers to vnrv from thiee or four montbs to n ve»r Its Ofsainmcr m

II IhkK to unv extent wiHiiti live wiiks hmI fotirdiva imist l/e ngarckd ns an ex
rcptic II In an extensive vric^, of oliserviilioMs lae witnesses for the plaintiffs
wi re till n jiislilieil in iissi^iimg Hie longest |*«issibk pern*d Hi it Ha e in iimstantml
evidence vioiill admit for its j/nnluethui in this lostaiice Tin fi<ls of Hos case
show tlul iidn>oeen nmv Ik pni*Iiienl in tlie InmIv of a ilreiwiied subj<al within n

'Smith 'v t‘W» IC"

ADiroci nc

tninsroniiatioii p"ire”witrl!Srir^'‘ucr^

'1:1," to, ,„p, „7.7.r”

It seems n renson il.lo ileiliioUon |„ ,Ir,„ timt llic time of its ippcinncc
IS fjoserneil first hs llic pcnrrnl ruin, uliicl, (mimi the lint miH),il,o„ „f the
hmir nnil scioralU lis cerltiin spccnl circumst inccs iiliich arc neccssars
for (IcconipoMtion to otxiir jii fits aihI nitngemus tissues it periods nupriH
jinalo for tJic formition of t|,c sulistoncc m question Bc\oncI this \erv general
sLitciiicfit Jt seems impossiiilc to go m the direction of determining vmUv
nceuracN «liet!icr it t\cr will optiir or when it will occur and we can onls
rcciird facts ns f!ic\ ln\e liccn nsecrUtned and winch imdoiihtcdlj follow
witliiii some rcisoinhlc dislnnoe the nbo\c suggestions thus it is much more
spct(lil> formed in Irojiicnl than in temperatt clinntes and m hot wcallcr
than 111 cold

It takes jilace most remhlj — (1) in the bodies of soung persons the fit
hong thiclh superfio d and i trj ihiind uit, (2) m those achilts w-hose bodies
abound m fat ( I) m liodics exposed to the sod of water closets (4) m those
iinnicrsed in water but iisuallv less rapidK m stagnant than m running
water, (o) m iiumid soils cspecialK in grasejnrds wliere numerous bodies
Ii»\ c been piled in contact w i(h cich other
Ucscr},ic has shown that the fit of the fcmilc brcists that of the hollow
of the (hecks luul other fiittx lecemmlations arc the first to take on this
(hnngc while the fatt\ lasers inimcdintels m eoiitoct with the muscles
present no nppcnraiict of sn»omfic itioii imti! i lonsidcroblt liter period
II ith tvgird to tJie {>cfKxl m »n onlinnn graic the cise of n fennk e\
humid ftt IJristol iri HTi after It months interment mav be referred to
I fie lower p irt of the liods w is found adipoccrmis It appeirs thit thcgnic
was \crs damp iiid the line of ndipoccrous tnnsfonnation m the deceiscd
W 1 S bouiidcil hs tlie Ie\ cl to svhioh the ssatcr hod readied
Our own cxpcricmes supported i>\ the cApcrimeuti! coincrsion of
human fit into adijioccre suggests tint whilst a slight chan 4 ,e m the fnt
mn\ be obsened after ilnmt three weeks mm eisioii in the water about
three months at le ist is required to obtain definite coinersion m in adult

linih , it i

As a cunosit) in the formation of idn>otere it is worth recording tlint
Rillrothrcnioied thefniitofnncxtm uterine pngnancy prr/ectO conserted
(bones and tissues) into adipocere e\er\ part lieing entire The woman was
belies ed to bi\ e been pregnant tsso sears before tfie operation was performctl
lo conclude the subject it is obsious tliat if a medicil witness is askccl a
cjuestion on the probable date of death ns judged h) the nmocint or (bstri
bution of nchpoccrc his answer must not be didactic he can onh
the loiuhtions to which the bodv has Iwcn exposed and tlicn repfv that tftc ^
condition found would (or would not) seem according to repor «
to be consistent with what might be expected for the time during w iic i c

bodv has been exposed to tJie known influences

Recent experimental work suggests tliat for rapid a ipoccrc o i
bacterial liberated fat splitting en 7 >j 7 i« must br well
(he bod\ before t/ie boch has coolwl suflKjentJv to pre' < "t b ictcrm! ii
phcation Though moisture « essenbd lor Um ‘

remembered that the bodj itself coiiUms a quantitj of water
‘Ullrotl 18S0 Bnl nff J ^

MUVVIJICAT10\

2m

utili/ecl provided tint pllt^cf^c^lo^ is relnidtd \\t Iin\t. found tint biun!
in snnd is ideal lor experiment'll production of adipoccre pro\ided that tlic
sand isregularlv moistened

Mummiflcation

Mummirication is the delixdrntion of tlie bodv eonstituents \\itliont
moisture pntrcfattnc oiganisms cannot proliferate and tlierefore n warm
dr\ atmosphere preftrahU wilh n free circulation of air around the bod\
IS ideal (or mummification These conditions are met iMth when burial
occurs m the liot and sands of a desert for there the drj liot atmosphere
iiid the loose sand combine to produce rapid dehsdration of the tissues
In this colmtr^ mummification is iimisiial in adults o-s the conditions neces
snrj for it are rarely present The mummification of infants liosseser is
In no means unusual NcnK honi infants arc commonly concealed m warm
dr% places and as their tissues ore iisiiallj free from organisms at birth tlicx
do not go tliroiigh the normal earl\ pntrefactiic changes Occasional^ a
bade which shows c\id<;nec ol nmnimification in certain parts riia\ ■•how
ndipoeerous change m others Tims there niaj be found some adipocerc m
the checks alidomcn and buttocks and mummification of the arms and
legs lliis IS accordance with the obscrxatioiis aliove It iv frerjiientlv found
during exhumations of bcnlics buried without colTins, it ma\ howeier
li ippcn eipialU well m the open as shown In the following cases

Ilirrs r iged jeirs w is f niiul li inging from a tree im wood in late Nosem
her has ing been nussing for nine weeks All the iidctn d organs had been Iicptelied
hv piitrefictinn and had nm out of the Ixdi through Die pelsls Adipooerc had
fumiccl o\cr the chest and abdomen ami anaivsis showed tint the adipxere
contuined Rn per cent fittj nnds lliere was munimificati n of the lower arms an 1
lower legs

‘ InJ^ X *1 ingrfl (K'ngsten Assizes 11142) the boh of igirl missing for 3j| wcclvs
was found btined in a sliallow sand and grace! j,ra\e on i he illi iieir Godalmmg
1 he right hand wltuli protruded sligl tie on thesuriacenfthe soil was mummified and
ndiporerew is apprctnlilv sicll advanced m its firnintion in both hrensts and on
the thighs The late summer |ienod wlicii these changes luicl taken place had Icen
marked h> warm siiii and mtcnmttcnt ninfall

Simpson K,104t 7*oJ<cc^ 1'

UIAPTEn u

APPARENT DEATH PREMATURE BURIAL

CAsrs Inve occurred „i uh.cl, pcrsom M.fferm. from cooiusuo,. olcclro
ciilion or npparcnt liWcscness from exlnuclion from cxpocure crave si, ocl.
or severe illness liavc liecn pronounced dcml bj untrained persons mercU
bemuse there happened to be iiionmwtion coldness of the surface anil no
outvvnrd signs of rcspirihon or cireulitmn 1 ven the doctor mav commit
tiic s'iiTie 5 rr'i\e error

In 10 ,0 one of the luithon. was at work in a Loiulon hospital mnrtuarv when the

hod> ( fa Monnn a^(i 7a was brought in stripped and 1 iid on tlie table Shehnd
Iwen found t> Id and appifentl> hfcles-. common groim I some '»0 minutes

pre% lotish \ doctor siiinnu net! into tl c ambu! im-e from tl c casualtt department
had pldwl a hand on her chest and felt for 1 er jmlse and pr< iw uneed her
dead *!omc four or fnc mnintcs aftcruaitJs faint hrcatlmig mosement* were
Msil le 111 the tpigastrmm and atctliose* pic exoniinjtion rescale I a 1 cart brit
slitsiirsised two in ( a quarter 1 ourv djmgof loronars Uin mhosi-.an hiisocarlml
jnfirction

Apparent Death In Recent Dross nlng Hanging and Electrocution
In coses of dross nnig in pnrbCiiJar )t is often diDinilt todeeiilc sshether dentil
Ins t iken place (.oldness and stiffness of the bods m the dross iied slioidd not
present the npplicntion ol means for the restoration of life One or tsso
hours mu elapse before signs of animation appear and in one iiuhnce a
dfotsnccl person «as nod restored tmd/f the means of resttscitndfon /tad 1/cen
niiplied for eight liourjj ami n half TJiere is reason to belies e lint some
persons remosetl from ssater m o state of apparent death are nllosscd to (he
osviiig to ssant of timels resuscitation and a srant of persescrance in the treat
ment TJie continued coldness of the 1 ods and the al si-nce of aiis esadcnccs
of success after a fess niuii/tes are conmionij taken js surt signs tint the
person IS rcalls dead 1 here appears Iiosvcscr to be in some cases if pulled
out of the ssater or suffocating mednini or cut down before stiffness is appar
ent a lingering \italit\ about the bodj and some caution is re«piired m
pronouncing that a person is renlls dead since it at once dismirngcs the
efforts of those who are emplojing means of resuscitation which should nescr
be rela’ced under at least an hour If howeser tlic bods Ins licen under
water for half an hour or longer or il itlm been found hanging or m a sulfo
eating medium and is cold and rigid there tan he no hope of resuscitation
oomraonsense would indicate the uselessness

•kfter electrical shoclxs tlie bod\ roav present esers apjieurame of death
but mans Uses have been saved b> the perseverante with artihcial rcspira
tion for long periods

Apparent Death m ^e^v-bom Children In new Ixirn cluldrcn it is
sometimes difricult to determine whether life has or has not ceased iltspiri
tion and circulation are carried oii in si«* « tranquil manner m an npparenm
lifeless bodj that, e.\cept b> the presence of some degree of warmth and llte

PliFMATl IlL JWJII IL ‘.05

obsonrcof nj,i(lit\, the child nn^lit Iw pmiioiinrcil dnd Cn<;cs nrctlMuIirrc
recorded m \slitcli diildrcn h'i\« Mir\i\cil birth for vi'c, mid c%cn 21 hours in
this state of jinttnc separ itt exiHtcnce

PREMATURE BURIAL

ITierc IS somcUiin<j terrible in admitting the possibihl\ of premature
burn! torty six ti.scs is here prcinftlure litirml is aihged to Inse taken phet,
art reeordtdbs 1 onlcncllc cithcrof the inUrnient of tlic lising orof apparent
dentil hting mistaken for real death I rom a nrcfiil cvnminntion of nil
these cases it is plain thnt the prcnlcr miiidicr if not nil of them nre ilcnsctl
from sources sshieh render them iiuitmissihlc ns csidenee of sslnL hontencllc
so strenuoush cndenioured to prose He Ins tollectcil these eases from
eicri source whether scientific or not, from the time of Plutnreh don ininnls
This \er\ cireiimstantc would make rcasonaldc men distnist those instances
of supposed death whieh nre iindoiihtcelK nutlicntic, even if the facts were
not c\plienbl( on the most tommon phvsiologie il principles

‘ Sliortlv after the gre it ebolerv visitation of 1800 Dr I ihppo Pumi
prufessornf inntomv inllorfiici cnllcil ottcntion to the siibjetL in n niemor
ahlcpnpir He cited not n few eases in which the piticnl eirtifuddcnd had
come to life on Ins wn\ to llie eemtUrv and he started the not unnntiirnl
if hornhU, inrereiHc tliat the resuscitation referred to mnv m several instariccs
have come nlxuit within the grvre itself To sin h nn extent was Hus ft ir of
premature Imrial Incn earned in \mcrien thnt nn association cilled the
‘Atiitncan boiutj for the Prevention of Prcmalnn IJiinal was netinllv
started *

There is no 'lutlicnticated case on record In England of prcmnture
burial that will stand examination, and in the present state of the law
as to certification and disposal of the dead there is not the slightest
po8sibllIt> of premature burial

M presdit m f nghuu! the emtte of death must be ccrtilicvl and a dead
IkkIv ciniiot lie disposevl of except H|Km the eertiliente of the registrar (i r
upon nn order of the coroner) Hie metlical nlUmlant bovviver lias it in ins
|K)Wtr to give Hie certificate wiHiuiit seeing or exnmmmg Hie Ixxlv of the
(k-cctscd lienee arise the {>ossil»ilitics of error irregular praitie*cs msurmce
fruid or even crime all eif winch woiihl lie prevented if the meilual
mill were comjKlled to vievr Hie IxhIv after dentil and to state tint
he had so viewed it and tint the dead bodv wus that of Hie person
n/rumfte AiKuerrmfeaf ifarrirgA/l If «cfvr^Ar At« it Jac » m

difiicult to ccrlifv the wrong Iwdv, or bur) a person who had been mimltrid
us one who liui diet! a iintuml ilcilli or n eullm full of liciv) rulibtsh ns
the liodv of a liiimnn being

A doctor g*iVT a death certiliratc fsr an « Id 1 1 is lie lind Ix^cn nUciiilitu, m a
three sti n v hoii«4 tlie girl wh i had ciilksl at the surgrr) )i id nicnlv sal 1 Uic « Id
ladv s d«nd In fit I then were Iww oM ladies in the house the girl wav rc{>orling
Ihedrath of a nIativT nn the third Hw but the doctor assumhi^ her to mnn the
* old 1 ul> on the sctsinil Ikwir (wlunn lie liad MMted) issticil a eertiliente for » woman
who was »tiU uhve

Mlicrc liv mistake or 1>) intiiitiuiml misstati ment a iiudical prutitnmcr
is induced to bihcve tint a piliciit iv dead of nntiinl eauscs a deiHi
eertitirutc given bv him nn) lx used to tonctnl enme, us m Hie f llowmg
eases

> I Ilk Umee' 1900 2, 7S2.

CIIAPTLn VII

INFERENCES TO BE DRA\\NrROM THE EXAMINATION
or A DEAD BODY— APART FROM THE CAUSE OF DEATH

It frequently linppens tlut the o\nct cnisc of dt nth is of less imj>ortniiPe in
helping tlie ends of jiistiec than the deducitons yyhich can be drawn l»j a
skilled medical jurist fniin the rireunistnnccs surrounding an unknoxin dead
bodj Haying re\ic\\td the signs of death with the clmnges resulting in
tilt hodj from death yse must no\y go hack to consider some of the prohhins
which may he soUed rtlntivc to the botlj, 1>> general obseryntion of the
changes yye liaye dcsorihed

Deductions as to hlooilstams or yyouiids y'dl be tonsulerctl tinder those
headings litre y\e siiall jiroeecil in the folloyying order,

DrfluclKins to be made from the poution of the both/ (a) from its posture
(6) from liy postnses and blood clots

Inferences as to the time of tUaih (o) before dceoinposition has commenced
(b) after dcioinposition, (c) from bodies putrefied m yyatcr

Decoinpn^iiion simulating the results of iliscave poison or y loli nee

Inferences from the Position of a Dead Body as to Interference at or
after Death

From its Posture The postures m wludi the bodies of persons
found dead from an) cause ire discoyend niaj, m numerous eases ht
brought forward to support a charge of immlcr, or, at least, of criminal
iiilcrfcrcnce

f.ixat cirt is always required in tht application of niodical principles to
lilt elucidation of these eases ns yycll ns a gorol gcncnil at (|imiiitancc witli
the yaiioiis phenomena imimahattly jiretctiing and following death Tht
Mgmficiuuc of cadny trie spasm has l>ctn discussetl on p IH t

A girl found dead on an ullotmcnl on the outskirts i>r taiilrrljury in tl»H5 1 1 ) on
her ha« k yy ith her h gs yy nfc apart the t fothing yh-x-uafeita/ s-fmrfgh <l bw li fu'/sfem
suggesird tlie of rijH On drayying nsnli the coat niicl fnick fresh blood

yy as ‘K*en trickling from till suh » no kniikcrs yytrt |>rc“<*iit and lla tommiinintof
a lintssien yvas found dragged »yyny under the right nnii Dwith yy is due to
stringulatK n hj the Iiaiul l'i>on further start li the kmrkers yyt re finiml di-e mleil
n short disl inec nwais Suhserpient cxniiiin ttkm pmy ed that rapt laid t iken glare
(s« I ig JO)

\ man ynis seen just sulamrgeil Miindiiig npridd hi a Sum y pond yvliosc yyalcr*
Wirt still J here yyas no ilisltirbinee • f nm kimt and a sln,^Ie line of footslr[is led
down the li ink into tht watir h tdgt he hid thnatiiied sintidt — and appc:m«l to
ImM yyadked ipiittK m todr iwn himself it yy tsyyinUrnnd the b™l\ yyns fntren stiff
Iligorinorlis miIim rpicntly «leyclopc«l iia the IxkI\ lirtaimt nufro/en in tht m irlnars
—a not uiK'oniniiin oIim ryalion

\s IIk litnly a< quires rigor mortis m till j«>siti»)u in whirli it hnj»p<iis to 1 h
on c-ooling luid if uiulislurlKd nssiimes t\actK the iittitiidi of the [Hrsoii
nl tiu. time of dcatli careful obstryalioii may, m some mstaiiccs shoyy

207

Fir 20 M ir ler I \ stran^t n„ <1 ir ng II e ait of miw 1 1 e s gii I eonce ot tl e
leofllclol) tl c |>QiUion of tl c <li«>r l«r«l rioll n ui 1 of i1 sctnled
personal art cles tn st on no occo mt 1 c oiortookc 1 It forii s inii>ortant
c\i Icnce at tl c circiinutanies an I notiirr of (1 e assault

whether in a ease of \ mlent ilcnth a sound inference could he drawn os to
foul pH\ \ question of tins kind arose m the ease cittil below

In the nou e Case the boclv of a man whose identity was ncser cstahHsl cd was
foim I in House s burnt out enr lyin,' face ilown across the front scitB the head
on the dni er a sent tl c left arm and leg doubled under the tnmk the ri„ht leg
stuck out through the gap where tic ncnrside door liad leeii Spilsburj form 1
the % lew that this di or had been open wl en the bo Ij had either collapsed or f dlen
tlirou^h on to the front seats llicre was evidence of the clothing being soaked
in petrol before tl e hre

V pugilistic, nttitiide is often adoptetl bj the dead liodv ns a result of
intense heat contraction of the stronger ami uid leg Hcxor muscles It bears
no relation to the position at death

kgam if a bodv is removed during tlie state of ngiditv then m some
instances the fact that it was so remoN ed after ngiditj 1 ad set in may be
indicated b\ the position of the still rigid limbs not being adapted to the surface
on which the bodv is found l>ing It lias been nlrcadv stated that the first
eflect of death lu the absence of cadav enc spasm is relavation of the muscles
the bodv tl cn disposes itself actorthng to the surface on whieli it li ippens to
belviiig tl c arms or legs nnj I e more or less fixed nr cf iitorted or I ecome
rigid in the position which thej issuined bj gravitation it the tune of death
llie lower jaw if left to itself drojis and bctoiiies rigid in this position ^^heIl
f? I House NortI an pto i \ss zes 1031

JM I nr.ML*> I imi ni ad noD\ 20 )

1 bo(U li roiiiul rigid with the tncinlKrs cnchU cxtcndc<l nml the jnws
closcfl that is cceten^ panhus itronglj mdicntuc of iiitcrreremc there
ivnsnnrnith ind phanoN in the limbs H hen, on the oilier hand the IkkK is
found rigid and doubled up with the Iiniljs more or less twisted h mg on an
c\cn surfnic like n bed tiie probibihtN is neeording to etrciimstnncc.s
that the bodv had been mo\ed from the spot in whieh the pcrs>on Jnd diwl
and m svhich rigitbtN had suptrsened In suiruhl Innging the Imdv and
cspcemlls the c\tremitics arc now and then found twisted in a singular
manner around articles of furniture In stnh cases the general mustnhr
coiuulsion at the moment of deith will plissiologicnlK explain what to
iminfornicd persons ina\ appear pliNsicilh incoinpatihlc with the dccciscil
ha\ingdcstro\od Ininsclf

J he following case will scr\e as an illuslntion of thcKcasiond import
ance of these inquiries —

In n trill for wife murder l>cforc the llich Court of Justiciars at I dintiumh
conflicting opitiinns were giscn eonecming inferences to lie drawai from tlic posture
111 wtiuli the hmls of the deceased svns found It was tlitis described Its a sntness
‘ She (deceased) waes sitting on the floor bs the side of the hc<! iicnrls naked
SMth 0 iKirtinn of the bedclothes wrapped around the lower pirt of her IvmIs the
Jie id erect but mehned a Jittle tnelnianls and to one side the face being towanf'
the bed The left nrm hung down hs her side svith the hick of the Jmnd on the
ground the right arm resting b> the elltoss on the Itcd and fiiainlained in thr
xipriglil povHon xulhoiit oiiif fiirlker $upport as if site had ttecn in the act offiutting It
to her fuca; The legs were crossed under the trunk, the left being less protruded than
the right

The ecrsacnl sertctira were fractured and d«splaeei1,s» that she had pn balds died
I violent and a er\ sudden death The attitude appearcil 1 o be also quite irrceoncil ible
with the possibihts of death from accident or suicide The ehicf question seems to
base been wliether admitting (tiat the prisoner had net mils pliecd his wife m this
liosture the nunntcnuiec of it was to be ascribed to n rodnseru spisin cr to the
Siqicrsention ofonliiiars rigor mortis IflheiHislurc were ndmff ted (o lias e lieen due
to ngnr llicn the inference sinuhl lie that the deecasoil had been doa 1 at least wime
hours The prisoner wais pcnseil to luse iKcn at home from nine until lidfpnst
nine the deceased s boilj was disoos-crrd at two Ilcnet if he srere resjionsdde
c'ldnscnc ngidit) mustlmccomconinfonrhoiirsiunlaludr On the other Itand it
wiis nrgnl that the ittitudc of the IkkIs mimI the singular jierjicndieular position of the
right nrm weredue ton spasnioilicconlmrtion of the muscle at tlic moment ofdrdh

itnessrs stated that the IkxIs of «lrc<as<at sslKiifnind snissvnnnandtnsds flcsiblc
\\hcn a bod\ i-> waimi and tlic limtis arc eusils mosid from their position llic
presumption is rather in fasour of the lUeil pistun* tieing due to eadnscru siiasm
Ih m to rigor mortis

1 letclier attempted to explain the firts b> s«p[w»sing that the diTeascal fiad
probnhls fillcn hi a fit while getting out of bed during the absence of the j rboner,
admitting that tiic prisoner might on his entrance at ah >ut nine o rlnck, base
attempted to mtsc the in d) and thus linse giscn the creel position to the trunk
while the jierpcndicidar position of the arm wnsentirels due to sp»sm On the other
sale It was eons;<Ier«l t<» ia improbable that tl« prisoner eoiiJ I li ive pJawl fJie
dc<*eastst in the attitude in which slie wn> discoxerctl admitting tier to hnsc dicsl in
nils otlier i osturc fur it s*ns not hkels that he ssouhl Irnse piirjioscls htH tier lieait
nndnrmmsuchnsmgularnttlliidcuiiUllierlKKls had become fixed rnlcril Snonler
to aeconijlish this tic must liase wailed until it luad beoome e«»l 1 whereas it is
stated to base Ikcii found with some w innlli and j Iianex atmut it

The prisoner svns disclmrgrd on o xerdiel of not prosen liecause it svas u it
s-itlsfai lords made out tint he lud realls t lUseil lus wifes deith The state m
wtiicli tlie deceased was fouml ere itcil a presumjitw n llial «hc had dieil fnirn n itiind
tamses not i jng lief in ttie diseoscrs of lier ImmIs, thcrefon at some time lietween
halfjxist niiK and two and sslith tlie priscner snis nliseni from tin liiiuse The
iKX-oHut of this s-isc as tis'cn hs Fhtelirr s««s most fieonnlile f »f ffw (insoiwr;
lie suggiMeil mans Ingenious expf inatioiis for smaimst inces wl leti sverr irrlninls
scrj blrohg against him

-10 time OI DEiTII

^^het!ler this v,as a rase of death from natural causes^ or as alleged
from an injnn to the spmal coni we must reffarc? the attitude m whicfrtfie
l>od\ was discovered as sen unusual Had a proper eiaminaticm been made
In methcal men when the bod\ was first disroverwl b\ the nemlibours
some of these difhculties would probnbU have not existed *

tMiile ngulitv m peculiar positions ina> sometimes indicate mtmlcr or
some form of violent death In lixmg tlie IkhIv m i position wJuch it could
not mturillv have assumed and which cannot be easilv altered dunng the
rigid state, we must beware that we do not give an undue imiKirtancc to
this sign of death as a proof of violent usage Tins caution is espccialh
required m the cases of drunkanK for the bodi of a person who dies m a
fit of drunkenness mav I e found contorted and arringMl in n vn^ which
might be apparentlv incompatible watli either accident or suicide

From Post mortem LivMit) (hvpostases) Vtc have alrendv noted
tint hvpostases form m the most dependent parts of the bodj and also tliat
thev mav be disturlicd b\ the gases of putrefaction and that thev maj be
observevl intemallv as well a.s cxfemalh Hence it is possif Ic hv notin the
position of the hvpostases and also the position of the dark, (cellular) part
of a large clot of blood~m heart or aorta for instance to tell whether a
both lav on its face or back or side after death and aKo whether it has
been moved since death

It wall probvblv hut seldom hipjien that such moving of a Ixx/v i» of
importance for bodies are almost imanablv moved to a mortuarv of some
sort before inspection but m the cases of bodies found under itispicious
circumstances notes should he made of tliesc ixnnts for it frequenth hajipcns
that little noticed |>omts iKconic of great imj>ortancc at a later stage

\n infint saidt have been foun ideadinitscot face upwards wus found— though
still face up OQ the mortiian table — to have pronounced hv id sUins ovor tlic face
front of tl e cliest trunk and tiuglis Marks os from bed ling were set in rel ef
agumst these plcrrfi-eo/<7«f«l 5trwr tl e e)aM tta<} ni.h thed dead tar

some hours face dovm The parents later admitted telling an untrue storv — in tl e
desire to avoid cnticisni There v as no real suspicion of anv del berate enmmal act

Inferences from the Bodv as to the Time of Death
(a) BeFORC PcTBEFSCnoS Hib SET IS

Inferences from ^^a^m^h and Condition of Muscles Tlit clmngcs
whicii take place ui a dead bod> before the commencement of putrefaction
if Qccuratclv observed maj sometimes enable a mcdital witness to fonn a
fairlv close estimate of the time at which the deceasevl died (tifep 1C3) Tlic
dead bodv of a person may be found in a house with niarLs of enmmal
violence ujxm it the crime mav have been so recentiv perpetrated that the
bodv still retains warmth and pliancv or it ma\ I e found in a cold ai 1 ngid
state

It IS of the utmost importance (ride Chap ^ ) that the temperature of the
bodv be measured even if it feels cold and that further ii easuxements be
made at mtcrv als m order to assess tlie rale of fall of tl e temi>crature Tht
timing of death is a vatal j art of anv trimiiial investigation

Perhaps the most imixirtant aspect of fmng tl t time of death as accur
atelv as jiossil le I cs in fun ishii g tl e jn lice vvith time limits wliu h ci al le
tlicm to concentrate their checkin^ < n the movements of susjhcIs The
veracitj of an alibi is easier to test if the fienod in question is, short and it is

7 IMF or DFATIl

211

as lire mK iiuhnlcd (Ch ij) \ ) fin isitr to 'n!ije\c iucuric> mJjcj) tJje boiJv
IS still fresh-- iiid prefer ddj still wnnn Apirt fn^m tlic mfornntion to lx
ohtniiicd from tlic ntt of toolmj and Uie onset of rigor m the muscles the
observer should keep in inmd the possibility of ncqmring uifoimntion from
the vnrions hiochcmicnl changes winch occur in the tissues nnd lliiuls of the
IkxIv, nnd make sudi tests ns appear appropriate Schourup' lias suggested
lint the elnnges occurring in the cerebrospinal nmd ma\ be of value in
supporting an opinion dcrivetl from other sources (sec p 17S)

In/? V Heath {L LL I'ltr) the mule body of a girl m? found liounti (reeenth)
gauged and dead of asjiliv \m m a Nutting IIiII Gate Hotel flie rectal temperature
atetOpm on thedaj the body was found wasSt® I (room 0 .J 1) Bearmgin mind
tlie temjxrature in the closed room and the iiaturcof the covering nameh one si eet
It w IS estimated that ihout 18 hours had elapsed since death the murder having
taken place nmtind midnight the previous nvlit Heath hail in fiet arrivc*tl at the
hotel with the girl at about 12 15 n m — and was heard to st im a door (ui leaving)
at about 1 JO a m

In li \ l/cAiwsIry (C C C , 1012) a girl s Ii vU had been found iit 8 *10 a m on the
foreshore of the 1 h imcs luidcr n [i ini|>et of the iiewh constructed \\ aterloo Bridge
Vyiohee surgeon eert died «le ith mid (after placing a )und on th( Ik dv) expressed the
view that deUh liad rxeurred four to seven days pnvaousK In fact on autopsv at
the mortuarv atgJOpni a rectal tempcralure of 47" I w is meisured (air *18 p
Thames river )l* 1 ) Bearing m mind the immersion and exjiosurc at mglit it vvns
estimatwl that death bail token place around 1130 pan the previous nigliL
McKinstn was seen to leave u hx-al piihhc limise with Pc^^v Biehards theniiirdered
giri at 1 J j) m niid to walk fowanJs Ifie (llicn) deserted Waterloo Bridge

See also the ‘ Tow Path Cose (p 172) *

In these two cases the possibihtv of a rising tciiipcnturc at dcatli from
asphyxia was considered 'Ihis is indeed possible in anv sudden ccrehnl
disturbance— natural or traumatK. Iia-nioixliagcs csjiceialh pemtine ruptured
aneurysms or tumours and tin, like

V girl loft stranded and suffocated m licil at the Ohl \ork Hotel l^ndon vias
found to )me a rectal temperature of 4* a little over three lioiirs after Jior h »y
eompaiuon for the ni^ht had stumbled blindly out of the place

Bodies King deul in a hot bath under Ixddmg (with hot hottks) or
heayiK padded with clotlimg offer particular diinciilty m forming such
estimates The general factors conccnieil are discussed in Liuiptcr A One
other question has been raised from time to time it lias been suggested tint
when the body has lost blood rapidh at (and after) death the temperature
IS mud) lowered but Ibis is not true

linally vraniing must be giyeii ag-imst assuming that tlic time of an
assault and tlie time of death are necessarily tlie same borne hours may
elapse before death ensues from even the most grave Inal mg wounds, nnd
some assessment of tlie period may Iks possible from the site (or nnioimt) of
bleeding Xo take two eitrenies mtra bnmchnl bleeding is likely to prove
fata! m minutes if free whilst extra-dural bleeding must take as a nile
some hours — during which the classical * lucid period may mten enc

In manv cases of murder and suicide such as the following the murderer
IS dearly pointed out by tlie dilTcreiices m the condition of the two dead
bodies when first discov creel The temiieralure is an important guide m this
respecL

A man and Ins vnfe were found deu! in bed the bodies covered in blfod from
wounds inJlictcd on both The woman liad a deep inccsiou in the throat, besides a
' ^cbounjp Iv IDjO DodstitUbeslemmelse, CopenI agen Dansk \ idcnskabs Torlag
* yfant, V Iv , 1054 J /or HetL, l,-(0

21J

fIML 01 DPATII

slnted tint he wnt into Ihclm s JH*dtoom niKJUt 0 n in nnd found Uie ii lyde id Ins
l)od% cold md Jus linns stiffLiimp Hnl he miglitliai'edicd to ni natural

causes It was J»^o^ cd tliat tlic pnsnncr mbs heard tjcnling the boi up to 11 30 p in
on the prcMOUs ni^Iit As tin boilj vas cold alien found and rigidity wtis com
inencing there aas a strong proliabililj tint tiie Iwv mast have been dead at least
si\ or se\en hours and therefore ntatimcwlien the prisoners as last known to base
been with him Ihe bodj Mas srcH dc\clopcd and coseresl mtli bedclothes

In 7/ \ Zltrtdgc (Bodwin Assizes 18l»2) mcdicnl evidence denied from the state of
the dead hod\ iilicn found tendeil nuitenAU> to corroborate the tircumstantn!
c\idencert»/iiMS( the accused Tlie deceased was lost seen ahic at 10 30 p in- He iiais
found about 0 50 the ne\t morning dead m his house lyang on his face inth his clothes
on lie liad rcceued Rcicre head iiounds niuch must have proved specdilv fatal
Ihebodj when found vvas quite told and the limbs were rli,id The medical ev idence
was tint the deceased hid been dead from eight to ten hours

The iirisoner w as connected with the act bv a chain of circumstanees He w as seen
drinking and conversing on fricmilj terms with the tleccused at ii beershop the even
ing before Vt midnight a neighbour iieard two persons m conversation in the
tlceeascd’b kitchen One voice he rccognizctl as that of the deceased and the other us
tliat of the prisoner with which lie w is well acquainted He was soon afterwards
suddenly an ikeited bj a none like that of a Jican f ill proceeding from the deceased s
kitchen in winch the dead bodj was afterwards found Ills evidence was u rrobo
rated bj tliat of his wife Contriry to his usual practice the prisoner did not return
home until one o’clock in the morning- and then, m order to account for lus return at
so late an hour he made a statement winch was jiroved to be untrue The coldness
andrigidit} etthebodj when discovered atOdOain , and the fact that the deceased
was m lus clothes were Iheinschcs quite consistent wath death soon after twelve
0 clock at night, or about the time when n henv-v fall was heard bj the neighbour
Other Circumstances left no reasonable doubt of the prisoners guilt, and lie was
convicted

Inferences as to Time of Death from Digestion of Food The state of
<li,j(stion of the contents of the stomach and bowel may be used as an addi
tionnl means of fixing the hour of death in relation to the last meal Vest
elaborate tables have been prepared of the time taken bj the stomach to
digest certain articles of diet but these arc to unreliable to be of use The rate
of digestion varies in clilTerent persons and according to the functional
elRcicncj of the gastric mucosa Gastric and intestinal activitj is much
ret irded in cases of coma and insensibiht> Deatli docs not at once cause the
process of digestion to cease — indeed the stomach may digest itself after
(Ic-ith Therefore, evidence fiom this source must be treated with great
reserve

(b) x\rrEn PcriiEFvcnov nvs set is
O rfila, after Iinving devoted many years to the investigation of this subject,
and after the comparative csammatiou of some hundreds of exhumed bodies
of all ages, and of both sexes came to the conclusion that it was beyond tlie
reach ot science to determine with accuracy the period of death from the
progress of putrefaction It will be perceived from wbat has been already
stated that the circumstances which affect the rate and progress of putre-
faction are numerous, and they are also vanahle A medical opinion can be
little more than a conjecture, if however, we are informed of the atmos
phcric and other conditions to which a dead bod\ has been exposed it may
then be possible to arrive at a more defimte conclusion

In 48 Jiours in a wann July the bodies of a suicide couple found m a gas filled room
showed varied changes Tlie man {3G) who was stout, was already bloated, willi
pronounced marbling ov er the shoulders and early blebbing the abtloinen was tense
The woman (30), a thin creature, was only commencing to turn family green m the

214 TI MF OF DE 4TU

flanks— was pale and litll- allem! cL«wliae. OUwr c\Td*Tce Oioned IxiUi ba i diKl
tO^tUier

In /? T CrfUtle (Bedford Assizes I'lW) where a murderer! boT of JO Isid latn ''«•
mn- davs tn a \ngust sun on a hallastsidm? tl,e ports of tU b«!v exposed to
the air were reduced to a dtunte;!tahnjr me^ of mag^t nd lied tisstjea. I rt>m tlte
waist down to the feet wlucli wus protected bv the clothm? the change* we*e more
like those to be expected in eijht to ten das-s m llie summer

It has been eLewherc stated that putrefaction docs no‘ cormionh com
mcnce until about the third da\ after death, hut there are ina n mst-rces
known of it conmicnans almost unmedL't^eh aft® dcaUi ami procrnl n'»
with nreat rapidits *

Oostndialgas-fomiingseptjcabarlionsare notonous in this re^pec’.des dop-
ing a septiKCTiua wbicli distributes the organism to the tissues before death

The bod\ of a woman admitted to liospital the night of tier deatli was noticed to
be rapidls becoimn* "dusk-v and somewhat seflow as slie Rpent ber lat three < r
four boors. Slie was plated tn tl»e cool mortuarv on tier death at 8 aon. ami I rotigl t
out for autopsv at pjn. Bv ttu-* time she was deseJopinc ! lood Ingcd I li ters
in the skin had liecome purple almost bbek m patch", and wa- tense with ca^es,
51*6 had died of a elostndial fras fonnin«» bacitlan mfecterl abortion — no doul t with
final septicaemia The uitinia of the blood vessek was pJum-coI.rtired tlmmglKiut
and ttte blood laked On would have judged her to be dead ttiree to fiur dacR at
that (^ptember) swaon. Stie Itad a fulminating CL tteWui scptxwmia from a
ennunal abortion

The same conditions are true of other coarse or widespread infections b%
putrefactive organisms as for example, m intolinal olitniction tn scp»i
csmias from infected wouiuU and the like

A man died at 10 pun. in November after on acadenl in which he sustained
cru-sfung internal injunes. 4t 11 ajn. next morning 1liou'’h onlv 13 fount bad
elapsed tie bod> was so bloated and puttefied the fan so swoDm and dtscoloo’cd
that Uk jurv could not be asked to approach tiie bodv for idcnUflcation { iirpo«^.

A man aged 50 died from an aectdetit tn Dcceniber Hektstmtich venousLl'wid
and svitliout slwwmg ans * mi of tallving from the accwlent died on tl* fourth dav
after lus adnussmn The man died at 6 p ro. and m an Iktu- rr two In* Ixslv wa^
earned to the deadhoose Tlie wealber was frosts, and tJiere wa-« a lianl frost during
the night on which the bodv lav id the d-adhouse- On the following dav (onlv
20 hours after death) putrefaction had advanced to such a degree that iJeceased
could ecarrelv be rew^ised Tbe skin was Ihnmgliout disleodeil b\ paves of
putrefaction- All ll»e visceni were decoinpowd, the liver contained putre-cent gases
and even the coats of the gall bladder were iIi- tended witli them- Tins was a ca^ of
rapid death probablv from blood poisoning

In \be^ cases the effects of the fowawis wwvl li2snolv<tu«; argam. ms are
eJearh seen and such cases could be inultipbed indefinitclv Tlic condition
of these bodies in refejeuce to tbe process of putrefaction is such as Devergie
assigns to deod bodies at a period of sti to twelve davs alter de^tli, on the
assumption that thev have been freclv eipo.ed to tiie ai“ at a mean tempera

ture. Had the bodv of such persons been found in a house in thescco''tbhons,

and had tbe history of tlie case been entirelv unknown i rictiicnl man
asked to assign a period of dcatli from common experience m su-li matter,
might have declared it to be impossible that the dcceaserl could have bcCT
Iivmg within 24 Lours preiious to tlie discoverv Su-picion mie’ht thus be
removed frem persons reallv guiltv of murder bccau'c i* migl t prov «l
that thev had not been in or near the house until witliin a dav of the dt.
cov-en cf the bodv On the other hand an mnocent person who had bera
seen m companv with the deceased five or six davs prcnotislr might be
unjusth charged with having been accesaorv to fus deatli- Caution is required

lIMh 01 DCATIt

215

m expressing' a mcdicnl ripuison on the time at which death took pKce iii
bodies sshich are found much decomposed

Upon burial decomposition is retarded to a remarkable decree

In 7? \ Gordon (Maidstone Assircs 1030) a cliihl s body was f )und buried in a
shallow pm\e (head inches feel b inclies deep) in a wood outside Canterbiirs oii
Apnl 2 tth It Ind disappeared on April 1 llh and cntpiirj later res-ealed that follow
III" chastisement iiilhcled b\ the foster f ither it liad liecn found dead m bed lie
had feared pnnisjiment upon eiiQUir) and Iiad buried it \fter ten daj s bumi (Apr;!)
tbc conditions were ns if it h id dieil 10 to *16 Itours pres lousK

lias had nn uniisiml opjiorttmitj of obserMuy tlit \anitions of
clniige after bund wlulst on scnicc for the War Crimes Commission in
Ltirope at the end of the 15 war and fommlatcd the folfowing gcnci il
fictors allccting tlic changes taking place after burial —

1 riic phjsical coiulition of the i) 0 <l\

2 The time lapse before burnl — during uluch onlimrs putrcfsing change

maj commence flics niaj iny eggs and maggots ma\ emerge to
hasten disintegration of the tissues

3 The clothing — anj coxenng tending to retard decomposition (and

promote ulipoccrc)

4 The fjpe of coflin—espccialty as to its pcrmeabihfs to water

3 The depth of burial and t\pc of sod deeper and well drained burials
detenonte more slowlv

0 Acicss of air m shallow graves Imstemngdccomposihon

7 Mass bun d contact with other bodies dch\ ing the process

(e) I iioM lloniLs PcTKLiiin is M \Tin

The principles gov criung toss of heat and ngor mortis ui w iter have alrcndj
been discussed (p ir>7) Some attempts must be made to generalise on tlie
phenoniena of putrefuctioii m water in order to enable us to say for how long
a period a tiocH mav have been immersed No satisfoetorj data however,
have been obtained to guide us m this mijuirv* The changes which take
place are modified in tlieir degree and the rapuhtv of their progress b)
numerous and often inappreciable causes Devergic believed that he could
determine with some precision the length of time during wliicli a de*ul bodv
mav iiave been m tlie water suppoiing the drmcnmg to lime octurred during the
xctnlcr season Thus according to him in bodies immersed /r»m //irec

we shall find —Cadaveric ngiditj, coldness of the surf ice no contraction
of the muscles under the galvanic stimulus and n wliite or sodden appearance
of the skin of the hands From four to eight days — Phanev of all parts of the
bodj no muscular contractions under the galvanic stmmliis raturai colour
of the skin cuticle of the palms of the hands verj vs lute From eight to tuehe
days — Die vvliole of the Irodj llactid the cuticle of the back of the hands
beginning to whiten the skin of the face softened and pallid differing from
tlie skin of otlici parts of the boilv About days — The face somewliat
bloitcd’ and covered with red patches a greenish tint in the middle of the

MlJiit V K ll>o3 inaiodcrnTtenlsinrorcnwcMf heme Td Keith Simi son I ondon
Ihittcrwf rtl

Irosiledtfel { 1 1 ( ( t f Inf l>t I or Jtell »lo«f the eonstflnf '3 tulJ » hJeh a
IhmI) will il at it f.i\pn iiionlhs diiniif! tl t jrar is W t. o 1 u Rit k ns nnv fmi i In ic to
ViUt! I m two to llinr d os Vj tnid cr to II U I er fiiir lo iwt NmiilrrU IHctiiil er
eicht I ten Jniiirv »nd 1 11 i\rj two to tl mi wicks M irrli to Ma\ (he ti pi„l t d i\s
(these irc tl e flsurt' rr m II c 1 n c t> n ch-s < rUc 1 11 in es) .....

*Owiiit to the fuel tliat tl c head Iiiiijs lower thin the bo ly m w iter I loo I tinls
to t,ri% itatx. into the liea 1 niid neck causing early discolouration of these f arts

time 01 DLATII

sternum the cuticle of the hands and feet perftdb «lute imd Keonun-
raised in folds \bout o »jo«fA — Fnceofa rwldish bro«n coIo ir esclidsand
lips green a reddish brown patch surrounded bv a green border on the fore
part of the chest the cuticle of the hands and feet ^^h^te thickened snd
corrugated \botit hco months —1-ace bro« msh coloured and swollen the
hair becoming loose the cuticle of the hinds and feet in grcit pnrt detached
the nails still adherent Tjro monilis and a Ac// — tiititle ind nails of the
fingers dctnchetl the cuticle of the feet deticheil but the mils still adherent
partial saponification of the checks and chm superficial m the breasts gmms

and fore part of the thighs Threr months and a half —Dc^XrMhonot part oUhe
scalp esehds and nose pirtiil saponification of the face and the upper part « f
the neck and groins dcstruamnoftlieskin iiidilTerciit pirlsofthc bod\ cuticle
of the hands and feet as well as the mils enlireU detached 1 our and a half
months ~ Almost complete saponification of the fath part of the face neck
groins and fore part of the thighs the appearance of i calcareous incrustation
or deposit on the thighs opilescent condition of ncarh the wholeof the skin
destruction and remosal of the ham scalp the bones of the skull hid bare
and beginning to become brittle. Tliercare no data togneeven appro-cimite
opinions for a longer penod than this In subjects drowned dnnng spring
md summer these changes take place at rates about three and si\ times as
rapid respectneh At the height of siunnier tJie bo<l\ mil fioit at two da\s
and bloat in three

In attempting to fi\ the time of death from the evlent of destniction of
the parts a pathologist must remember that crabs eels etc attack tlie both
within an hour or so of immersion and maj remove most of the exposed
boft parts in a few hours Detow the ‘salt divide of the Thames bodies
are seldom found after the first two (lavs have elapsed
In those who are drowned during winter and vrhose bodies remain long
below the surface or are covered with mud so as to prevent fit-e awe^b of
nir decomposition takes place slowh and crab digestion is less active

\ man found in the sea off Portobcllo after 12 weeks minicrsion shnwnl tlie skm
fairh intact but loose and discoloured distens on of the aUIomen and ifsirlv good
state of preservation of the internal organs In the boib of a man immersed for hv c
months in the sea the ctieeKs and remains of the scalp were transfoniied into
adipocere but the rest of tt e bod\ vras praclicallv intact

V man aged "0 was missing from January Cth to Fehruan 4lh Hii l>odv
was found m a nver and there was reason to bel eve tlmt he fell m nn 1 was dr mmed
on the dav wlien lie was last seen The head neck and n portion of the clicst w liere
unprotected bv clothing were thicklv covered with mud ttlien this vras removed
the features were perfcctlv recognisable and although *S dav s had elapsed identi
fication was easv The onlj changes observTd were os follows The cuticle peeled
awav from the cutis when slight friction or pressure was made over those
which liad been (XJTered with mud Tbc face and neck were Komewhat <lirkcn™ m
colour and the front part of the chest was marked with slight lines of Iivi Idv
The tluckened skin of the hands and feet were eorrugated and whifei ed bv long
continued munersion but remained fiimlv adherent to the tiss ics liciie'ith it
Tavlor bad once to decide in reference to a vroman deJnered of n child
18 months previouslv and suspected of murder wlietlier it wa-s jHissiblc I mt
a human Ixidv could remain so long o tune as lb months in water witliou
being totallv destroved and further whether the action of water would not
increase the bulk of the Ixidv so as to make a new bom child appear wnie
weeks old The answers to these qucsUoiiswcre (1) tint a dcid human Ikh v
submerged is not ncccssanlv destroved in 18 months and in referents o
this ease it apjiears probable from the description that the liodj had liccn

siMUhiTJo\ 01 PM CIh^^aI■^ 2ir

immersed for i% lonpcr period (2) Unt jn Uio t-irh st iges of gaseous putre-
fiulion the I)od\ nn\ oppe ir lnrj.tr from gaseous dislci sum but ngc could
best be decided from tbt state of flic ossitic centres There ssere no datn to
detcrnuiK whttlier the cJiiid had liecn plated in the water Itsiiig or dead

The following is n rctnarhnhle instance of the effects of water on the human
bod\ after submersion for tbe long period of 26 jtars

A healths muscular man iige<l 24 fell into titc shaft f f a mine 100 feet deep,
of sshicli 180 feet wnsislwl of ssaler eflorts to recoser the bods s\« n unsucecssriil
ilie sh ift ssas tlosed ostr for 26 3 cars sslaii working sv is rcstimtd liie skeleton of
the missing miner ssith portions of tlie clothes ssliicli he ssort sms discos end m one
ff the Icseis, m whitli then wassiatcr Tlieremsins ns well as tlie clothes buttons
and boots found on the skeleton sscre identilicd 1»3 his hrnthcr Ml the soft parts
ssith therxccplioii of a smdl piece of fatl3 sulistance sscre destrosul but the bones
ssere linn in I svcll prefers cd There ssas no muscle ten ion ligament or cseii
cnrtilj„< about nils of them Hies were 'll! slot iclitii from the joints and sscre of a
ilirts Imiwaiish or almost black colour Tliere was nothing m the sratcr calculated
cither to destr03 the soft parts or preserse the bones (t id( the case of the Tolland
nnn huried in a peaty sc il for 2 04)0 3e«rs (p It)}

V precise opinion is not infre<pientl3 required of a nicchcnl ssitiicss respect
ing tlu prohahle period at ssliieli death has taken place from drowning ns
u{)on the rcc'o\er3 of unulenlificd persons or of suicides last seen on giscn
dates In the case of /f t ll Afhuay if iKtainc a sital part of the cii-sc for tlie
Crown to sns at sshat finur tlie sictim jnst rccoscred had died and on wlmt
(lay tlK. second (i tile p 172}

Post'inorteni Conditions SimuJntJnji Disease,

Poisoning or Injur>

lincf reference to some of these Ins alronils been inailc in the ss-sleiimtic
description of mortein changes —

(0) 113 postnses (p 17d) sitmilnting bruising or inflnnmmtion or poisnning
(p 174)

(h) Jlkbbing of the culicic (p 18S) simulnlmg scalds and burns

(c) Swelling' detaclinicnt or sphlling «l the skin simulating injur)

(n) H3postatIc stains m the skin arc often pntch\ m their dcielopment
and Idas thus cause local discoloiirnlion simulating bruising and requiring
incision for their differentiation In Imdics hanging for some hours the liniuls
and feet nn\ become i»rofoundI\ discolourcil Gn the hands and feet the
colour of the uitirosscous inuseks mn) cause n similar uiicertaintN Incision
it omc makes it clear whether or not then, has been an cscoi>c and inriltnlion
of blood into the tissues for this lias n distribution outsule the \esscls and
docs not iJdjh jjwa> upon inosion Liixhiv larks the atlema of inflamnnlioii
md (iiiiscs no swelling of the parts if there were doubt nucrosc-op) will
settle tlic issue

Jljpostnsis m the stomiuh or Imwel is more often a source of ptrplc\it\ or
error In dead bodies \unous diseoloiirolions take place 111 the stomach and
liowcls often elosel) simulating the cfkcls of |>oison

One tf the mithors was calleii to 3\otfonl to esnnime (at M>con I nutoiiij) tl»c
Ihm 1\ t f a mna siisjxcted to have been poisoneil b) his wife (with whim he was
known to on bn/l terms) The nason for tins suspicion was (o) tliat lie Imtl ilietl
imcxiH.ct«llv 111 tvcil at honu after complaining of pdn in tJie up|>cr nlidomen
(t») the loetjis of Imwel 1310^ in tlw jkIvis wen. aer) mueh reddened In comparison

TIMLOrDLATII

sterriiim the cuticle of the hinds and feel perfectb ivliite and becorniiirr
raised in folds ^hout a month —Face ol i reddish brown colour, evelids mid
bps green a reddish brown patch surrounded bv a green border on the fort
part of the chest, the cuticle of the hands ind feet w-hite thickened and
corrugated About tuo months -hace bronnisli coloured and swollen the
liair becoming loose the cuticle of the hands nml feet in great part detached
the mils still adherent Tu-a months and a half -Lntnle and nails of the
lingers detaclied the cuticle of the feet detached but the mils stiH adherent

partial saponification of the cheeks iiid chill superficial m tlu breasts groins
and fore part of the thighs Threi months and a half —Destruction of part of the
scilp esehds and nose, partial sipomlit ilioiiofthc face and the uppir part of
the neck nnd groins destructionortlieskmiiidifrcfent p irtsof the bmlv cuticle

of the hands and feet as well as the nails cntirch detaclied rmr and a half
manlfis —Almost complete saponificitmn of the fatts part of the face neck,
groins and fore p irt of the thighs the appeirnnte of a tdlcarcous incrustation*
or deposit on the thighs opalescent condition of ncarls the whole of the skin
destruction nnd remosal of the hairs scalp the bones of the skull laid bare
nnd beginning to become brittle Tlierc arc no data to gi\ e e\ en a|>pro\irnate
opinions for a longer period than tins In subjects drowned during spring
and summer these cliaiiges take place at rates about three and si\ times ns
rapid respectnelj \t the height of summer the bodj will doit ittwodajs
and bloat m three

In attempting to fix the time of death from the extent of destruLtion of
the parts a pathologist must remember that crabs eels etc attack the bod^
within an hour or so of immersion, and max remoxe most of the exposed
soft parte in a few hours Jletow the “snlldixidc of the Thames bodies
are seldom found after the first two dajs hue ehpscd
In those who are drowned during winter and wliose bodies nnnin long
below the surface or are covcrwl with mnd so as to present free acl<^s of
air decomposition takes place slowh and crob digestion is less nctixc

A man found in the sea off Portobello after J2 WTeks inuncrsion showeil tht skin
fairlj intact but loose and discolourwl distension of the abdomen nnd a fairlj good
state of preservation of the internal organs In the 1 <idv of n mnii iimnerswl f if fis e
monttis in the sea the cheeks and remains of the scalp were tennshmicl into
adipooere but the rest of the bo<Ij s»as practicalh intact

A man aged “O svas missing from Januirj feth to Icbrunrv -fth fb'' bod\
was found in a riser and there was reason to bchese that lie fell in and w is drowned
on tlie dav when he svas last seen TIic head neck an I a portion of the ( best where
wwwTOXetAeA bx e\otbswg v.awt.Uv(!:kl\ covered wstU mud XVlicn tins was rcnioscd
the features were pcrfectlj recognisable and although 28 class had ehpserl Idcnti
ficatinn was eas) The onlj changes observed ssere as follows Tlie euticic peeled
asras from the cutis svhen slight fnction or pressure ssas mule oser Ihow parts
sThieh had been eosered ssitli mud The face and neck svere somewhat ilarkcncd In
colour and the front part of the chest ssas marked ssatli slight lines of hsi hts
The thickened skin of the hands and feet ssere corrugated and whitened l^y lon„
continued immersion but remained firmh adherent to the tissues beneath it

Taj lor had once to decide in reference to a woman delivered of a child
18 months presiouslj and suspected of murder svhctiicr it was possihic that
a human bodj conld reniam so Jong a time as 18 months in water without
being totalh destroxed and further xvliether the action of water would not
increase the bulk of the bodx, so as to make a new boni child appear some
weeks old The answers to these questions were (1) tint a dead hum in hi dj
submerged is not necessarilj dcstroxecl m 1« months and in refereme to
(his ease, it appears probable from Uie description that the body liad hetii

217

snnLiTio\ orP3/ cii t^GEs

iiiitiK-tNttl for a loiigtr jitnod (2) thil in llic c irh st ipcs of pnscoxis putle-
fHctioti IIh «m\ appear larger from gaseous distcnsioii but age could

best be decided from the state of tlic ossiiic centres. Ihcrc s\cre no data to
detcrmiiit ^Iitther llie child had l>ecn plae«l in the Mater h\ing or dead

riie tollowing IS a rcniarhable instance of the cfTccts of Mater on the human
bod\ after submerMon for th( long periorl of J<i jc-ars

A licalths mtivcular man iig«! fell into tlie stiaR of a mine 3()0 feet deep,
of ninth 180 feet consisted of m iter eih rthio teemer the hods Mere tmsiicccssfu!

1 he shaft was rinsed o\er for 2ft vtairn m1k.ii norlaiig Mas resumed The skeleton of
the missing miner, svith port ions of the clothes ttlncli he More mhs disrovTrcd m one
o/fhe/esefs rn fhcft owswatcr Tfieremams ns «eWns f/iecftitfies inffons

and hoots found on the skeleton, Mere identified by his brother \ll the soft parts,
Mnththc csccjitiun of a small pieceof fiitv bultstnnoc Mere destrnstd but the bones
Mcn firm and mcH prestned There wis no muscle tendon ligament or csen
cartilage nljout an\ ofthein Thes Memitl defacliet! from the joints andMereofn
dirts hroMaitsh or nlmi st hhek colour There mos nothing in the water calculated
either to dcstrov the snft parts or presersc the bones (tarfe the case of the lolluml
man, buried in a peatv soil for 2 0i)0 j*. irs (p 5t) )

V precise opinion is not iiirrecpictitK reqiiiml of a medical Mitness respect
mg the probable period at Mhich death has lihcn place from dmivimig ns
U|wm the rtcoscrj of miidcntifieil persons or of suicides last seen on given
dales In the ease of /? \ n/<ih-t«y u liccaine a vit d part of the ease for tlie
CroMii to su at Mjiat hour the victini just rcc-ovcred Imd ilietl and on Mhnt
liny tlK* second (tide p 172)

Post-mortem Conditions Simulating Disease,

Poisoning or Injury

Uncf refereme to some of those has nirendv been made in the svslematic
description of post iiwrlrin changes —

(ft) II\i>ostases (p 173) simulating bniismg or inllamm ition or poisoning
(P 171)

{//} lilebhing of the cuticle (p iRS) simulating scalds ami burns

(c) SMtlling' detachnunt or sphtliiig of the skin simulating mjurv

(a) Hypostatic stains in the skin arc often jwitcliv in tlicir development
and iimv thus tniisc local ihscoloijmtion simulntiiig bruising— and requmng
mcisiun for tlicir (hfrcrcntiatinn In bodies hanging for some hours the hands
and feet may become profoumllv discoloured On the hands and feet tlie
colour of tlic interosseous inusilo nnv cause a similar unctrtaintv Incision
at once makes it clear m Ik liter or not there has liccii an escape and infiltration
of blood into the tissues for this Jms n distribution outside the vessels and
docs not ilram avvav upon incision Iividitv lacks the cwleiim of mflammation
and <nuscs no swelling of the parts if there were doubt microscopy Mill
sttlk tlic issue

IIv jxislnsis in the stomacli or Ixiwcl i> more often a source of jierplevity or
error In dead liodics various diseolouralioiis lake plate m the stomach and
IhjmcN often iloselv smiulatmg the effects of jxiison

One of II e uuthors was calleil to Watford to evanune (at second autopsy) the
l»xlv I f a man siisjKo.ted to Imvi b(>c‘n fwisoncd by his wife (with whom he was
kMJUti btfl lentil} ’liee resMin Airf/us suspicion nas(a/ Chat he fiad cfieti

uacs;|>«1e«Uv la Ik-sI at hninc after complaining of jjam In the upper abdumcn,
(h) the loops of IkimcI bmg in the peliu were very much redikned in conipanson

21 SniVLATIO\ OF P CI{A\GES

will tlieollicr inrt5< rtlielwwcl Tlc\wcrc in fart »>erelj tiircid from Ii\-nostis >,

Autopsj rescaled a coronar\ tlirombosts— aiidamljms ^as ncgntne

Tlie mucous merubnnc of the stomach nia\ \ irr m colour from a red
broun bcoomiiy a brighter red b\ exiKWurc to the air to a deep niirpJc or
slate colour and sometimes black from decomposition of the 1 lord \t tin.
points where the stomach is m contact with the spleen or Incr the Inichh is
often well marked and clearlv denned through all the coats These spon
taneous changes which are the result of piitrefnition ma\ be casih mistaken
for the elTects of irritant poisoning There are no rules tint will alwavs
enable a medical jurist to distinguish sucli cases Miidi must (Upend on the
period after death at which the bodv is examined and cspetialli on tlic
experience and acumen of the pathologist We n aj presume that the redness
has taken place during life and is not a result oZ j ost inoAevi rliangcs (I)
w hen it IS seen soon after death (2) when it is met wath m parts not dependent
norm contact with other organs gorged willi hloo 1 (3) when it is accompanied
b\ a considerable clTtision of coagulated blood mucus or Hakes of hinpli
the result of ulceration corrosion or dcstniction of the coats of the s iscora
(4) if decomposition lias not advanced too far an cflort mav be made to
strip off the mucous membrane of the stomac! if it separates rcaihlv this
Is suggestive of irritant poison Jf death has been preeeded b> severe
vomiting from any cause small submucous liaanorrhages mav sometimes be
seen so tint tlieir presence is not neccssarilj indicative of an administered
poison When tlie hodv is not inspected until a long period after death it is
difficult to distinguish these pseudo morbid aj pearances from those depend
ing on the action of irritant jioison In a realh d mbtful case it is therefore
better to watliold an opinion and indulge in analvsis for sccuritv

It must be remembered that the contents of the stomach mav he of more
importance than its ooiuhtion If tl e irritation is due to mineral irritants
It is practical!) certain that traces of the substance will remain \ee,etable
irritants (bits of leaves berries flowers etc) are likeK to be recpgm*ed
though naturaffs liquid preparations of irritants of anv Ajnf mav have
disappearijd

It IS impossible to assign a definite tunc at wl lol tlie effects pnxliieed bv
irritant poisons are dcstrov ed bv the process of putrefaction On one occasion
the effects of arsenic on the mu<x>iis membrane of the stomach were dis
tinguishable in the case of a child nbose bodv Ji «d been inlcrred for n pcriol
of iS da)S and in two other cases in which the viscera were well prexerved
the) were so after a vear gnd 19 motiUis rcsjiectiv el\ Of course when the
inflammation is only slight its results will be mu( h more sj eedil) obliterated
or merge m the redness caused b) decomposition

Again melanosis in the stom icJi — i e o dcjiosit of black colouring matter
beneath tl e mucous coat — might be mistaken for tlie effect of sulphuric or
oxalic acid or caustic alkalies but meJanosis is unaccompanied h\ an) marks

of inllamniation corrosion or destruction in the mucous membrane benea i

and it IS alwajs seen in well defined spots

(h) Blebs found on the cuticle due to pulrefaclion are alwavs accompanied
h\ a charactcnstic purple or gr<?en colour wlueh distinguid sue i j in r cm

blisters from those due to the application of heat m life Manv vases arc seen

especialK in tLeelderlj n licre bottles applicil nt tlie cnil orlife eniise leilileiimg
Hid simple pink blistering Micioscopj iiiU dislin.insh the Mfil eel ihr
tinneter of nn inHamnntoi^ or trmmabc lesion lutitliiaj tic txceedin^Il

snmAJio\ oi PM r//^iNcrs nt

(ItflicuU to till lu)\\ lon^r htforc donth tlie\ ncrc snstnincd Coiupnntnch
slight lie it %m 1I cause blisterin" iii those sslic sc cm ulntiim is fading who ln\c
|>cri|)hcml \ asciilar st-isis nrul whose lapillnncs arc nlnacls sii(Ti.niig siiboMC

(c) Swelling nncl discolouration from decomp >sitit)n is often inistat^cn
f ir injure The cjtlitU or fact inn\ swell discolour n jiurple or hliic hlnck
imd look pulT> ns if thee had Iwcn bruised The lips nine thicken and d s
toll iir in tl c snnic wnj nnd eeheii blclis nre formed nnd dclaihmcat of the
tutitlc oitiirs the danger of confusion is teen greater Incision is still the
lest immediate test — and microscope tie tiltimnte bisis for distinction
btleeecn ] ost mortci i chnngts nnd hniising

I/itcr the skm inaj soften brink down and tc ir with moeciiKiits of tlic
laxie Wlitre blood hns attumulated (ns in Hit i ijnit rc^ in i f the ficlns)
tills process iiiae be nettlcmtcd

aiAPTl R \7II

LEGAL PRESUMPTION OF
DEATH AND OP SURVIVORSHIP

Inassiucii ns a person lins been prcsumctl lo Iw dead nn\ }kasi1iI\
re.ippenr and r«iuirc identification tlicre is n certain proprietv m d ■sriissiiiy
tins subje-'t iindcr tlie gencnl beading of ‘ Death

Utliough the rnghsb Courts are called upon frequentU to deal s\ith
appheafions ansing out of the presumed death of persons who ha\e dis
appeared in \arious circumstances medical cMdeiice is rarely ntcessary
except in certain rare cases *

In cases where a missing person is shown prior (o disappearance to have
been sulTering from a serious disease which was llCclj to prove fatal in regard
to which he mav hare received medical advue tcstimonv bv medical vut
nesses might assist the Court in coming to a conclusion bv showing tlie stage
to which the disease had advanced and the probabilitj of its causing death
within a certain period No general rules to govern such cases can be laid
down each case must depend upon the circumstances whicJi accompanv
It

The presumption of death after the expiration of sev en \ ears from the date
when the missing person was last beard of is the general rule of law * In the
Probate Court where such applications arc frequent this rule is not rcco^
ntzcil as nbsolutciv binding

The Probate Court does not presume the death of the allcgetl deceased
hut after bearing the tacts mereh gives the appticant ?ea»c to aKcar for
the purpose of obtaining probate or letters of administration that the
deceased died on or since a certain date

Cases have occurred wliere the presiiincil deceased has returned otter tlie
Court s decision granting leave to swear his or Jicr dtatli The following is a
case in jKiijit

\n application w is ina<lc for the rc^isvion of on onler ma le on ainrcJi 28tti
}!tOi for lesi'e to presume the tleath of EiXen look TJic ease Ii 1 1 been reported
in Uie press and bail in this wav been brought to the notice of rilcn Cook wl o
since her disappearance 20 sears presvously liad been married again to a man
namcil Atherlev svitti sriiom she had lieen living at I pper Sutton Street, \slon
Manor Birmingham Mrs Atherlev communicated watli tlie solicitors concerned
Subsequently she was identified by lierniccc Mrs ThcmasBeck niidbv aMr» OJivc
Beck No grant of administration had been made tinder the order as the fact tli it
Mrs Atl ertey was alive liad been ascctlamed before tlicrc was tune f r such grant
to be made

Tlie President of the Probate Court liaving considered the cvideine sai I tJiat
tie was satisfied as to the identilv of Mrs \therley and lie acconlingly rescindctl
the order of March 2Sth lOO#

• E.S to prove that a g rl of 10 d ed unmarried amt v llho It i« le to r rove tliat nwon an
wosawidow to defend a cliargeof bigamv to obtain a legaev to o! tarn in<urnnce monev

* If it be alleged tl at a pereon was as a nutter of Cict aj vc on nnvfcwcn djv m tl ose
seven vean jt is incumbent upon the one wl o makes tl e allegation to prove tl c fact I v
positive evidence

2^

pIiI:suMPTIo^ OF svnvivoiisiiip 221

Dunng mid after a ^var there are manj applications to the Court for lea\e
to presume the death of senire men (and sometimes cuihans) reported ns
‘missing’ Before making the desired order the Probate Court alwoiS
required cogent eiidence concerning the moiements of the presumed
tleceased The disinclination of the Court to make such an order iMtliout
strong e\ndence has been justified In the fact that manj persons reported
as ‘ missing but believed to be dead , have been ascertained subsequently
to have been taken prisoners of war

PRESUMPTION OF SURVIVORSHIP
Since 1st January, 1026 the law as to survivorshij) uhere death tnf.es place
in a common calamity ( commonente ^' ) has been revolutionized for by the
I avv of Property Act 1025 s 184 it is cnacteil that in all cases vvliere two
or more persons liave died m circumstances (such as sliipwreck battle
earthquake or motor car collision) which render it uncertain which of tlieni
survived the other or others such deaths shall (subject to am order of tlie
court) for all purposes affecting the title to propertj be presumed to have
occurred in order of seniority and accordingly the jounger shall be deemed
to have survived the elder

This enactment renders obsolete the decision in the old case of Ting v
/tii^iaie *

Direct Evidence of Survivorship This if reliable is obviously the
strongest cv idence which can be given
Provided there is some direct evidence a verv small amount of proof is
required for surv ivorship

A father and son were entitled to land as joint tenants Both father and son
were luingcd at the same time m one cart but becau«e Die son ns deposed to hj
some of the witnesses survived, as appeared bv the slinking of his legs and probnblv
some other tokens, the wife was itcld entitled to an interest in the land to which she
woufd not ofherwase have been entitled
The following case occurred m America

Hugh Swinton Bill with his wife ami adopted daughter was lost on board
the steamer Piila^Kc on the coast of \menca B> his will Ball bequeathctl his
propertj to his vnfe and a claim was made bj her heirs on the ground that she
had survived her hiishand It seems Uiat an e'q>l'’vu)n took place on boanl the
steamer at eleven o clock at night and that husband and vnfe were at the time
m different parts of the vessel and were thus separated from each otliir Mr Ball
was not seen after the cNpfosion and although he perished with inanv others the
precise time at which he died could not lie determined Mrs Ball was seen after the
cvplosion rushing m o terrified manner about the detk calling for her husband
hut no reply was mode She w-os soon afterwards missed the promenade deck to
which she had retreated having been submcripid with herself and all who were on
it. Clianccllor Johnson before whom the case was arguctl said that it was a cose
to be decided bj testimonj and as the nglit on the part of Mrs Ball was dcriv ative,
the burden was on the plaintiffs to prove tliat slic was the survivor llie evidence
regarding the non appearance of Ball when had he been living tl ere was sulficicnt
time fori im to have shown himself with others on deck and to line ma le nn cITorl
to join his vnfe was consideretl bv tlic Chancellor to be conclusive of his death at
the time that the wife was seen and recognised bv minj who knew 1 er On these con
siderations he decided m fav our of the plaintiffs that the wife survived the husl and
and therefore she succeeded to lus estate. On appeal this decis on w-ns tonfimied
This case is pecuhnr in that the wife alone was seen liv ing and tlic imture
of tiie attulent was such ns to render it pmbihlc that the luisbnnd had
>8 11 L C 283

I'liLSVMPlIOS 01 SUIlMXOhSUIV
peri?Ijefl in the e\p]osion The counsel for the <?cfendnii(s ingcniousfj ir„nit(l
that ns tlie death of the ^\lfe could be fixed whereas tint of the Iiusband
could not be fixed it was fair to assume that she died first but this ar^ii
nient failed to satisf\ theCourt Tlieplaintinsweretiotre<inircdtop osewhen
the husband die<l lhe\ estabhshed suflicicnt to render it probable that the
^v^^e was tlie suraaior

For a case where the medical esidcnce of survnorslup in an aeroplane
smash was lield to be inconclusive Hee Lancet 10 ’C I oi5

laJlickmanv iVnc/ ey (lOt ,) 1\ N 153 tl e House of I ortls held ll at wl ere
tlie es idence w as mconclusn c the statutory presumption appl c 1

Death of Mother and Child in Parturition I or a case w here a husband
and a wife were kilkil bj an cxplosuc Ixniib during an air riid where tl e
evidence was not suIRticnt to rebut the statiiLorv presumption see In re
Liiidop ^

On tJj s subject Tid} wrote os follows* —

Death by Pari irittnn If a moll er and cliild botli die in chtldbeil without
watnesses the presumption is tint the mother survived the child For
first there is a priina facte probnbilit> ol the child being still Iwrn and that
a woman in childbed without atlciilion or attendance will be unable to
render her child the assistance necessarv for its preseriation ^/vorilJij a
large child or marks of a dillicult labour or the absence of the signs of
respiration would suggest the death of the child as occurring before that
of the motlier Thus from both points of view the presumption of sur\ i\ or
ship in those rare eases where moll er and cliihl both die is in favour of tlie
mother

agree with most medical jurists tint tliosc who assert that the child
survived the mother should be rcQUirod to adduce dchnitc evidence ol their
contention At the same time it must be remembered that although the
cluld may die from cold or from sufibcotion or from its be ng of unusual
size or from protiacted labour or from labour comj licatetl vnth eonv ulsions
or from pressure on the umbilRal cord or from partial detacliinent of the
placenta and other causes nevertheless the mother runs the risk (and that
risk a verj dangerous one) of lixmorrliage \gain it is quite conceivable
tliat a mother might give birth to a child and herself fie the cord and then
<lie of sjncojie irom the c\jiaii>l»on conscijucnl on the efiort wlcrcns the
child would be temporanlj safe

*[l«M2]a V"

* Leg Med p S J

CIU1»TIR 1\

WOUNDS AND OFFCNCCS AGAINST THE PERSON

Tfir fr^.qticrIC^ of Hic \nnotis mdict iMe offences tJnt unolvc mjtin to
the person ind ^\}llell tomprisc the Mihst iiite of the following; sodions is
reHectecl h\ the inmiml statistics of Fn^lantl nnil \\ nlcs

Table I

Om sers Ao-msst tuf Pmsos (JO *1) { W ics nti i Quirler VsMnnt)

Off jirri ItNifr ( 1 otirr

Mur Jer

IV

r«

aUenij 1 to murder

1. 1

Msiwhu^litcr

1S>

80

Infanticide

.ft

18

Cl I’l I)c«tniction

_

I ilonlotis woiiii tln^

•|H|

1U

Mai oous wotui tin^

.»in

UH

\ssiult

hi

Crucll) to eltil Iren

Jh

at anilonm^ (imdir two > c irs)

.1

1

I miirinj. &l>orncn

SM

^1

Coiicealmctit of birtli

31

10

I nri itnml olTifKrs

'00

1-t

nttcini ta nt ditto

LlOt

1.8

Iiideecti^ with n nlcs

)f*3

'»)

UllJK

U\.

In iceent altcinj tsoii fmtul -s

'017

4A

Defilm vnt ofgirh itiiler 11

-►11

“0

r Itt

£501

_

a 1

It)

J

This InhU iiieuh (fi'ts a (,(ncml id< » of the inliire of tin nion lominou
offtners jyiDDst tJic person The spii ml jhnmttrr of tertani of liitst cjj m
ciiics of nifanfirKie anil nlwirtion ripi ami othtr sc\ olTentts will lie con
fulcml m detail under the appropriate litndin^ hut in Iht set lions a Inch
follow below we slinil coiiCLni oiirschcs more willi the lulurc ami cliariutcr
of injuries in ociicr d and with the proptr iiitcrprelntion of wounds of all
kinds liowc\<Tlhc\ mat have liecii infti<.tc<l

It IS eltar Hint olfeiKcs of such widch thfiirijijj uiiturc must include grtnt
V intlion in hoth the sourct and eharittcr of tht injuries siistnimal Ihcv
lunv lit inthitod with width diffeniit instruments in an inhnitv of wavs
imv }>c Mifxrficj i) ptnctratiii" or thsinte^rilinjj to the tissues involvtsl anil
dctmuul a consi<Uratiou of ccriniii j^iicrd pnutiplcs befort, csaimintion of
their detail

The th iraelcrs of an injurv caused liv sonit tucthanti“d fnrrt an th jnndeiit
ujHin -

1 Ihc inliirt and shnpt of tin weiptui
J The iniotinl of riicryv nap irtetl to the IkmU
^ £Tt

^^OV^DS STiTJSTKS

J It IS mllittcd a moving or a fixed bwh

4 The nature of the tissues insohed

The consequences of an injur\ from some mcclnmcnl force depend largely
on its \iolence the length of time it operiles and the t ssiies injured The
destructiye energy liberated when a inosing bo<ly is suddenly brought to
rest IS expressed bj the formula M\ * where ^f— mass and ^ — yelocity of the
i

object The mechanics of impact is explored m later sections but it must
be clear from this formula that tlic Velocity is much more mipirtant timn
the weight of the yyeapon used

^^e shall discuss m some detail m the sections dealing with the Cause of
Death in W oiinds the consequences of the inllietion of injury to the tissues

FscL-ssn Asn Malts

1>* STIK TROJf \CCfnE.STAL AHU StlCmtL CaLsLS IOjS
hto tllfltfpslriT(eteraltSlalutfalHeCinecifi-tgli ii iJ irnfc*
{Toblfs I otl I MrJ ralf

Co tr of 1 Jor}f

itidf

M

r

M

P

Total (all Injuries)

0017

OIaSO

30 (1

irj4

Motor y el icle

otl er trwnsnort

800

aj

tails

Mail Inerj

107

5

1 ailing object

•MO

tire eq los on

"10

104

rirenmis

87

Heat — or cold

II ineer exposure

Ct obing — food

40

•Po soning

42S

4-4

1C03

' 7 ‘ 1

Hang ng «trang1 ng

C ittmg and stabbing

Precipitation (see fall )
a ariotis other causes

4IU

•»!M

110

Jl!

* Scr tal S 1 II

Reference to Table II detailing the Registrar General s statistics of injury
by cause (in accident and suicide) shows further tbeyanet> of instniment
and other causes for injury— adding more than mere mechamcal factors
to their potential for harm and indicating a yyide feld of enquiry and stu y
which we must now discuss at length

GENERA!- WOUNDS
Legal Considerations

Offences against the Person 4ct 1801

Definition ofa Uouod—Bnuse— Abrasion— Lacemted Mound Incisec

Mound— Stab or Punctured Mound— Effusion , . „

M capons — ^Nevfer defiralMm bj Preycwtiow of Crime Act •>

Gnevous Boddy Harm

^^oa^^DS

225

Wounds

Points to be Noted in all ^^olmds p 228

la t!ie ound dangerous to Life? p 230

Is It, if not immedialelj dangerous, likeK to !ea%’e Permanent Injury’
p 230

as Wounding tlie cause of death (a) directly, or (b) mclireetlv ? p 231
Age of ^\ound!> p 240

\\ ith wliat capon or how was it Inflicted* p 248
W as It Inflicted before or after Deatli? p 2C1

Ifow long did the Victim survise? Wiat faculties might be retained?
p 2(>)

Accident, Suicide, or Homicide? p 271
Atounds of Special Regions p 801
Feigned or Self Inflicted Uounds p 330

LEGAL CONSIDERATIONS

Oirences against the Person Act, 1801 Sect 11 however shall by any
vieans nhalsoeier tcound or cause any gnevous bodily harm to any person utlh
ifihtit i6 commit murder shall be gnilly of felony '

Sect 18 "Whosoeier shall wilaicfuUy and maliciously by any means tchat
saner uoiind or cause any grieions bodily harm to any person or shoot at any
person, or, by dra ctng a trigger or tn any other manner, attempt to discharge
any kind of loaded arms at any person with ttUent, an any of the eases aforesaid
to maim disfigure, or disable any person or to do some other gneious bodily
harm to any person shall be guitty of felony ”

Scot 20 "Whosoever shall unlawfully and maliciously wound or infitct any
gneious bodily harm upon any other person either with or without any weapon
or instrument shall be guilty of a misdemeanour ”

Definition of a Wound The preamble to tiie Offences against the Person
Act 1801, states tint, ‘ it is advisable to consolidate and amend the hvv
relating to olTences against the person” The Act contains no definition of n
wound but it has been held that, to constitute a wound witluntlie statute, tiie
contimiitj of the shin must be broken, the outer covering of the bodj, not
merelj the cuticle, must be severed* This plainij cannot hold A division
of the internal shin — e g , vvitiim the check or lip — is sufficient to constitute
a wound within the statute,* but it is not sufficient to prove merely that
a How of blood was caused *

1 jaw.wdfj* de&niioa, cspol'le of gcseesl test /s a as a ^nfjnn nf

the natural contmuitv of nnj of the tissues of the living bodj

This definition expresslj omits—

(1) Any reference to the effusion of blood, for it is quite possible either
to wound or to cause grievous bodily iiarm to a person without causing the
effusion of blood A wound of the cornea of the eye, for example, may result
even in death witliout spilling of blood, and, in ordinary medical parlance,
we speak of abrasions and injuries of the cornea as wounds of the cornea
(t ide supra)

(2) Any allusion to tlie skin being severed Wh^ should the skin be tlie
only tissue m the body the laceration of which constitutes a wound, when in
ordinary ineilical conversation one is constantly referring to wounds of tiie
liver, of the spleen, of the intestines, etc?

V7? V At LowgWin, 8 C. A. r CM
*7? V 5m«rA,8C.&P 173
*Jiy Jones, 3 Cos C.C. 441

2-R I)flIMTIO\ or UOUM)^

{■}) \iu olliision to the nature of the tissue dTiingcil A\Ii\ sliould t
fractured bone or a ihsloiated joint not he ti ssoiuid’

(■t) Aiu nllusion to the cause of the solution of continmlc, disease pro
diiocs Hounds ns casih as n knife though not by tlic siimc process
The o\ erw helming nds antages of the definition arc tint it includes bruises
tiic effects of bums from fire and heat on<l clcctncits the effects of anv
corrosne luiuid or solid all lacerations and bruises of internal organs and
tissues it presents nnj possible quibble nbofit the skin being or not being
sescred it makes no reference to boss or by what means produced it is short
and simple and is constantly being used in profession/)! disciissu ns in relation
to all organs it assuredl\ includes all dislocations of joints and fractures of
bones and rightly so for they m turn iiiclude some of the most severe injuries
and grievous harm tliat can be done

If it be objected that the law did not intend to mehide slight seratclies
from finger nails pm pricks and trivial vvoimds of this description it may
be retortid from a medical point of view, that many of these and especially
small punotured v omuls from a septic or dirt\ instrument are more danger
oils to life than many open wounds

Having thus defined a Hound in genera! terms it is nccessarv to define
the various kinds of injuries that inav be sustained

A Brufse or Contusion is a blunt uound crushing blood vessels so that
blood IS cfTiiscd from the rupture of the vessel and js unable to escape frcelv
from the surface cither of the severed skm or of tlie injured organ In the
ease of tissues sueh as the eoniea of the eve or the cartilages of bone which
liavc no blood vessels a bruise niav Iw siinilarK defined as a enisliing of the
tissues without bleeding In common language the terms bruise and bniising
gencralh refer to the bloo<i whicli is efTiised m consequence of the ruj)tiire
of a vessel or vessels or to the change in the tissues amongst Hhith th s blood
has spread they have no reference to the injurv whith caused Uic eltusion
to develop •

A Graze or Abrasion is a superficial injury to the skin sucli scratches
or scraping injuries bleed but sliglillv as a rule and heal readily Their
importance lies m the fact Uiat llicv ire usually corroborative of violence
as for example m strangulation or rape m vehicular street accidents and the
like

A 'Lacerated ^'Vou^d is a wound Vne edgi2» vA i.VivtViMt wvl wit

clean cut This term usually refers to injuries from blunt instruments m
which the tissues are split open — often against bone

An Incised Wound is a clean cut through the tissues usualh skin
and underlvmg connective tissues— including their blood vessels Jjlooil
escapes fretlv through the wound to the surface Incised wounds have
greater length than depth often tending to gape

A Stabbed or Punctured ^^ound is one m which the depth (measured
from the surface of the wound) is great in proportion to l ie eng i o le
entry wound These are penetrating wounds often bleeding freclv interna y
Extravasation or Effusion Inasmuch as these two words are frequently
used by medical men in describing injuries it is well to draw attention o
their meanings In our present connection thev both mean the same thing
V ,z a pouring out and they are applied to the outi ourmg of blood amongst

DE1IMTI0\ Olr \\OV\DS 2 Jr

tlic tissue!) s\Iueli follows a solution of pontinuitv of a blood vessel Custoui
has to some extentlimited the me of effusion to a pounng out of blood into
anaturalcavitylikcthepleiirilsacorajoint cn\it\ Yen small outpoiinn"s

tic 21 Kn Te st lb ^ro md showing (left) the s I tare 1 Intck m t (ri„l 1) the
fcliarp i 1 1 le mark of n sin»le-e<l"e ! kn le

of blood— mere spotk ot blectlm^ \ce sjwjkeii oC as ecchjmoses For
instance the httle spots of escaped blooil bencatli the pleura in aspln via
are common!) spoken of as ecclunmoses or ecchtmoseil spots (often dso
called petechia) It is advisable fora medical witness to use these terms
with great care m giving evidence and use the term hmise onl) when
he wishes to mchcate that bloo<l has escaped into the tissues ns the result of
violence The subject of ecchvmoses is discussed in full both m the section
on shock (p 284) and m that on asplijvia (p 438)

What are ^\eapons* Those legal doubts which formcrlj niose ui reference
to the true signification of the term nfojMw have been nmoved In statute
Thus the teeth the uncovered hands or feet were formcrlv lield hv the
judges noi to be weapons and injuries produced bj tliein however severe
were not treated as wounds within the meaning of the statute Parties were
tried on charges of biting off fingers ami noses and nltlioiigh the medical
evidence proved that wounds of a severe kind liad been thus inllicted the
jiersons charged vvere acquitted under an indictment for wounding since
woniids in a legal sense could be prcKhiccd oiil) bv weapons Such assaults
would now be dealt with as eases of grievous Iwclilj harm

During a trial some 5 cars ago the prisoner s counsel claimed for artificial arms and
legs the same privilege of exemption that was accowled to natunil arms and legs
It wws argued that n wooden arm with nn Iron hook at the end of it w ilh which an
assault svcis committed had become bj long use part of tlic bodj of the prisoner
nod Umt like a natural arm it ought not to l»c consideretl a wx ipon in law buttlic
contention was disallowed

Fxcept in so fir as the deliberate use of a weapon maj indicate nn intent
to inflict n greater nmoiint of personal mjurv such questions as these cannot
now arise

Tlie vanetv of articles that ma\ be put to use as weapons is of course
t^uile vs ilhovit limit No statvitorv definition has been attempted but the lavs
1ms m the Prevention of Crime \cf 1953 prolubitedthecarrvingof ofTcnsivc
weapons without lawful fluthontj or reasonable excuse Ifhas m Sect 1 4
gone so far as to sa\ that olTcnsive weaimn am article made or adapted
for Use for causing injurj to the person or intended bv the person hav mg it
with him foi such use bv him

Grievous Bodily Harm \4ith such n comprehciisne def nition of a

wound tlicrcisvery little positivcground left f>r tliese words to cover fhev
might include shocks from elettncity which did not burn tight ligatures

FFATURFS OF \WmDS 229

5 Tortign bodies attached or embedded— metal, glass hair dirt, etc
G Iltcmorrliage its amount md source
7 lnllamnntor\, reattion and healing processes

I ach of these maj he of ^ itnl importance tor dran ing accurate conclusions
silien a medical man ceases to be a common witness of fact, and commences
Ills more appropriate function of gning expert e\ ulence Lach wound must

I-io a rtgliteca slnli wounds mil ctrd in qiiHk succession into tl g d est
oser the hcan b> a double edgeil d'»''gcr with a 1 ineli wide Hole (luJf
si7c) The voriclv of wo ind caiKCil by sorsing ilej lli of j>eiietraticiit and
putiul witl dniwol os b> rocking also is well illustrutcd

1)0 described so that it can he accuntcl) localised and precise meT-surements
of the size depth, etc must inxannblj be taken V photograph or sketch
showing the position and size of the wounds i» desirable the usual medical
figotes for chnicnl mapping out arc too small in pmttice \ scale drawing, or
e\ cn natunl size tracing often helps to elucidate the issue

It IS impossible to impress loo strongls on tlie mind of a medical witness
that in describing the wounds sshich lie has found during the cxanimntion of
a bods he should use plain and simple language and as oul as much as possible
the use of tcclmical or professional terms The natural desire of a good
svitness IS to make himself understood but this cannot be accomplished jf
he expresses lus ideas m language which is incomprehensible even to educated
men ot the legal profession ami a Jorliori to tlic more oriimarj class oi men
who constitute juries lo employ plain and simple language in describing a
vsotind and its interpretation as well ns in giving evidence gtnerallj, is to
jirescnt the facts to the best interests of justice
In medicolegal reports on the examination of wounded persons care
should be token to avoid the introduction into the bodv of the report nn\
remarks m the form of inferences from or comments on the non medical
facts of the ease and even on the medical facts Comments ami inferences
should be carefullj separated from the facts At the trial of ITcLachlan tJie
Judge objected to the statements in the medical report tliat the body of
the deceased had been found tinder circumstances ot great suspicion’ and
‘ that there were marks of a severe conflict No meilical facts by which this
form of expressiAn could be jiistiited had arisen these were matters — as they
always are — wluch are best set down in a sujtplemcntary report or m answers
to specific questions

= ItHCTOl noV\DS

Js the ^^ou^d Dangerous to Life*

The menniOj: of the uords danfermf h life is left enlircli to the pro
fessional kiionle, fee o o uitncss H „ not siiHieient that, he sl.ould nuiU n
simple assertion Hint the uoiiml nas chogerous to life, he must be prepiiRil
to state to the court snlisfneton reasons for tins opinion nml tliese reasons
niiN ben^orousl^ Jnfiiiiml mfo In cnunM*! for the defence
IMnfxer to life pnnmnh depends upon lixmorrlwce sl.ock or damnPe to a
\ dal organ and sccondarih on tin clnncc of complications such as infection
leading to scptiCTnna p\ cmia tetanus or gas gangrene and of infection of
particular pirts or tissues— pneumonia plcuns\ empsema pericarditis,
meningitis or peritonitis or more remoteK to the effects of scarring
causing stricture (of the urethra u-sopliagus gut etc ) paralj-sis unnarv
mfcction etc

\s a general principle the court is likely to consider asMangerous to life
m a legal sense onlj those uounils m which the danger is imminent The
law appears to contemplate the more iiiiinediate rather tliaii the more remote
possible dangers If the last yies\ were held it is clear that the most tmial
laeernlions and punctures might lie ])ronounted dangerous tohte since tetanus
and other infections prtuing fatal ha\c resulted from \cr\ slight injuries
A difference ol opinion will often exist among the wciheal witnesses n/jethcr
a particular wound is or is not dangerous to life but after all iiimnimit\
can hardly be e\pcctc<l c\en when the judgment and e\pcncnee of the
witnesses arc equal The rules for forming an opinion m tJicse eases will
perhaps he best deduced from commonsense and fn>ni good surgical
authontics on injuries and tlieir risks to life

Is the Uound L(ke{> to Lease Permanent Injury*

The only connections m nhicli this question esn arise are either when
considering compensation m cases of accident or when a judge is ocmsidenng
svhal sentence ought to be passcil n|)on an assailant m cases of criminal injury
riie answer to tins question mas be obs ions m cases in winch there is actual
mimediate loss of e\e limb or member In otlier inst mees the possibility of
pemianont damage ma\ depend on llic nature of the wouiul and the possi
hilitj of such seijuels as sympathetic oplithahuia jwssilile gangrene fnmi
damage to vessels sesere injuries to ncr\cs amount of inflammation chances
of septic cniia cli

Semiring and Its cJTects proiluting yontmction keloid etc the cfrects on
muscles hones and joints leading to slifreiung and loss of function damage
to the central nersous S)-stem lending to immediate phvsital elTccts or to
ps^cliiatnc or other lesions less easy to trace to their origin and lowering of
the resistance of the tissues leading to secondarj diseases or to malignant
groivtlis must also he considcretl

^\ounds of the face yshen at all cxtcnsise are always folloyml m healing
bj greater or less disfigurement V m«lical yvitness may well be asked if the
yyound is likeK to result in blemish whether a yvound of the fnce could heal
yyithout disfigurement or yyhether the defacement or marring haye been
produced bv any cause other thin the wound’ These questions arc o impo
ance A. person may allege that he was wounded m the fate ayliereas the
doctor may fiml no trace of such a wound \gain a person may seek damages
m a CIV ll action on the ground that a particular ilefoniiit) yvns proiluced 1)}
a wound whereas the medical witness may be able to trace its origin to a
deyelopmental defect or to disease

i:rrncT or nous’ns 231

Was Wounding Responsible for Death?

Ill nlUnses where Mounds hive been cnmtnalK inflicted ami dentli ensues
n medical witness must lie most mpeful m Ins assessment of their contribution
to the cause of death

Xo man ought to he consiclcd upon mere medical probalnlitj As a rule
there is onl\ one principal cause of death, although other circumstances nn%
ha\e assisted m bnnging about a fatal result Hence it is essential when
scscral apparent causes for death tvist, to detenmne which was the principal
cause and. in stating it to the court, to i>c prepared to offer reasons for that
opinion In most cases of focaf injun when a person dies quickh. there
should be no dillicultj in detcmuning wlietlicr disease or the wound was
the cause of deatli Tliere may be dillicultj wlien a person wlio has recovereil
from the miti d effects of a avound subsequentK dies Desides tliere ma\ be
cases in which the cause of death m spite of the most careful consideration
IS still obscure, or sometimes it ma\ liappcn th it the death of a person appears
to be attributable ns much to bodilj disease ns to an injiirs prosed to base
been reccued at the time when he was suffeniig from disease How is an
opinion to be expressed in such a ease*

In 7? s Aih« (C C C tlie esadence showed that accused a sionian of Hii

s> hose husband Ia\ dsanjj of c-anc-er of the bowel, p ml him a s isit as he la> beJund
Screens in the hospital ward In the temporarj absence of nurses, slie took the pillow
from under his head and held it oscr |ik face. Iving on top of him she was pulled
from this position on the return of a nurse a few moments later and the patient was
found to Ijc still alive tie died three da>s Utcr and the esidenee of the doctors in
charge of the cisc — and of the pathologist making the nutopsv — vtos to the effect
that, though such an net might ointously be calculated to cause deatli, there troe no
eiidenee that it had caused immediate harm or contributed to the cause of death \
charge of attempted murder was found proven, but in view of the evidence the
accused was conditinnallv disclmrged

A charge of manslaughter brought at Lambeth Police Court m IfUl against a
man of was dismissed on the medical evidence The circumstani-e;. were that
during r- ' ** uit with his s<iii aged 46, blows were being exeliangcd when the
.VO”* lenlj coll ipsed ami died Autopsj revealed i ruptured develop-

" urvsm.and the medical evidence was tliat, though a blow to the
Iscd rupture, so equallv might a rise m blond pressure which could
•luarrc! On medical evidence being Ictl to this effect, the charge of
-iimg was not proc-eeded with

\ ^nc course which a medical witness ought to pursue provided he has dtilv
considered the circumstances before he appears m court anti his mind is
ecjiialh balanced between the two possibilities, is at once to state his opinion
without circumlocution, and not to allow equivocal views to be extracted
from him m cross examination Tlie sooner this position is made clear the
belter

In all cases a iom|)lcte autopsy must be made in order to aseertam the
full facts and the precise cause of deatli

V lecturer in chemistry it a London medical school fell in front of an electric
underground tram at Monument Station and was cxtncateil dead Not until
autopsy was jierformcd was it found that lie liad jast swallowed a small jiackage of
sodium cv amdc— -and that he liad fur some tune Iiad tuberculosis of the lungs

Wildlierg was called u[)on to evamtite tlie bodv of a girl who had died, apparently
from the effects of the violence suffered wlule her father was cliastising her for
steahi\g Ou tlie arms, shoulders, and back manv marks of blows were found,
and under some of them blood was effused in large quantitv The injiints although
severe, did not, however, appear suRicient to account for sudden dciUi He
therefore performed an autopsy, ami on opening the stomach he found it very

-32 i:fi£ct of ^wunds

much mllimed and lined \nth a tihuc ponder, -winch was nro^cl to h,.

It turned out tint on the theft Iwuig detected the gir! ha<l taken arsemt for Sr
of her fathers anger she Nomited during the flogging and died in sliaht <nii
vulswns Lpojj this nildherg attributed death to the arsenic, and the father wis

A bus driver, faced with suspHion of careless driving when he ran down a voiiti'’
man on nn ojicn ro-id crossing n common near Last Ham, was e\oneratcd before the
enquiry opened ns a consequence of what w is found at uutopsv In addition to
injuries consistent with liemg run over hj a heavj \c1ucle. the autniisv revealol
seven suiierficnl incised wounds of the left wrist such ns arc commonlv found in
suicide nehmd some bushes near the scene of the affair a til lodstainal s.ifelv mot
was found and it was later shown that tlie blood was of the same group ns tint of
the dead man I vodence was given tint lie Iiad threatened to commit suicide and
the cirtumstnncps indicated tlial Imnng tried imsucccssfiillj to end lus life bv
cutting lus wrist, he flung himself iiiider n bus

Lven when there ninv lie no suspicion of poisoning, it is neccssar) to
investigate the state of the stomach and its contents— whetiicr it contains
alcohol the nature ot the food and the degree to which it lias -undergone
digestion, for nnj of these matters nia} provide iinjjortant evuknce which
ma\ be incoinpalihlc willi the evidence of the witnesses

In ^ V iS/ncer the f ilsehooil of one |Kirt of the prisoner » defence was made
evident hj nn examination of the deceaseds stomach The deceased was foiiiul
dead ut the fwit of a stair The prisoner stated that nfler he and Im wife lind had
dinner he heard n fall The worn in had died inslantancoush , and the fall was
heard b) neighbours at or near tiie dinner hour The stomacli contained no tniec of
food It was therefore clear that this part of the prisoner’s story was untrue

A wound ma) cause deutli tillicr ihrtclli/ or mdirecUi/ V wound
operntcb ns a direct cause of death when the womulcd person dies cither
immcdiatelj or verj soon after its infliction and there is no other caase for
death In wounds which cause death ttuhreclly the deceased survives for a
certain period, and Uie wound is complicated bj inflammation, emholisni,
pTieiimoiut tetsnus, or some other morto) disease wJjjxh is a coDsequenee of
the injurv Cases which prove fata! bv reason of surgical operations reiidcreil
miperativeh necessarv for tbe treatment of injuries, presuming that tliese
operations have been performeil with onhnnry skill and care, also fall into
this categorj

If a wounded person has been the subject of a nnscarnage of treatment
and he siibserjiicntlv' dies, the rjueslion will arise as to -what was the cause of
death A cival action might well be mamtamed but no orimmal charge
would be bkelj to lie proceeded with

It would be no answer to a charge of death from violence to saj that there
was disease in the bod> of the victim unless the disease was the sole cause
of death In manj cases where death supervenes upon wounding, and it is
admitted that v lolence has been inflicted, but asserted that it was not the cause

of death the medical ev idence may be decisive

A fracas developed in Poplar during ‘ \ J day celebrations in the second n odd
War two men were hghting when onc.accowlmg to an eye
and fell down m tlie gutter he lay still, and was found to be dead
was arrested and charged with murder Autopsy showed Uie
advanced coronary occlusion by olherwiia — ^wtiicli

collapse and death at any tune, whether diinng a quarrel or not Accused was allowed
bad and later rbscharged at a summaiy hearing at a police court

Cerebral or subarichnoid luemorrhage, diseases ot tlie heart and large
blood vesseb, asthma, phthisis, etc, provide similar exercises in common
sense and reason In some of these cases the person appeared to be m a goo

CAUSE OF DFATn IN }]OU\DS 233

state of henltli up to the time cf fhe\iolence and mothers tJiere was a slight
indisposition The histors is nearh nhra\s much tlic same it is onl\ bj
careful medical examination and sound reasoning that the tnie nature of
death is ascertained and justice is dispensed

The uoundtd person mnv bi/ hi9 om fault cause an othensise simple
wound to become fatal V man wJio has Iktcii severeh wounded during a
quarrel maj obstinaltlj refuse mcilical assistance or he ina\ insist upon
acting m a manner contrar\ to tlie adiice of las mcihcal attendant or ba
other imprudent jiracticcs he nm present liis recoverv In the case of the
notorious Gosemor \\nll who was comictcil of causiii„ the death of a man
h\ excesbise punishment it was attempted to be shown m evideiite tliat
the deceased had taken his own life b\ tlic immoderate drinking while under
treatment m the hospital In charging the jiirv the Judge said that no man
w oiild be justified in placing another in so perilous a prcdic imeiit as to make
the prescraation of his life depend mereh on his own prudence Neglect to
call in a medical practitioner or refusal to receisc medical ads ice wall not
always he tonsidered as a mitigalorj tirciimstance in favour of the accused
even though the wound were originally capable of being cured Hefusal of
medical a line or Ireatmetil does not always operate as a mitigatory cir
cumstance on tlic part of an assailant because a wounded person is not
compelled to (all for medical assistance or to submit to an operation A
niedicnl witness ma\ not be in a condition to swear that an operation would
have, saved tl e life of the viitiin he mnv merely alFirm that it might have
alTordcd him a belter prospect of rccoverv Wiere a person Ins received a
blow on the head producing a dcjircsscd fracture and svmptoms of com
pression of the brain a surgeon mav pro| ose an ojicration to elev ate or to
remove the depressed bone but the friends < f the patient may not permit
the operation to he performed In such a case tlic surgeon should stale the
facts to the court and it is probable that in the event of convaction there
would be some mitigation of punishmci t because sucli an injurv if left to
itself would us mllv prove fatal and no doubt could exist in the mind of
any surgeon as to tlie necessitv for the ojiemtion But the negligence or
impropercondiictof a person wliorcccivcsawouiid thus rendered fatal does not
always cxculp ite the aggressor Fach case must be judged on its own merits

'Verdicts of manslaughter on the ground of negligence m cases where
children have died without proper medical attention have been found against
parents and guardians {ii le Neglect and Children and Voting Persons
Acts 1035 and 193S)

In some cases slight blows have been followed by f ital consequences even
when no visible cause existed to account for the result (f irfc Vagal mlu
bition)

Possible causes of death which must now be considered m some
detail are —

] Death from h'cmorrlnge

2 Death from injiirv to vital organs

3 Death from reflex (vagal) uihibitioii

4 Death at aTemotc period —

From enforced rest causing pneumonia embolism etc
Irom pathological cliaoges due to the wound toxamiia or infection
From pre existent disease accelerated by injury
From independent disease yblfouri ig injure

234

DEATH FROM n^MORRUAGE

1 Death from Htemorrhage Los, of l,!«.d operates b, l„„cn„o the
blood pressure and produerOB fatal shod, b subrtsottal of W«„,

escaping rapulh from a \essel miy besufitcient to cause denth In iimctin.
the heart and circulation It maj niso menace life hj disturbing tl.e functions
of some vital organ or part into which it is efTused Tlius a small ouanlitv
effused into or upon the sulistance of the hram or at its base imv prove
fatal bv local disturbance again if m a case of face or throat wounds
blood should flow into the windpipe it maj cause death bj aspbjxia

A girl of 17 who vras nding her pedal c^ele along a suburbin roa I sva.s knotked og
as a result of a passing milk van cntehing her liandlebars She was thrown to tl c
pound concussed and bleeding from the nose The van driver and his mate nlaml
her on In back in the van and drove 1 er J mile to hospital— v» hen* she was found to
be dead Her onlv mjurv was a broken nose but she liad whil t h in" on her back
inhaled a quintitj of bjood with fatal results

In wounds of the chest involving the 1 cart and lungs death is frc<i icntlv
due not so much to the actual quantitv of I lood effused as to the mechanical
changes which it prod ices m these organs Several ounces efftised into the
pencardnim nnv arrest the action of the heart whereas a similar loss into
the abdomen would be negligible

A joung man who was endeavouring to remove a p ecc of fim ture from Ins
parents liome was obslruclcd b> his father Angrv irords toUaned and in an
exchange of blows the older man was puncheil in tl c throat 1 e 1 roke t ft the hgl I
couglung to get his breath and went indoors 44 ithin ten m nute.s I e was struggling
to breathe blue m tl e face and d ed before mcdicul nvustance could be obluinod
Autopsv revealed a fneture of the right wing of the thvroid nnd an intm larvngcnl
h'cmatoma suITlcientlj large to obstruct breathing at the level of tl e vcwil cor Is

The absolute 9 tanltly of blood required to be lost in order to pmve fiitnl
vanes according to various numerous circumstances The voiing the ngetl
and those who arc hl>ourmg from some disease nnv perish from lass of
blood sooner thin others who arc heaUh> and vigorous Infants art liahl?.
to die from this cause as a result of sh^ht wounds Jt seems hkrJv tJint m
the adult a rapid loss of anjlhing over 2 litres of blood (about one tl ml of
the total volume) constitutes on immediate danger to life J luid rcplncen (nt
of the blood volume is rapid but protein replacement takes some ihvs and
tiic cell V olume mav not be restored for sonic weeks *

Some persons are hnble to excessive Weeding from si ght iitjunes— « con
dition tbit IS iisualh hereditnrj (liTmophilua) llie slglilest wound or
puncture nuv be followed bv intractable bleeding which mav lenil to ileatli
4% hew wpeT^swVvkevU to death Hv what would uvcvnvmQatuxumstances he
an unimportant wound the admission of this fact mav well lessen the resign
sibilitv of n accused person though it cannot dispose of it

V su I ten loss of blood has a much more senous effect than the same quant
itv lost slowlv * A. person mav succumb to a quantitv of blood lost in n f«w
seconds which lie would hare been able to survive rcadilv lal it rscapcil
slowlv This IS one reason wbv the severance of an nrterv proves so ninth
more rapidlv fatal than that of a vein Death spetdilv foil n's severance of a
large arterv like the carotid but it takes place with c pial ccrlaintv ahhoiigli
more slowlv from wounds of smaller arteries Wounds of large vtms such
ns the jugular niaj from the quantitj of hloo I suddenlv lost spcedilv
end life "Sueb optn veins are also luble to aUimt air into the circulitioii
causing death hv air embolism irrespective of tl c vol imc of bloovl lost

• Wr^ltCl iyj 4 \n Jntroducl on to I atl ot g5 | US 1 01 don. Ix«ngmn s Cretn.

jKichards D \V Itm B ill N 4 \ca! Med iO '^<>3

DPATII PhOM ni MOnuUAGr .>{5

Inlcrml IlaiiinrAnge nii\ ef|uall\ pro%e falnl for hlooil lutd not \ i^ibK
escape from Hie l)od\ In incised xsounds tin flow cxtcrnnllj is coinnionl\
nbnndnnt but in crusliinfr stnbJicd or perforating wounds tlie ilTusion nm\
tike pine uiteninllv and rtipidlv cause death In sc\erc contusions or
contused nouiids m\oKing highlj \ascular organs or tissues Die efTuMon
ma> go on to 1 f ital extent either mio the iiuties of the bod\ or tlirouglioiit
the adjacent loose cclluhr tissue Jn dtatli from severe flogging lilood m i\
lie (fluscd in large quantitj heneaUi the skin and among the nniscles this
elfusion will operate as fntalh ns if jt hod llowetl from an open wound
surprisingh large \ofunie of Wood maj thus lie effused Most fatal internal
lifcniorrlngcs follow ruptures of the organs— injuries of tlic he irt lungs
Iner spleen and kidnev's in partitular having thus caused death Thesi
cases of ruptured internal organs and concealed Iwmorrlingcs eoiistitutc
a V crj diflicult chapter of surgical diagnosis ow ing to the lapse of time before
the V olume of blood lost produces signs

\ man who had been run osxr was brought to liospital lie complained of pain
in the back but there were no svniploinsof severe wjurv and no jiLirks of vaolcnec
were seen on the akin of the back He lea the hospunl and icnlLediulk ^ome rmis
taiiec to hts house \ few hours aflenrnrds he was found dead m Iwd A lirge
quuititj of I lood was found effused into the ab<l iinen V ki Incj liul been rup
tured transverse!} tlirough its whole substance

In Ditsc cases the Inetnorrluge iiia) have tcnipornrilv ceased when slight
muscular exertion mav liavo tuused it to recommence imil to lend to death
V lucid jnterv al ofthcsnmckindisscciimcascsofhcadmjurv (fi/ep2f55)

llic means of nsiertaming whellior a person has died from bleeding b\ an
open wound arc these Unless the Wound is siluateil in a vascular pnrt wc
shall liiul tin vessel or vessels (rom which the blond Ims issued divided
Die tcssels nlativclv cnipt} and the liodj more or less exsanguinated
JUood will toiumoiilv be found more or less cloUetl or dried on those surfac es
on which it has falleu If with tlicsc signs tbert i\ im absence of disease
iPkely to prov e rapidly f ital and no other probable cause of dcoDi is apparent
it may be fairly referred to loss of blood This opinion ni ij however be
mntenailv modified in refercnoc to ojicn woumls by the fact of the lx>dv not
bung seen on the spot where the mjurv was ntlinllv influtid by the wound
hav mg been spongeil the blood rcmiovcd hv wasbiug or blood soaked dress
mgs Icing destroved In these cireiimstnntcs the cast must in a great
measure he made out b\ |)re*sumplivc proof and here a medical witness may
liive to depend upon the diitv of eMinmmg articfes of dress fiinuture or
weapons for marks or stains of blood cstiiimtiug mdincDy the volume lost

It imist not be suppose<l tliat all the IiIochI met with round n wounded
dead body, or in a cavity of the Iwdv w is lutiinllv tifused during life \s
soon ns tlie heart s action ceases the arlcrici cense to spurt but so long ns
the blood ninaiiis liquid — and after it is again liquefied — it eoiitmucs to
druii from the divided vessels

In U V llume (L ( C 1030) n motor ciir ngctii n uncil Setty dis q jicureil on
4lh October lOtO IIis torso stntibiil live times in the chest was found wrapjicfl
in a ft It Inindic in nn 1 ssex mnrali 17 dnvsl-iter Police enquirv revinled tliat Iluine
liid lured a two scaler plane at Flstrce on SUi Oclolicr placed two he ivy parcels
inside and liown east, making n fi reed landing at SoutI end In lliin e » linuse liioosl
of a eorresp Hiding grou|) to Umt if llic victim was f und iKlweni tin crniks of
Ikx rfwjTrtfs iiff I a crtffs/cteml hr rpeterf/tv < n tlw lathe and / ! atec tmte ith ufiich
miscil till Mispinnn tl at liic munier nncl dismeinlicrmcnt lm«l lict n romimttcsl tiierc
1 ( r the defence it was argued tliat ll K did not mean citlier tliat tlie stni li tig was
di tie in tliat hoase nr tliat Die Inxly wiw dtsmendiered there— for 1 1 xxl ci minonlv

DLATu rimi SHOCK

The quantity tliub lost, howeyer, is seldom considerable unless the vcin>
mil heated arc large or the body is dismembered In y\ounds myohing the
^reat vessels of the neck the quantity of blood which drams from Ihc wounded
part alter death maj be large The entry of air ma> limit the CMt of blood
(vide Air Embolism)

2 Death from Gross Mechanical Injurj to a Vital Organ Manj
instances of this becoming a direct cause of death ocrur m the crushing of the
heart lungs or brain, as in falls and in street or railwaj actidonts Scyere
mechanical injurj is sometimes accompamcil by a considerable effusion of
blood so that the person rcallj dies from h cinorrhage but in other instancts
the quantitj of blood lost is minimal the extensiyt. damage to the tissues
being suHicient m itself to cause death by what is called “neurogenic’ nr
prtmartj shock

Secondary shock maj deyelop lusidioublj some hours after an injurj,
resulting from loss of blood yohime, fatigue, deh} dration, pain, csposiire
to cold and wet, etc A person ma> liayc rccencd mnnj injuries ns hj
blows or lashes not one of yvluch taken alone could in medical langimge
be termed mortal, and )et he maj die directh from the efTecLsot the violence
either on the spot or \crj soon aftenvariK At the trial of Governor \\all
the judge directed the jury that the long conlmuanct. and seventj of pain
(m flogging) fnaj be productive of as hital consequences as if instnnnents
or yyeapons of a destructue kind were used It is rare indeed for a sihool
beating to be a cause of death in Great Britain One case hovyever, which
excited public attention from the atrocitj of the circumstances nttemhng
it, yvas the subject for a trial for manslaughter (H y Jlopleif)

The evidence sliowcd tliat the master had l»eatcn u youth of 1C verj FC\crel>
for neatly two liours wath a rope and a stick the e\tirnal wounds wtn slight, liut
autopsj showed that the muscles ns otII as nil the wfl puts beneath tlit skm
Jiad been eonsiderablj bruised and criKlicd and tliat tJiere were c\tcnsi\x cffaMons
of blood in ttie connective tissue spaces of the anus und Icgn There >ras no mortal
wound m the common sense of the term but there wats lui reasonable doubt tluat the
bo> liad died from tlie sum of the violence inllitted ory luiu bj the master

On a trial for murder wlueU took pi ice in Germanj, it w is proved that the
deceased iiad been attacked with sticks and that aflerwards lie Imd been Ooggcif
on Ylie 'oac'K wat'ii wfftow swVnfnea Wt Awi’* vn wv. kk U'/isa

was no mortal wound and no injury to a vital organ there were merely tlMnarks
of abrasions and bruises on the skin apparentiv not siillicient to nrcount for death
but this was, nevertheless very properlj ascribed to the violence

3 Death from Reflex (vagal) Inhibition Freeman* has rev lewetl the
pliv siological mech inisni of this form of siuMcn death from minor stimuli
or injurj of the wide net of ‘ receptor nerve endings forming the afferent
pathway for reflex action b) the inhihitorv vagus nerve hatnl iiiliibitioii
of the cardiac and rcsp!rator> centres maj occur after slight traumatic
stimuli applied to certain parts, for example, a surgeon pissing a catheter into
the bladder orthenbortionistaninstrument into the ulenis It has alw occurred
from a slight blow on the throat or testicles and similar ’ reccptivt sjxits .

V Cflmnv I 1 IOjI Med te„ J 19 2
^Ireciiian V,GtyO*>I Jjitxcci

* Ssimpson, K-, 10o3 yiodem Trends to forensic Meditme. London Uutterworth.

DEATH FHOM 11.JIJRY 237

Cardiac inhibition maj occur from pressure on. the carotid sinus asm strangling
On the shin there maj be some abrasion or shglit discolouration but these
are neither constant nor necessarj accomiMiniments of this e\ent
Concussion of the brain unattended bj \isible mechanical injurj furnishes
another example of sudden funcbonal death ‘ A man receives a severe blow
on the head he falls dead on the spot, or becomes senseless and dies in a few
hours On an inspection there maj be merely the mark of a slight bruise on
the scalp In the bram there niav be no rupture of v essels or contusion of
substance and microscopy will not necessanh elucidate the issue

IMiere boxing contests have ended fatally we have experience of death
occurnng by three distinct methods (1) by exliaustion the combined effect
of manv blows with intense effort and excitement in n person having
Some physical defect, (2) by gross injury — ^fractured skull meningeal
Inimorrhage rupture of n viscus etc (8) from knockout blows on the
point of the chin or into the solar plexus Thesp produce temporary inscnsi
bility and occasionally death without any obvious mark of injury *

In 1049 a weU knowxi featherweight boxer matcl ed in London against a Irenclt
man lut his opponent a blow to the \ omt of the chin and two to tl e brow m the
tlilrd round None of these appeared to be particularly damaging but the 1 rench
man went down on one knee took a count of \ was told to carry on but shook lus
head He left the ring unaided but aliorlly niter complained of headaci c felt sick
and became a little short of breath He was sent to hospital dying 81 hours later—
of a subdural hzmorriiage on the left side «

In such circumstances and in estimoting the culpability of the opponent
due regard must be paid to any unsuspected pathological condition found
such ns degenerate V essels kidney disease thinness of skull enlarged heart
etc A referee will usually be present to give evidence that the blows ex
clianged were fair according to the rules of boxing
In addition to shock from wlmt may be called physical causes there is
bevond any question a mental form of shock for it is familiar to every one
1 amting from fright or from some unpleasant siglit or smell is too common
to need mention but such a ‘ faint may be a fat'd one and is a not very
infrequent cause of sudden death in persons who so far as careful post mortem
examination can show are in perfect healtli especially^ in the elderly

Some of these cases must be ascribed to vngal inhibition of the heart,
others to effects on the v asomotor centre

From these considerations it cannot be expected that in every case of
dca'i^i Irom vidience or maVcreaVnieift Vnete iimA Vit xume xTsA/ie 'ntuAt^
iryiirj/ IMien the circumstances accompanying death are unknown a
medical opinion should be expressed with caution but if w e are informed that
the deceased was in ordinary heilUi and vigour previous to the infliction of
the V lolence and there is no morbid cause to account for Ins sudden illness
and death there is no reason why we should hesitate in referring death to
the functional effects of injuries

In 7? V Cono (C C C ISS**) a vouth was charged with the manslaughter of
another boy of 20 whom he had struck with lus fist in the doorway of a Ilarnnier
smitlishop 1 IS head liadlwen thrown by tlus blow against a door knob Tleinjured
boy did not lose consciousness he went to a milk bar where he com] lamed of feeling
rough , arrived home an hour after tlie assault and tumbled into bed still partly
dressed At 3 aan. lus brother noticed be was snormgnoisily — an unusual event —
and at 0 a m, he was found dead In bed A slightly depressed fracture of the skull on

* Denny Bro^Tn D onci Hussell VV R 1B41 iJrn/« 64 03-

*Blonsteui,J L. and Clarke E 10^ Bnl med J 2 15‘’3

SIS novsm iMiiiircTL] f n tt.

the left >..!e il.c,> e the nr Ind roptiiral the miiHle men,ne<-il nrlcr, ,.i, i „„

extn ditral Jirmorrhaip? *3 nn

Among non mcdipnl persons a pnjudicc t\istv tint no j)trv>n ran <I,e from
uofence unless there he some iifWU nioclnniral uijiirN to some oj^m or
\csscl im|X)rtaiit to life Thms nn erroneous notion since dp ith nn^ take
phee from the disttirbniicL of tZie functions of an orpin mijwrtmit to life
«itIiout tins being iie<essanh nceomp'iniccl h\ n perceptible nltemtion of
structure Tins is after all, hon Zifc fermuntes m the ngcil a functional
lapse occurs

I ounds indirecth Fatal Certain kinds of injuries are not imnualiatcK

followed h} serious consequences but an injured pcivoii mnv ibf after a long
or shorter period and liis death mas lx; as much a toiisctjiicnce of the injurs
as if it had taken place on the sjsot \n aggressor is as n sponsible as jf the
deceased had been direeth killcil hj his \ lolence— pm » fed He fatal remit can
he traced to probable consequences of the injury

In /t a Elste Mhle (Herts Assizes lOt*") a girl hurled an aspidistni m a pot
(weighing 20 lbs ) down a narrow fliglit of Matrs ufter her drunken fitl er wtio had
l>cen abusing and striking his mfe and armed waih n brr «d knife wns threatening
furtlicr siolcnce It struck him on tlie liead felling him to tht passage was Iwloi^
iineonseious \ fen moments later lie iras sirk and his famiiy rr/ti? 1 not rouse Jitrn
he had died of intmlatioii of sumit Ilie skull mis not fractiirwl utid tliire wis no
sasible contusion of the brain, but he ha/| clcarl> been cvnpussed b> tlic licad Injurv
apd a charge of murder followed as it wns argued Ih it this was resjionsible for Ins
inliahng somit

Bcatli mn\ follow a wound and he a consefjucncc of tint wound at
almost ans period after its mlliction It is netessars, howctcr m order to
mnintnm a charge of lionucidc, tint death should he strictK and clcnrl)
tnceablc to the injurs \ doubt on this point must of course, Itnd to an
acquittal of tZit accused In Lngland a peps<m can be com tcfetl of murder or
manslaughter if the dcocqserl was m a fiail state of Zicalth wZien nltoeked
and the jun are S'ltisfictl tliat tZie injuries inflicted b\ thcactnsc<lamlemt«l
the death ‘ Death must,* for the pur|H>se ol iunmuial charge follow within
a i ear and a das This conddion doo not apph in Seolinnd

III If s IlaifxariP the jirisnner was ImlicteU for tlie manslaughter of lus wife
Froin theeudeijce itapjicired that the prisoner conic home m a condition of siolent
excitement and expressed the determination of psiiig tier soinclliing when
she returned that on tier oommp Into tlie houx. tlicre wire « luadsofan uHrmitinn
tluat the woman ruslied from Hit bouse fwHowed b\ the prisoner who used siotcnt
Ifireals toAvarils her tfiaf she fett info ffte mnfwajs nmf tefttAr If toff fiVarr
kickeil b> the prisoner on the left fore irm and tliat when picked up she was dead

Tilt medical es idcncc sliowcd that the bnii c on the arm could not per sr haw heen
the cause of <le ith Autnps> sliowed tli it tlie deecaseil hail a l>crsistcnt thsaiius
glind two inches snilc and weighing Ij ounces SikIi a state of affiin was stated
to be quite nbiiomud at the dcceaseil s age — 22 The cause i f death was giieii as
cardiac inhibition, 'and the mcdicil csidencc was to the crfcct tlwt in a jie^n
the subject of |>ersistcnt tlrnnus gliml iueh ns the deccaseif am tyiifiifianoii
of ph\-sical exertion and fright or strong emotion might oceasi m deith In suili a
fashion* (ounvl for the prisoner suluiiitlcil lliat Ihere was no cn«c to go to » jurs
But tlie jialgc held tliat there was Midieicnt evadcnce to siij port the iharge ot
manslauj,hler if the jun Iwlioeil it Nq proof cf nctiid plnMtil siolcncc was

« /{ V Jfartin 5 C 4 r 12S It \ Murlon 3 h A I 40,
*B V Djifin 11K)9 2 K It 437
•ions 21 Cor C. C. C«2

• n c prol 1cm of status l>anplnlicos i-s reslewes!
lal Iveitli Simmon HOt I,on loo ItuUrrworth
lyKcjTies 0 IM "rtf J ,2 &tS BBS

Moilem Iren Uin hnrcnsir Mnliciw
nil! >»iolog> of tlrt- TJnmiw Clan I

230

L iTE DP iTIl JN nOUND^

necessnry, but death from fnffitf alone caused by an illegal act, such as llireals of
violence u-ould be sujfteient The abnonnal state ot the deceased s licaltU did not
affect the qiiestion-whcther the prisoner knew ordid not know of it if it were proxed
to the satisfaction of the jurj tliatthe death was accelerated b\ the prisoner s illcfril
act The jur> found the prisoner guiltj, and lie wns sentenced to three months
imprisonment mth Iianl labour

Manj cases might he quoted m lUustmtion of the lengtli of time winch nn\
elapse before deatli takes place from certain kinds of injuries the injured
person hating ultimately fallen a \ictini to indirect consequences thereof
\\ounds of the liead and spine are particularly liable to cause death instdi
ousI\ The wounded person may appear to l>e going on well wlien without
any obxious new cause he has a relapse and expires In general an exanuii'i
tion of the body will suflicc to lay bare the facts b\ whicli it can be orgued
whether death is to be attributed to the wound or not

In one case the nietjil portion of a penholder was found embedded in an abscess
in the brain of a deceased man The foreign Iwily had been there upwards of
25 years as the result of an accident when the deceased was. a boy at school No
symptoms had been exhibited at Oie time and none seas exhibited subsequently
until a few months before death

A man xvas shot in the left side of tlw chest and the bullet remained lodged in the
left lung for a period of 25 years The bullet in penetrating had fractured the
humerus at its neck in consequence of s»hich the upper extremity had been
amputated at the shoulder joint Ihe wound of the eliest soon healed, but the
patient remained during lus life subject to Ills of seserc breathlessness and hxmo
ptysis which eventually caused hisdeath Oneximinationofthebodv the bulletstAS
found lying behind the third intercosUl space in the midst of fhepiibnonary tissue
but lodged in a evst xrluch commumcateil %Mlh the large ntr tubes An almost
identical specimen lies in tiic Gordon tfuscum of Gu\ s Ifospital the man survived
frfim IDIG to 1051, onl\ then to die of the consequences of the bullet wound
sustained

In severe injuries affeitmg the spinal cord or column dcatli is not an
iniinecldte consequence unless that part of the organ winch is above the
origin of the phrenic nerves {suj)[>l\mg the diaphragm) is wounded Injuries
affecting the lower portion of the spinal tolimui do not rommonlv prove
fatal for several months deatli ensuing later from septic cvstitis {often with
tnlculous py chtis) bedsores and fox eima

In discussing the deaths ot persons who have recovered from the immediate
effects (hremorrhage shock gross injiirv) we mnv for the sake of cleirncss,
classifv them into

(a) Cases in which either operation or cnforceil rest proves fitnf — from operative
shock pneumonia thrombosis and emlioh«m etc

(i*) Cases m which tlie wound becomes complimtcd bv a pathological lesion
which in turn proves fata! e g fat cmliolisni infection septicaemia tetanus etc

(c) Cases in whicliapathological condition was present before tbe injury e g ,c\sts
or tumours, tuberculosis etc and where deceleration of the dtseasc process might be
argued

(rf) Cases in whidi n pathological condition of a totally different nature arose after
the vvouiiding, and the consequenti i1 sequence is doubtful c g , brain tumour after
a liend injurv

( f) Consequences of Operation or Fnforeed Itesl Both the necessity
for operation (ami un'esthesia) and for treatment m bed or enforced rest ns
for instance m plaster of pans carry their especial risks death may ensue
ns a consequence of opcmtioii/an esthetic risks (wdr p 71) and the question
may arise to wiicllier a person rcsjKmsible for injurv should still he Ik Id liable
at law for death dut to these less direct cairses

Tlie law of Ingluul regaids a surgical oi>erutioii which has been made

deaths atter operatios’

neccs^arj on account ot an mjmj to bo a tomcquencc of that ,nj..r, and
the pc^on responstble for the .njuo .t held be UponK.hle also for all the
natural eonsequenecs of the mjur,. .aclucl.aj, ant contphcat.oas a„s,„g
from operation or anesthesia Faon ,f the dnoao,,, nere si.bscqiicatif
prosed erroneous and certain treatment thus si, on., to l,e uinicressart
the position ,s unaltered pro, rderl Hint ,t midcrtalea tioaa tide and
timt a ronsonablc degree of skill and care wei-e exercised
From deeded cases ,t ssould appear that ahere death ensued uiam a
surgical operation the law has regard to three cmimstaiices (1) the necessit,
for the operation itself (i) the competenej of the surgeon and (3) the fact
that the wound was dangerous and would lie I1UI5 to pime mortal in nnj
cent A stupid error or gross], mcompclent p,cce of surger, would Uli
douhtcdlj quahf}— e,cn dispose of-ciilpahilitj Mere refusal to aicipt
the treatment considered neccssjtj ilocs not iiltft ihe svln dion

In P \ Draper the accused so enrelesslv dros« a va„gon that he knocked domi
the deceased and 'i wlicel passed oser lus left ami just dJx)\c the clbo« Hie
deceased was taken to the Ro\al tree Hosjntnl }i pwpcsfd at varr fa
amputate the ami but he after consulting \ntli hi,, fnends refused to submit to tlie
operation The ami was tlien dressed and put mtOsphnts and the man wis told tlmt
his life would be endangered if he did not iicrniit li,s orm to be amputated \ week
htcr he consented to the operation TJiearm iiisremoied but he died of pjxmia
one of the secondary consequences of the operation In the oj inion nf the medical
oircers of the hospital the man s life would lia\e l»een sasrd if he Jmd allowed
immediate amputation

The judge directed the jurj to put out of their Pnnds the quest mn wlictlief death
hod ensued from the refusal of the deceased to Iiase his arm omputnlnl as t lul was n
matter of law niid that the question for tliem to consider was whether owing to
the negligence of the ac-cused tic decease*! suslametl the lnjur> which Iwl to his
dcBtli Thejurj f< und the accused guiltj

Competence for forming a judgment or for UIulc^t^klng nn operation
means the possession of that «\cmge skill mid experience wlmh c\erv Jegalh
qualified medical practitioner is prcsiimeil b\ hw to possess Tliis docs not
preclude the possibilit) that error in diagnosis (mid thus perhaps of treat
ment) niaj occur lascrjonc is liable to make mistiikes but it is imjiorfanl
tint thci shall be reasonable errors mule in s})jjc of due e irt and skill
1 xceptinnal eases occur xsbere death results dircctls from tlic medual
treatment but these art reducible to two tlnsses (I) when the wound is
not in Itself mortal but the treatment causes death and (2) when tl e death
IS clcarlj caused b\ the treatmait either bj reason of it being unskilful or not
being neccssarj to sa\c life

In li \ Mclnl /re ‘ where the pnsoncr was tried for the manslaughter of lil« wife
bj kicking ber tlie surgeon who attended tlic wonmn said tlint she liad dlctt from
kicks In cross-examination he statedlhat hefancicil tlialaporllcnofttw' bnwily—
gisen b> him to restore her— had gone the svrong ivav into her hing>* and lluit
death might iiase occurred m consequence He further wil tlmt tlie womans
poiver of swallowing tiad liecn affected b> tier state of weakness but in his oj inioii
her death was caused hi the blows winch she huj rtfcKeil and tluit these Jiad
produced a general shock to tlic sj'slcm and great Ws of bloo*!

The Judge addressed tie jur\ in tiese words Are ^-ou of opinion tlwlstr
received mortal injuries before the surgeon was called in? Ifvouare « f oj iriion tlicre
was no mortal uijutv before then jouwxllflnd the pr^yjocrguiltj of nn assault onh
The jurj returned a verdict of manshoghtcr

InJ? V Feuting the deceased had been kicked «\crelv on the right knee lutwas
able vnth much dilllcultj to walk Jiome Disease set jn and about ten montlis after
theinjurj llic leg was amputated UlcemWonofUicstumpeasued.andlhcdcecaseil
» 2 Co*, C. C. 370

COMPLICATIONS OF INJVRirS 241

died from secondary liTinorrliagc not long after tlus further operation The
prosecution alleged that, notmtJistanding the long pent d which had elapsed the
deceased liad died from the unla^rtnl act of llie prisoner The defence was that
the deceased had died from an nper ttimi which wjis not ncccs«ar\ to the treatment
In addressing tlie jurj the Judge •i iid that if n man attacked another and certain
results ensued in the course of which the qualified and competent medical ads iser
called m took in his disortinn a step the teniunntion of which was unsuceessfiil
nnd w Inch, perluips m tlie CNcmsc of superior skill would not lias e been adopted
that termination svould not sase the man bj whom the mjtir-v was inlhited from
the consequences of his iiit The jurj had nntlung to ilr> witJi the question wlicther
or not the offender oontcnii lated the result of his act Hie prisoner was howescr
acquitted b} the jurj

It remains that, in manj cases enforcetl ita.t results in cnmplit vtions like
hjposlatic pneumonia or phlcbo thrombosis tisuallv in the leg seins and
subsequent embolism

An old lad\ of 80 w is attaekerl wath a shovel b> her husband susttiining feur
slicing tears of the scalp nnd slight surface contusion of the brain The skull was not
fractured She sras admitted to hospital where she died tendavslater of apulmonars
embolism due to right femoral aoil tibial pitlebo thrombosis The accused was too
old and ill to stand trial (II \ Bryant Stratford Polite Court 1D48)

It is not netessarv to show that the \cins afTectecl were injured though
this is often so mere stasis from rest is sufficient for cither complication
Time IS nn important factor to bear in mind in eacli case, for whereas pneu
moma or embolism de\eIopuig within a week or ten da\s of injiirv waauld
seem to be acceptable as a complication of the esent the longer the lapse
of time the more remote would appear tlie connection so long Jiawcs'er
as there has been a continuous period of enforced rest tlie argument rein uns
(B) CompUcations of the Injury //sW/ resolve tliemscKes into three groups
nccording to the tunc lapse —

(a) Unexplamed ejanosis and intractable cimilalori distress oltcn svith
hjperpsTCMa (and occasionally with skin pctechit) (le\elojnng wthin n
few hours indicate the entrv of fat globules into the blood stream from the
site of local injurs Though most common after fractures of long bones
ctusbing of fatts tissues of any kind may cause fat embolism

(fc) Pinmng and crushing injuries ma\ be followed withm a few days b\
necrosis of tlie injured muscle as it was described b\ B\waters in I^ndoii
air raid v ictims ^ A fatal suppression of mini function ni ly ensue

(c) Infection of the wound either by fulminating clostridial or strepto
cocca’i bacterial invasion "wbirti -rqnAVv ttAo Wic UiT/ta'i \ti

cause a septic'cmia, or In a more insidious introduction of an organism
rwjuiring some dnvs to develop such ns tetanus or imtlirax
The connection between trauma and disease in the latter ciscs are not so
simple and it may be necessary for a doctor giv mg e\ ulcnce to dilate to some
extent on the mode of growth nnd spread of spormg organisms in order to
establish the connection

A man of T5 liad an accident iicccisilating aiiipututiflii of Uie riabt leg m Alav ,
1035 The left ankle was crushed and laccrateil at tlmt tinu. mu! was dressed wath
!mt and a while wool packing On Octolicr iO tint v car lie Jiad a wibtaloid nrth
rodesis nn 1 a plaster of pans sj hnl was applied lit was discharged on October
On November 1 he was admittcil vnth classical tetanus which proved fatal three
days I Iter

A spored tetanus onanism was cultured at aiitofisy /ro»i llir st betitmiroui li^vie
of the right knee slump after sterilisation and opening of the unbroken skin Cultures
from tlie left foot gav e varied growths of no s^nifieancx

» By-waters, T G L , 1&44 J Amer meJ In , 124 1101

212 ACCELEIUTIOX OF DISF ISE /ll' l\JUnY

A bo) oT nine «-as p]a\ m(r In a South I.>ondnn st rect v lien he retTi\ e<! a nnnoi itr-f
wound m the sidc^the neck from a piece of wood The wound hcnlcfl Imt i\vf du\H
l-jter he TOmpI lined of a stiff neck and was taken to liospiia! Two di\ s htcr the
^SMCol fcatmes of tctnnu, dexelopeil and though nnt.scnim wa g. cn du h

SiTo breJSt™ ™" ''™"' i"'"' "• I* «

The source of a bacterial infection of a wound seldom rwitiires proof, for
the air, skin, street dirt clothm^. weaimns .and of eoiirse the nir pasMgrs
and bowel all contain micro organisms of dilTircnt kinds It is usimlK
onK in cases of tetanus and anthmv that proof of the source of mreelion
iKcomc neecssan. owmg to the possiluhts of cjmI jiroeecihngs

{() Acceleration of Ihvnsr Present before the Injury It is h\ no nu-ms
unusual for a person who has retened a wound or sustained some personal
injurs to die fnmi disease which was present before the injurs, and wlicrens,
m the miptls of las persons death inns natiiralh appear to ht a direct result
of tlie injurs, the truth can be renclied onU bs the most careful asses-siiicnt
after autopsj \ man m is be iiijiireri while sufTiring from disease or some
morbid change tending to enuse death niaj hnse become estdent suhse
quentls to the innietion of n wound and death ensues Uithout a ran fill
autopsj It IS impossible lo-rcfer death to the real muse and flu imiiortaiicc
of an accurate diserimmation in a case m which wounds nr personal injuries
hast been caused hs another must bt obsioiis \ hnsfs opinion mas msolse
the actuseil m a charge of in inslaughtcr; and nlthough it nms be possible
to show at the trial that dcatli was probabis nttrihulohir not to the wound
but to CO eMslmg disease, one result of the esidciiec of a medical witmvs
gisen before a coroner or magistrate mas !>t that the person charged is
imprisoned for some months hcforc the trial

\ man mas bescscrelj handled and jet deal hmnj take place from ruptiiri
of the heart the hurstiiig of an nneurssm, from lanbrnl ha morrlngc, or
other morbid c uisc winch it is here unneccssarv to spec ils If death can lie
ticarlj traced to ans one of these diseases the aggressor cannot be consielcd
of hoirucide, for tlie nicdieal witness mas gne his opinion that death might
base taken place aljout the same tunc and in (he same eirciimstanres whcliMr
injiirj had been tnflieleil or not

In It s Otlfs a ni in of 2 ) uppcaml nt the 'nmnu's I’oiicc Court on a eli ifce of
murder lie hail ticeii insolscU in a sculllc In the street m whieli Mows haij lieen
eschanged and m which his up|K>iient Iioil l»cen struck in the face and clii-sl and
{lossiWi kiekwl Iiefwre fiHi/ig dead AmIojwi indirnlnj tJi.it nniir of the injuries
sustained, iisunclj bruises of the face ns fn»m a fist, a glniicmg alimsion of tlie
scrotum as from a iKWt, and bruises of (he left sh mJdcr, cIIkiw and hip ns from
collapse and fall to the ground, could l>c held hkcb to nffeet omsci nisness or to
luisei-viiscd death Iheresvas bowesct.odvuneed conwinrj oecliMoiihs atheroma
whuh was sullicicnt to base eauscil sudden death death svas no doubt due to this
though It was admittcsl that the rrncxelTcclof a blow on the sirotum might
luisc added another factor In mcw of the meditail findings the prosecution omred
no csidencc and the accused w is discliargid

On the other hand there can lie no nlisolulc coiiicntion that u victim i>
bound to be so hound and heallhv ns to make plniiiU eulpal le an un uithonnal
assault ui>ou him \ man who tajiiinuts nn un mthori/ed rissniilt iijxm hts
fellow man must take the risk of the coiisequc necs of sm h an assault-

In/f V SJiaiiiier (Ifcrls Asiiirps 19 >OJnn old woni.m c f SO fpiniTcIling frw|Ucntb
with her husband, was seen being hustled indoors, bjh!m«t«pm nti nllercntlon
ofanoiss clmractcrrillowcl then snenee At 0 tt n m a dlslnct muse wets asVM
b\ tlu old man ‘ to lav out hw wife— which slie did at ' “ "'r* '‘*i‘“,!,rif^

w as at the local doctor 8 surge rj asking for adtath t-ert ilicatc This was refused ui

JCCLLJJl tTIO\ 01 msntsr IlY TIULM I 2n

coroiRr'\a^!nruni»r«l Htitoii«;\ rIioiwI («) frcsl« bruises oftht left side of the jaw iiml
the dun together M-iUi n black c^c (i>) the ka slioiilder Mas more heniih bruised
nncl thcbecondnb Mas fricturccl It-Mnnclenrslieirnd been struck ficseral times Mith
tt fist nnd tlirmni igaiiisl tier left sliouldcr I milasshc muh, hkch tn(lie(nt80) these
injuries Mire felt to Imic mi'clcnUci! herite^tli A manslaughter charge folloMcd
In ll \ Uallis, old standing >Rl\uI'ir diseti.se of tlie heart m-v? present in an
dderh Moiuan who had lH*cn sc\crel\ m iltrratw! and the he irt disease liad emsed
seserc sjaiiptoms long licfort thenvsauU I'nr the defence it miis urged tint if in nn%
case the cause of dc itli In. p irtl\ nttributiihlc to injuries and pnrtlv to natural and
othir causes, tlie nmiscti is cntilhd to an adpiiltal It m w held that tliere could he
no doubt tliat but for the injuries intlMleil tin. woman Mould not lune died therefore
the act of t!ic accused Mas the Immtdnle c uist of htr death

In cases of a mixed intitrc prolnldx the best test is to delcrmiiie the
extent to mIhcIi tin. nlligid x lolence xvhin not of a ileiinitcix mortal nature
might endanger life Ininscs of tliisdrscnplioii tlieepiestion is ixlicthcr the x lo
It nee, although not tlu imtnuhate.xxnsn sigiiific int ucttlcr itingnust of death
In 7 ? V LotiisiiJ Jni/lor it xxas held bx liord llnlc that tlie laxi appheahle
to tliese eases is ns follows

* It la sullicient to proxe that tlie dcalli of a person xtos iiccclcnited h\ the
malicious act of tin prisoner although tlie foniier Inhoured under a m irtjl disease
at the time of the att In tliose cases m xxliieh n slight degree of xioltncc lind been
folloMcdhj f ital consciptenees it is fora jiirj todecide iinderall tliecireumstaiues
upon llic actual and spccifit intention of the prisoner at tlit time of the act Mhith
occisioncd death In most of thest eases tliirc is an absence of inlention to liestroj
life, but the iialua of the Mound as xxell as ll»c means hx mIiuIi it m is inlliited
Mill often f>ufiice to show the intention of the prisoner An oceiimtc dtscnption of
the injury, if jilight ina> nfrurdstnmgcxidotiocmfaxourofthcacLUsed smectiiclnM
docs not so much reganl the means uscil bx bim to pcrjicirile the violtnce aa the
Rcfunl irdrriffon to Aa//. or to do great bodilx himi Sirious mjurx causing death bj
secondarx oonsequenKs xmU admit of no e\cul|Nilion xihen an assailant was nMiirc
Of ought to haxe Iteen nxxnrc, of the condition of the person whom ho struck Thus
if a person notoriousK ill, or a Maunan xxliilc pregnant, be inoltrcitid and death
ensue from a setondarx cause, the asscailant xxilJ lie licld rcsjionsibh because he
ought to luxe knoMTi that xiotcncc of anx kind to a person so situated must be
attended xvitb daiigcroas ion»e<jucnees So if tl»e jterson maltreated Ik. nti uifmt
or a decrepit old man, or one hdiourmg under a mortal disease it is notorious that a
comparatixelj slight digrceofxaolcncc wall destroj lift mthese cases and the prisoner
xTould jiroperlj be held respi iisibk A xM»imd xvhicli nccflerala death eauaes
death, and iiiij therefore render tlic aggressor rcsjmnsible for rnunier or man
slaughter, acionbng to the cirnimslanccs

This diitiim applies eipiallx to general frniitx or ill healtli ns to some local
diseisc mImcIi might make tlie xictim of mi injurj more xiilncrnble tlie
aged niul mfinii arc subject to the same protection at law as those lit and
able to defend tlieniselxes

Tliose xvlio Iiaxe suficred iimlmitnlion for long periods -from gn.strie
or intestinal complaints or b\ mere shortage of food liaxt. undoubtedlj a
lowered resistance to trauma and iiitecliim' (see starxntion) Tlie chrome
alcoholic sulTers the same defect for niiicli the same reason nutritional defects
are natural to alcoholism k (Sec alcoholic poisoning)

In some persons the bones of the bodj arc unusiinlij fragile so that thex are
fractured bv the slightest force, and death maj follow xxhen no consukrable
xiolencc lias been used but these being unexpected consecpiences and de
[ pending on an abnormal condition of parts unknoxvn to the assailant, his
V responsibihtx inaj not, ctr/ms ponfriw be ns great ns in other circumstances
This condition of the bones tan be determined onlj h\ X raj or section
? at nutopsj Facts of this kind can shoxx tliat the degree of oulpahilitx from
^ * Siinjson, K , 1031 Modem Trends in Forensic Medicine London Butleniortli

-Jto TIML 01 !\JVUY

Where the condUion js one tlial does not Irml itself rendiK to nswH.itf^n
ujth traiinm on the lint's -set out nlmvt ns for inslnnec «ith kulncv Icsom
follosMnfr hmb cnislimjj proof of assocntion nn\ rtqiiire some siwial
reference to Mork like that of B\ waters* in order to suhstanlinti a lelatioo ! ip

WHEN W'AS THIS INJURY INFLICTED i
This (picstion m i\ arise in tasiinl deaths fmiu falls m abortion h\ lustm
nient in rape and when the nceustd asserts that a wound cither on Imnvlf
or Ins \ictim, was caused in on innocent wo\ on n date tint dois not n'-rer
w ith the theorj of the pmsetiition ns to liou or when it aios'' It cannot Ik*
answered with an\ cwtncss, hwt a nicdienl witmss mas be asked to m\
whether the state of the wound is eonsisteiit with the statwl /acts as t»‘ (mic
making allowance for the exceptions with which cxpenenct iiss nude him
familiar It must lie rcnicrnbcrerl that some injuries like those to the hi men
ncserhenl inerelj becoming eoscred In a iitw siirfnte
AorjHfl/ repair When a part of the ImhU is injtirid certain ihcmicsl and
phvsical changes occur ns a resu/t of which tnpillnrs dihtion aid rislcn a
deselop almost at once This is followeil In the migration ol white cdK fn in
the c-ipilhries into the ilninagrti area nn<l if the pirt hi txanuncilln tic
“window method * the white cells mas lie seen ilmging to Hit wall of the
s essels prior to migration w itliin o few minutes Q hc\ then migratL in iiicrens
mg numbers n phenomenon which can he seen fpute will nucrnsropiralli
within SO minutes^ but which no doubt is a lonliniiing proicss from III
moment of damage The amount of exudation and infiltmtion dejumiliiM tl c
extent of tissue dininge Inlhcenrls stageslhewhitciclisortlu ivtraiftsalnl
blood must l>e distinguished from migrators cells T hesi jiDKinorphnniwlcat
leucocs tes begin to frognicnt in three to five hours a prod's** of degitnnboa
sslueh IS usualls complete within 21 hours® and wlmli liberates a dijcstivr
proteoljtic enzjine

In a clean wound the process of repair is si on m ii hw hours wl«n Vw
fibroblasts begin to prohfernte and budding of loops from the eapiUirics
with tilt formation of granulation tissue occurs If the ed„is of the lu »" b
are m apposition tlics hcionic gludi fogctliir h\ fibrin and luiding
without the fonnntion of granulation tissiu

Ol/irr radars So mans factors arc contemed in tbi tniising nu'l hcO'U*?
ot wounds that exact determination of the age of a wound is iin|>ossiblr' I at
vt ms be said that small clean woumls will scih o\er in from 10 l'> •*
tmrs si-ms of inllamniation (in smh as arc inferted) will he iipparcij| m
tromtiO to 40 hours after inlliction nml towards the Inter linuts j iis wi*
tvidtal, granulation tissue of nppmmble extent will mreb be

*,*,-^j^,^^uppwnit»o«*“*‘'*”^“<^^*'blish«lmawound fht w'lim

Vetnon aippurating for an indefinite time w ilhout iniu h sign of lrea»
tb-'vfo’T thehniils will base to be so wide tlmt thi\ ma'

nunwsei. K parts of it show signs of “

liniusl not l>e forgoUi » that m i xsrsof bwe

-“*amcsand in ileficicm v <Iis'’ast-s

^jUMcs from bums and n rn-si'*'^

AGC 01 IUtUl*ihS 2i7

111 iKiciies long dend llierc m-iv be M>n!c difliuilU in distiiigiiishmg the
tlTctls of giiiRreiie in n %\ omid from those of putrcfirtion Gnngrene iinjilies
the dcith of n part in the In mg lK)d>, nnd piitrefnctne chnm,es tnhe phcc
m the deid part as in flic entire dead IkkIx If rlnngis rcscmhhng those of
gangrene arc found in n aioundoil limb while the rest of the bodj is not in n
putrescent state, there mn\ be sonic reason for the opinion that there was
gangrene during life In such a case howexer due nllowanrc should be made
for the more rapid deronipositioii of wounded parts If putrefaction is
advnneed the opinion of a person xslio has not seen tin deceased while
living can be little more than a conjecture

The age of a bruise nuist be given also with siunc caution TJie changes
wlmh take place in the colour of a bnnsed spot will serve to aid the witness
in giving an opinion on the probable time at whieh a contusion has been
infliited \ftcr a certain period commonlv in 18 or 24 hours the blue or
livid margin of the spot is observed to bccoine ligliter it nccjuircs a violet
tint and before its final disappearance it passes succcssivcK Ihroiigli shades
ot a pven jellow and lemon colour During this time the spot is mere ised
in extent Init tlic central portion of the bruise which received tlie violence
i« alwavs dirkcr than the circumference These features arc due to changes
in nnd the absorption ol, the blood pigment The colouris finalh removed bv
tilt absorjition of the o/fused blood The extent and situation of tlie bruise
the degree ol violence bj winch it bas been prodiitcil ns well ns the ngc nnd
stntc of health of the persons nix so innnv circumstuntes whuh max in-
lluoncc the jirogrcss of these thnngcs Ihus n bruise takes vers much longer
to ilisappear iti old pers<ins than in the voiing One frccpienlK finds efrused
blood 111 n bruise in an old |icrson four or live weeks after the infliction of
tlie injiirv \Micre the meinbmiu beneath which the blood is cfTiiscd is
dense the bruise etr/erif ponhiit is not so mpidlv ajiparent to the e\c as
the blood has to travel farther to remh the skin surface, nor when formed
do the above changes take place in it so spccdih ns when llio blood is crTuscil
mto a hwisc subcutaneous tissue like that siirroumlmg the eie or cvistmg in
the scrotum In some iiistnnccs a bruise Iins been observed to disappear
w itbout mulergoing changes of colour at its iimrgin On cxnnumng a bruised
portion of skin which has sufTcred from a severe contusion wc find that the
discolouiatinn affects more or less the whole snhslance of the true skin as
well as the tissues beneath jl

ihtsc remarks in general liohl gtwKl for stipirfa mI hniises where there is
no great ipiantitv of blootl i>oiiivd out if on the other hand there has been
u lopiniis oiiUIow of blood winch has l»ecn alile to coagulate into a clot of
sonii size absorption of tin clot with n rc^lituiin « I i/itr^nmi of tin nlTixlcd
tissues IS n jimccss of \cr\ mucrlnin dimition

\ii niitoi*sv was ixrromiwl on a man s<nwwl»at ndvaiietsi in VTars who four
weeks pftsi wisls I a<l lire ken a tKiie hi lus Kg- ll« ends of the tut kin l>one were
ijiiilr hnKwthtsl off liv iihsorption, hut mtiiul them was a Isrgr still njjnmitls
ipiite rreint clot of IiIoikI It w is ifn|x»ssil>lc to stale tlie date of llie fRiilurr
c\TU njiproxfnialcK from tlie c-oimHH n of tlw. bloiKl c! >t the Mnnottiiicss of tin
broken ends c f the bone strongK sugirrsled u pre b ible diimlioii of at least two ( r
tbrec w-ecks but tJiorc vi is nocUlus

Truutnlit elTiistons into tin siilHliiml space nre notorioush slow torcpiir —
mdt ( d most beixvmc cnev 'tcil and remain so for hh gruhinllv losing pigment
(Six* Ib/id Injuries f> M)I)

Intact nd iclls hm tarn found in Imiises iftir sevend wicks but it is

24 1 ACCEIERATJOV OF DISEASE III' TR WV t

iiolcncc used m an assnult ennnot alnass Ik n, ensured b> tl,c eirecls >
carcM assesnjet of tl.e Bcuenl cond.hons and prcpsr nltcnlU f(l,c
signincance of local disease are essential to a fair judjnent

m A speafic disease apparently muioniu-eled leidtle rroiiiid n™r, ml.

sfQUCiitiy

CfLs« of tins kind are Iikeh to cause grcit diir.ciilts m mtcrpretation
though certnm ticks ed consetjucnces of injurs arc common enough to dcinind
actepknw l-or example after x loUnee to the head « dh or without «k ions
p issieil damage, menuigitis max superxene rinsnnv not become tl.nicallx
obx ions for minj weeks ex en months, or it maj be retarded for 'tn indefinite
penod Similarh aschoollxix mix hix e hu ears Iioxcd h\ amastcr and nn\
suhscquentlj complim of pim in the head and max die xx itiun a week or two
Vt the aiitopsx meningitis nm be found and the question arises xshcUicr it
IS «lue to the blnxx or not If the meniivitii is due to the ordinarx septic orpin
isms an effort should he nnde to -isccrtain where the septic process began,
for it IS jwssible tint a quiescent middle ear or antnim infection max hixe
itcen ht up bx the xiofenee

\n \mix despatch dnxer a^nl Vi sustjiinctl n fmetinvd skull m a xchicuLir
accident in lOW lie wn.s treated at the Anm Head Injur> Lint it Ovfonl for
scxcralmonthi but onili>tliargc xsasstilldeafio the left cnromlsufTercttoeeasfiij'il
otorrhcpa Tlic left side of tlie fnec was x«eak On Dceenitfcr .it, 12 xfors

after lus mjurx— he xias found uneonsciotis in l)cd tlic T S 1 xriw purulent {-»3 (KW
\\ OC witli 03 i>cr tent polvnxorphoniiclear wlN) Grain poMtixx ewri xicre
present in hrge numbers and non luemolx tic streptococci were cultumL He died
Ixxo (kxs htir \ulopsj rex cafetneft otitis mciln osteo mjclilw of the niastofd
bone and an abscess in ttie tcmponi^phcnoidal which liad ruptured on the surface of
the brain

Exen if tuberculous nicniiigilis is found it is still ]>o«ibIe that the injurx
mij haxe initiated the disease nllhough in such cases it is higlJx probable
tint another focus of tuberculosis xnll be found in the bodx Vn injiirx to
rtnj part af the had} max feid to a huem) res/fiarfce at tJnt part ar/d thn
maj predispose to the lodgment of bw ten » nt that silc and the suliscciueiit
onset of disease The fact that no txidcnce of injury mix lie found it the
alleged site leads intunllj to difTtrcnecs of opinion about the rclaboiiship
of the triunn to the subsequent disease In such cases the mjurx must l>c
proxed and it the sxmptoms of disease npjiear m a reasonable time in a
prexiousix JicaUJn jierson there is a presumption that the mjurj max haxt.
been the casual lactor

\Mien a pathological condition such as tuberculosis or a tumour such as
a ghoma appears sonic time after an mjurx it is quite iintuml for a lax jitrson
to assume that the txvo exenU arc clostlx rchtw! 'Ihis a.ssunipti<m is not

xxarranted when the relationship is one. mcrclx of time exen xxlicn the dexelop

ment of a disease folloxx-s cIomIv upon injurj Hnth disease processed niwl
new growths dexelop naUirallv in llic xnst majoritx of cases? an 1, nltliotigh
mjurx max l)c a precipitating agent, it must rest xntli the utrdiril examiner
to dclmc as far as he can xxliillicr an) causal relationship exists TIic
principal iroints on xxhich one wouW base Mich opinion axouKl l>c —

{«) the clear understamhng that a rtlitionship m time dexs not m itself
form a nccessnrx indication of aiix other fonn of n htion'Iiip

lb) that persons xxho an. the subject of disoc or nexs gniutji r«elih
attribute the beginning of that disorder to an niitce-ceknt mjurx if a din-cl
question to that cITect is asked This must be eonstaiitl) bornt m miiul xxhen
the historj and s\ niptomalologx of a case t» being examined,

PJiE EXrSTl^G DISFASr AXD TJiAUVA

245

(c) funclionnl disorders are quite common nfter })otIi disabling injuries
and minor trauma These functional disorders sliould not be assumed to be
examples of ninliiigermg, for thej mav be aerj real to the sufferer though
no pin sical basis for the s\ mptonis can be found,

(d) special conditions must l>e satisfieil m order to establish a possible
relationship between trauma and disease

(i) tint where injurj has broken down barriers of defence or admitted
infection or the process of repair is complicated hv disordered
proliferation of tissues the ordinary consequences of tlie&e events
might reasonably be said ‘to follow upon and be due to the
injim

(ii) if trauma can initiate a disturbance of the tissues requiring
repair— ns in a bruise a tear of ligaments or a fracture of bone —
it needs only some disorder of that repair process to cause the
development of *a tumour

\lthough It might be thought reasonable to set some limit of time to
permit the continued appliiation of these principles no arhitrarv limits
should be attempted Some processes of disortlcred grow t!i— certain tumour
growths in particular are remarkably slow m their development
The subject is a vast one, and not within the sroj>e of this work Stern
set out in 1'>4J a oomprclicnsne suriev of the evidence for and against
trauma being assoemteal ivitli new diseases arising siihsequenth, and those
who desire to explore the matter fiirllier should consult his work '

Acceleration of Pre-existing Disease (which may have been unsusjHcted)
constitutes another problem altogether A disease process sucli as tuber
culosis of the lungs or a quiescent septic infection may be disturbed by injury
and thereby enabled to spread Even njierc the original lofection is pom
paralively slight the breaking down of tissues bv a blow mav result in the
free access of organisms to the damaged part and cause a sudden evacer
bation of svmptoms V kick trom a horse iti the region of a vascular renn]
tumour may easilv cause it to break down its natural barriers and— for the first
time — to bhed oi to ilctach growth cells into the renM v cins w ith fatal results
\\bcn injury to a part is followed sliortiv after by svmptonis referable to
that pirt and the development of a chain of events which miglit be related
to disturbance of pre existing disease it is reasonable to ascribe the process
of rcactiv ation and spread to trauma

A child of ci^ht attending school as a normal child fell to the groun I trfij »

I hying one I-cbniary 27tli It opiHrarcd lo have been eoneassetl romunraffsemr
consci JUS for about on hour and sleeping for the rest of the day On t/ e n«t j
there was a squint the t,pecc1i was slurred and the child could Hot Icen it, luJu
whilst St indfng A neurol igist made a chiucal diagnosis of a hrniu stem
probihly developmental — ■uid \ ascuTar enough to have had its 8uhslann»ffK-fi.,i*^^l
by the trauma of f dl to the ground Deep X ray therapy effected *0fne
improvciHcnt hut towards the end of Xuvrinber the condition deUnoniBl
respiratory infection ultlmatelv developed m the first week ofr)(?fi>n](;e,f,f,l °
year Ihe vaew was expnssed tlint (Ac tumour iris a «'«hg»wn/rfad
and that the ilinicnl course of events and autopsy rinding!^ ajf nJa/vg »
yiig^testion llinl injiirt/ jias lo be assvnoted sciih ihe dnrlomc (i^g , ,
that it would have Icen jiassil/lf for tiijan/ to thr head lo fim.r mtrd btee
suhseance anti lo prenpitaled a period of unconseionanetjoiJaniif^'^'^^'""
dratcirif’ atleiiliaii*ta its preAfnci It was most uiiJtkcIj tl*Jl Iftewirrscof n* ^

(over some ten months) could have been intlueiieei! to anvjcaiftant d l
mei 'lent 111 the play gTr/und egree

* htern II 1013 Trauma tn Jntermd Dixase London. It

240

TIME or IhJURl

\\ here the comhtioii is one tint does, not lend itself rcadilv to ass.x , ,tiun
witii trnunn on the lines set out abo\e as for instance witli kidnc\ Ics ons
following hmb cnishing jmKif of association ina\ require some siiocinl
reference to ^\ork like that of Bvwatcrs* in order to siibstantiitcn nlatiouship

WHEN WAS THIS INJURY INFI TCTED J
This question maj arise in cnstnl deaths from falls in nlorlion h\ instni

ment in rape and when the accused asserts that a nound either on himself

or his victim was caused in nn innocent wav on a date tli it docs not n^rec
with the thcorv of the prosecution ns to how or when it arose It cnnnol Ik-
answered with nnj exactness but a medical witness mnv be asked to siv
whether the state of the wound is consistent with the stnleii facts ns to time
making allowance for the exceptions with winch experience has made him
familiar It must be reniembercil tiuit some injuries like those lo flic h\ mm
never heal nierelj becoming coverevi In anew surfiiee

Y ormal repair \Ilicn a part of the bodv is injured certain chemical and
ply steal changes occur as a result of which cipillarv dilation ami tidcina
dev elop almost at once This is follow e<l In the migration ol white cells firm
the capillaries into the damaged area and if the jiart be exammtil hj the

window method * the white cells niav be seen chnging to tlic wall of the
vessels prior to migration within a few nimutc!, Ihcv then migr item iiicreas
mg numbers a phenomenon vvlueh can be seen quite well niitroscoiiicall)
within 80 minutes^ but vrhicli no doubt is o cuntiniiing process from the
moment of damage Tlic amount of exudation hiu ) innitralinn dc|)eiids on llic
extent of tissue damage In thecarlv stages the while cell'> oftlieoxtravasuted
blood must be distinguished from inigratorv cells These polvmorpliomicliar
leucoev tes begin to fragment in three to five hours a process of degeneration
which IS usually complete within il hours* and winch liberates a digestive
proteoljtie enrsTiie

In a clean wound tlic process of repur is seen in a few hours when tin
fibroblasts begin to jirohfcratc and budding of loops fioin tbc cajullancs
with tlie formation of granulation tissue iKtiirs If the edge-s of tli< wounds
are m apposition tliej Ijecomc glued together b^ fibnn and litaling occurs
without tlie formation of granulation tissue

Other ractors So main factors arc concerned m the causing and healing
of wounds that exact determination of the age of a wound is inqwissiblr bnl
It mov be said that small clean wounds will scab over in from 10 to .>4
hours signs of infiainmatioii (iii such ns arc infitfed) will be apparent in
from 20 to 40 hours after lufiiction and towards the later limits pus will be
evident granulation tissue of appreciable extent will rarcK be seen withm
a week hen once suppuration has Iiocn established in a wound tbc wound
niaj keep on suppurating for an indefinite time without much sign of hcalii g-
in such n case therefore the limits will have to be so wide iJmt llitv mnv bt
useless for medico legal pur|ioses If parts of it sliow signs of scarring a
narrow er limit mnv be fixed It must not lie forgotten that in i ases of low tre.f
vitahtv m certain endocrine disturbances and in dcfieicncj ihsfases healing
of wounds maj be greatlj dclavcd Injuries fn m Imnis and corrosives
lieal verv indolentlv

■ m-vater! F- C 1- II»M J iffT ntti Ur t24 llOt.
»rirf<alsop ini wjetetlengeofascariscoas Ici^l
» Clark I ll and Clark J U lOVJ -

‘tarsenddon W J lt»2" trel lath lab Urrf V , ,

* lIiggiM C M i 1 aimer B JI tO-ll Ueb lath 7 63

tGL 01 mthlSI s 2i7

In bodies long <lentl, there be some thfRculU in distinguishing the
efRcts or gingrcne in a ssoiind from those of putrefaction Gangrene imjilios
the death of i part in the lumg bod\ and putrefiutne clunges take phee
in the dead part ns in the entire dead bod\ If changes resembling those of
gangrene are found m n wounded limb while the rest of the bod\ is not in a
putrescent state there nia\ be some reason for the opinion that tliere \sas
gangrene during life Insuchatnse ho%\e%er due allowance should be made
for tlie more rapid decomposition of noundetl parts If putrefaction is
adsanced the opinion of a person who has not seen the deceased while
In ing can he little more than a conjecture

Ihe age of a bruise must be gnen also with some caution TJic changes
winch tahe place m the colour of n bruised spot will sersc to aid the witness
m giMiig an opinion on the probable time at which a contusion has been
inflicted \fler a certain jieriod comnionK m 18 or hours the blue or
livid margin of the spot is observed to become lighter it acquires a violet
tint and before its final disapjwaraiice it passes suetessivelv through shades
of a green vellow and lemon colour During this time the spot is iiii-re iscd
in extent hut the centrnl portion of the bruise which received the violence
IS alwavs darker than the circumference These features are due to changes
m and the absorption of the Idood pigment fhe colour is fmalh removed b>
the absorption of the efrused blooil The extent and situation of the bniise
the degree ol violence bv which it has been produced ns well ns the age nnd
stite of liealtli of the persons are so nianv circunistonces wincli mav in
lliienee the progress of tlicse changes Thus a bruise lakes verv much longer
to diiiippear in old persons than in the voiing On< frequenth finds tffiiseil
blood in a bruise m an old person four or five weeks after the infliction of
the iiijun \\’hcre the membrane liencalh wlncli the blood is effused is
dense the bruise ccrfirris paribtts is not so rapidiv apparent to the ova: as
tlie blood has to travel farther to reach the skin surface nor when formcvl
do the al>ov e changes take place in it so speeihlv ns w lien the blood is effusetl
into a loise subcutaneous tissue like that surrounding the e\c or existing in
the scroliini In some instances n bruise has been observed to disappear
without uiiiUrgoiug changes of colour at its margin On examining a linnsecl
portion of skill winch has siilTcrcd from a severe contusion we hnd that the
riisiolouration affetts more or less the whole substanct of the true skin us
well as the tissues bcneiitli it

nicsc minrks in general hold gowl for superfii-inl bruises wlicrc there is
no gnat ipiantitv of Idood poured out if on the other Imnd therv has been
a lopious outllovv of blood which has been able to coagulate into a clot of
some size absorjition of Hie clot with a restituii i nl i/i/rgniai of the nffccted
lissut^s Is a pro( css of v erv uncerliun duration

\n uutopss was {lerfonncd on a man somewliat ndvaniTd m sears who four
wcek-s pftvioiislv h id Im ken a bone in his leg* tlie ends of the brokin bone were
ipntc smoithfd off h\ nkxrption but roiiiHl them was a large still npimrciitlv
quUe recent dot of bltwxl It was inipossilile to stale the date of the fnnturr
even iij jiroxim itch from the condition of tlie bl xxt d it the smoothnevs of tJ e
bn ken ends of Ihe 1 one >ln ivh suggested « pn hable duration of at least twai c r
tl ree weeks but there w is no williis

T rniimatic effusions into the siilMlural sp ice are notoriouslv slow to repair
iiulceii most heionic cnevsted ami rt mam so for lift graduallj losing pigment
(See Iftiul Injuriis, p fOI)

Intact red cells have Ictn found in bruises after severd weeks but it is

218 ^GE OF FRACTUEES

ob> lomU ,mp„s,,He to tell whether ™eh odi, ore the prodoet of the or™oI
lojurv or ohethcr thee ore due to a subsequent sccondirs h-emotrhoee
Il-emosulerm maj be found and about a bra, sc and ,n t) e adueenl h mph
glands soon after it, inll.et.on and its presence g„ es us I, tile dcnn.te n.foran
t.on alxait its age It ,s probabi, safe to saj that .t ,s not usual to fmd
tins iron eonta.nmg pigment in less tban 12 to 21 I, ours Ifcmaloidin an
iron free compound denied from blood niai seen be m the form of ncedle-
bhe cn stab m old bniises It is unblelj to be found in less than a iiecl. ■

In fractures of bones it is usual to find the dnn clots of blood siinoundine
tJje broken ends of tbe bones shomng^ signs of or^tiizafion in nfmut -18 bouts"
the formation of osteoid matnx m aliout three das-i and its transfonmliou
into callus starting about the end of the first sveek Callus formation is
^^ell advanced in 10 or 12 da\s Callus is the cementing material thrown
out between the ends of a broken bone, which gradtialK changes into Ixinc
if then callus is felt the fracture is piiobabl> of this duration at least but if
none is found it is impossible to state in tlicliv ing wliat is the age of a fracture
If callus is present we nia\ form some idea of the 3^.0 of a fracture bv the
hardness and firmness of this substance si\ weeks to two inoiitlis is tlie
average period for it to undergo a complete conversiioii into material as hard
as fione Callus mav remain for /ong periods m cerfaiii c i*.cs and tl is iiiav
cause difTicuJtv is estimating the age of a fnielure Once a fraiture In-,
aquircd genuine Iionv union there is IitUe einnee of ascertaining its age In
all cases however an \ rav examination of tl e bone and where possible a
microscopic examination of sections of the tissues sliould be made
In dislocations the nnlv chance of estimating their age is the possible
presence of a bruise tlie colour of which mav give some indication Tins
IS a comparativclv slight chance and if Uie blood has escaped verj deeplj
amongst the tissues it mav not come to the surface for o long time mid giv e
tlierelora a false estimate of the date of the injirrv In older cases the amount
of new fibrous tissue or the formation of a fabe joint maj give some indi
cation of the age of the injurv, as for instance with old fracture dislocations
of the femur up onto the w mg of the pelris

\MTH\\HAT^^EAPON OR HOU, WAS THE INJURE INFLICTED?
Evidence from the Wound itself

It IS not necessan to prove that a weapon has been used for the production
of a wound tor the wonls of the statute arc tHiosoevcr sliatl By any tnaitis
chalsoever wound or cause anv grievous IxkIiJv harm to a person etc
vet evidence of the use of a particular wcajKin in case of assault mav he ui
important part of the evidence and mav also matenalJ> affect the amount
of punishment awarded on conviction Wlien upon the clearest evidence
it IS certain that a weapon has been used it is not unusual for the accused to
allege that no weapon was emplojeil but that the woiiiul had been occasioned
bv an accident \ medical witness iib seldom m a jiosition to swear that a
particular weapon produced at a trial must have been used all he can state
IS that the wound was caused either b\ it or b\ one similar to it

In K V Ilealh^ (C C C 194G) the marks left on the skin of tlie victun bv a
switch with a diamond patterned leather woven covering were so dean>
defined that tlicj could be measured with mathematical precision and com
pared in fine detail watii the weapon found in Heath s attache case

>Miiir R ANnen J 1033 J Path Poet 'll 183
*&imp-K)n Keilli 104” Plaice J 20 2'y

I^TrnPRETATlOS Oh MOVh,DS 210

Oreit ran must ne\t.rt)ic}ess bt exettisal b\ the doctor iii nxsixnling
particuHr ^^()un(ls nith particular \scapon<i

A 111 m lias stabbed in tlic fu-e and a knife ttil/i Ihf entire 11 1 le was imidiicod as
circumstantial cvideiict igjinst lus assulanl the surgeon hiMiig stated that the
woun 1 bad been caused bj tluit particular knife The wounded man rccoaertol but
ft >0 ir artcrwurds an abscess f imied in his face and the broken point of the wc ijw n
used bj the assulant was distliargcd from it flie wound could not tliercfure 1 a\e
been called 1 j the knife wlucb was pnidiiccd as c«denec against the accused at
the trial

AUlioii^h the cnmmalitj of an act is not lesstnecl or impugned b\ nn
occurrence of this kind it is adamble that such mistakes should he a\oidcd
hj the use of proper caution on the part of the medic d w itness

hen a w capon is produced there is no didicuita m answ cniv the question
Could this weapon have uinictetl this wound’ but the ddhcultics immctli
atclj bc^in when no weapon is rorthcoinuig nnd the witness s opinion is
founded on ui examination of the wound onlv

There are one or two fiindnincnfal projicrtics of tlie skin whitli liave a
ven important hearing upon this sulijcct

The skin Is clastic, and is m a In mg henllhv state slightlj on the
stretch m all directions parallel to its surface It therefore follows tlint in
piuictiiros with a blunt instrument the hole must be as a ni)c a iittlc snnlJcr
than the diameter of the wcaimn for the skin vnclds In slrctihing without
tearing round the lutual I reach of toiihnmtv ( \n experiment with i lend
pencil on a piece of sheet mdia niblicr wdl well dlustratc the iKiint) II the
weapon IS sliarp at its jioint hut hhmt elsewhere tlie incqmlitv between the
orifice ami the weapon mnj he even iftcitcr SinuInrK in incised wttmds
the tension will draw the ^ges apart so that the aperture bccomts mutli
wider than the width of the ciitlmg blade A stab witli a double ctl^ed
weapon jiifts s/ion^ a contp/cfo diamond shnpetf npcffure whde Otar with a
single o<lgc and blunt hiuk mu show a half diamond slnpc as below but
unless the. blunt edge is verv bniid it is unhkclv to Iravc more thin an
elliptical split with one extremilj lorn

'ilic skill IS vnnnhU movable on the under!) ing tissues, It is flexible
fair!) tougii and somewhat stick) It follows then that wj«« an cil„td
vveaiKin IS ilrnwn acros^ tlic skin we ina) get several cuts from one action
sc|nratcd from one another hv small hmlges of uncut skin wlicrc it folded
on itseff

1 ven with i si irp kmfc the skin ma) he thus dragged for however
sJnrp it j", it nlw us has sonic projetling points which nnv catch mid with
jagged and blunt knuts this is tnic to a still greater degree Ihe stickiness
ol the skin and the jaggedness of the weapon explain the inversion and
eversion of tin edges of a stab wound showing the direction of tlic last
force used

M e must now consider m some dclftil the various fomis of wounds tippl) mg
tlic ftliovc pncij lc.s

] Abrasions \^ hen nn object pres es into the skin it makes nn impression
on iL If the contact made is more forceful the culielc hceoim“s cnulud at
the j)omt of impact ollcn hcnnngu pattern of the mstrument Uhcii emit vet
Is of ft hnislimg or graying kind the cHntv of an) surface pattern u obscures!
hut the dirwlion in whuh the cutis is tom miu give an mdicition of tlic
direction in which the blow was lUlivcred—or the bod) slid

-™ l^Tl UPItl TAnOh or IIOUAH?

Mo-t ahriMon? l,ccomc Ik-U(t <Wiiic<I is ll,t iiijiittd iiiliclc lines for it
becomes broiin and tin contrast belsiccn It and the iminjtircd stin imreases

- Incised Wounds Ibe slinrpness of the nistrunient is to some istenl

directlv rclnled to the clcmness md teRliInriti ofthetdscs sbottenne llvina
glass nin> cause retnarknbis sliarp ec/ged cuts flifiugJi when s/nttered on
impact local surface abrasions ma\ also lie present The amount of blood
clTusccl niaN also give help in assessing sliarpness lor it is a\cI 1 recognized
that a sesscl cut clemlj is more apt to bleed freelj than one nlucli has been
torn across Cases arc known in which a hmb Jms actuallj hecn avnilsed
withbcarccK an\ bleeding and torsion of a vessel is n well recognized method
of checking h Linorrhage from it It must be admitted per coiitra that an
artor) half sescred bleeds more freclv than one eompletch cut across for it
can neither retnet nor contract

Ihc length of an incised wound gnes no indication ot the length ol the
cutting edge for the i>omt of a knife nn\ lie drawn anv cUstumc clovstx or
across hmh or trunk

fl Punctured and Stabbed Wounds li\ a punctured or stibbcd wound
ts understood n ivonnd produced In a poinltd iiistruiiK iit being driven in
through the skin ns opposed to n cutting edge being drawn across the skin
The sue of the entr\ is slightiv smaller than that of the instrument iinlevs
rocking enlarges the opening

The depth of the stab is one of the most important points to mile for
It wdl often gne a chic to the length of the instrument used though it must
he rememhered that if <lri\cn in with mutliMoIence thcjicldingnr the tissues
ma) allow of a pcnctpatioii dcejicr than the length of tlie weapon This is
espceiallj true ol stab wounds of the abdomen

Iho careful examination of a wound once disprovcil a charge of mahetous
stabbing bronglit against iimoeent jitrsons

\ little girl was allct.cd to luisc rcccisotl while sitting over an iron grittng n
wound III tlie pudendum b) some person piisliingn toasting ft rk or pointed instni
inent between the b in of tlie grating from below Tliere were no punctures which
would hasx been found had this statement been true but ii slight laceration of the
parts siicli as ought liase been produced b% an accidental fall on the edge of the ire ti
gratin ' while tlie girl was iii a sitting iKSition. There wen also marks of bnusps on
the tlugh supporting such a snew Jlic child for a certain purpt se luul placed
iiersell vohinlnnlj m this jioMtion, and l» id on her own adnwsswwv slipiwd and tints
injured lierself

If it be asserted tint a punctured wound was pnidiued b\ a lali on some
Afiarp bodt such as gliss pot sharp stone etr it is almost imimssihle for
tlie wound to be of anj great depth without a part at least i f the nuitcnal
being found bniken off m tlie wound

During fas lor s tune a bpeamen seas ploecd on the shelves of the Cor Ion Museum
Gu\ s Hospital from n case iii which a man of -0 was smoking a elav pif e when
a stra\ blow from an elbow thrust it into lus nioutli brealuns it off nerovs e sicm
He fainted but soon retov cr«l and nothing more tluin a local punettire of the |lwr
of the mouth under the tongue was seen Two da>s after a small hen.oirlmge
occurred and four dajs liter a \ust Inemorrhage burst frcmi the ninuth i a
immediatelj fatal Tlie broken stem of the ila> pipe was found buried under the
tongue partl> plugging the left lingual nrters

^\hen a stab has traversed the bod\, the ciitraiHc aperture is commonl)
larger than the aperture of exit owing to the tai>cring of the blade and the
greater tendenev to rock in the entrv wound

iM'CRPitn ATiox Oh noOiNin 251

TJic both iliouUl be seen soon nfler the mJhction of a wound and before
there hai Ixcii an\ interfereiue with it surgical repur or further surgical
stnV) wounds for drunnge mat easils tiU',c error

4 Lacerated Wounds do not m pcntral present greater diflitults witli
regard to their origin timn those whuh ire incised or punctured 1 lie means
svhieJi produted tlie Jarcntion art lommonh indirstcd hi the apjicanuK-e
of the wound Dicse injuries are gcnerallv the result of blows from stmi
sharp instnimtiits like clioppers or iron bars capable of splitting the skin
cspccialU where ( is os er the stnip) it is pinned and split against bone

'ihc\ arc tommon in street \ehule attideiits from cither impact or fall
The\ are, litiweser frequently met with on the IxhIics of new born children
whose tender skin is casiU split by direct impacts

Glass earthenware sharp flints usualls produce hccrated wounds with
Jagged uncsen edge-s but on the other hand it must be remembered that
tlie nc-tinl edge of a piece of broken glass is probibh sharper than t{ie
sharpest of kniscs It is therefore exeeedmgh diflicnlt if not impossible to
distinguish hv the mere cleanness of the cclge of an individual cut between
I cut thus produced and one produced b\ n knife It is the little marginal
cuts and abrasions produced by frigments of the glass or jiotterv tliat
Will cliieflv throw hglit on the nature of the wounding object fragments of
ghss or btonc are < ommonK found in the wound

A cose occurred in which n deeply |>cnctratiit 4 wound on the genital organs of
a woman whidi had esidcntlx causcil her deitb was ntlnl uted b\ the prisoners
charged with the imir<}cr to J er fallen on wnie hroKcti gliss but it M"is

provwl tliat the edges of the wound sscre Itounded everywhere by clean incisions,
winch rendered tins licfcnec luiprobiblc if not impossible A sundar definec has
been made on other oecusmns fn one a man struck the prosecutor and knocked
him npuiist n « mdow On exnmination there were three deep cuts on the face of
the ]m*heciitnr but no weapon tnd been seen in the binds of the prisoner lie was
cliarged witli cutting and staliinng flic surgeon «tnted that tiic wounds appeared
to Imve 1 een inflicted with a kiHh. or razor hlide and not with broken glass Itut
If the wounds lu I Iweii made snlh glivi, particles of that substnnee would probably
Inve been found m 11 cm and tlierc svetr none The prisoner was ats)Utltc<t, the
infliction of the wounds b\ a weapon not being considcrnl to Ime been suftlciently
made out

In It ^ /In/ rrs n clean cut as from a iK-nknife about two inches iong and one
indi dexp wws found on tlie person of tlie prosecutor win liad fnllcn during u
cjuirrel willi the pnsoncr borne broken ciwkrn was King near tlie s|K»t and it
— sins alleged for the defciieo tlinl a fdl sipon this liad entued the wound This alic
gntion was inconsistent with the rJron and e'cn nppearance of the etlgca of the
wound Tht jinsoticr, in win sc j ossessionapciiknifeiiml liccn found wascoiiMCted

A earcfiil c\aunmtion luntlc vslicn n wounded person is lirst seen enables
a iiiedunl witness to meet suggestions of this kind

5 Contused bounds— ic bmiscv nssoemtod with some skin lesions
present loiiMdirnble difliciiUy to ibe mcdital jurist It is not often in lus
jinwir to sav whether a contused wound has rcsultetl from tlic use of a
weajHui or nyifW b\ reason of tiic diseased Inving arcidcntalh fnllcn against
some hard surface The qui'stnm is frequeutlv put to liicxhcnl witnesses m
trials for honuculc w Inch arise out of the pugilistic combats of drunken men
One of the combatants nnv be killed cilbcr b\ a blow on the head b\ nfall
or by Ixitli kinds o( v inhnce combined flit skull imv or in iv not he fractured
The general defence is tli it llic deceased struck his head agniiisl some hanl
substance when falling and the doctor n» asked wbclber the particular

2^2 I^TEItrJiETATIO\ 01 WOUMiS

appc-irances may not be explained on the supposition of n fill \ mnliral
Hitness IS rarelv m n position to swear with ccrtninlv that a conbisoil woiin .3
01 the head must ha^e been procInce<l b> a wtnpon and nnt b\ a fnll Sonic
circumstances however, mav occasionalK enable Inm to form an opinion on
this point If the marks of violence are on tlie smiimit of tlic lirad it is
liighl} probable that thev have been caused bv a vvcaiKin siiire tins is nit
tommonU a jinrt which can receive injurv from a fill If however sand
gravel grass or other substances be found m n tontnsctl wound this will
render It highlv probable that the injiirj wasrcnllv caused In a fall ^Micnthf
vpicstion issimplv vv hether a conluscil wound was prodiicfd bv a Mow of IIk.
fist or b\ a weapon it mav admit of an answer from an c\aimnatinn of the
wound as in the follow ing cases

In It V llo-tes, the deceased, the wife of the pri oner w is f mid with wjvTre
contusions on the head and face and a lacerated wDimd on llie tcinph Sla «IfnI
from extravasation of blood on tlie brain The dcfcnie wvi". that decea^l liad
fallen against a fender while intoxicated mid so hid i-nuscd the vroiimLi Jmt it
was profierlj stated bj a niedual witnos that nhluiigh n larenUst w«-\inl on
the side of the head might have beensocauscti tlie other injuries l*orc thcclLirocters
of repeated blows Counsel for tlie defence widied to m ikc a general nin ik'-umtion
of all this violence, although the vrifness had slated Ih it Hit ticail from Hie temj le
to tjie octiput, was * one mass” of contusions in lepcniltiitJv of tlie hnnses f mn I
on the face Apart from all soentific s|ieoutilions no fill iijMm rt finder cniin
possibl} account for the whote of tbese injuries Iht j n oner was roiivfitcd of
manslaughter

In/? V JJwW.vihcrc a man waschargcil with killinghis wifebs Hows ilopjK-nred
tliat be liad cither kicked her and produced tlie mjurj vrlnrh canscil her (Jeath or
that she had fallen upon some w-nod as a result of this vaolent'c It was held th it It
was not mntcnal whether <lcath vrascauscil direcHj bv the blow or kitk orwhether
the prisoner struck or pushed his wafi and she fill so as to iirrxhice lli< injiirv
which caused her death the prisoner would wiitaJIv !« guiUv of nniislaivliter If
it could be shown tliat tlio fall was the result of some iKsnUnl, then it might Iw a
good grouiK] for defence He vrns convactcil

Tile chief difllcultv in regard to contused wounds arises (as has lircn
indicated above) when the wound m the skin lies over a Ik nc scpnmtctl fnun
it b) a compnrativelv thin la>cr of soil fivsuc tiie tvpn i! plates licing tlie
scalp, clieck bones tlie jaws and the back of the fingers In these sifnations,
wounds produced bv blunt objects such as a wooden crate iron I ar jcninij,
liainmer stone in a stocking etc are rominonlv nppanntlv i lean cut skin
wounds and onlv a close scnitmv of the eilgcs and the surrounding tissue will
reveal the fact of a crtislied or bmiscil conddiun tiring iircsciA \jswa\W
examination bv a hand lens w ill enable the observer to sia the lorn cxtreniitics,
tlie rough margins exposed liair bulbs and tom fibres and ves cN in wounds
from blunt instrument-s If sonic time has cl ipsed btforeu wound iscxaniinctl
great caution vv ill be required m forming a judgment

\ man it was alleged liad liccn stabticd on ttic head witb n knift The |
stnick. the blow, and he ccrtairih IumI a Knife m hfs han 1 at the tunc '« w
the wound was or was not prodiiccil hv some part of the knife cotil I "

nimeil from the evidence of e>c vritncsscs In defence tt vius urg^l ttut t hej^vni r
tiad indictcil the wound vnth his knuckles ami n >l wath n knife ' am « „,„.i,
called to examine the vround some time after its inflicti n

contusion nml laceration about Us edges tlial it vvas ° ..ivnlfion

the necessarv precision bj wluil means It liad l»ecn ntiwd There I

but no medical proof, tint a weapon liad been en 1 1 veil

Doctors nnd pathologists should Ik cautious in mxxptmg H e stnlimcnts
of others tliat a weapon has liccn used unless the wound ilscl K-ars s

JNTEIiPRFTATIO^ OF ^OU^DS 253

features ns to render the fact rensomhle Dimn« n scnlDc tlie person assaulted
mns he cnsih dccened ns to the was m wluclrnu accused picts niHiclcd a
voimd upon him, and a motup ma\ sometimes cmsI for imputing to an
nssadnnt the use of i uenpon dtinng a qiiaircl In stidi eases a medical
witness should nh\a\s rcK more on the appearance of the wound for proof of
the use of a weapon than on nn\ account Riven b\ mttrcstcd jinrtiis

There is no doubt tliat some means of discrinimntifm hetwcLii the cfTccts
of falls and blows nlTctting the same part of the bod\ would gre itlj aid the
adinmibtration of justice, but ns no two nses coming under this class of
injuries nrc prccisch nlike, either in the part woundc-d or the amount of lorce
emplojcd it is scarcely possibly to inlrodiuc general rules It is commonij
hchued tint a mere fall is not sulhiicnt to produce the same degree of
injurv that ma\ he caused h) t blunt wcijion n|iplied suddenK to the
lieiu] b} bunian force, but a severe fracture inaj arise fr»jm a simple setident
of this kind, and ^irescnt iicarlv all the features of lionucidnl violence The
dilTicuUics at ermiiml trials wdl he foiiiul lo ptwetd not so mucli from want
of rules to assign the \ lolence to one condition or the otlier as from a want of
proper observation when the wounds arc first examiiud If mmutc -iltcntum
were given to an evamiintion of these injuries soon after tJieir otturrcjicc,
details might be noticed whicli would help the medic d witness to i more
tertam conchibiou

IJie case of Mr Brij»s who was niiirdennish nss.uillei] in a nihrav currn^e,
furnishes an illustration of the ease with which honiicidnJ niul accidental violence
mn> !)c distinguished provided ittcnMon is dircctcvl to this ijucstion at the tune
There were scvenl wounds on the lead whiih eould ikU Jnve resulted from
one cause It appeared protnhie tint soim hid been inlhitei! on thi dcenscil bj
an Instrument while he w is in the cnrrngc, that he had l>een thrown from it while
the rarrnge sms m rapid motion and the fill hnd pn^iiued other bruists Die
doctor who evaniincd the dceeavsl loimd •» transverse j'il.jvO wound »en ss the
left car, and above tins there was a sculp swelling as well ns two wounds, with
effustoii of Mood fjeiic'itli, oikI <orns|M>ndiiig fra<(uns in the skull riierodiad
obviously Iwen more tlnn one distim t applieulion of fon i to prixhiee sue h injuries
3 he fractures in the skull in t'\-o distinct places Malimled the use of n lienvv blunt
vTcapnn while the waJp swelling was prolnhh csiii«cflltj the hea/l w ming in contact
with the ground at that point

A B O A C Oniccr vms found dcadontlie Southern H nlwaj track at Bennnnd ev
at 10 k» p m one 1 cbninrv ^ c m pitch dark following reports that a crish lud
bccnlicard A triln at London Brid^cw is found to hive i hrokeii window niid two
dentures soiled with blood Jiv on the carnage lloor In'spcctiin along the line
sfiowcd an iron fitaiuhion with fuair siniif ir to ifctTaMsl s cnisfied into the pnint,
and there setmed little doubt timt the man must have Iktu leaning b ickwanU out
of the window, as is common in I’ecjdng Tom episodes and as a latnscqiicncc
sustained a sweeping iiiipaet wliiih threw tire head hack towanfs the traifi, dis
lodging the dentures and breakimj the window Tl«? grwiterpart of the left side and
back of the Iinid Mad l>ecn siotcntlv enislicd and t< m nw iv, and then. win. further
hrnises riinning along a line across the hock Iietueen tJie hips, where the man Jn
back across lire door window lie lud lift homo paving he was going to clinrch and
then to vbit friends, neither of which hedi I there w is no i|iiestion of snictde
\Miin it IS a ipicstion wlmh of two weapons jirochierd certain woimcls
found nn the bead, the dillictiUics of medical evidence arc increased

lull V V hitneay (C C C., IVS'i) the Tow I’lHMIurdcrs twogirb bore wnunds
of thehcadand trunk winch it seemed hkclv, wereinlhcleil with tire same wenjions ‘
In most instnnces an nrciimtt obscrv iticm of tlic fonn of n enntiiscd
wound and an carlv comparison of it wiUi the alkgcd wcaipoii or lh< suli-
> aiant, A. i\ 1851 J J or tterf , I ^60

7A 1 7 iU*ItE7 47 /0^ OJ 11 0U^ DS

■itnnce Mid to li iic produced il, mil cnoblc a mlnins to come to a rorreel
■■onclimon on the ^ulijctl Tlic situation and cliamctcc of the wound mat
lie such that no sctiilciitnl fnll could rcasoinhh aivount for its prodiKtnm
In 7t s ?AeIton the ilercascil nn old man died troiii snoltnre to the head lie
was found in the road insensible and bleediiii; not fir from the nnsoiiera I ouse
AH ftr»g\inT Stone Avaa Ijing near his head Hicrc ncrc no bruises on llic l)«!%
but on the Jen suie of.tiie oroivn of the henil there utk n square sliaiicd hole about
the sire of n h ilf ^svn the bone lieing tliere dnsen in IJirec Indus Ju^iow this
at about the tip of the ear there uos another fnietiine of llu. sViiII under u narrow
scalp xvound about an inch m length Tn tlie j nsoncr s house wus found n Iwmmcr
vvliich h id a square face wth the comers Tounded nlT arul on cf inpanng this with
the indented uound and fracture it corresponded sert rJosch m sJiape an I width
rJie other end when compared with the smaller wound near the car, also eorres
ponded The liammcr us it frec{uenlK hapjwiw with lieavj hrui-sm), Snslruinentc
had no bloorl upon it nor am thing to indieute tliat il lud liec n useil fi r mnicliii >
the injuries TJie stone found near the deceased had upon It Mood and mu 1 at one
c-omcr and a white human Mair adhered to jt It wn^^ ndmittnl bs the nudual
wntnesses Ihit if the deceased had fillcn hcjMl) upon thw stone It woull Iiav'c
accounted for llie smaller wound but in regard to the indented wound it eras
siiggcsteil that if the s iclini h id Item knocKcd d ovn h\ a horv; and tnmplcil on
the caulker or square piece of iron at tlichce) ofn horseshoe might luneproil iccil
It If that were true it was csident tlint tlie other jiart of the shoe irould lime left
some mark of ulnch there uas no twee The hat iinm t>\ the ileecnsed at the lime
prc'ciitcd no indentation or mark It seemed probable tlut the /njiirs wnsproduecti
b} a weapon but the evidence failed to connect the prisoner with liic net.

0 Bruises without SWn incision Conunent on the nntUTC of n lirmse
or effusion of blood nm\ Ih. olTtrotl on tlie following grounds

(«) tMicn death follows quite soon after injiirv the sJnjic of ft hruLse cnire-
spomU furls clocclj with the shape of the brui mg agent or weniJon
{b) More frcqiientls the bruise lias no close relation either to tl e sh ipe of the
object prtKliicirig it or the amount of saoicnee emploscd, Iinsan^ li id time
tn spreid

(c) There mav lie a dcci» effusion of bl lod without nn> sisihlc cdcrnal hruiso
wlutescr its real nature mas Ihercrorc l>c quite obscure

(rt) Urtuse eorrcsjiutirfim: to lihnjtr of Objfel In healing tin imprc'>sii>ns
t luscd h\ Ihe ssnpon on the skin are soinclinies cctIimhosc d, and indicate
Its n itiirc ssjth precision io also in strangulation sshen the lingers base been
siolcntls applied lo the sofler part of the ti«k the inikntulions produced
mas serse to induatc the nmiimr in which the grasp was iffcctcil Ihc form
of m ccchjniosis maj orcasiotmll> furnish prcsumptisc esideme against
ail iccuscff fnrts

III If s //cfl/Afttt 104R> and also m If r 6om«gc (Maidstone Vssircs 1018)
there w-ere marks of biting on the skm of the breast In the latter case thes were
particularls w-cl! dsfineil In surface nlirsstons oPthc csitieU and direct
ssas made lictwccn a bile impressioiT of n cast of acrasctl s ni jmsing front letlli
and the skm injuries TJics »Tre identified in numerous ilctaiH

Innn attempt at niunlcrmeiilRUiesIb) Sinekie the prosecutor Jii
struck the assailant siolenUv In the face w-ilhlbcke> ‘ ^

tliconis w-eapon he lud near at hand Tlierechs-mosi-. whah f »i,„,„„i, tl ■«

eomsiKimiecl m sh .pc with the wards of ««■ kes an I it was ehiens I M

sers singular and imexpccteil soiirre of esadinec tiiat the assai i
identificil and bioiiglit to tnai

bmiihrK in cases of nltegcU ni»e w»th struggling on tin part sictim

small bruises forrcsjKuuhiig to fingermarks nns Ik found nlwut tin. anus
and legs kasi^s of mstrumcntal alM>rtioii nns 'how simil ir marks.

‘Simiison Kcitli »».»t hrenutt Cow I^J re Her 6 at-

IS'l'ERPlinTATIOS OF ^^OUNDS

A loiTj dmcr !> mate of H), found dcadui a j-ard «li(rc a Ic>rr\ lun] batiwi was
Ihoufrht to !m^ e collapsed and of some natiiml cause Them no external
mjuncs Autopsj rca-eale<l a crushwl nght lung «,tli iLTmopneimiolhoJ^x a lal^
nglit pennepbrit bruise and sub capsiilnr lumorrliagcs o\cr the iner which
suggested lliat he had U-en crushcil hy a lieat\ sehitle It was found, on cniimrs

to ""

Atoj n5e,I c,sl,twKl„ou|;l,HntollKl,mp,t.o,!™,I It »,t!.ni,,rt„UI„t te M
knocke<l down bj a lieasn cart and was siipiKised to hn\e been run am
There was not the slightest traec of abrasion or bruising of the skin of the chest
nor behind the ribs and sternum, but the upper lobe of the right bin" h id l>«n
cut completely, off from tlic root of the lung and was floating freelv m n^'nlcura full
of blood '

In the first place, tlie clothes pres cut actual contact of a Imrd IhkIj such as
the tliassis or tlie t\Tes of .i motor car with the skin This in dstlf tends to
spread tlic blow and so to diminish its lotsi toncenfmted effect. Again, the
abdominal panctes if taken unaware^ as they are m such tascs, are soft and
Melding to a broad blunt surfaLC, while the hver, spleen and kiilntys luid a
full bladder arc coinpamtiv cl\ fi\cd and iin\ icldiiig. and so suffer Isccr dion,
often by being pinched betwten the applicil force and the ^Cllchral csihiiiiti.

As regards the brim, “shear strain” is well mognircd as a cause of Iiumorr*
hage into the organ and its sciitricles (see Brim Contusion)

Ijsen on the limbs it must he rcmembcnsl that, to laccMtt a blood'S easel,
n mere compression is msutllcicnt, unless there is a Innl resisting surface to
gi\c a counter pressure sufrieieiit to sjilit the scvsel or mi)cs.s there is sescre
stretelung

7. Abnormal Fragility of Bones. There are ipiitc a number of disenses
which iTia\ e.-iiisc undue fragility ot the bones. Iii old age, m riekctA nnd
generally in long standing nutritional disorders and wasting discuses some
ntroph} of the bones and consequent fragility max occur. Atrophy from
(inssstrre and presence of fomowrs cysts, ctc.itrcWe)! tok.a<}to»eakcn‘
ing of bone Fragilitas osstum and osteoporosis and their rcHtionslnp to
bone formation arc matters wliicli need not be discussed here as they are
fully described in ans text lx>ok of pilliologx.

It IS gcncnlly accepted that fractures nre more readily produted iii chrome
mental disease The importance of tins condition arises from the but that
when a nurse m a mental hospital is under suspicion of hising ill trcilcel a
patient, possiblx itn oU ing a criminal charge, it is nssumwl that great \ lolcncc
must June been used if scxeral bones arc found to base been broken Hie
defence made is tint no more siolcnee was used than was nbsohilely nercssary,
and that the Imncs broke unusually' easily. Iladiological examination of
the bony tissues mas enable the witness to gi\t a decision on this point;
if the patient is dead, the presence or nlisencc of am pathological comhfion
of tlie Ixmcs can be est.ablisbcd by the jnat mortem examination in those
conlincd for a long time to be-d. tlie skeleton Icmh to bcc-ome more fmil from
disuse nnd rclntixe malnutrition

Es Idence from Examination of the Clothing
This IS n most important pari of the iluU of u medical man. In n rase of
wounding, he should nlwaxs see the clothing of the woiindtal person It may
tlirow a material light uiKi'n tlie mo,Ie in wlmh the wound has bren produwxl.
it may remoxe an erroneous suspicion of iiiunler, nnd may sninetiines serxc
to indicate that .a wound has been sclf-mllietcil for the concealment of other

]\OUM)S j:T7/^riYC/ JJiOM CIOTJIl^a

250

a trjnl at llie Old Bnilc\ uherc it had been pwed that a tut aipl a fnctiire
haji been received without h ivtng cut the Int of tlie wounded person

Viiotlitr iiistruLtivc cast shows the uvixirtiriee of (onipariUj; the article
of clotlmifi with liic injuries which mnv have jiroved mort d

A wonnn aged (0 jircvionslj quite wcH was ftuncl dead m her bed She liad
vomited shj,litl> and there were h uiid two wounds iliout tlic middle of the ri^ht
parietal bone with a lar^ tint of WohI in this sitintion hcneilh the skm On
removing this clot, the hone was found fraetiircd to the extent of four inches
Ncnrlj three ounces of dark tl died hlooil weir found liclwecn tlit dura nntcr md
the skull This w IS the onlj dijurv and quite sullieicnt to nccount for death but
a c/iicstinn arose respceting the mode in. winch this fracture « is caused

it was stated ni rsndciue th it on the evening liefore her deilh the deceased had
l>een suddenly knocked domi hv a man neeidcntullv running igainst her while she
was walking in a public rind One witness hi iled th it the dee eased fell heavilj on
the Intk of her 1 ead <in which she w w wianii^ a bonnet She appeared stunned
was njsed up bj tliennn xf me brandy was given Iicr, and she rwi vtred siiiricjenll^
to walk home and to c it her supper as usu il after whith no c tie siw her uiit I she
was found dead m bed cm the following morning Some suspicion irrse th it the
violence done to the head was too grt il to lx* accounted for b> a men. full nnd it
was i question whether with such m amount of mjurv the dccca-scd could have
walked to her home at the distanceof a mih nnd i hilf ami have eaten her supper
before going to bed At hrst it vi is thought that this w is n r ise of murder and a
min who lolgcd in the house with demised wissusjwctcd IIis room w is searched
and a hammer with two cHwr was found On c< nq aniig these el iws with the two
indeiiLitions nnd fne-ture the medicit wiliicss thmight that this weapon woiilJ
account for the injuries flie dcceised nnd the lodger hid been m the liihit of
quairelling and thej were the. onl> | ersons m the house on ffii« occasion llio
IcHlgtr said that he had let the wrmnn m about nine o clock (the fall in the mail
occurred about 7 Hi p ni ) her appcirmec presented nothing unusual and he saw
no mure of her until i died it seven tlic next morning when she vvis iciund dead
android ItwasonU at the ndjmimcil inquest tlint the bonnet worn bv thedcccased
at the time of the fill w is » allcit f« r bv the coroner I wo indentations were llien
found upon the back of it corresponding to tho i. on the skull of the deceused
Ihe imiciitalinns on the buniict contained dust and dirt thereby ci'inlumlng the
statements of the witness, amt tciwlcnng it ptoliable th \t the fall in tlie toad had
caused the fatal injuiy to the head

Tlic exiimnation of the elotliiug m this case cleared up wlint might have
been otherwise doubtful It is probable that tlic large internal cfrusion of
blood which caused death did not develop far iiiilil the clLCcased had reached
home and had her nit il She. must liav e died verj soon after she went to bed
as her bodj was found cold ut seven o dock the next luornmg 7’ersons iinv
undoubfcillj Walk and die at a considcrihlc distance from the spot where
serious mjiirj to flic 'liead 'has 'been Mislaiiicct 'lor 'tune is reipnrefi Tor sub
membnne bleeding to develop

Iluringlhesccon 1 world waraniimlierof IxhIicsw is brought into a North I ond n
public mortiiarj for idc;>tili(.xtio» loHonWa an ur r-ii 1 \ jiolin oUkit iin in-yfing

tliem noticed th it the knickers of a jaiinggiri wen. inside out carpiirv revtaW tJrat
she hid been found l>hig Insirti. a front gmlcn a short distinee fnm Iheitlicr
Mclims Autopsy reve ilnl that slic bore no injucv, but w is frcsliK dead from an
uistrumcntal aborticti Aii habitual ilxirtinnist who had kIiowu jjomo yjjsftugj
la placing her in the milieu of a raid, w w convicted of the olfciiec

T\ itb reference to clothing it is advisable to h ivc some clcsrpmof tJnt
the clothes s( III for examination were netuall> worn hy the aeriJ^f or tlmt
thej^ had belonged to the ilceeased and were in fiitt taken frora ft* Uxiv

rii/l V Ilalln it turned out li> thcconfes'.ioncfthci nsoncqanPrjfcrdisrovrT*''

of other articles of ilotlung m pHees wlicrc lie admitted I e kidhcfrxijetl
that the clothes vrhich had l^ecn cxnndiietl were not being won In tr*
pcrpetnitcd the murilcr InJf a 1/«»ro the clothes suppoi<(*if iave f

260

^^0U^DS rjlDI^^CF I-BOM CLOTHING

ty the prisoner were sent for eviinmitinn Tliere was
and It nppeJetl from the CMdenet at tl»e tna! that the
article of cJotljin^ before he iris arrested

n ■) Wood on the trousers
prisoner hid changed this

In a case of suspected murder one sliould examine for blood, not onK
articles of clotimig prodnted bi the police hut ant others that miglit Jn\e
been s\orn bv the accused at the time of the occtirrcnct In the Iln id murder
(A’ s Coinlaitce Kent) tlie omission to inquire mtnutcU m the first instance
into all the articles of clothing created se\cra! difficulties
I rorri the nature of the wownds on thctxxlj of the infint it was prohaVle Uiat
the clothing of the person who inltieted them woufd liase been stained She had
l/iree niglit dresses but onI> two wen. produced \\ I cn asked f^ r nn explftnalion,
she said tint one li id been lost at the Jaiindiy a week after the murder This was
proved to lie i falsehood there w is no doubt that the prisoner soon after the
murder had Secreted one of her night dresses which was stained with blood she
then put out a dean one for the laundrv to avoid suspicion but aflerw irds dindes
tmd> took tlus back igam to her bedroom ^^lthln twentv four Jiours of the
murder a chemise wnipiicd in brown paper urol stained with Wood was found 113 a
))oliceinan in a fire hole m the scidler3 this was most probaWv the missing night
dress She stated in her confession tint she burnt the dres-s worn on the night of
the murder five or si\ dajs aftcrwanls

A medical man should observe on these occasions whetlicr the blood is
smeared m large patches on clothing or whether it is sprinkled and also
make a note of the quantity Tlie stains nia} hav c come as a fine spra^ from
a wounded arterv or from a splashing of blood as a result of v lolcncc He
slioiild likewise notice wliethcr if the wound is m the throat or chest, blood
has flowed down in front of the clothes or person or whether it has flowed so
as to collect m the armpits on each side of the neck or under the back, for
these appearances will sometimes show whether the wound was inlhctcd
when tlie person was standing sitting orlvmg down and often also what
position the victim adopted after being injurc<1 If the throat is cut while b_
person IS h mg down t he Wwd vvill be fmiml chicllv on citlicrsidc^ f the neck
anil no^tT k C CTii l i TTlto^lli^front of tlie bodv, 1 ew suicides cut the throat
while m a r^uinbent posture” and the course whicli the blood has taken maj
therefore, help to distinguish a liomicidil from a suicidal wound

The nature ot the dried spots of mud fragments of vegetable matter or
fibres on clothing inav occasionalK serve to connect an accused person with
an act of murder

In ft V Snipe el al there were sp< ts of mud on the boot# and clothes of the
prisoner wluch when esamined mien scopicnilv, presented infusorial shells some
rare aquatic vegetables atwl Imrs from the sccils t f KroumLsel Tlie mud f f a ditch
close to which the bmlj of the «leccas«l was found prcscntcil the same microscopic
appearances as the mud from tlie prisoners boots and the witness who gave tWs
evidence deposed that in his opniion the mud spot# were dcnvcil from this ditch
He had examined the mud of all tlit other ditclics lu the loenhtj ond found it to be
different

This circiim-slance connected the prisoner with tlie act, and there was
corroboration from the fact that he had been seen near the spot on the night

of the murder

In another case Tavlor found gronufes of wheat starch n^ved wdJi 1^^
stains On the gaiters of n man charged with murder Just tieforc 1 .r

he tod been engaged •='""!! ""I <»"• S.m.hrii. m « ^ °

the boots belonging to tlie prisoner portions of farmaroows natter were ’

adhering to the nails in addition to blood hniraiid viool en fibre# Wler the n ur
der the prisoner had gone into a countrv baker and flour dealer s sliop, and trodd^
Sn £e £.or. on which there wns flour These facts tended to corroliorate evidence
that tlie pnsoner was the man seen in Ure shop

WOUNDS Ax\TJ OR POST MORTFV 2R1

WAS THE WOUND INFLICTED DURING LIFE
OR AFTER DEATH >

The means Me lia\e lor cletcrmininf! tins important question are nil con
neclcd with the reaction of /iun« tissues to irritants and injuries If a Moiind
has !)een inflicleil before ilcath some or all of the following signs Mill be
obser\eti —

Free hicmorrhagc e\temnlK and into the tissues
Iletrnction of edges of Mound
Signs of innunimntion or of repair

Hcemorrhajic In another part of this Mork a full dtscusRion Mill be
found on the cessation of the circulation ns n sign of death also on pnti
rnor/em bleeding (p 177) \gain on p 291 the minute differences between
Ining and dead blcwhiig (fihrm csidcnre of spurting etc) arc discussed
We shall here concern ourselves more with the quantity of the cfTused blood
hen bleeding from an ineisetl vroiind is the sole cause of death the person
dies cither rapnll), as a result of copious bleeding from the Mounded organ
or some large V esscl or he dies after some tunc inMhuhcitse if the wound
continues to bleeil during the time that he survives the longer he lues the
more copious will he the effusion of blood In a voimd mflictcil after death
and Millie the bodj is still warm, these features are far Ies.s pronoimcctl one
IS struck b\ tlie cvimparative absence of bleeding from such vvouiids nnd
it M ould be fnir to sav tint tlie quantity nf Hood lost may assist tn detmiuning
whether the wound was made during life or oftcr dcatli When the IxxU
has been moved and all marks of bloml cIT'iccrl bj wnslnng rules of this
kind cannot operate, nn<l the time at wIikIi the vvonnd vras actuallv inflicted
must then be deduced from other circumstances

In R s Oreennere, Mhere the prisoner vras convscled of the murder of u woman
tills fomied a material part of the medical evidence The hend of the deceased
liad been severed from the IkkIj nnd the question mus Mhelhcr tins sevcrinre
iiad taken place diinng life or afler death The prisoner oHcgwl tliat It was after
dentil but the mcvticni evidence was tlmt tlie head must Imvc been rut off while
the MXinuin vcos hsiiig but after she had been rrndcrevl Insensible probnhI> hv a
blow on tliat part, the marks of which were plainlv visible

This medical opmionwas founded on two oliscrvalions flic muscles of the neck
were TLtmefciI, nnd the head was completely drumnl of blooil, showing llial a
copious and nhundint flow must have ensuevi during the process of separation, anil
therefore indicating tlmt the bloml continued tn fjow freelv at tlmt time On
cutting off a head after death a qunntitv of Idooil mav escape from the jugular
veins, but this soon ceases The chief medical witness Girdwwnl, espresseil himself
vnth proper caution hv stating. In answer to a question from the judge, that tht
M ounds in the neck Iwd been inihcted either dunng life or vxrv shnrtlv after death,
while the bodj still preserved its warmth The circumslanlial cvidcnix showed
that the deceased had been stunned, nnd that lier head had been rut off while slic
was unconscious

If n wound is imde after the bloml Ins dotted in the vessels little bleeding
can take iiiace, but it is impossible to lie didactic about the exact time at ^
which dotting occurs in the vessels Indcwl it mnj never occur at all, or the
process nnj soon be rcvcrsetl bj Hlinnohsis UIccilmg mav, after some
liours liccomc ngain jHissible *

A post morinn laerratfd troiimf octumng as the result of accident mav be
ntlcndeil with such an olTiision of blood ns tn deceive u incdicil man, unless
nil facts of the case are known In ntiv rase in whuh it is doubtful whether
ii wound was infliclctl mi a living or dead bmlv it woifld I>c most unwise to
> Mole, iCh , IHta J PolA Hacl^ 60, 413

IIOUMJS A\T£ on POST MORTEM

form an opinion on tlic extent or nature of liTmorrhngc and no onmicn
shouia be guen iwtbout microscopic sections being cviniined to ascertain
tile mriltntion of the blood into the tissues tlie amount of aKlenn llie
jircsencc of Ieuc<jc\tes nnd other changes prodiued during life It is a con
sidenble step m c\ idcnte i\ hen we are able to nssert tint a particular wound
fouiul on a dead bodj must base been inflictctl eitiier during life or tunif U
ately after death

\ copious effusion of blood has been stated to be a well marbed tlnracler
of a scscre wound rcccneil dining life but this observation applies chieflj
to cuts and stabs L'lccratcd ind contused wounds of a severe bind arc not
alwavs acconipanifd bj mueb bleeding even when a litge blood vessel is
implicated It is well bnown tint wliere a whole limb has been torn from tl e
Ijodv little blood inaj be lost but in 5 Uch cases eoagiila or clots of blood are
comnionlj foiliul adhering to llie separated parts a feature which mihcates
that the wound wis inflicted either during life or soon after death while the
blood was still fluid and coagutablc

1 Jissection of \ asciilar parts like the neck and cutting of big \ csscls haudUiig
and stripping the organs iiiav result in artcficts which are easilj mistaken
for bruises *

If n bmise 1 as been caused some hours before death there vviU be swelling
and mliUration of the part with blood cmigralion of leiicotvtcs and {lossiblv
certain changes of colour in the bruised area m winch case there will be no
dillicults in forming an opinion Mtlio igli bruising or an appearance on ilo
goiis to it mav be produced on n IkkU after death the changes m colour
are then met wjtJa on)> under peeul ar cireiinistanecs to be mentjoned pres
cntlv If the blood found beneath a bruised spot is clotted it onh proves
tint the effusion must have taken place either before death or verj soon
after it i e while tlic blood wav still uncoagulated liut capable of coagulation
Again blood effused under a contused wound being Uqia I is not a proof that
the effusion took place after death if tie aiifopsv be performed verv soom
after death vo that the blood has not bad lime to coagulate tor is it so
if there has been long delav when it mav under a vanetv of cmamistnnces
have become again fluid * Generalh speaking blood coagulates more slowh
m the dead bodv than in a vessel info wl icli it has been drawn during life or
after death TI e blcxid ordinanlj remains fl ucf m the a esscis ui a dead Ixidv
from four to eight or ev en as long as 12 hours after death It rurelv begins to
CO igulate until after the lapse ol four hours but if draw n from a blood v esscl
and exposed to air it cajagulatcs at once or in a few minutes after its remov al

These general pnnciplev must of course be tjuahricd b\ the recent inv esti
gations into the presence of fibrinolvsinv lo. the blood— both during life
^ cspeciallv after iiijurv or ojveration and after death the blood inaj never
CO Igulate* lliis aspect of the problem of ante and jml mortem injurj is
discussed in detail in the section on Changes VfterDcatli (seep 163)

The period of time after death within which a small bruise can be innictcil
so as to resemble one produced diiniig life has not I een fixed vnth anv i egree
of precision Chnstison found that blows inflicted on a dead o v no more
than I to hours after death gav c rise to appear* nccs t n the skin sum ar o
those which resulted from blows inflicted on a person shorllv before tleatli
but that at this period it was often di/TeuIt to proiliice a bniisc He fount!

•IrinlooC and Ctmlon lO,,! 9 V'L '

vSlacfarLinc It G and H ggs R IWS 3 110

* Alole R H 104S J Polk Baet 60 HS

\\OU\nS A\Th OR POST MORTFM 2m

that dark fluid blood niipht be efTiisecl into the subcutaneous cellular tissue
so as to redden it but this erfiision was never extensive It follows tint
bv trusting to external appeaniiitc onK contusions ni idc soon after death
nia\ be confused with those which have been produceil h> vnolence short!}
before death

The similantv mav be so strong if the experiments are performed within
half an hour or even on liour after deith that it is difliciilt to state jiositivtU
whetlier the blow producing the discolouration h is been inflictcel on a liv ing
or on a dead liodv Cliristisons expcnnients lead to the conclusion that
sp~ ere blow s inllictnl on a bof}\ rccentJv dc id produce no greater degree of
ecclnmosis or cutaneous discoloiiralion than di"// blows inflicted on the
living Assuming that the great extent of spread of a bmise would in nil
cases serve to show that it had been inflnted during lilt it nuist 1 c remem
bered that the importance of tlicsc fails in relation to mctlical evidence is
not alTectctl bv the size of the injiirv Slight ctclivinoses ns in cases of
strangulation or siifTocation if llicv can be certaiiilv pronounced as rinfr
vwr/ern mav make all the dilTerenoe Ix-tween the acipiitt il and convution
of a person charged vrith murder Might occhvmoscs on the Iwdies of tlie
drowned mav excite a suspicion of strangulation prior to immersion of the
bodv m water and an infant nmv be killetl bv violence tliougli onlv a few
slight marks of bruising be found upon its bodv

\s a rule however n bruise mflictcil lieforc dcatJi shows frank infiltration
of the tissues with blood that is to snv the blood is ortimllv forced m amongst
the tissues No amount of violenie inflicted after death cm nceiiratilv
reproduie this appearance (vriiich depends on the jircssiire of the beating
heart) until the tissues are disturbed tom or stripped at mifojisv

If considerable violence were usetl after death it is cpiite possible tlint a
certain number of cells might lie driven from the niplured capillLifies into
the tissues enough pos-sib!} to confuse the issue in tin examination of a
microscopic section In generol however (he tlifTcnnce is quantitative
rather than qualitative and the amount of (he extrav asation and its dis
trihution should be sufhcicnt to wnrrant n definite opinion from an experienced
observer (Eilema wliicb ma} ilevciop rapidl} is a useful guide

In if V Cvrnoc^ (Bristol Vssizcs 10*7) six bruises fount! on tlie head of a man
fouiui imund bv tlic wrists and ankles drowned in Ins bilh were alleged 1 v the
Crown to baveljcen caused bv hislxangstniekln atov bout Tlictlcfenec consulting
Spilsburv on the nutter, made comidernble use oj tie nrgiai nit Uni xo restrictcfl ant
I? e fsnipe oJ blood into U e caniierU e fittncj o/ Ur sadp Did Off must 1 ; e hem pan
moTlem injuries— an I might well luveoccnrrevldunn„ attempts I v a i ripple and tl e
accuseil wife to get the bmh t ul of the Ixitli and int > an udjaeent rw m for resus
citation rite dead man vtas known to be a misuelnst Mrs Conioek w is fnind
not guiltj

Violence inflicted on a living body maj not show itself in the form of
a bruise until after death V inan reeiivcvl scv<ral kicks on the lower part
of the abdomen which caiisctl n rupture of tlie bladder nn<l death from
peritonitis lie diftl in alioiit k> hours but (here w is no vi ihle bruising in
the scat of the blows — i <* in tin pubic and lumbar regions — until aflir
death Ilin/c met with a case of suicidal haii^iug in which it was < hserveil
that eechvniosos appeared m the course of the cord onlv nfttr death No
doubt It was ptwluced ficfort death buHhecomprcssioiiof theconi pn vrnfi 1
It sliowiiig itself cxtcmallv Gravitv inn} direct the settling of tffnsetl llual
blood after deatli

WOUNDS A^^TE OR POST MOliTEM

For det^lls on the dilTerenccs between bruising and j>osl mortem hvpostascs
i if/e ' IIj postnses ’ (p 175)

Retraction of Edges of the Wound The heiltlij skm is during life,
slighllj on the stretch the muscles are too jn a similar condition of tone ’
Consequently, if in a wound on a dead person we find the shin gaping and
the muscles retracted m a manner winch cannot be accounted for b> the
cfTccts of rigor niortir we are justified in asserting that the wound was inllicted
either during life or serj soon after death while the skin was still supple
and the muscles were still contnctile (prosuled tiie wound is not in sucli a
position and of such extent that the mere weight of the parts might open it out)

On this point ns well as incidentally on the otlier points the following
experiments bj Taylor are still apposite

In conjunction with Aston Key lay lor performed some experiments on recently
amputated limbs T^io nnnules after a leg Jiad been amputated a deeply incised
wound was made in the calf The moment the wound was made the skin retracted
considerably causing a protrusion of the adipose substance beneatii the quantity
of blood winch escaped was small and tlie cellular tissues by tliew sudden pro
trusion fonvards seemed mechanically to prevent its flow The s^ound was examined
after the lapse of twenty four hours the edges were red bloody and everted
the skin was not in the least degree swollen but merely somewhat flaccid On
separating the edges a small rfuantity of fluid blootl escaped but no eoaguli were
seen adhering to the muscles At the bottom of the vvound however there was a
small quantitv of coagulated blood but the coagula were so loose as readily to
break dow n under the finger In a second experiment ten mi«u/ea after the senirat ion
of the member from the body a wound of simJar extent was made on the outer
side of the leg penetrating to the deep seated layer of muscles In this case the
skill appeared to have already lost its elaslicitv for the edges of the wound became
only slightly ev erterl and scarcely anv Wood escaped from it On examining the leg
twrntv four hours aflenrards the edges of the incision were pale and perfectly
collapsed presenting none of the cliaracters of a wound inflicted during life At
the bottom of the vvound and enclosed by Ibe divided muscular fibres there were
some eoaguH of blood but these were fewer than m the former experiment A
portion of the liquid blood had evidentfv escaped owing to the leg liaving heen
moved Other experiments were performed at a still later period after the removal of
the limbs and it was found tliat in proporbon to the length of time suffered toelaj se
before the production of a wound so were the apjienranees less distinctly niarked
that i> to say the less likely tliey are to be confoumlcd with similar injuries inflicted
upon a Iniiig body tMien the incised wound was not made until heo or tfiree hours
after the removal of the limb although a small quantity of liquid blood was effused
no coagula were found

These observations have aquired new interest since the work of Mae
farlane and Biggsi and others on fibnnolysins affecting the coagulability
of blood

Signs of Inflammation Inflammation is a process which can only be
carried on by living tissues if the vicinity of a wound shous any swelling
effusion of lymph or pus adhesion of the edges it not onlv indicates that
the wound was inflicted during life but it may also give some indication as
to the time when it was inflicted (see p 246)

Signs or Repair Scabs granulation tissue or the groiith of epitWiiim
over a wound prove conclusively that it was inflicted some consi era e
time before death The processes of repair m damaged tissues have leen
well reviewed bv Payhng Mright *

V Macfarlane R C and B ggs R 1W8 Blood 3 IICT
•Wright G P 1954 An Introductou to Pathology
Green

2nd Ed London Longmaas

}\ou\m Pi-tiioi) or f*i nvnM.

20*5

now LONG DID THE VICTIM SURVIVE?

Tlie cITcct of tJie pnbsnpe of lime on ^voumK m tht \t\ mp hns nlrrnch been
tliscussid (p 2 10) U hen n person iv found dend tlie question still nnintniu'f
jts imjKjrtnnce, but from rullur a diflenent point of \ic«, for it is nou not
so much n question of duration of siirMsal, but rather of sshat llic Mclim
could base done nfttr reecismp the s\ound

Acts of Volition after an Injury

It IS obvious that this question can hardiv nnsc ui connection with a
(iiTfte number of injuries Victims have licen known liowcvcr to ilnip them
selves considerable distances after most isfensivc lujiirics and the problem
of \ olilion after injun, demands close attention c shall disc uss
Injuries In the head and hram
Injuries to tlie throat, speech after the throat is cut
Injuries to the hinft
lluptiirc of abdominal viscera
^ inlcnt filmgphnp after injury

Injuries to the Head and Brain Cases frequcnllv occur m which a
patient who has received a blow on the head survives several hours or dnjs
allhmiph the injurj to the cranium miplil have been cvpcctid to Imv c caused
death almost mstnnth On the other hand a person ma) full dead from a
blow which produces no appreciable phvsicnl chanpes in the cranium or its
contents It is b> no means casv to determine from an esninmation of a
wound m a dend hodj how long a person miphl have lived after its infliction
Hut It must not he assumed that an opinion on this subject is never to Ik
expressed from the nature and extent of an mjurv w hat should be miprcsscd
upon a medical witness is that it must not be hastilj piven \ wound nmj
be mortal but it b) no means follows that it must Jiave caused death instan
taneoHsJj

A plrl of ncvcn mu off the pavement mto the side of a private tar anil was thrown
to tiie gmiinil She was da/cd but conscious sal on the kerb until the iirrivul of the
nnibulnuct and walked into it. Mmut twenty live minutes nftir tin iicrhlcnlshe
walked out of the ambulance into tlie Cnsualtv l>epnTlment of on L C ( Hosj ilnl—
nnd was found tn Imvc the handle of the mr <lo«r penctnitinp the skull bchin I Ih
right car, to a depth of ncarlv three inehcs She rcmameil full> conscious unti
arccsthctiicd hut died upon w ithdrawnl of the handle from ttic hlerd sums v>hic
It luid pliiggcil

The medical opinion m an abstract ijiiestion of this kind is cominonlv
based on indtvidml experience, but the real question is not whctlicr Hit
vv itness himself h is seen such a ease Init whether such a t nndition of thinps
15 jwssiblc A watucss is nllowet! to express an opinion from commonsense
professional knowledpc and experience

The fact that a person after iicinp eoiicusscd hv a blow on the head some
times rex'ov ers consciousness and performs acts of volition hut subsequenth
bcconies unconscious npnin is an ordinarv jioint of ililTcrcnlial dinpnosis
liclwcen extradural lurmorrhnpc — ic. Wcedinp lictwcen the skull and the
dura — nnd corcbml contusion bmisinp of the brain itself 1 he ‘ lucid period
IS an important forensic event

A Imw of eight, hit on the head bv a bnek during a fight at 4 *10 p in among
sehoollKiva, was fcllevl daz«l but not unconscious lie got up, hoi ling Ids head
ran off and arrived home some ten minutes lajer He spent a iiormd evening
msking no complaint to his mother— there was no external wound He ate hts

IIODA/JS PERIOD OF 9! R\I\ u
«.prcrnt 7 pm mnt In Id n 8 30 am! x,n found dead m bed nl -m am.

S|.nl.mn .,. ncneml tcm.j ,t must be n.bmltd tint c.eii extemo e .iamane
to the brain is no proof lint tbe xietim died iiistantancoiisli nor Uiat lie
could nut base perfonncil ncU of xolitioii after the injiin The localiti of
the bmn iiliiili is injured mil in a fc» eases enable us to express a decided
opinion thoiigli one ol the tases detailed below shows that eicn this rule
IS not will out exceptions and n |iems.al of them must ninhe us all lets care-
ful alxmt exiiressiii" didactic opinions about what niaj or mas not be done
after se%cre brain injuries

In 1 rrmil rase* i jnan nmoMlted su/cjde shnotin'r Imnself with a
rc\oUer The hultcl entered under the chin passeil thmu^h the floor of the mouth
ami tongue ontere J t! c sJoiU just behind the roof of the left orl it passed through
the left front d and tcmimral lolies of tlic I min and made its c«t through a hole
1 J inches jn duinictcr at the fop of the beid BiU of Iwne and I ram matter utte
dn\en to the roof of the shelter in which the suicide occurred The injurv was
jnJJjctrd pnor to 0 JO a-oj and after ^hoottng hmiseir the man ivalked round tbe
gardens in the snow for at least JCo \-ard» returned to the slicltcr for an indefinite
pcncKi thtn walked acrrxs the road to tlie house where lie lis-cd at 7 30 a.ni. spoke
msonahls and jnteJhgibls to « c mud who let him m huag up his oiercoat and
umbrella iralkcd upstairs and collapsed Death occurretl af>out 10 00 a m.

Two men quarrellesl in a pubhc-hou«c and one struck the other in the face with
nn umbrella The \netim not onis wulked from the cab into the London Hospital
but shoss-ed so little sign of bram injur\ that )tc was allowed to go home and ssmip*
toms did not set in for 48 hours during wlurh he ssalked and talked as usual
kt the autopss tt e end of the umbrella four and a lialf inches in length was
found cmiieddcd in the Ixmcsofttie base of the skull and liad penetrated compicttiv
Ihmiigh the I’ons \aroIu (a region of the junction of brum and cord usuallr
considered 1 \ers fifaf region}

^^oumU_of the cnrotid nrtcrics^re often pronounce*! nl mast tfiato nlan
eoi/r/i//(7/nL_,fjiiL.opmi£ms-Df-tlusJamI liatt uot onb bt“Cji refiitwl bj j-irTum

stances, but nlso b\ the- c'lJciicc-of e\c witnesses i. nictlicaJ^mtncss

must admit tint n person im\ siirvise for n variable period after such an
injurv

Tiiere nre seveml enses on reconf vshicli show tint n-wi/fa imof-i n^ the
coiuuton carotil artery and ife branches ns well as the internal jii"ular_\ein
do not prevent a person from exercising voluntnrv povrer and even.ninning
a certain distance

\ ninn set out nme razors on his dressing table and was found bv lu» dauglt^
cutting his Uiroat with the fint of U>c<ie — standmg in front of the mirror Tlw
girl ran tlowustairs to fetch help and some tliree or Tout minutes later returned
with a St John s Vmhiil ince man Tlie would be suicide w-as bv tlten alm<^
decapitated with Jong deep wounds of liotli the front and back of the neck b*it |ie
stiU stood on his feet Iiaeking at hr. brvus Jle liad enough strength to^ck the
St Jolin man downstairs in fact it sras lie who was hrst ailmittel to tasuaitv
with 1 Colics fracture of the wnst Both jugular seins were dmded comjileteij
and one externa! carotid arterv partialis disided

In I? V Danhi the deceasdl woman di«l from a wound m the
bj the prisoner Tlie wound divided the trunk of the carotid
hmnrxhps of thp evtpmaT carotid and the lU'ralar veins It ims p

t» 23 V snls and climbeti

certain tliat after the infliction of this wrund Their

over a gale the tune res|uire<l f w this being at least from !.»

was no dra-:^ng of the I»dv awl iiu motive for its licing dragged In Uie prisoner
to be cxpo.'cd in an open roa*l where it was found

'bmiUixSidncv PolueJ 16 lOS

iiot/AiJS' prmoDOf svnvix ih 207

A girl \\a<i brought into the Lomlon IIc^piUl wtU the left Internal jugiiUr -stin
cut through and the left comnu n r initiil nil hut Her thro it Ind been cut

hv a jealous lover, nlvo hid olvi gn-J ed the 1iu:k of her nwk Notnitiist Hiding
tliese «?vere nounds, she liad run ibout dxtetn jards into n piibho-housc before
falling dovm She dio<l in about two minutes

Speech IS ftssuredK an act of volition and the question of whether or
not a person with his»throat cut can speak, is one of great importance
for if lie he tillable to use his voice so ns to eill for assistance inurdtr inav
m this wav, he quittlv rommittcd without persons in an ndjoining room
hearing anj noise, and the fact is that when the windpipe is divided ns it
gencrallj is on these occasions the voice is iisuallv lost

Ilarvej Littlejohn * however, quotes a most unusual and instructive case in this
connection A woman cut her tliijnt tlie windi>i|»c bciig con plctclv divided two
Indies hclox the vocal ewds On tlit arrival of a phvsui ui si e « is sensible and said
that she had torn u tiunour out of her neck because it was die king her and tint she
wanted to die

She died shortly aflcrwanls Littlcjolm foun 1 that the trvdici was denniv cut
through and that the upper end of tlit divided tube projected fnim tlie vioind
■'together wnth si\ and three quarter inclies of the irsoph igiis Beside I er w is a
small tumour consisting of the nglit lobe of tlio tlivroid gland whuli she liad torn
out witli the gullet In this ease the wuiiuiii was able to sjicik after cultiiip, the
trachea belaie the vocal cords

In another case* a hoj s throat vms cut across nnd the larvnv dividctl just nfcoie
the vocal lords The wound severed the final ind hngii d iirtcni s ind iiNoihvided
the anterior w*all <f the (csopiiagus Shortiv nftcr tVie inlhclion of lh( mjurj he
was alleged to luve spoken and made a statement invi King certain persons fj c
nearest medical olliccr did not arrive till after the ho> was dead He saw the
Injuries and held tlie pnst viortem examination He g-ivc his opinion tint the g-iping
wound of the throat rendered speech impcssihic from tlie inonient of its iiillirti m
Medical opinion to the contrarj vias hovievcr, obt lined In llic dcfbiiee It was
stated b> this nuttiorit} that, the wound being situated ubitie the voc-il cords
would not have prcvcntcil the i>o> from speaking fairlv loudiv and fairlj distincllj
though the voice vrould naturiilj grow fainter ns the Imj gridiiallj succumlrcd
owing to loss of blood

In such n case the voice of the victim woiihl be much impnirccl but even
though the injurv to the larvnx were verj tomjilile nml the wniiiul gaped
grcatlv vet a jiortion ot the expired air might pass into the nioiilh niid give
rise to suriiiicnt voice to be hcanl and nndcrstooil

Wounds of the Heart Penetrating wounds of the lieart nre often con
Ridcrcd to be lustaulawcowidv’ fetal but cxpencnce ha.s shown that tins is
erroneous The sirt mnl direction of wounds entering the Jienrt is all import
ant in relation to the period of survival

Mhen th< cavities of the heart nre cxlcnsivch torn or j>cnctrntcd death
IS likcl) to be iminodiatc hut persons who have bustamed wounds of a
lesser inlihcr have frcipicntlv lived siiflicicntlv long to cxcrtise jKiwcrb of
volition nnd locomotion ®

Matson met with n case in which a man who had been slahlKsl in the n„hl
ventricle ran 18 yanU ifler hnsin,. Tcmvcit the wound He tlicn fell hut wais
not ogiin able to rise, tie died In six hours On di:.scction it was fiiind ll it a punc
tured vTOund had extciiled into tin. Ti„hl vintncle in un ohhq iilj tnnsverse
direction dividing in its course the coronarv nrterj Tlic )H.nnir<iliim was
nenrij tilled with I loud, nnd about five pints were effused on the left si Ic of tl e
chesU

* * I ortnv e Medicine , I0"a 1 A \ Cl tircl ill I-on Ion
*lAsnecl 11)0) I ISnt

•Samson 1' L l&ta ^nn Suig, 177, IIJ"

uom\ns PEmoD or SURVIVAL

Datlinir, of Jsew ^ Ork Jaid aoosewhirfiomirred m 185s m wfnpti n m
for a period of n da, j, a bullet iiounil of the heart A bijlrt
m diameler ,™. found lodccd in the nealiy partition betnee“ l.e tlifnnVh'?;

Tiicre ^ras no communicfttion with the cavities the «oun 1 hid i>n<imitr i
nnd mdammation of the pcncardmm was obvioiislj the cause of death ^

discharged a brace of pistols into his clicst on the
Jeft side The man Wns brought into Guj s Ifospital and was able to conUrse on
A »»««/« after the iiihiction of the woun^

After denth it svns found that one bullet liad perforated tl e pericardium entered
the right 'cntricl^ and after traversing tie septum of the ventndes, mailed
exit Jrom the heart at the junction of the left auricle with tlic ■ventricle It tra
vei^d the upper lolc of tl c left lung and was found fixed in one of the Tertcbrai.
The second bullet jierforatcd the left ventricle and then traversed the left lune
this wound was of such a nature tlint at ever^ contraction of the ventricle the
opening must have been closed so as to arrest the flow of blood This man owine
to sev ere suffering rolled about the floor and was with dirficulty kept quiet

In cases where the ventricle wall is not conipJetcIv perforated or vhere

the penetration is slanting thin and therefore tends to become ‘ valvular’

or even to close upon contraction of the muscle little or no Mood jirobaWy
escapes from the heart in the first instance but it may afterwards tontinue
to ooze gently later reaching a fatal quantity It must not therefore be
supposed when a person is found dead with a wound of tlie heart attended
with abundant Jiamorrliage cither that the flow of blood took place man
instant or that the person died immevhatelv and was utterly incapable of
exercising any voluntary power Only one condition will justify a supposition
of this kind namely, when the cavities of the heart are laid widely open
This remark applies espctiallj to wounds of the auricles wlncli are thinner
nnd incapable of “valvular’ closure

Oflatejcnrs manv cases hav e been reported in which recovery has taken
place after wounds of the heart Ue have seen a man survive five slab
wounds over the /leart three of nliicli penetrated rt If the hiemorrJiage
occasioned by the injury is not suflleient to cause death bvf the embarrass
ment of the lieart the organ is able to function nnd to undertake a large
amount of repain though tiicre is alwavs a danger of the ultimate formation
of an aneurism a good firm scar is by far the more hkelv

Ruptures of the Diaphragm A nipture of the diaphragm has been
considered sufficient to incapacitate a person but still m some cases the
power of moving aiici walking may’oe reUDicd aiXvrunqAf/niAWmrttcr^A
In the following instance reported by Dcvcrgie the proof of locomotion
was material —

An intoxicated man after hav mg been maltreated by another returned home
walking for at least two hours with two companions Tlie man died m fincen
hours and on inspection among otlier severe injuries there was found a
Jongitudinal rupture of the diaphragm about two inches and a lialf in extent tne
stomacli protruded tluxiugh the aperture , j

There was no evidence to show that tlie deceased had been attacked « beaten y
his two companions in journeying homeirards and therefore J' ^ ^

reason for inferring their guilt simply because locomotion after such an injun
something unusual as a matter of iDcdwal experience

A man fell from a height of twenty feel lie liad fractured both amis had
sustained other severe Injuries On the day after admission into the hospitd h
SmSed of a fixed pain on the left side He sumv^ about tlurUen
On inspection the diaphragm was found lacerated m two places in one to the exte
of an mch and in the other to the extent of six inches

nou\Ds vrmoD 01 surmvil 2 co

In a case ndnulted into Gm s Hospital, tlie {latient siini%ed for nt lea?t nine
7iwniAs the on!j accident iilueh coul I lm\e produced the rupture

The in m h id fallen on the deck (fa aessci from a preat licipht si’i months prior
to his admission Ifis nhs %\ere fractured, and one ankle nas so injured as ultiimteK
to render amputation necessary Ht. died three months after admiss on anl on
insjjcttion It Mas found that the sloni ich and the colon occupied tlie leftside of the
chest Imanp protruded through nn aperture in the muscular part of the diaphragm
t«o and a lialf inches m extent This hcmia was ev idenlly of old standing, ns the
aperture Mas cicatn cd and the omentum alhercd to it The evistcnce of thes
injury was quite unexi>ectcd and at the tune of admission there was nothing to
interfere mth loc-omntion and exertion except tlie injury to the ankle

Tins iiijurv IS far from being inimeiliatdj fiiLal and n great many cases
liave been recorded of complete Pcco\crj after rupture

Ruptures of the LUcr, Spleen or Kidneys unless followed by great
loss of blood do not prc\ cut a person from exercising muscular power

Ruptures of the Bladder In ruptures ol the bln Her attended with
extras asation of urine n question mxy arise respecting the retention of the
power of locomotion The lollow-iiig cases mil show tint this power exists

V man at 31, while intoxicated received a blow on tlic lower part of his ab
domen He vras soliercd hj the accident and walked 1 omc a distance of a quarter
of a mile, although suffering severe i am Ifc died four davs after the accident
On msiiection tlicre was no mark on any i>art <f the abdomen liic bladder was
ruplur^ 111 Its upper and b lok portions f »r about nn inch

A gentleman who liad been compelled to retain his urine fell occidentaliy in
descending a staircase with the lower part of Ins abdomen against tlie edge nf one
ofthesteps Ihc sense of fulness m lus bladder immediately ceased anlhewalked
to a fnend s house to diuncr The nature of the accident was mentioned to a
surgeon who was there who immediately suspected tliat the Madder must linve
beenru4|ljmd T1 e case terminated fat lUy m twenty four hours

V casd^s^ported in which a man walked n distance of two miles after having
sustamedai rapture of the bladder and in another the man who sustained the
injury in a sculllc was able to w ilk for I etween two and tluee hours afterwards

Hie medicolegal implications of this subject will be apparent from the
followang cose —

A man passed some hours comivnily with a few friends after which a quarrel
ensued blows were excliangecl and the parties wrestled with each other The
deceased then walked liome, a distance of more Hum a mile, and m crossing the
tlireshold of his own door lie fell forwards on lus abdomen ^^^len lifted iij) he
complained oi gnaftpam inrfi -tras \o Ve* Vising vycf At anaWic \ti -cxwV
He died in two days and upon dissection tlie Madder was found ruptured at its
upper part (fundus) to the extent of lictwrcn two and tlirec Indies In these cir
cumstauces it becomes a question whether tlie rupture was caused by the violence
of his companions or by the accidental fall at the door of lus owm house If by his
compaiuons he must 1 avc walked more tliaii n imic with his bladder ruptured,
but two medical witnesses declared Uiat lie could not I avc walked this distance
after the rupture and consequently that it must Tiave been occasioned by the
subsequent fall

It would in this cose appear that llie symptoms oi rupture and extra
vasation of urine occurring immcdiatelv after tlie fall rendered it highly
probable that this accident was really the cause It is obvious that the power
cf locomotion may be exerted m such cireumslances to a much greater extent
than lb commonly supposed

Struggling after Severe Wounds Tlie power of moving after severe
injiirv, if not considerable, may be retained and is occasionally a mitenal

2™ iloyMJsr miiiODoi iVBvji’ii.

q.icsl.o., ks-.! m„I,u.,c It murt not l,c I,«t s.gl.t of nken ne ire .Irtt,,,,,,
...romtccs os to the rclot.vc i«.,.hom ol n„ osso.hnt „ncl a murdered ,,e„™
froin the s, net, on in n Inch a Imdv ,s found t deod man mtl. mortal rniun
to the head or lieart ma) be found Ijing on Ins face iihen he acluallv fell
upon iris [nek lie might still hate retained suflteient power to turn over
beforodealh or lie mas I, arc fallen on Ins lace and hare nlltrivnrdsnioitd so
that his hodj inaj he roiiiiil Kny in another positiori Local morementa of
tins kind are eoiiiinoiiplnec Iiidivuliials siilleriiv. from mild coneusrion
na\ c been frcqucntlj known to perform acta nncoiisciouslj ond nutomatically
The medical \Mtncss must Ivoirin mind tint hcjs not rr-qmmd tostifejn how
many tins power of jicrformins acts of volition and locoii otion imj remain
but simply \\ licther tlie performance of these at ts is or is not possible It is
on this point onlj that tlic law requires infornntioii V lijjiotlicsLS of guilt
when we nrc coinpdJcd to jin)«e from cirtumstancei in n doiihffiil case,
can onl> he accepted on the exclusion of e\er> other reasonable explanation
of tJic facts In Ic^l mcdicmc meihcal experience iiowcvcrnrc admits of
a verj imfiortniit and signiPKant application remote possibilities hn\c
an imjiortant phec nlicit it comcs to flssrwsnig other explanations of events
at trial

Altfiough m cases of severe vroimds vve mav agree t/int persons moj
survive for a suinticiitli long period to perform various acts of volition and
Jocoinotion jet the presence of a mortal wonnd (sjiccinJIv when nccom
panicd bj n great loss of blootl, must prevent slriigpbng or violent exertion
on tlie part of the wounded person such exertion wc ma) consider to f>e
incompatible with iiis condition V ineilitiil pirist ma) thus have it in his
power to detcriuine sc me tlimg of the circnmstnmes and to judge something
of tlie vcrncity of the statements made m cases of this kind

A man was tried for the murder of a woman nt Livcrjiool b) stabbing lier Jn
tlie ciitst The prisoner an 1 the deceased, with two i ther women were tjuarreUmg
in the passage of a I ouse A 8tm5^;Ic ensued lictwccn the prisoner and the deceased
which one of the witnesses said listed for ten vnntilfs AMitn the prisoner Jiad
reached the dmr he pulled out a kmfe ami slabbed Hie deecased in the i best She
fell and died almost iininciliatel) Jlic pnsoier alleged tint ht was attacked bj
several persons and tliat he slabbeil the woman m self defence flic judge said
that if the blovr In 1 been struck v'lth preme htnlion before the struggle the crime
would be murder if during tlie strupt.le, it would Ic iiuuisl lUghter The medic d
evidence showed tliat tlic blow could not have been struck hefure the struggle be-
cause it was of a speeddv mortal nature and tlie deceased would not then have
hi-mn'iM- ’ix A -noft V.> kbi? si-'.'.v/issfts taxtt'i’a.ift-'imlexEct her strength

with the prisoner for ten miHide* aflcrwanls This being the cose, it f llowcd that
in all nrobabihtv the deccised Imd been slabbed towards the eonilusiin of the
quarrel it might hive taken place wlife t(tc pmoncr was athnipting to defend
Inmsclf IIic jur) returned a verdiit of manslaughter

Tins question was also involved in 7? v /Mbs

The prisoner was indicted for the wilful murder of a man with wlioni le had
been drinking and quarrelling It oppean that ui the carlj part
the deceased threw the pTLSoncr down ml stniek linn 7*.^

hv the landlord of the inn to go home JfcK^diwf MefjwcJJ f'-hout

the prisoner went through the entrance gate of the }"» “P /’'I?" ‘laltiJatnicnt
saw Mim/fes tJie deceased who had vompl uned to the landlord
which he I ad undergone returned into tiu. iim yinl and was sem 'k >t

io Si doli im waiScoit and button lu, eo it A witness ndvis^ SSeTof c
and he left the spot A sliort time nflemards iic was f und *"*• kack
V anl Iv .n« Sad on his face On examining the hod) it was «

cleeeaseil had been stabbed m two jdiees, one of Sd in

ventricle of tlie heart On arrestmd the prisoner a large cla^p knile was imin

wouM)^ iccinf\r, svicidl on uomiudl sn

Ins pocket stained with blood The pn<ontr adinitlcil tbit he hail stahbeil the
deceased, but said it «ns duriw" Vfqutml and llml he Ind used the knife m self
defence ululc thc> were on the ground lor the j rnsecutiou it svas alleged that tlie
deceased had been stnhhcd h\ tliepnsonersulisctiiientlv tn the quarrel — tint he Ind
gone through the g-ite into the j ard tomcct thcdiitased Ind thi re stabbed him and
Lad caused lus instant death A molical witness who sias tailed stated at first that
from siieli a wniunl death must Jiaie been In ero-.s-esanunation

howeser, he admitted that the deeeased nii,;lit Imsc lived some tunc after ho hid
been stabbed and on this evidence the prisoner w is coiivieteil of manslaughter

The iiiethcal facts of the cimj arc imperfcctK reported hcncc it is difliciift
to give a definite opinion rtspctling the time at vvlnth llie deceased was
stabbed in the heart Tin si/c ol the stab in tlie ventricle is not stated nor
was it c\ idcnt whether an\ blood was found on the sjiot wlicre the deceased
wa-s struggling with the prisoner Tal iitg the facts as reported it would
appear probable that the deteaseil was stibbcd b> the prisoner subse
quentlv to tlie quirrel while he was walkuipC in the inn Mini flie onlv tir
cumstances m favour of the defence were the prisoners statement and the
fact that, in some c ises, woimds of the heart do not prov c inimcdiatel> fatal

In H V E 1/ lircrui the prisoner was eliargcil with the murder of her husband
bv blows on the head while in her room but she insisted tliiit the violence on the
head was producei! bv the kuk of a horse The medical evidence shovfcd that
the iKines of the nose vrere hrokcii there was a stellate wound exposing the bone
above the left ejebrow another similar wound exposing tlie bone at the top of
the head and a third wound at the back of the held fbe left ear vms perforated
and behind it was a long wound divided into two The skull vault was fractured
from the orbit througli the parietal into the occipital bone Seven pieces of bone,
varjang in sue from luvlf nn inch to three niches had been driven into the brain
and a large qiufitit> of bloc<l was e/l«<ed lie prisoners aeeoimt iru tlut vjie
found her hiishand thus wounded and bleeding outside the house that she drig^c I
the 1 )(k 1> into an inner room and further that thoiidi thus wounded he held
her ti„htl} bv the clothes for two hours afterwards U wis provTd that there
was no blootl over the front of the person or dres.? i f the deceased nnil tlrnt there
vvas no blood in the. passage or m ni)> part of the house tseef t in 11 c room where
the liody vvas found Ivuig 1 urther the injuries were not such ns a kick, from
a horse would produce, and the mechcii vntmss said that o man thus injured
could not have held the pnsoner tij the clothes for two hours so ns to prevent
her from seclang earlier for nsvistaiicc Tlicsc facts showed tliat the dcec ised lud
bcenkilledbj blows where the boiK wasactiiallj found riieprisonervcasconvicted

ACCIDENT, SUICIDE OR HOMICIDE ?

It niaj at first sight be felt that llic dctennmation of a question of this
hrgfh riMj-sitlc iJbr ^ortwjtorc of n mcdicai witness In some mstancis
it may be so and the decision js then left to the police and legal authorities
but in a large number of cases it is so closely dependent for its elucidation
on medical facts and opinions that n jurv conk! not arrive at a sntisfactorv
decision without medical evidence Tlic medical examiner in cases of tins
nature should direct his attention to cvervthing connected with the body,
the clothing and the place whore the body was found ns follows —

1 The position and lie of the bodv cvidcnte of disturbance

2 The medico-legal nature of the wounds
(a) Suicidal \ accidental v-Oiuids general

{!/) Lv idenee from the of the vvoiind

(c) 1 V idence from the iifiture aiul etient of tliu woiiml

(d) Pvadcnce from the iltrcclion ol a wound
(er) Ev uknee from ittulltplt'-ili/ of uounds

l-K .) ]«f oc from tl e |»o lionortUlmK Xnillprlvi nTo ;re«)

un 1 bound on t is si o| \ rcm ses dead T1 e exa t jjos I on of ll e bodj
espM ^ itl ret ir ! to tl c tigs and ll cl e of Ilof oo nn 1 tl Cj reci^enian
ncr of p n o im„ b^ conh for n in | ortant i rts of tl e cv lenee TJ c \ etim
I ad been cosicd nd left n s icliar a asm Ml elJ ca isc dratb

0 Evidence from an examination of (he assailant
The follow ir g brief epitome is inserted as « useful guide to t) c ftrraiigement
of the facts for reports —

Ft idence mnv be clern ed from - —

Posmox OF Body and Clothes A bodj gagged and bound with

tlic clothes disarranged or torn
aw aj {eaadence of a stnigglej is prma
facte e\ idence of homicide Note the
amount and especialJ\ the j osition of
the blood and tons der how it
became distnbuted so

W OUXDS —

Number ■'I'lnj shglit wounds often indicate

suicide if two or more important
organs are wounded a more simster

n0t/AD5 JCCIDF\T SVlCIDt OR llOM/CWF m

Position

Nature

Direction and dejitli

Bruises fingernail marks etc
Direction of flow of blood

Surroundings —

Furniture

Floor

capon

e^ent is bkelv AInnN wounds on
liauds are iisufllH from attempts at
protection ^Innj deep wounds
suggest homicidal sa\agcr\

Suicidal wounds are alniost in\ar!
ablj on the front of the body but
there is InttHy a position esen m the
back III which a lunatic may not
contra e to wound himself Hammer
ing on the head drt\mg m of nails
chiseis etc are hin'it{cs tncks
Genital wounds arc more common
on wximcn ami usualh sadistic

Blunt injuries are rnreh suicidal
except III lunatics but thri'iniite m
the mouth and red hot irons dn\ en
info abdomen arc occasionallv re
sorted to b) suicides Strangling bi
the hand cannot be suicide

\ cut IS usuallj shallower at its
termination indicating whether a
wound was made from left to right
or \ice sersfi \n assailants hand
coming from bchiml cuts tl e throat
like one s own hand starting m
front

Homicidal cut throats are usualh
liolder more widespread and more
iimlercut suicidal cut throat w ounds
usually run clUpticaUj tcntntisc
cuts arc usual

\ determined suicide niaj often
cut down to the spuie in cutting his
throat the sharj’uess of w eapon and
the strength of the anctim must be
considered

These demand explanation either
from the nature of attack or
defence

Often gives a strong clue to the
position of the victim at the time
of and after injurj

In disorder or broken wath finger
prints on it as evidence of struggle
Blood or hair attached

Stains Dusty or bloody footsteps

Foot prints

£xact position Nature Blood
or hair on it whether gripped firmly
inthehand if absent whetherthrown
awav or hidden

271 ACCinE\T, svicwr on IWMICIDF

The Accuser ,

B ood stuns On the cJothinr
scntches nnd nnj minor m^^^cs ns
twdence of a struggle GenenI
plijMil condition An; ob;,n „5
mental disturbance

The Position and Lie ot the Bod>

Evidence of Disturbance KivimportanttlnttlicresliouMbenodisturb
ance of the hocH of the iicnpon of articles of fiimiture or of other matters
in the inimedia e a icinitj If the |K«tion of the hodv or the neaped has heen
m frit '"•‘I'thtraneentcntoftlieclotliesnllered thlsmav

matcrnlh nfTcct a medical opinion ^

A patholiyiat performing a roiilme on a wc man found den 1 m bet! b%

her hush ind found no sienitwant natural daeasc The hlood which was bricht
cherrj red conUuned 04 per cent of carbon monovide ^ p gas uas Md on v, Lt
room S»ie could not haae got into bed sntiirated to that degree The liusband
tjwcstioncd more cinseh admitted that he fiad found her m a Inmff room down
stai^ l>ing on the hearthrug will, n gas tube leading to her face and liad earned
her to her bed to a\oid the stigma of suicide

If the position of the deceased %>itli respect to surrounding objects Im
been disturbed if the ucapon has been remoted and the lipdv transported
to a distance then it mat not be easj to distinguish a wound occidentally
recen ed from one inflicted b\ a suicide or a murderer The e\ jdence of those
who find the bo<U can alone clear up the case and the medical witness mav
be required to state how far this cMdenec is consistent witli the situation
CNtent nnd direction of the wound bj winch the deceased 1ms fallen Before
n bod> IS moved a photograph must wlierever possible liet'tken o! llicntti
tude the clothing and position of surrounding objects in relation to it — of
blood stains and anv other relevant data

Medico-legal nature of the t\ound or Wounds
(a) Genera/ facts Suicidal and Accidental Bounds It is not often
that any diflicultv is expencntctl in distinguishing n sruci !al from an aeci
denial wound B hen a wound has been siiicidnUv mflicted it usunli) follows
traditional lines and gives clear indications of design the whole of the
circumstances arc seldom reconcilable with the supposition of accident
Circumstantial evidence is iisiial/v sirflicieot to shoir whether a wound has
been accidentalU inflicted or not but ns an accidental wound maj sometimes
resemble one of homicidal or suicidal origin so if the body Ins been divturheil
it follows that it IS not alwavs possible for a medical witness to decide the
question from a mere inspection of the wound

A woman was found dead face down in a forest hollow near Groombndge Ifer
bodj was removed to the local mortuarj where a pathologist found tliat she Ijad
a severe blunt injurj to ll e front of the throat across the voice bo\ with fractures
Suspicion of foul plaj tiaturall^ arose and it became vatal to know c\actl} i ov s) c
liad been King face down wlen found "No photognipli nor anv deacripUve
record had been taken before the bod> had been moved and tlicwe wl o had found
her could not remember cxnctlj bow site lav tlic case thus remained obicurc

A vvntness must be prepared in all cases in which death has taken place in
secreev and the nature ot the nound ts such as to render its origin doubtful
to be closeh examined b) counsel for a pnsoiicr charged with honi^idt <m
the question whether the wound might not have been accidental The hw
requires that it should be made quite dear to a jurv, before such a charge

^^OV^nS MJDICOIIGAL \ATUHF 275

c'ln be sxistainetl that the fatal viound could not have Ind an ntcidcntal
or siucKhl origin

Ihe death of a person from woimds has liithcrlo been considered ns a
subject coniicctcd wjtii a criminal eh irpc, but nn investigation of the cireum
stances in winch death ensues is occasionallv rendered ncoessarv wlicn the
deceased lias efTcettd an msurmec upon his life A policv of life insunnce
IS in some cases remit reel void bv tlie act of self destruction and therefore n
person bent on suicide might for the sake of Ills famiK take precnutions to
conceal the manner m winch he intended to take Ins own life IIis both
might he found wounded in Mich a wav which would render it nneertain
whether lie had been wounded nccidcntiilh whether he had been murdered
or whctlicr he Ind f illen h\ Ins own Innd It is incumbent on Die insurance
ofhee in a disputed case to prove the net of stiu ide wlicrcas the relatives of
the deceased would nttimpt to show the coiitrarv Such ligitation must of
course call forth n searching investigation into all the circumstances con
nected with the death of the insured and the wjiole case would in some
instances^ rest almost evelusivelv on uucheal evidence

In ScplemlicT t020 a man aiw\ tws vnfe were found npparenUv burnt to death
In a motor c ir It was assumed at first that the ear had taken fire by accident
blit Investigation showTd tliut (he m in h u) shot Ins wife and had poisoned himself
after wluch he baturntctl the oar with (Ktrol and set fire to it

Though sev ere incisions ov er \ dal purls do not often hiippcii b> nceulent,
severe punctures and st ibs tilTecling v dal organs hav t frcqiientlv an nccidental
origin These stabs arise generally from fnlls while Die person is in Die net of
ninrimg with a pointed instrument m Ins hand or his pocket They are
commonly directed fixnii below upwards Honnculal stabs may likewise be
directed from below ujiwnrds but this is soiiicwhnt mrc m tins coimtn,
unless the person is stnhhcd by an oblique blow while m the recumbent
posture

Ihe fact that there mnv be some instuices in vihicii rules of tins kind will
not be applicable must not prevent the cautious npplic ition of them m
doubtful oases Ihe following cases show how aecidental mav resemble
homuidnl stabs —

V lilacksnnlh while forging a piece of rod Iron vs-ns irritated at some ohserva
ti ins made by n lijstaiulcr Ife niad« « nisli nl the oITindcr with tlic heated iron
in lus hand the end being red hoi lit htiunbhd nnd fill In si me way the piece
nf jrijj brtwme aiTidintaJJv reversed he ftJI u/mmi the red I ol jKiint which struck
against n jxirti m of the hnast Imnc glaiicsMl fu m Ih it an 1 Jiem tmted Die iipjicr
part of the left lung He died in a fiw diys If only one iicnon had been
present wlitn this nreiimstaiicc oceiimsi a clitrgc of munler nn„Iit easily have
arisen

Taylor told hnvr n man was 1 rouglit toGiiv s Hospital with a punctured wound In
tiebaok 1 m tween Ins she ulikn It I adlacn mllieti^ by a stoncnnson s chisel The
instrument had j cnelratcd to Its hen I (wldrli had prevented it fnim gc mg furtlier)
into the chest pn diicing a severe wound ns U vuis supjiostal of the lungs attended
with copious hemorrhigp It upi>«ir«l Hint the man lead fallen from a htow
lut did not c( ni] I im of Icing stal lied an! was eonveved I ome His wife on
remov Ing his tasit, f mnd that Ins waistcoat nn I *1 Irl h 1 1 be en iviatnittal hv the
chisel wlmh was still slickin^ «n Ins IiniL Imt the outer roat had ni t lioen rat or
pirfomteil liv It Sic withdrew tin iiistruinent «I en n pi ms bleeding came c n
and lie was suit to the liosjnlal It was elieitcd fniin vnlnesses tleat n> weapon
w IS Man III the hands of Dll amiscal tl it the chisil belonged to Die wfundcti man,
ami Dint 1 e us<al it m his tra le ns a stonemason D»cn were no marks < f IiUmmI i n
Die 11 Kir where he fill oronhisel Dies Hint aDcr leaving D e puhhi*-! < use where
Die qitaml took j lire he wnlkcil with a pc liceman who said tied tlie man exhibited

^WU^DS MrBlCOIFG4L \ATURE 2 ~

Inspection re\ ealed Hie thickened oerted edge of a cancerous grow th around the
edges of the root of tlie penis iihich had been roughh amputated b% the victim
wl 0 Iiad afterwar Is cut his oivii throat A bloodsta ned knife Ia> in a drawer,
partlj wiped Ills sister gave c^^dence of threats to perform such an act

It IS Hirelj that we find suicidal slabs in the tliroat but it is much more
common to find them in the upper abdomen the heart often felt beating
in the pit of the stomach— being the objective In regard to situation
there is no wound which a suicide is capable of inflicting upon himself which
may not be produced by a murderer hut there are many wounds inflicted
hj a murderer which from their situation and otiier circumstances could
not be self inflicted the precise election of a classical suicidal site is a strong
indication of deliberate self infliction

The situation of a wound rarelj senes to show whetlier it is of an acci lenlal
nature or not Accidental wounds generall) exist on tliose parts of the bodj
which are exposed hut may equally penetrate the clothing

(c) Evidence from the Nature and Extent of a Wound Generali)
speaking wounds found on the bodv ofnsmcide apart from those faj firearms
are either incised or stabbed Contused wounds are rarelj seen in cases of
suicide because in producing them there is not that probabilitj of causing
deathspeedilj whidiasuicideusual!) desires Thereare of course exceptions
to this remark as where for instance a man precipitates himself from a
considerable height or in the path of a train Circumstantial evidence will
houever rarel) fail to clear up a case of this description I\hen death is
caused by a contused wound soluntanly inflicted the nctim is like!} to
hare been insane

A case 13 related in v Inch a man first attempted to kill himself by running his
liead against a wall and not having succeeded m the attempt he struck himself
repeatedi} on the forehead with a cleaver B) this he produced such violent injury
to the brain tliat death soon followed Tl e man was seen by several witnesses
to commit tl e act If tins liad not been the case the nature of the wound
vrould certainly have justified the view tliat It bad been ennunaU) iaflicted by
another

A close attention to the slope depth and direction of a wound m the throat
made bj a cutting instrument will sometimes lend to a definite conclusion
in a case rendered doubtful from the circumstances m which the dead bodv
of a wounded person is found The eJemenlarj distinctions between suicidal
and homicidal throat wounds maj be tabulated thus —

Suicidal

1 Across the front of the throat
less commonlj on the side very
rarely at the back High level

2 Marked b\ tentative cuts at the
beginning of the mam wounds

J Sloped up if at all

4 Gradual deepening and shallow
mg

5 Curv ed across the throat

G Main wound maj contain several
deep cuts

Homicidal

More commonly on the sides
occasional!) round the back Tower
level

No tcntativ e cuts

Sloped down if at all

Boldly cut m at commencement

Straight or set obliquely down
wards

Mam wound usuall) sohtaiy — but
sometimes repeated parallel wounds

^^OU^DS MPDICOLrC IL ^JTinE 270

Ihe pnnciples generalh used to dishtigutsli homicichl from suicidal ^\ounds
must lie applictl guardcclK in the cases of msanp persons

A woman suffering from deJirjum tremens tore ojien her abdomen with her fnnds
The wound produced was eight inches long and about eight feet of the small
intestines protruded from it as well as a portion of the I irge intestines which had
been completely tom across She h\«l J7 hours after mllicting this injury A
pregnant woman under a delusion npped open her abdomen so tl at a large wound
was made and the omentum md gra\a«l uterus protruded A gentleman svas found
lyang m a state of insensibility in the kitchen of Ins house with a cleaver b\ his side
On exammmg the 1 cad ui wards of 30 wounds were found over the back part of the
skull The wounds many of which were superficial had a liorizontal direction from
behind forwards One however Jwid removed a portion of the skull from the middle
of the lambdoidal suture so that some of the brain had e caped This insane person
died four days afterwards but recovered so far as to admit tint he had inflicted the
wounds on himself From other circumstances there coull have been no real
doubt as to this

Incised wounds in the throat are generalU set down as presumptive of
suicide but n murderer sometimes wounds this part with a v lew to concealing
his crime Circumstances conncclcil vvith the form and direction of a wound
may in siidi cases lead to delcetion for unhss the person attacked be asleep
or intoxicated resistance niav bcolTcreil e\ idence of vrhich may be obtained
by the presence of great irreguhntv in the wound or the marks of other
wounds On the hands and on tlie person of the deceased In some instances
Jiowcver it is extremely dilTicult to state positively whether the wound is
homicidal or suicidal Attacking a person who is asleep intoxicated or
from age or infirmitv incapable of offering resistance ma\ easiU produce a
regular and clean incision of the throat

A woman of 00 whose daugl ter of 38 was m need of constant care as a mental
defective deci led she void 1 not nsk leaving her to fend for herself m the event of
nld Hge or death. She cut her vlaughtcrs throat as she lav m bed asleep — by a
single seven inch stmjit woui d through the mid trachea and left internal common
jugrrfaf and t^ifwtftl She thenettt heconn throat st t}t\TO-h}ot<i tnembrane

level b\ a senes of five elliptical wounds me lined towards the /loor of the mouth and
marked by some 14 tentative cuts at the left end of the major incivions, — a tvpied
seif inflicted cut tliroat

The depth to which a suicide can cut hiv own throat is often a matter of
wonder but there arc limits to it and careful reasoning may thstingmsU
the occasional homicide from the more common suicide —

In ft \ Edmunds a voung woman was found deid with her throat cut and a
razor taken from the house was Jving near the bodv There were three deeply
Incised wounds in the neck made from left to right the upper one four inches m
length commencing below the left car and running parallel to the jaw the middle
cut about seven inches In length commencing at the same point and running
across the middle of the neck to a point belund and lielow the right ear and Ihe
loicer rtil ste tiicf es in lengl/i nmmenein" abocr ihe middle of Ihe left collar bone and
terminating tn tie front of lie tied Ij joining Ihe middle ii mum The middle cut
dmded the windpipe the gullet, and sdl the great vessels and nerves in front of the
neck to tl c cerviril spine There w/re two distinct cuts into tlie spinal column
about lire third cen ical v erlebra one penetrating deeply into the upper edge of tbe
bone and the other a quarter of an inch below it commencing on tlie body of the
■vertebra and running more deepiv to the nght side Tlus divided the transverse
1 roccss of the vertebra opened the jomt between it and tbe bone and severed the
vertebral arterv Tl ere icere deep cuts icf jcA /arf//fd on the itmdc and outside of the
left I and, and tl e pad of tl e it ullfefnger of the ngft {laud f ad leen sherd off an I icas
found iced^cd mile joint of tie ra or There was iio blood ujuin the handle, wlule the
hands of the deceased were bloodv

Suebovounds ns tliese could not have been inflicted by the deceased upon

iior%/)s ^initcoiFctt \,iTU!i

l.er,olf Tlmt s,t«„t,OT, „M„tr «tml. ar,l dirrrlinn tl.n„
homicidal The Imekina of the Iwacof thc.,.„„| cohmui m fcr» dudiA ; hW.
« ilh such force as lo cut uIT pari of the lauic an. r l.ilh car, h I „rlm„ ,od
juculyicinshadliccncut thmupli miKhl lai suHmuil lo pisl.f, tl,,,,,
and the classical ' protcctuc' isounils of the hands plate the taaltrr lest ™1
all doubt

Kerr' reimrls a ease of stutidal cut throat in svhich the left transsrise
process of the fifth eeriieal sertclira had been etit through and aas I ain.!
1} me free in the inciseil tissues and simidal nickme i f the prciertil ml
lipnmrnls is hj no means iitirommnn
In /i’ ^ />«7Xifi * llip meshed csidrnce was v> unpnrtniil nndllic juiljr s
cnticisms so jntcrcstmg that tliotipli much dntal lhp> Rn. «juote<l in full
The defence. «as of stiicitle lint the prisoner Mas cttn\icf«l of murder

Dr Horton Smith «.ii t he va% callnl to the sernr of the tmpsh on
aJanuar> new! found the l>ods of the drerased Tlie left Rrm be across tlie rliett.
the hand holding* n larpe knife looseh There sms a wotin I In the nerk ttjk*} mj
almost from ear to car ri\ Inches In length ami Hip result of tun mHslons One
incision Ind first l»cen made on tlie left »l le an I the knife hn I lieen mlftnjueesl |n1o
the uounil ajcim almost to the bottom of the first joeinon on I another ineukn
Imd tlien lietn made passing almost dirrcll> iipx-rnl* to the l»srk of the mouth
The wound seas psidentU made from left lo right There seerr In llentt ins of otljet
attempts on the thrant On the thumb of the left hnrxl Itiere « ss a dight nx un 1
n scf^ deep wound lietwcen the thumb and the first fiftcrr Tl err wtit oilier rut*
on the left and right hand*. The throat srounds pould not ha'r hern »elf inflleteil
If thp> had licen he wont I hose expeeled to fin I the knife firtnh rrij pod In Hip
fight hnnl and the wounds transirrse an 1 not lending npwanls

ttoss*cxnm{ned Ur did not rvmeintier wslnj* at live impiest tlial It was eon
ceisnble the wounds iiiighi have liren self mllirtrsl \Men rt nfrmilfd snlh hi
vrriltpn evidence the wJincss admltlPil Ms ngnalure, hut lie could not rmenitipf
making that atatenient It was n fact tluit mW Jal wounds variril more H an anv
others tMilclicver of the throat wnumb wa« first jnnicted unes nseljusness *»mi)l

have fiijicrvemrl an I It w< ull have lieen iiiipossihlp lo Infiict a »eeon<l

l)r Marsh depv»wd to making a part mortem exainimli n rf tlie li*»lv The
wounds on tl e Hiront had lieen made liv two dlstinet InrMons Tlie first dbvltsl
uU the struct HITS (low II to the Iwne nml cut a groove In tl e Mine Tlie seton 1 went In
tl higher direction and dm leil the deep structures uj ToH^e^P I of Hie tr ri-ue Tlte
reason whv lie said there liad lieen tveo Incisions was tl st Hr n sin arterj on Ihek-n
side had been divideil twice Tl e first incision wliehwasHel west ml Hr msin
Brterv across il« treon t incision vs I loh was I igl er nlw* rut H e artrr> amws
His IxrcWiip Me nil agree llrre were two Indsl nv Tlr p-inl Is whv d)
vou speak of one innsion as being j n >r In time to Hr otlrr? H w d > v^ ascertain
which Incision was the earlier’-Ultnws The fm Inelslrm which I. Hr lower of
the two cut throagh tlic skin an I tlie win 1| ipe ami Hr pillrt Hvving mt
through thev vrouM retract lie drasm dnwow-arxls an I upwanls w H^t Hrr
sltucluies were not divided bv Hr secowl Indslon Tie semroi
them fhere was nothing ilivilrd twice but tlr artrrv Tlr
windpipe Iring in a line wilh the lowest of tlr two fnrivl ms and sHth '*

in the Imne It netrssanlv folloic timt the other IwmI «v must ave
It, otherwise the wlndpijr must liavr Iren divl Inl luglrr It I* W r «'J

wounds In the neck In luive Iren self Infiietol ,4u,i sow

Crossrxamlned bv Mr Trevor Uovd Mhen before

I think It exeeedmgh Improlable lliat Iw th wourvls ro J J ^ •

rninnol sav Hull thev havx- not Iren seIfKIxted - Mdr-* 'f’

not quite the same tl log ,

\ou dll not aw It was mif»>««lble*-I »»•<• « wasevewl
Hut >ou Mil I mnmt »ar tlrv liavr not Iren rl i
onh sav it Is imprv I vt le

fl*- Impn fa‘iV
'’tr-teil ■’—■Ns 1

» herr I) J t- !«» ^nt rvd J 2 I"**
•Orster \»s»es Jti-e !««

ran

MOUXm MrmCOLfGiL \ 4 TIRE 281

His Lordship But to da\ \ou said “unpossibJe ’ and vou understand
* impossible ’ and ‘ improbiblc ’ are not quite the same thing fs ‘ improbable"
n|,ht and * impossilde -MTone Of w«4T — Impossible consulenng the two
wounds

\Sh\ did jou sa> * improbable onU before the eoroner’— \\e were mixed up
lictwecn one and two wounds The fact was not clearly brought forward tlml
there were two wounds

Then with regard to one wound jou would sav it is improbable but possible
that one wound was self InllicteiH — \cs but I said both wounds to-dax
D\ Mr Llo\d I admit the first wound might have been self iniheted
Prank Thomas Paul was examined at some length The throat wounds he
(IceJareil vrerc certaml> not self mflieted Either of tliem wnuhl have been rapidlv
fatal Mans of the deep tissues were divided into two parts Tliat was quite
sufficient to decide that the wounds were made in two cuts In the witnc'^s s opinion
neither of the wounds w-as self inflictei! Speaking of the Imcr cut b\ itself if
tliat Iiad licen the nnlv one liis reasons for naving that such n cut was homicidal
rather than suicidal were — ( 1 ) the sue of the wound and (i) that the deep tU^ues
were cut further tlian the skin Tliese reasons were applicable oiiK to the hvpo
thesis of onlj one cut on the neck, and without regard to the other w-oimils on the
tiands etc

JfJv l^onlship Hon a wound on the hands con affect the view rcgartlmg n wound
on the neck jiasses m\ comprehension — \\itiiess \11 authorities on medical
jurisprudence consider them of the utmost unportnnrc \\c cniinot judge a single
till bv itself ■\ledieal men, anj more than courts don t come to a conclusion on
one point alone Here is a wound which might liave been either homicidal or
BUieutal if vou take one alone

Hts Ixirdship lleallj X must ask )ou to bear in mind vou have nothing to do
with the Issue of this case ^ou come here to pve scientific evidence and if a 1 iv7k>*
thesis is placed licfore vou >oii must answer on Hint h>i>othtsis - \\ itncss I was
tning to answer m such n vva> as not to mislead vou

rxaminntion continued ^^ltne&s »a{d it was m Ins opmi >n imimssiblc for &
Kiticide to inflict the second wound which was on upper cut, because the seriind
wound commenced in the first cut Hic effect of the first cut iii>on the victim
would render her almost immediatdv uniomeious The wound vras mi deep
upvrnrds as to be ulniust unknown In eases of suicide \\ itnes* never licard of a
wound being in an upmml direction m thrait wounds of this kind Tiie throat
wounds were unqueslionatfi) from left to nglil 8uch a wound if suicidal must
be cut with the right luind The other siimlt cuts and soonngH on the neck were
quite different from the tentative wounds caused bv n suicide m making up ins
mind to cut Ills tlmiat Tlicv rather rcscmblevl the wounds made when the nss.uled
was trj-ing to escape the nsv,iilant s knife The cuts on the liiinils showed several
attempts to grasp the blade of the knife

Cross examined Stiuidal wounds varleil more than anv other in direction and
extent It was not a fact tliat n maniac would often cut upwards hut It vnis stated
in some books tint maniacs might cut upwards It mis nlwnvs rrg-inletl as a
sign of homicide when the wounds were iipvranis A maniac w-ould cut m almost
anv direction It was a fact tliat a suicide sometimes droppeil lus wcajion, lie
either grip|>ed or dn>p|>rd it

\\e have licrc dealt with at some, length with incised wounds, hut rcison
dictates that similar jinuciplcs — «v to what ir nud wlint u not possible of
self inllii tions oppl} (o all classes of wound and injurv

should alwnvs search the whole of the liodv carcfullj for evidence of
violence The itistdes of the arms or thighs mnv present marks of mjurv
wliicli could not |x)ssiblv l>c explained on the siipjiosition of necidental fall
Mulliplt severe contusions on both sides of the IxkIj or nntcnorlj and
jmsterinrlv , commimlv indicnte homicidal v lolencc
The binlv of a woman allrgcil to liavc been murdered bv her hiisbatnl prrwntrtl
miniemus marks of contusions and one arm was dcrplv Imdscfl fn m the shoul Icr
to the hand Tlie person charged vrith the murder nscriljcil thev apjicaninres to the
fact of his wife Ivav mg nccidenlh fallen out of l»ctl but on examining the l>ed it was
found to lie onlv a fiwl from tlie Hoor A fall from this lieighl wiull not account

MULTIPLE \\OV\DS

liad been associating wth nnotber sroman «.-.{h iT k j i? j ** o

had piahed up the firet Hung that camrSher haJS^ Ime Ih”'’^ llA" ?"'* *'

ESSifSSS-Sm?

in a (icfensue gesture Accused was found not guilts
Wtcn a medical mlness has admitted that the ivound mmj hare been
nreidenlallt mnicted he has gone as far as professional Ijtotrledgc mil pemat
Ihe question of probabihls must be soiled if at all bi the other cTreum
stances of tlie case Self inflicted wounds ha>e certain traditional features,
but ncCKlent is capable of infinite ranation

\t Doughs Isle of Man a man was put on tnal for murdering hw wife. Medi
cal eaadcnce proved that the fatal wound had penetrated tl* left side of the chest
close to the sternum in the third intercostal space Oose to the sternum tlie wound
vvas deep and liad cut the pulmonary arterv Farther awav the wound became
sliauowcr ending as a mere skin incision The prisoner alleged that be was cuUin>;

his nails wath a sharp penknife (the admitted weapon) and tlint as lus wife aggra

v-at^ lum he had ptisbcfl her avrav with hi, liand rouUumng the knife and broucht
lus liand round in a sweep Tlie wound preciselv corresponded with such nneaplana
lion and led to the acquittal of the prisoner

Jn a Lyoru (C CC }03!>) a gtrl Hung a table knife at ter sister wl o was
sitting on a couch facing lier— taunting her snth not having a fianc^ The vaclim
turned her head avrnv but receiveil the impact belnnd ti e left ear 4 fionrontal
vround was caused penetrating under the mastoid between the first and second
cenncnl vertebra severing the vTrtebral arterj and penetrating the spinal cord
k third part> was present to witness the accidental nature of tins fatal wound

(e) Evidence from a Multiplicit> of t\ounds It is obvious that much
will here depend upon the nature of the multiple wounds and their situation
For instance wounds found on the hands in conjunction with a fatal cut in
the tliroat or a stab are strongh presumptive of homicide the hands Iw-ing
wounded in attempts at defence

In /? V Gardner this question was of considerable importance Sequeira the
surgeon w! o was ealleil found ll e woman dead of thrust wound* and blood was
copiously eflused but onlj on each side of the neck not m front of her person. \
large table-kmfe looselv placed m her right han 1 ivas Ivmg in the direction of the
length of the bodv the liack of the blade towards the cliest on I the sharp edge in
front There was dn blood upon the blade and liandic The Ixidv was Ijaog at full
length m a comer bv an ojien tloor tJic right arm which held the knife being partlv
tinder a bed The wound m the throat cut through the bone and thjToid cartilage
of the larvnx dividing the thyroid arterv causing deatii bj mhakition of blood
It commenced over the larvnx as by a deep slab and extend^ for about tivo mch«
dovTOwards and backwards on the left side It must have been inflict^ wMe the
deceased washing doivn and it was not such a wound in the opinion of the medical
witnesses as a woman could have inflicted on herself while m this position

The palms of the hands and adjacent fingers presented ni^erous fresh cuts, ilw
sharp blade of the knife had probabh been grasped by the deceased in

death. There were four cuts on her left hand and slx on the right

middle finger of the left hand one h.ad pone completclv through to the Done jne
hitsband iros concifird of tl e crime

These mjunes arise from an instinctive elTort to protect the iJ^at
a sudden attack Thev are readilv distinguislietl bv their situation on the

craspmg surfaces of the hands from the cleaner cuts, usualls acTOs the

rLts of the wnsh, mfhcled b, smcrdcs Tl.c,r pmscncc
some reasonable eapKnation In B T Gonbur this ™s one of Ihme facts
propcrlj considered to bo mconsrstent nilh the mnocence of the prisoner
Their absence implies an inability to resist

MUI/IJVLI

28fl

Tlie circiinistamhl evidence at the inquest supported n theorv rf \ ci

nZmX cur,;?’ ,1" h^.V’T”'^ ”" ""'" '■" '■ '"■’ ■’"'’"'■'J

On Ihe contrarj tlic mimber of tifal woimds swvf wicd mav alone he
sulbcicnt fo prcoliiilo the possibilitv of self infliction »

' Jtnmertnn (( C C , 1010) n taniltenvel! vmitrrss line! been found dead m
the Muberj of licr liniiie n tun in« knife tlinist to the lull m her left breast throiigli
the heart ]R otlier st di noiiuds viire present, II of them Jn tl»e rbest — of whieb
SIX !iad riileml tht biek iiotuecii the shmildir blules Protective viouilds were
prestnt in the ri„ht upper anii (ulmli had lieen tnnslivcl bv a knife) the left
forcnmi and to the rfj,hl hand (tietween the pnfm and fmjfcrs) and «nst V s.nn?re
nsviull by her flaiic^ a buttbers assistant had Ixtn warded olT to some extent
lieforc slie «ucctirnlie<!

In nets of murder pcrpclratcil bv insane persons it is usual to find even
larger nunibcrs of wounds on tin ImkI> of the person attacked and tlie sonic
mn\ lie true of suicide in the insane the dinertnccs bciig the cliaraclet of
the wounds

In a case at \ ork, a man in a fit of dclinum tremens killed Jus vnfi. by cutting
and stniiblng her Tliore wt re ,>0 viounds of wiuch some were pUml> meonsistent
with self inllitlion

Kcrt* has dosenlxd u case of suuidc in wblcli he rounted +t0 separate incised
wounds over the front at tl e h« I), full> a half consisting merely of suiwrflcial skm
cuts ovxr tlie cliest front and abilomcn

In examiniii" an injured or vroundwl liosJv, ntlcntion should be paid to
the mouth and throat Assailants sometimes endeavour to close the mouth
or to compress the throat so as to pre v ent an alarm from being gi\ en In the
tase of the Duchess dc I’raslin there were marks of rmgcrnails around the
inontli I ( cliv mosetl impressions as if prmliKed bv a hand arc found n^n
the throat of tin \ ictims m some eases of blunt mjurj to the head— as if to
steady the head or pin it in order to hit it squnrclv

Two or more Mortal Wounds It has been asserlctl by some medical
jurists tliat wlicn two mortal wounds arc found upon a bodv and particu
larh if one of them is of o stuiimiig or sttii>cfv mg nature (i e alTccting tne
head) they must be considcml inconsistent with smcide \n “

this kiiitl can he applied to those cases onlv m which the
on (lifTcrent parts of the bodv, were Iikclv to prove imr/tf(nr< / , ,

must however Iw )x>njc m mmd that nil siiiudcs do ti,e

perish from wounds which are esiensive and ^ loromobon

„„trarj 11, cj h„,eof,cn t'.c ,, 1
aliich might seem ttliolU incompatible nitli tlieir eonc i render it

sn, 11 1, ether one nonnd r,»s bWch to cause dentil so rap.dlj ns to render

‘iimfsofi K Po/ire T 27 110 resminn

» Kcrr.D J A , 10^1 i grensicMwlicuie SlUrd London

Vd-im 4. Charles JHnek,

’ MhLTlPIL ^^OV^DS 237

impossible for tlie person to Iia\e inflicted another ssound upon himself, but
\Oien there nre sc\enl (hstin< t innsions or st ibs on the thront eith jinolijng
importnnt blood \essels there is <i strong sugRcstion that tliej were cnminalK
inflicted There ate no rules b\ which the instantaneous mortahts of wounds
can be acciiritcl^ dctcnnincfl—a Inrt wlitch is apparent bv experience of
wounds of the head heart and throat
>.or IS it possible to say, from the mere extent of marks of contusion or
inpit\ on the head tint the deceasctl must hisc necessarilj suffered from
inseiisihiUs or concussion and base therefore been afterwards unable to
inflict anj wound uiwn himself Injuries of the head are accomjianied In
singular anomalies in this respect One person will be rendered insensible and
jiowcrlcssbs a blow which ma> lensescarcelj anv appreciable marks whereas
nnofher wall be able to w ilk and exert himself after the skull Ins been frac
lured and depressed blood effused anil eren when a portion of brain has
been lost The appearances maj be such as to induce an inLaiihous opinion
that de ith must ha\ e taken place inslantnncoush A medical witness should
be full^ jirepnred for tlic occurence of such anomalous cases but a strong
suspicion of homicide maj fairh arise when in addition to marks of grave
mjurj to the head a severe cut or stab is found on the body A man is
not likclj to cut or stab hnnsclf after having sustained severe violence to
the lieail, hut he mav retain the power of jirccijutating himself from an
elevated spot, and tliercby of producing great injurj to tlie head after
ha\ mg prev louslj attempted to cut his throat or stab Imnself
A man was fnuml Ijing dead m the street in a low cjuirter of Lotxlon with his
skull severely fnetured and Ins throat cut Tlie cvidenec adduced at the
inquest showed that the dcce ucd liad attempted suicide b} cutting his throat
111 his bedroom and had tlien thrown hi/ixelf out of the window, by wlucli the
fnicturc and other severe contusions liad liecn produced

The ciicimistantial evidence and the nature of the throat wounds are
all iinporfant to ilte proper assessment of bueh n ease t smiilar ohsen aCton
may he made in regard to the following cases —

A prisoner in a London jail was fmnd hanging bj Ins tie to tlic window bars
Onlj Ht autopbj was it discov cred that he had a m ulbag needle thrust into the heart
tliTongh the front of the chest it still in situ the'eve end just visible in a small
skin puncture the three and n half inch shaft biined obliquelj into the wall of the
left vcntnole There had been a bnrelj incnsurnblc loss of blood — a sohtarj drj
drop at the cntrince wound

In W V Carder, n sioman v\as found dead nearly twelve months after she was
first misscil \ handkcnhicf wasdriwn (ightlv acuund 1 er nech and a bullet wound
was traced through the left side of her liead passing out at the right orbit tliree
other wounds were found one of winch had entered the lienrt and all of which liad
been made with n sharp instrument The { nsoner tJiargeil wath the crime alleged
that the deceased had committed suicide hut the variety of the me ins and the
instruments employed to cause death is well as the f let tint the bullet wound m
the head the stab in the heart and the net of strangulation were individually
sunicicnt to account ft r speedy (lisahleincnl If not death, left no doubt tlint tins
was an act of murder

f In 7 ? V Cini n young wom.m was found m a farmhouse dead from a seven inch
long wound m her throat it w is situated oti tic left side of the neck iiearlv trans
verse hut passing sh„hUj upwanls from Inhind forwards 1 he incision commencctl
a little 111 front of the spiiu opjiosdc to tlie second or third segment and terminated
about an intli ninl a half from the centre nt the < hi» the tore part of the incision
being orer the body of the lower jaw and quite superticuil The important parts
involved on the left side were Uie external and internal carotids which woire cut into
hut not across the internal jugul it vein thevagus nnd 1/ie spmnl cord were com
plelcly severed The wcqion entered tlie joint between the sec md and tJurd cervical

nOUNDS ORDEK OF J\FFCTIO^ '

ilpapsisSs

^ 'iDunded lo«cr dou-n on the same side, sho\nng that several strokes

dmli^Side ‘J’ rJ'”*’®" deceased a common
wcf^ni cL 1 ^ looselj Arfrf It wa^ in fl reversed position vnth the back

ns tend of the edge towards the throat The left hand {.resented tl«eTnc.S
to the’jnnfo One of Considerable depth and another reaching

to the bone over the on er side of the ring finger The right hand had onlv one
slight wound upon it The deceased was ngAl handed ^

ounds of this kind were quite inconsistent with suicide \ suicide couh! Iiavc
inllictcd a wound m this situation and direction onl^ with the right hand but the
weapon vvas Ij ing looselj in the left Imnd of the deceased There were deep recent
cuts on the back of the left hand showin^ tint the deceased had raiseil it to protect
her throat A feUow servant of tlie deceased although not at first suspccteil was
tneil and convneted of tlus act of munlcr upon hjs own confession His clothes were
eKamined und it is worths of observation that iti/A lAe ea« 7 J/ion o/n/ra’smnHsyw/J
on the shirt they uerefree/rom nnij marks of blood The kn fe found m the liand of
the deceased was bent towards the cn I as if it had been used against some liard
obstacle Tt liad been wn|.ed but it still contained in its depressions and irregular
itics as well ns between the h>ers of the handle eojgula of recent blood inivcd with
rust In a small coagiilum found on the knife dried and fixed to th^blade weresome
woollen fibres of a peculiar purfile brown colour These corresponded exactly to tJie
fibres of the woollen j icket vs Inch the prisoner wore Tins observation was of great
importance in connecting the accused vvithtlie crime This case affords an excellent
example of the immense weight of gmlt vclucli can be laid upon a suspect vrlien
circumstantial ond medical evidence arc carefully collated an 1 presented in orderly
arrangement No jurj couhi ful to l>c convince I b> such argument

^^^len seveml wounds arc found on a dead bofl>, the question is frequently
asked ^^hlch vvas first received? If one is likel> to fell disable op kill,
and the others not it is prohable tliat the latter were inflicted first This
remark applies both to c ises of homicide and suicide but of course when in
a murderous assault a person has been rendered unconscious by a blunt head
injurj likeU to become fatal other equallj lethal injuries may follow More*
over if n victim has been set upon by several assailants at once numerous
grave and superfieial wounds may have betn simultaneously produced
This IS however a question to which il is not easv to give a specific answer
Eacli case must be liecided from the spetin! circumstances attending it and
m most instances unless some direct evidence is fortlicoming a meihcal
opinion can be little more than conjectural Tlus question is almost always
put m a court of law and a witness sliouldat least prepare himself to meet it
by placing the wounds in an onler wliicli satisfies the medical conditions
A reconstruction of the crime under these conditions may he extremely
helpful to the investigating authority and may also be helpful in court as
in the follow mg cases

In 7? V Cn»W (Leicester Issues 1M4) I*® ? ''tW™

hnd been found in « sp.nnej at Ivcrai»ton Beds ^

II to ha™ sustained at least font blunt injunes thtec to the face and one across

;jftr.f„d«o;;'o.h"™^fto'?hi«

and depressed the sknll s ault helui^ *,5,“ beSi^ the ground at the lime
molar (cheek) prominence suggested the face lad oeen cm t.

»Stnpson Keith 1M6 Pot>eeJ»l^ 180

]Oi{FIG^ nODllS 2S0

Di-censeil, it (vis sug^sted tlicreforp hid been stnit\ wdb a hea\-j bludgeon (1)
across Uie left cse (probsbl^ folJccling eiebron him) (2) in the mouth disIo<Iging
teeth and causing blectliiig— but still nft rUling tlie victim (I) n knock out blow
to the lo^ve^ jan, felling him nnil (4) n tnortal count! on Ihe Intel of (be head inflicted
after the tichm .uisfelhd and ihcti/uiM« ofrcsiilanee Hits last inference nude nnj
thought of rcdueing the charge to one of manslaughter impovsiblc sescral dasaj
later a 1 lb 2 or bough beasih bloodst nned, wiis found iiearbs vith one head
hair and six c>cbro« Inns nidcntioai with •nniplcs from the \actim attached

Gribbic a bnv of Hi suspect of the kilbng mule four sueccssise statements
coinmeming In saving ‘f iiestr s»%\ Iloli (decciscil) on the Sundiv afternoon
then soluntcering details of a fight nlucli did not fit the mcilicnl lindmgs described
abo\r,fina!h admitting I hrst struck him on the side of the fiei ffe hit me in the
stomach and I lot limi again nalh thepiceo of tree on the he id He was bleeding but
eonlmucd to fight so I hit bun twice mon. willi tlic pieec of wowl on lus be id lit
fell down then and whilst lie was l\mg on llic ground f hit him twaec on the head
with the same jucct of wood I rcahzeil I had kiiotkeil him uneoiisiii us

Not one hut two wounds intheted on i lieipkss felled Mctim (almost certainh
knocked out bj th( jaw wniiiid) sms enough to shIkI inti ite the cliargc of murder
This rcconstrut lion of the order and nature iiid prob ible efftt Is —of these siicecssis e
blunt injuries was Mtal to the polite in pressing acttiscd on the fiUicies of Ins
earlier st itcmcnts, and to their elurge of nninler Com iction f illowi d

A man found dead hi his kitchen bore one cleft wound on the top of the huid
hca\ > bruises m cr the 1> ick of the st-ilp and a senes of se% en p irdlel t left or chopped
WDunds vjt close together on the left temple rhere were no prolectnt injuries
It was suggesletJ tbertfnrt tint he was first struck a di'iblhig blow ns from a
chopficr on lilt top of the held causing Inin to fill on to his back — where whilst
unconscious from the first wound he was struck sesen marc wounds m quiik
succession The nbsenee of protective kind or forearm injuries rccpiircd cxplaiu
tion lie vns not nsicep for this itapiKMieil m the middle of the kitchen unnUsu
showed he was not drunk, and the lUcrnalivc was ‘siiqirisc lie ooiild have liceii
caught with the heud down entering the room wlicrc, it turned out lus son I iv m
vvQit for him chopper in h iu<l The bov shot himself with a 410 shotgun djing
before he coiihl be am ste<l for tfic enmc

Evidence from Foreign Bodies in the U^onnd
roriign substiiiccs nre iometimes diseovcrcil m contuseci or latetnleil
wounds, and these iin> throw an ini|K>rlint light on the tircunistnnees m
which a crime has been perpctralcil

In I! V Ifii ell the bmlj of the dcee-md was round in a well When examined,
there were on the head scveril wounds siillkicnt to neeount for death llurc was
much blood on the clothes and fact and m tlic bloml were slicking a quanlitv of
h ij seeds, winch led to the coiiehision tint the wounds must Ime been innictcd
in a stable or in some placa: where there was lu\ On esaimniiig a tu ighlKiuring
stable the spot where the murder w is eonimittctl was made clear b\ the diseoverj
of bloodst iins

'Ihcrc ina\ be faiind in the wound n imrlion of the weapon itself The
preservation of this is netessarv, ns it mn^ serve to connect an accused
person with tlie crime

In U V I)f Srth I the deceused dicil from n stab mllicleil on him bj the prisoner
Two inches of the {Kiintisl portion of the lil idc of u kiuft. vien found inilieddeil in
one Ilf the vertehn IIic sjiiiml eon! lud been divided, and jiinilvsis cmling
f itallv , vTOs a result of the wound TIk* identitv < f the wcajxin vi is not onlv eslah
hdicil, but the force bj whiih It bid lictn u>cd !>v the prisoner was Unis tlearlj
iiidic itcd

In It \ 1/oore, where the prisoner was cliirgial with munlenng lus wafi Uie
worn in s thro It had liecn lul Uimngh In Che fipetiai column Small particlesi f steel
which had formed part of the talgc of n cutting instnimint, vicrc found embuldet! in
the muscles and lumes These were exaimncfl imcroscopie-ilh , anil their imtiirc
vcnRcd riicj vserc covered with blood In ii box In the jri’-ouer s nnim two

.00

iior\m /'/ i\

clUl I «* < f 1 c » I ftt ni ' ull rti

202

iioL'.Nfls suitnouM)i\n'!

arnTwy! ' ' '“’ ' ''“' *“''''" * '’’'■ """' "“■ <'!"’« 'I"'

Evidence from the Surroundings

^\ltll rc^nnl to tlie IjonunihJ or mtcidil n ittirc of HoirtifK nKcntjon >ii»\
be cnllccl to the v\ciRlit oT the tvulcnrc lUnvol fmm tlic ciruimstitu-cs in
which the bo{?\ of jiersnii is ihsco^trwl

It Would cortninlv be wron^ to bisc n jitoftssionnl njiuiinn rvrJu^ivtJi
on the facts so osctrtnincd but it iss(nK(.l> j»ossihh forhim to avoid dm\\in„'
an wfereme from them Iht tncdicnl evidence mav Iw vriak nml msuhieiiiil
to support tlie charpe npainst liu nccitscil in such « evse jf nn^ viisj)!!! >iis
circuinslanies have come to Ins knowledge he tiiiv Ik (*r(cn iimoiiMKudv
induced to attach pnafer imjwlance to the medical faels {him he iv
in doinp Hut if u proper deprtt of cnulioii is t verriscd in dm« iii« inferences
and the circumstances arc not nKuwed to create a prcjmlire iii Ins niiud
against the accused ndoctonsl>uiind tooliscrvcnud (orveord tfani for iKiiip
usuall) the first person called to Ihedeccascd inunv factseajsdileofthmwmR
QJi important tight on the ca<c mi^ht remun mmoticed or miknowa hut far
his attention to them

\mong Uic questions winch present Ihrmsches ou tlicsc ocewmas an
the following Is the jHisition of a woimdcsl IkuIv that which ii suicide, could
have assumed’ Is the clist ince of a wca|Kni from the IkhK such as to render
it iinprolnhlc tint it could hue lieen placed then, h> the dereisrd’ In
nnswcnng cither of these questions it is iicec^sarv to take into eunsuh nlioii
the CNtciil of the wound and, the time at whirh it probahK pnwrd fit il
iffa/n it wnt JiO //i/{ninf} fns thr hhf) w inorr /hi'r^ iJn/i ot>p‘*

\rc the streams of blood all eonnetled’ Are Hurt aiiv marks of hi ki^I on
Ins person or clothes whicli he could not well Invi prcvdiucnl luiosiin’ tn.
there, anv proje cfiiig ii uls or either articles whitli nii{,!il aeeniinl f< r wounds
on the IkkIv as the. result of utnlcnt’^ llie-se arc epn-stions the answers to
which niav nntenalh affeet {lice tse-herieeaelf rfor m ootiemgamJ rwTinling
the circuiustnuos niiplit to esere ise the eitiiiost iiutlion

The rules rrspeelmg tiie luliiiissiluhlv of thu kinel of eMilciiet an tlwse
whnlnpplv toall faelinltvidemi il iiinv Ik oral or dtKuinrularv \dorlor
would do well to inukc notes or a pi in at the, Imit f ir he is allowtsl to * n fre^h

Ins iiu more In rcfcreiiee lo these

Medied faets when projHrlv nine rve^l and m!en»retcil nreeflcMof tin
liigliest imjKirtnnee In onlcr toe-oiiviet on ee-eusesl j>cTv>n on eirt'uuntftfifinl
iMiteiHC the facts provesi jn the nst shcnld lie tsaiMsletil with hn j.uiU
andlie ultcrU meoiisistcnt with bis iiinoccnee In the I uign i„n nfa judge n
certain tmmlicr of material fmfs shoiiM Ik inesjoteslahh ( nor I in the
which are epiile iiieonsistent with the inmHinep of the nerined II esc
shtnild be sueh as to render it imi^ssibU m the ioukN ef tie j'lrv ttat

am one but the accused roiihl Jwive roimnittcel the enim Mdefson II in

charging a jur> to tins effeet made an oliservutien m nf.rriicr to ttmim
stanlial evidence whieh shoedd lie renicnilKfrd In methf-jJ witopws He
cmphasi/,cd the immcne-es of Hi. Iitimaii mind to dntort the facts in onh r
to ritahhsh such a proi>osdion (the Rwilt of the acensetl/ forgrttmg H
a tniglr arcunulance tehich u tith tu(h a u u ej n

\^Ol^nS CLOTlItfy ♦.">3

pn/w/r/rtiirr lhan nil ihe rt^l, iimiiiiiph as it at onc*e dcstro\s tlie hN}Kitlic«.K
of fniilt

Ih IJjc 'Ujrimc f'lH (I^Hcs JPJC) it ira« far tlic <1efcti(x‘ thrtt

i Imc Oitncmi «Ik»s* !kkK Iml Ijrtn fmifwl Imnnl on Tliomes clnckrn finn nl
I ri)Mlx)ro«is;1», )ia<l li in^ctl lursilf fnwM Ihe «n*ss I*cni7i of hi-* hut in lii> nh'cnft
fon’^uknihlo an'ummt ciisiuil iil tml lietneeii n« le**’* llnii <lrK.lor^ on thi
It iturr of 111 JiLs on the neck tiiici of hnii«e5 of tin fire — hut Hie |>! nn fnrt m »>« Hint
tin l)cnm in ejiiistion w-h fuimil to be ttitef vnlh dust nn tli ii/j/kt surfaet no roj>e
liiu! him o\xr it In recent %cnn

Position of the Qod} and Clothes I lie ImhH innv In found in n ;>oMtinii
nJijdi tin ilm iMiJ inijihl not httt nssuinctl an tin Mjfiftiisttion tint tin
wound or injiin wns arc idciilnl or sum id il TIu jHiMliun of n dind wounded
IkkK is often oiih eoMipatdilc with Iioinicidnl inlcrfcrLiu-t iillitr at -llic turn
of dcatli or nfti rw nrcis

1 he position of the hoiK w!un a wouml wns iiillu fed is n frequent question
on inquests anil iriiuiruil trnis

In (I CISC of fmlricutc the dieeiscd liid itn-ci^etl n scMn wouml it tiu lotur
p irt of the neck, niid nnolher In tlie fnmt of tiu chest whiih h ul ted to las dcatti
As the hlivMl h id run dnun the fnicit of tiu ImuIx fnitn Inith of Ihe wi inids undone
of them wns so «lap tint the d«n'ns«<| tinlesc >.upporte<l wiultl pruhitih Inst
nnnieduteh filler it w-ns Inferred tint |w«|»ersons!i id lieen cn»’'i<:eil in the immirr
iind thnl one liehl fht deeeiscil i,% the anus while ttic other «ln»k liim in front
1 ins suspiemn w is rorroluinted tw there U ms >•<> in irks of wounds ii|Nin the Innils
Tile opiliinn tlius c\]>rrvsed was ccrnlimied b\ flu csideiiis t.i%cn lit tlie tri il uf t1 e
tmirdercr

U the di'ceasid Inis ti((.n wounded witli Iits clothes nu wc should notice
sihether niis pnrt of his rlotluns tins or 1ms not betii i ut or injured user the
situ itton of llic wound wlutlier the cut iMirtHuis of dotlies art hlcKul) and
whcllurthi lilood Ins hecri ciTused or ipplici! on the inri fc or r ii/ti fc N\hen,
together with n wound in the Him it we find the tie and the shirt cut thmu^di
this all other cifciirustniK lieiiis tsjiinl isstmiiplv jUTsiimplivi oflioinindc
Suicides seldom allow unv metlinnu d obstnehs of this kind to riunin as
nn ohstriK tion In till iisi of tin wenjum However in one cas< ofhniniMdnl
wound of the Him it mtlii teil in tlio m uintKnt juMun the tie of the ileeeasrd
h id Ih'Cii hftiil lip nod artrrwnnls niiowid to ilmp ovir the wouml in unkr
to txinri il it Till iiiquirt imc of rsniniiuiii; the elolliin^ nod n»inj) inns it
with III irks of V lolcmc on till luulv h is aln-adv hex n juuntiil out

Marks of Hlood or other Substances on the Deceased and In the
Room All nnrks or st mis of IiIoihI or dirt on n dead IkhIv reqiiiri sjki nl
ntlintions The iniprr»suii» of n hand or of some of the finprrs in iv It
found on Hu skin in a silmtioi) wbeir it would hast Itecii inipmhible ir
imiHissiIilr for the deoriMil In Invc prmlui'eil it even stipjx>suu that om or
lustii of ins hinds wire istvind with bloutl

In II \ (iintiirr s<«|neira fnitwl nn imprt^sh n unite tiv soitv lin;?Ts «m Hie
in'iite Ilf Itic Irfl wri*t amt n »inMl-ir wiotv ini| rr^ioii on H«e left illiow ns if it
liid Ixni fi n ihtv irm'jie'I Hn Hie insi leof ttie n^ht tiugh Hiere wxs the iinprrssu ii
of Hie iRilni of a iiloiMis Innd of full sire |M>fntiti;! ilfivvnwunls Ifc ii Iiit« 1 tlu-se
ni irks lurk rv the prisoner, wlio was » chimties sweep hsd enteml Hit mom srul
tie also 1 livrvitl Hnl tticrrsiss lui so«»t « n tlie hniuis of ttie deceased anil n > 1 1 "■!
nunMnent to pnwluei sueli an imi rrssioii of bl xxl as ttwil rxisJiiip on ttie right thi,.h
The impres'i in was also lirgir Him Hie harwl of tiu* deerasnl

In a htrnncling (/r v Mnnhull.i tf'.IPin) urn at \ trli n » wiHiin an
hour of di nth (wideh vvjis tinieil tn Mrenming purjrtmjj noivs and Hien stkneej a

IiIOOr)STAJ\S

bejiTimcd finger mark — one of se%erBl on tlie ♦»-».!

In It y MMlcwan (Tlie Towpnih MuhIcm) (C ( C. in*j) Ijlmnl mm f„»n.l
client front ft stab wound In tlic ilicek « f one of tlic
linil Tn f I” ®" pnsdion after Uic iniur\ She

Imd in fact been raped after this disabljo" woiini) ^

If there are several euls ot stalls cm Uic IkkIs msohiii. the eMhcs il
should he obserted tthtlher the eeljcs of emc or more of 11, cm ore shmcil
ttilh blood ns if from the tripiOBOf n ueniioii imil iihether the stun ,s , „
the outside or uisidc of the article of (lotliing
In judging from marks of blood on the premises «e must Inkc dirt tint %\c
are not misled b\ the accidenfnj dispersion of this liquid b\ persons going m
and out or touthing the borU Mo\ mg tin nijiirtMl bods or uinircssing it is
also n common cause of soiling of the face and hands Ihc following uisc
uhicli occurred m rrtiicc will show the ncccssitj for c\(rcinc (uution
A joung man was found dead in liis beilmom with three wounds on tin. front
of Ins netk The phj'sieian who was first cjtfid to sec the deccas«l hitil unkno«iti,lIy
trodden m the blood with whith the floor was coierwl, and Iiad then walked into
lui adjoining room passing nnd rcjnssiiig seseral time* he had thus left a nuiiil><.r
of bloods footprints on the floor No notice was taken of this nt the finii hut
on the following daj when the examination was rcsumcil, tin sc footpnnts excited
a suspicion that the >oung man li id lieen niimlered
In the trill of Mrs McLacldan hr the niunlcr of Jessie Mcl’lursm '^Incleod
ohsersert footprints in blood m tbe heilroim of tlic dccenscd wl o wtis fiiuii I dciwl
freini wounds olmousl^ horrucula! There were tlirrc iiiif rints of a ii iktd foot, • nc of
tlicmparticulnrU clcarl) defined a small well formeil fool nt rest Before aiij «iih
picion veas attached to ansotie tlie medical witness expressed an opinion that tlitj
were made bv a woman s foot with a high Instep At the tiim of tins ticl of murder
there were onlj three persons m tlic house tlw prisoner the deceased and u iiuin
Ofeed 97 James Ple/nuig 'Macleoil obscneil lliat thrrr was no bJoixl on the feet of
the deceased further, he made a rnrcfirt outline of lier Irfl fool und found that it
did not m any was correspond to the footpriiils on the tlonr of the mom In hw
opinion the left foot of the deceased could not Insc produced tl esc msrks Ik com
pared the foot of Jann s riemmg witli the footi nnts nnd thes were olni nisls fpiilc
different he Ind a flat foot m tontradisUnclion to a hiji sole hj wliirh 11 1 marks
had been nroduccil lie also comparcil the feet of the jirisoner with these marks,
cspccialls the left foot and the marks m his judgment mijit ln\e l>«m jmshiwd
b> her foot The meused made no objection to treo 1 with her Ictl foot in a thin
laser of bailor k s blood and then step on a pi mk of woml When nil tin. con Iitions
of the floor were mutated, two ImpriKMons were obtmncd which nirn qnindcd witli
a remarkable degree of aceurao with the marks taken Tnm the house
Marks of Blood on Furniture U « proper to notice all of

in the room ami to obserse xvlierc the greatest qimnldt of bIfXKl has bren
clTuscd this Js gcncrallj found on the sjiot where tlit dcccisal 1ns dicil Fhe
deceased nni Ime blerl m more pberw than one if so it >hould ht iioticwl
whether there is am commumcntion iii hlmwl between thfst dilTcrml plna
Blood on distant clothes or fumiture will show whether
moved nr has been mov ed 'nlxuit and whether he ,

receiving the wound \cts ofloeomotion bv n wmimicfl jW^n »Ik> li'i" ‘hfd

;n.rncr,lh ,nd,catc<n.j ImcV, or olhhvv! '7',”

the Melon shouM oinats he etara,ne,l. f< r ,t II,., »re 'I”'""'

* Trial of Sirs. 'leLachlm Notal Ic Scottbli TriaU

iior.N /)9 h \ ini \rr inoM wi iro\ 2^3

presence of l)lotx!\ fof.lprinis or finpinmittv jnauntf^ the pn-st nee of nnotlier
jKrsnn fhe ol)smfttHm of Hirst iimVs is of nutlitnl inijH.rtaiuf flux nm\
Hirrov n licht ujwin llip ipieslmn whether denth was Intiniriilnl or miicuHI
III li \. Ilnllo a innrk <if lilornt as from the smc-ir of n Innd »ras traml nlonp
the passaj^r of the houve m which the timlv of the dceeiwt wit fminl The miTk
Mras cnnlmneil over the <loori) 0 >t into n back, tnoni which wns fnimi locked nnd
bolted on tht inside The erime wns thus fixed upon thi pnNtmrr for no om bteik
inp into the lioiise m front could Jmn JlwI aecevi to this room Hie cvi Icnce thus
hrmipht njrnnsl him w is the n,«,MU of Ins freluip his wnv with a hlooilv liaml
in IJw dirknrss nfler the jnunJer

hilt V the outside hnniHcofttieoirmpe door i« iih/th the filal ftss.iHU

wns mndc wjts iinrkid with hlootl whereas there was no hlootl iip< n the liaiids
of the ileecnscil. which wire cxamntrd rooii after the iis'xitilt fins was idvirse
to the theofv Hint the deceavd hnd oixneil the door and luid fallen mil

Great care must he taken to ensurt tint such st uns art looked for before
tlic niitopsv IS eonimt.ncid the IkxK iHi-onies iiievitibK slnmetl during the
post iiifirtcm, and all such cvidemc is lost

II \ Spicer nfTonls an illustrition of the iiiiportniicc in eases win re it is
siippestiil that tliiifh Ins liccn caused hv neeuh nt not tmlv of cxitnmiiv
minuUlv thcwounils hut also the location of the dead Ixxlv wlipiifouiul
The prisoner wws thirpnl with tlic murder of his wife The dcecnscti wws f nind
(had at the foot of iMlaIr asifsht h id oeridenlollv filleii b ukwiird* The pirictnl
Ixim. wns fractured an<l the frwttm extemled to the base of tlie skull The hniin
wns I unmtnl.and there was copious effusion oHdooil The second cervical vrrttbpi
vnw rnicliirwl, and Iht spmil wM crushetl Tfiese Injunes were tjuite mlTlcient to
neeimnt for dentil an<l hid thev < xisted nhme Ifien. ini^hl Invc been tin n*as<in to
eJmrp* the hushind with the niunfer Itut then wus n merit wound on etch mde of
the temple fuirllv heerntcil nnd partfv tmiiMil ami a hnneh of the rijlit fciiii»oral
arterj hnd l»een dtv hlcil tins injurv hnv Im^ Unti inflietcil nppnrentlv with a itointcil
hlunt instniiiieiil There werv marks of IdntNl on the wall it the tap of the staircase,
which hnd evideiilh l•cen jinxlueevl In nrtenni spurtinp It vnis nhvimis tluil tlie
injuries In the two temiih’s esiiild not liave oetumnl duniu; the fail for tliere was
no projecting Ixxlv opninst which sht cinild hnvr struck in her di-vn nl Ml the fnrls
ft I) led to shove th it a iniirdi rotts ass mit fmi |,rtn nndc ii|Kin licr at the top of tlie
stair, an 1 that slu luid nfterw »rds fnllen or hnd lieen pitched h«ullonj» Imikwnnls

Inference from the Ouanllly of DIood hen in spite of oj>cii wniiiids
the amnnnt of blood on the spot where th* l>odv is fonml is small llicri is
re ison to irifir tint tin n li is f>c< ii iijtcrfi n nee with the IxhIv nfh r the wound
wis mllieled It nn\ have l»etn niovnl after denth fnrm loss of IiIikkI ehi
where, hut it must aho he Imnu in mind tfuit it ma\ have lx*en slahljcil
nfer denth fnuii Mum other must Uhen a IkkIv with ojxn si iIiIkiI or
mcisid wounds liecoiin-s iimnersvd m wntcr this hisis for argument is of
ixiurst, lost

I vldcnre DcrhaMc from the Wenpon
Thin an stvtnl matter, tit roiinrtfion with a wtni»oii whuh nnj nffonl
slnmp cv iditifx

1 he Position of the Uc tpon hen a |Kr*oii has iheil fnun an am idcidnl
or stlf mihcliil wnmul hkilv tn muM dinth either imimdintclv or within
a few minutes the wnjmn isusudlx found dost tothclxxlx or within n six rt
distance of jl Ifni a short distniio xxe must ronsnh r w hcllicr it nii..ht liav e
fillmtothi vjiot or hnxc liein thniwn or placeil there hx the <li-eeis«l
In NnxTinlw r, I'H*,, •» IMoh airx.Ipcrr w'xs f mud shot deal rn tVcvUninstiT
ItHd;re at ntw iit I jn nan \n rnt mnee wtuin 1 fmm the cl >»e discJuirjs* < f a Prrarm

■-’'ic. ^wu^ns n iDr\cF Fnov u EAPOS

mu, M,,oKio J,

n.!?* thro«-n the weapon o\cr the hricjgc after shootin hmiself

Wanfr* the?.^.U°«n ^ electro irngnct Were undertaken and -i Iji j ,TtI 1
lJeann„ the Tolish oniccr s issue numhee « is recovcretl from the riser lied ‘

If there h IS been nnj interferenee with the bods c^^(lcnce ns to the relntise
positions of It nnd the weapon \s ill of course he niadmissihic
It IS compatible with suicide to find the weaiwn at some distance or e\cn
s\ ashed and put a\\n\— eonccnled but it is much more freiiucnth foiiml
titlier pnsped in the Innd or U inR In the side of t!ic deceased V Tceptimnl
cases do occur liosscser in a clear c isc of suicide the dctc^scd InJ mt lioth
internal juguhr s cins and both superior tin raid aricrics tlie cut Jias in" passed
to the fourtJi intencrfcbnl disc which it injured Jfe t/jen juit the razor
in Its case and replaced the case iii Ins kit bag *

There is one tireumslame m relition to the position of a weapon which is
strongU cojifirmatnt of stnetJe If the instrument is firinli gmsped in the
iinnd of the deceased no better cirtunistanti tl esidenee of suicide can l)c
offered It is not possible for am munlercr to imitate tins condition since
the relaxed hnniJ of a dead person cannot k made to grasp or relam a
weapon like the haiul wIikIi has firmh held it b\ powerful miisnilar con
trietion at the last moment of life xule ‘ Instantaneous Cadaicnc Spisni '
In regard to the fiiuliiig of (Ik weapon at a distance from the body all (he
cm umstanccs of the case should be taken into ronsidcmtion before anj
opinion IS expressed If the yreapon cannot be discoyered or if it is found
tonctnlcil m a distant place Ibis is ordinarily prcsumptiye of fiomicide j
Soinetbmg mas be Icanicd from the actual nature of the weapon itself
taken m conjunction with the cuxumslanlial eyidence as to whj the parti
cular weapon was use<l

In/? \ Cordon (Isingston \ssircs 1PM) a kmfc found di-carJeii m a licdgtroyr
cl ISO hy ydierc a girl had been stabbed was of a t>i>e issued to Cjnidiau soldiers
y\lio at that time yicre stationcil nearby 1 nijuiry reyeiteil tint me of tliem had a
hhioiist lined handktrrhicf in his |>OHScs«.ion it Imre foJ l«l-cloth blooil tains (lus if
usetl to snpe a knife hladc) one of ulncli was si aped exactly like ll c lient back of the
blaife of (he tnm issue knif< It ««sn weapm eicri sold er caiTJcil Jii Jiis kit
It should be iiotKcd also yyliellier the yscapon is sharp single or two edgeil
straight or bent and nokhcil or not Tlicse circuiustances may throw a light
on the question of suicide or niunler (he yytapon found may not ‘fit the
wounds

In 7f y (?d/ the prisoner yeas cliaTKwl with (lie mimler of his wife The woman

was founil dcail with a wound in her throat diswling the larvnx tiie tfivToid arlen«
and gullet It reached the spine which yeas hocked ind notched npparciiUj wit i
some Molence scyenil pieces of bone were detached A blunt knife w-as lying in
tlie riglit iLifid of t/ie de«“is«I looseli tu t graspeij Tlie cut tlirough tl e skin J»n i
muscles of the tbroat was clean and lia<l exideiitlj been m idc by a *harp ”
meat Tlie knife found in the liand of the dcccascil yvas lu t only blunt but t‘
at the point ami it liad no handle There was a ni irk of a hi y«ily linger on the dress
over (he left shoulder of deeciseil .

1 rom these facts Porter and Ge<i{:lie{rui dreyy 11 e rOnthi'> n
had not Inihcttd this yround on herself Tlie yvouiid Iw.l not Iwn m wle with tl
blunt ktiife /mind in the hand and jf this wrajion lud bwn u ta lor tr c p n sc u
smckle It yy-ould either hase I«n graspcil m. or uyr ^

hand The dec-eased h id not made tlie blood> mark of a linger fotin 1 u|)on her tl
The prisoner yeas neyertheless acquitted

‘Fallon T IMS FoltrtJ 21 110
* Shore, T K G,, 19^ Laaett 2 180

^^OU^DS F\AMI^ATIO\ OF ASSAIJ t\T

his throat and had attempted to
Imiigmjr himself

seser the artents at his wnst before

Hair and other Substances on Weapons lusomcimtanccsa ftn Inin,
or fi res mnj he found adhering to n »ea|K,n and the mam ,],iclti,„i mat be
he her the nhres are of cotton linen silk nool or other fabric and a), ether
the hair is tint of a hunnn licmff or of an animal In one of our cases the
driver of a motorcar was aircslctl for causing the death of a child The child
v\ns found ilcsd on the road and from the marks of the tvres of a car
the police traced and nrrcstwl a certain driver Some hair was discovered
on the front mudguard of the c ir and found to he cow s hair

In nimihers of oases wc have Iieen able to nlentifv hairs and fbres of
different kinds found on lioth vehicles and vveajwns as cxactlv similar to
those taken from the ejolhing or person of a victim lor the means of idenli
fv mg such fifires and ilfustrafivc eases tule Identification of Hair (p 122)
In /t V Harnngton ^ a razor was produced in eva Icncc with which it v>a.s alleged
the throat of the decenswl had Ixa-n cut Tlie wtge vrns esaintned and frtm a
eoaptilum of Wood some small fibres were separated winch iin ler Uie microsci pc
turned out to l>c cotton fibres It was prosed that tl c assassin m culling the
tliroat of the deceased while Ijing nskcp had cut through one of the strings of her
cotton nightcap This vras a strong (ircum'iinncc to show fhit tfie razor produced
vsas the weapon wath whicli the fatal w-oiind had bc< n mfiietcd

In If v Steed’ Paw and Tavlor e\nmii>e<l the loots of the prisoner who was
ehargevj with murder Tlie marks of violence about the bead showel that the
asNidant lind trampled on the deceased after he v'as on tl c ground provluelng
severe vvoimds wl ich led to his death Some lairs vrere f iind firmlv wedged
tienenth the large hohnalls of (he boots and in eerta n dark stains of congulited
blood on tilt leather tlicre wrre sonu re<l wm lion fibres The Iia r was compared
vnth n jKirtiun cut from the hca I of the deeeiHnl ami ct rrc*-pon Ic 1 In w lour an I
size On iitquirj it vm\s founl tint at the tmu of J i« deatli the deceased wore
around his neck a rwl woolten comforter ef which t) o vrooj corresivon led m colour
ami nppe imnec wath that taken from the prisoner » hot U

Evidence Derivable from an Examination of the Assailant
Marks of Blood or Wounds on the Assailant It is a common but
erroneous idea tint no person cnii commit n murder in w liicli blood is effusctl
Without hnv mg his person and clolbcv more or le^s covered with Hood On
several occasions articles of clothing have been examined which have been
worn bj persons siibseqiiCJitlv conv iclcrl of murder bj wounding and either
no blood has hceri found on am part of flic dress or onb small spots whoU>
out of proportion to tlie quantitv of blood which must have flowed from the
deceased

In R V Gardner m wbicli there liad been e large effusion of blood frem a severe
wound in the throat no blootUlains were founl on the clotlimg of the man who
was convaeted of the murder

The throat of a person while standing sitting or kneeling ma} be cut b> a
murderer from behind and thus simulate suicide In these
the clothes of the assassin would probabh not be stained wath blood the
flowing or spurting of bloovf upon lux dotltes would rlepeml upon
in relation to the victim at the time of inflicting the wound «nd his mu t
alwa>s be a matter of pure speculation In entire v lolat, on
principle the fact of a prisoners clothes not being marked with blood
been on more than one occasion urged as proi f of las iimoience

* Essex Assizes flS52)

• Ma (tstone Asswes (1863}

uovxns I \ tVIXATIOX OF ASSAIL isr "W

In Jl ^ Datrnn^ tin c-oiin*^! for Uk. pn^oiier wintcnded tliat no person could
cut the tliroit of anotlier sulliout li isihr Ins ilothcs co\erc<J with hlood, and tint
Hs it «i-s not proved that tlurc «ns anj lilond mi the clothes, the prisoner eould
not have been ffuiltv of the crime The throat of tlic woman was cut while slic
was walking across Battersea Bridge the pnsontr hav mg inihcted the wound from
behind In the case of I ord M Ktisscll the act of murder was committed bj
Courvoisier while in a state of nudity In 7? v Muller this line of defence was
earned to a still greater length Although the clothes of the jinsoner were not
produced, and the evidence showed tint he had had tunc to change them the
counsel for the defence said, * Blood spurted out from the deceased and there is
no doubt Ins nssailant, whoever he w is must li ivc licen eovcre<l with hlooil or liave
lieeii considerublj stained with it ’ Tlie wounds were of n contused nature nn<l little
blood was hkelj to have flowed at the time of tlicir infliction

File clothes worn h\ the issaihnt need not therefore be rovired with
blood’, nor “eonsidcrnhl\ stained *'cHing aside these erroneous assuinp
tions the evidence mnj show thnt had blood fallen upon his clothes the
net used had ample time to dispose ol them and thus jirevcnt nclieniiciil
cvuninatioii of them

In It V Haven (C C C , IhJO) aeeusctl bad battered two relatives to death in a
living room of their home with 4 television aerial base Chance resulted m their
liemg found 43 minutes after the ineielcnt. and Hnvxn the nearest relitive vins
immeehatclj calleil lie arrived m a clean suit and a delcclive oniccr having his
itiispiclons amused, made an cvettse to run round to Haven s liotisc — where aenrcli
revealcil a lieavnlv blond stamed suit stuffed into (he boiler of a kitchen stove,
partlv humid and still sniouhlcring Fresiilj washed shoes stoml outside a hack door
In li \ Svnlli the fuet thnt too great reliance was plnccil upon the nbseme
of blooclstiuis on the dotlimg of the accused ns adverse to the thcor> of
guilt, appears to have led to a failure of justice
The deceased vras found with wounds in the throit of such a niturc tliat thej
could not have Ixcii indicted bv the deceased himself, and might hnve l>een made
hj Another person from bdiind The accused was traced to the spot and a esip
belonging to lam and saturated with bh>o«), was found under the d\ mg man In Ins
charge to the jurj the judge Is rcimrted to h i\c wld “TJicrc were verv slight. If nnj ,
traces of blood upon his clotlies, and it appeared (to bim) imi>ossibIe tliat the jicrson
who committed thisdeeil slinuhl not have liecn deluged with blond from the wound, ’
etc The medical cv idcnec was to the effect thnt tlicrc were some stains of blood on
the clothes which were damji, thej hid liccn washed The jiirj acquitted the
prisoner

In the I llimm nnirilcr case (It v T’eoJl) a j"oung woman was foimd dead with
grive injuncs about her htud inflicted bj a plasterer s hammer One of the wounds
divided the teniponl arterv llic prisoners clothes were exammcil hv a medical
imiii who found upon them numerous small spots of hlood, npparcnllv recent
Ihc judge, in charging the jurj, said * Wos it likelv that the person who Inflicted
all tint violence, dividing arteries as be did In some places could have done it
without constdtrililc marks of hlood l>cmg afterwards found ui>on las clothes’”
This question if addressed to n meslicnl witness who had had tvpcricnee
m cvaminin^ such cases would hue Iwcn nnswereil m a verv different
manner the spots were just such ns might hnvennsen from a blunt weapon
inlhcting these wounds Thi eflctt of spurting from the divided temjKind
artir) vvould hnve depended on the |»osition of the nssniinnt at the time
and m injiirv of this kind *'eoiisidcrahIc marks of blood ’ were not hkelj
Even when there has liccii a good deal of splashing, shown In the presence
of spots of hlood around the bodj of the deceased, on the walls, furniture,
etc , it IS quite common to find that the clothing of the iiss ulant shows
comparaliv elj few stains this fact must be kept constantly in mind

Per cotilra, the presence of spots of blood on articles of clothing, kmves,
etc , taken from the persons of those who arc accused of murder, may be

300 nOVNDS FXAMIXATIOX or ASS,III.A\T
quite consistent «ith mnoccncc Simll spots or stains line nrie„ „„ j
importance attactied to tlieni Minute spots nt lilootl on the shirt of a
tried or iiiiiriler bi iioniidino ,,a,o „«ptcd “ „ of
iintil It Mas cvplaincd that tliej Mere proliaHi deriicd from tlea biles ailii
tint some Mere on one side anil some on tlic other, sliOMiiig that tlie 'shirt
bad belli Morn on thotnosides Tlieeoirscelotlniig Mom bj niaiiml iiorhm
mas acquire blood spots from a sanetj of act, dental eireiimstanees mIocIi
llie nearer mas not nlnajs be able to eapiniii Mhen an allciiipt has been
mule to iiasli out the slims or the nccuscd ndiiiils tlici are there and
BlioMs great aiLMels to give some eaplanntion of llieir prcsciiec as that he
had assisted in killing n pig mbbils or rats, or that he had Imeii larnine
game tlietemaj be some giaiiiiid for siispiiion Hut alloiinnee should ills ass
be mndo for the nccidcntil prewnic of Mood

\^ hclhtr hlood is or is. not found on the <Iot!nn{r of a jicrson clnrfreU with
nmrdcr nnj wounds or marks of Wofence upon hfm stTionld be specially
cxaimnetl Tlicsi. niaj hjut been produced in t stnifcrgle witii the deceased
nnd tlie ncciised ma\ not be able to gi\e nti\ consistent account of the time
or nioile of (heir production A case has licen related (p >5i) m which llic
idcntiU of nil nssaiinnt was to some extent cstiblished bi the form of nn
ccclnniosis on tlie face htieh a wound iiia% l>c found on n suspect, and }ie
imi\ pretend to account for bj some accident or in onicr to evade suspipion
His statement nuu, liowcver be whollj nrectmcihble witli the appearances
of the injurx The kind of weapon used and the jicnod at winch the wound
was inflitted, nnv soniclinies l>c inferred from o simple examinotion and
prove Hint the prisoner s storv is fnhe V case of this kind was tried m which
nil nssiilont was ideiitified b> the pecnhanti of n wound on the knee

lie Ind broken into a house at ni.,ht witli some others, nnd discharged his gun
at the prosecutrix, w liile ho wns m tlic art of kneeling or stooping Tlic gun hurst
and the rccoil of the breech produced a mixed limnlion and contused wound on
tilt knee of tJic assail int IN hen the prisoner was c-illed u|)on to aisvimt for Uus
wound he refcrrciJ it to an n<s idenlid blow from a iinmlnl some time before The
nppcinuiec of the injurs was liotseser, meonsistcnt both s\ith tlic time nf its
uilegcil nocidentid inllictiun and scitli the instrument sud to have jiroilueed it
while on the other hand it was jm>sc<I to corre'i>on(l witli such an injurj as the
broken breech of the gun siould luxe pro«lnceil iit llu date of the burglarj lliis
led to the ulcntirieation of the prisoner nn<l to Ins siibseciucnt roimction

Two men were elurged with lining bssiuIKhI with intent to roh, a surgeon
who, while he w is wiilking along « loiieh mid in the countre nxcrtfxik three men
who were strangers to turn One kiioek«t him down \>\ a sexere Wow on f\co
nnd held him while another put Im )wwl upon Jus nioiitJi to prexent his gixmg
alanu One of the men eontnxcil to get Jus linger in the surgeons mouth and
during tlic struggle the httcr bit oft tlie end compictclx between the nail nnd the
first joint Ihe piece of finger xras gixen to a coastoblc who eight hours 1 iter found
one of the men with Ins liand bmdaged The tip of one finger was niissuig rhcnisfi
ni counted for this b> snj ing tint Im- aoeidcntallx cut it off I iit on comp iriiig the
piece of finger with tlie injured hn^r of the man s liantl lliex were found riosth
to lorresjiond lie iiiid his eomjnnions were conxnctcd

The bo<lj of a girl was found near -x lietlgc in a direct Imc with the back of the
street m xxJuch slie lixed Her liaiuls were ticxt willi n rojie Her icct a % w
tied together, and the rope went tliree times around licr wai'l /b®, ' ,
deepU cut, and a piece of rag tied around it I ho b ick door t ifth of house

xshere the accused Jixed with Ins father slioxved signs of hlwKislains At oneoeloek
a police xntness saw tJic accused in the house in his shirt on xdiich xxire
of tilood TJjcre xeas blooil on Jus hands also, and the forefinger of eacli June! fiad
been freslilx cut Tlie accused said tint he cut Jus finger with his jwket laiile
The kitchen towel was smeared with blood A bloodstained razor xras found in tl

\WV\DS or ^PrClJL JiLGIO\S 301

kitchen It looketl is if it Inti been newj^ deancd \ piece of ng «ns found which
corresponded ^nth the piece wliicli %nis tle<l nrountl the girl s neck The accusal s
trousers and waustcoat were liloodstaincd On the shelf in the coal house m the
aecuseil s house the girl s lan\ o Sliantcr liat sras f juiid wilJi blood upon it The
JUT) returned a \erdict of ivilful murder

Tliese cases illustrate the Jniportance of e\aminin" a suspect soon after
a enme

^\OUNDS OF SPECIAL REGIONS
Some of the foregouirr gencml principles must no« he considered as the>
appK to special regions of the lioih Cut throat h is alreid} been mentioned
in nnnj connections it will not be dealt with further
A\ e shall consider the following —

Hounds of the scnlp cranium and bmn
Wounds of the face mouth and teeth
Injuries to the spine

\\ oiinds of the chest \\ il! lungs and of the heart and great a cssels
Hounds of tlie abdomen and its contents —

{a) h\ cr and gall bladder
(6) spleen

(c) kidneys

(d) stonmcli

(e) bhdder
(/) genitalia

Fractares, otlier than those of skull and spine
Dislocations

WOUNDS or THE SCALP, CRANIUM AND BRAIN
Scalp Hounds of the scalp from mechanical nolence must he looked
upon as potentiallj serious no matter how they arc produced for tliougli
serious scalp Mounds often heal in a remarkable manner, should the skull
aKo be injured these wounds are particularh liable to give rise to fatal
comphcstions ouing to the esse wilJi which p\o^et}ic orguusms cm resell
the brain The loose manner m which the scalp is attached to the cranium
affords further facilities for the spread of inflammation and supjiuration
There is still a further reason for considering scalp wounds dangerous m
tJASf .'t )S Sreqventi} djJfJjfuJt. to l»p jout whether or not to what cvlent the
skull or the brim his been damaged Seiere or fatal briiij injury niav be
caused without pirticulir damage to the scalp and m this connection the
presence of a good crop of hair or of stout headgeir may be of importance
lhc‘ crash helmet has undoubtedly saved many lives
Owing to the free manner in which the scalp moves on the closclv subjacent
hone injuries produced by blows from blunt jnstruiiients frequently bear
a close superficial resemblance to cut wounds It is advisable therefore in
all scalp wounds to shav e the scalp closely and c\nmine the edges and termina
lions of the wound with siietial care to sec if tiie tissues arc cut or toni
The presence of foreign bothes, such as fragments of glass fibres, jiamt etc ,
may proi ide imjiortnnt clues to the nature of the woiind metal fragments
tom from vehicles are sometimes found in the depths of impact injuries

Cranium and Brain Brain injury mas be ev ancseeiit lending to but a
momentary functional upset it mas he more intense and lead to ct nciission

yccjl i\ics 01 IWAT) MOU\DS

Death mat occur nimicrinteli. but ns a ccnernl rule nulc. n .

estensne ,„,uri to the bnu. .s ™relj lhe?4"= ol suito. fat

IS instiintflneo»s and takes phee at the moment of imnrx T I « ^^’^cuisswn

lu'or'cr 'r'* 'Tr <"• m'm'a m '»l™I™rse'"tKc

Mho e cITtxt mnt not he ohsertd forsomc t„„c oftc. the loj^j iXt" '

iUl::zTt,;vr

F

lit sr n i^rttui to si ow tl e complex pfi\6 Co! firoMcms imolved m Wunt
to tlie t C3 I Itsl on^tl c resolution of n force (F) into I near an i torsion
strains and tl edra^ caused b\ moincnuir} Lisgingofthe I ni n witlunUiisKkiill
ttarc^etJon and |hI ng up in tl e brain are eoiggcrated

The Mechanism of Cranial Injorles Certain basic phjstcal principles
u liK li nre essential to a clear understanding of head injurj must be stated
first

1 fhe skull e\cept m infanc\ is not easilj defonned bj compression ot\ ing
lo its arcliitcctural strength it'more easih fractures and the fragmciifs mat
become tUpressed or nngiilated and fissures opened out

J Uie bniin is not rcatfd} compressible jt is casih Jacefafed or tom and
ma\ be displaced bj lixmorriiage or b> tlie growth of a tumour but room
h IS to be found for the same tolumeof brain elseirJieri when this is so

3 ■Mo\eincnts of the head as a whole are sjnchronoiis with moicmenls of
the skull but tlie brain tends to lag momentarily whilst its inertia is
o\ creome and cither linear or torsion strains are thus set up I urthcrniore.

HE ID \^OU^DS tO\CUi>SlO\ SD'i

^\hcn the lieid roiiies to rist ns A%hcn it meets n resishnt object the
brnm contmvies to mo\e forwird jn the direction of the J lou in iirttie
of the momciitiini md is thus injured bj tliosc f( i-cci. resist

its mosement

i It IS clnngts in the rati of niosemcnt { iccelentionMcceUi ition— or
torsional) that ire of greatest importance m producing temng injuries
^^hether the ■whole lieid op a small region oi tract is affected depends
on the nature of tin. agent A lieava blow from ti sandhig is likelv
to cause acceleration or tiwsting of the ivbolc head and produce widespread
contusion and torsion of the brain wltcrcis a Mow from an instrunitnt
with a smaller striking surface is more likeh to cause a localized depressed
frieture or to penetrate the skull llie clean cut hole made b\ a hi^li
\elociU bullet shows this loeahml elTcct in a marked manner In general
the smaller the area absorbing the force of an impact the more likelj is it
that local head injurv w dl folloas

If the head lies on the ground no aiceJeration deceleration chmgcs are
possible though torsion strains maj suddciile deselop if the head is suddenh
twisted Coutre coup which depends on acceleration deceleration strains —
IS therefore not likely to be seen if the head is struck whilst on the ground
Injury to the membranes or to the brain results m (a) an nnmedmtc
functional upset often concussion (b) lixmorrliagc ami (c) redema •wliicli
increase the pressure localK displacing neighbouring brain and forming
the pressure cones around the brnm stem which rcHcet anj increased intra
cranial tension

\\t must now devote a certain space to the consideration of tlic results
of violence concussion contasmii laceration and In niorrliage
Concussion Concussion ma> be defined as a slate of unc( nsciousiicss
or impurcd consciousness siid<lenl> produced 1>\ mtcliatueal font applied
to tlie skull and often followed bj a varving period of rclrogrido amnesia
There are many theories to account for this clinical state * There is com
pletc loss of reflexes almost imperceptible pulse slow sighing respiration
and cold clammj skm

The shock mav be sufJiticnt to inhibit conipktcli the vital proc-esses ami
dcatli ma) result Vs a general rule however the jutient revives after a
few minutes with sjmptoms of hcadaihc giddiness vveakness and vomiting
the result of microscopic injuries and of post traumatic adem i

If death occurs the _posl mortem cxnimnalion may reveal no naked e^e
lesions but as a general rule bruising or laceration of the buim or scattered
petechial liTmorrhages oedema foci of mvclm degeneration etc are to be
found

Recovery mav be complete or there maj be an irritative condition
probabl) the result of small contusions and subsequent oedema of tlie tissues
around them llic commonest sequel e are licadKiic which mav be of a
most persistent and distressing nature loss of memorv mid attacks ( f gid li
ness VIore grave sequeK such ns epUtpsj are uncommon *

Felling* puts tlie imidcnce of cpilqvsv after closed mjurj at 2 5 to 3 5
per cent and open injcin at 4 5 to 4 0 per cent

* Dennv nroww D anti Kusscil V\ 11 1011 ilraiti 64 Oa
’ Caims H igli 1W2 7? ^ >c Med 32 200

*Rovvbot/»m fl I lOiJ Veute Iiijuneaof iJc Head , Swl I I I dini irgb
ifone

‘Gills r \ loic J tin Ifprhopal 8 "S

‘leSling A lOol VIodem Trcn U in Neuroli^ I.on Jon Uittcrvortl

80i

HEAD ^^OV^DS A\n DRV\KE\\rs^

Loss of niemon for ents occumn" just before the
Olid IS most important from a inedicxi legal standpoint

injur) IS constant

Contusion Wtcn tlie skull is slnttcrcd looallv h\ a blow, local bruismi?
or laceration of tlie mcmlirnnes and of tlie uiiderhing brain are IikcK to
follow no more need be said of this except tint sub membrane IiTinorrlmee
ensuing ns a eonseciucnce of this is n lesion described separatch (u le infm)

\Mien bonescr some broader area absorlis tbe momentum of impact the

sshole skull IS suddenU inosed from n stale of inertia (or brought siolcnth
to a standstill) Sudden changes of the rate of mo\ cmciit cause a widespread
disturbance of the contents of the cranium as «c have stated nl)o\e Thus
am force accelerating (or decelerating) the skull causes a pile up m the
region of impact and a rarefx ing or stretching os er the opposite surface which
ma\ result in local compressions and anti|XKlal stretching injuries *

Sudden rotation of the skull is more gradual!) imparted to tlie C SJ
and brain b\ means of frictional force and the imll of tethcmig \esscls—
which ma\ tear and bleed Tlie brim ma) esen twist tear its own sub
stance as a result of tins torsional strain developing whilst inertia is being

overcome (or rotation brought to a standstill) and this mav result in wide'^
spread surface contusion of the convolutions

Hoimorrhage It is obvaous of course that IiTmorrhagc mav occur as
a result of trauma of the brain or its mcnibruies and there is no doubt that
renctionnr) oedema and oozing of blood from tJie injured bnm or its mem
branes are responsible for the deaths that occur in patients several da)s
after an injur)

Apart from this cfTect violence applied to the bead mav cause free hremorr
hage between the <Uin mater and the skull (c\tn dural hjcmorrhage)
between the dura and pia arachnoid (siihdural hermorrhuge) under the
arachnoid (sub arachnoid liTmorrlngc) or into the brain matter

In traumatic lucmorrliage there is ns a rule a distinct interval between
tlie application of the vaolcnce and the onset of svmptoms The victim mav
have lost consciousness b\ concussion anil mav have apparentlv recovered
before the gradual increase of pressure due to the hamorrhage is able to
produce pathological effects This interval ma) varv from a few iiiiniitcs to
several hours or even several weeks

Alcoholic IntOMCation v Head Injury \Icohol and other intoxicants
ma) cause effects which on occasion mav be diagnosed onl\ wntli diflicuUv
from the svmptoms produced bv injur) Conditions of shock or concussion
are often attributed to drunkencss the reverse is less frequent

Tliere is nothing in the state of the brim in a dead Ixidv which will enable
a practitioner to sa) whether shock or intoxicition h id existed and had bwn
the cause of the S)-mptoms which ended fatnil) The discoverv of alcohol
in the stomach or in the blood or urine might lead to an o-xsiniiptioii limt
the deceased had been dnink and marks of violence on tlie skull ^

brain might prove that he liad been injured but obvionslv neither of tli«e
findings and assuredlv no negative findings would enable us to Y
problem whetlicr alcohol or mjurv was Uie principal or
^^e must get our answer if one is possible before death The follownng arc
the principal directions m which to seek It , , .. i...

The Ihslorij of the Ca'ie Tins if obtainable mav decide the matter but
Mlolbourn A II S 1943 Latetl 3

IfFlDUOlMJS t\D imVShl \\J SS ^05

«:ometinies jt tnnN le\«.r> mcompictf fore\nmpl< tlic person inn\ Invehecn
found insensible b\ someone or the histon nia\ l)c inUntiomll\ mishadin"
Sviell the lirealli A smell of drink docs not preclude the poNsil)ilit\ of
injury to the bend nlcohol mas base betn Risen ssith the o\ject of
rcsiviDR If there is no odour of spirits or beer ttc the presumption is
that the s\ mptonis ire no/ iIiR, to intovitstion It niiist he itniembtred also
that the brtntli of o drunk {wrson docs not haic the (lean punRint smell
ofnlcobol but has a sour often mlhcr foul snicll On tlic other hand intosi
ration mn\ be so sc\erc ns to mtrodliec Ihcnskof <lt itli frtmi this cause nlont
eoncomitniit marks of \ioltncc imisl not )k nllowetl to driii attention nw i\
from the inloMenlion

}>ntc Hie ViiptU If thej arc dilateil it iim\ mdie itc fairh scvircshukor
aleoliol mu be suspected if contrietcd pontine b rmorrhiRc or lortnal
irritation mn\ be suspected if uncipial tlie\ rouse ii strong stispunn of
scnniis head mjiirj if inactive to Ivlit the ease is scrii us iiliatcver he its
precise nature niul must be cnrefiillv w dthtd If both pupils rciu t sluirgisliK
to light* it IS m favour of nganhng the ease ns one of dnmkenncss
llic condition of the pupils in nieohohe coma is now istahlished and
filially iictiptcd ns it uns stated to he bv Mniewrn manv jtnrs ngn If a
person in simple alcoholic eonm be alloweil to he still for half an hour or so
ins pupils will be found to bo eontnilcil if e\temal slimulntion be applied
such ns pulling the car sla()piiig the face or pulling tin patient about the
pupil Mill dilate on Icav mg him alone thev vvdl ngum contract This nctuih
of the pupils to stimiih oilu r (imn light vv ith thor suhseijuent return to the
atolut quo ante is prac ticnilj a patliognomonit sign of nleoliohe eonm
Jn/c tie Temperature If riiscd this suggests he id iiijurv nntl jvissihls n
iia-niorrlmgc into the brnm (pons) nlthough in the c irlv (ondition of shock
It inaj be subnormal if loncreil this m itself signifies ihngtr hut it docs
not ililTcnntintc the source of it

Measure the Ihspiraliiiit If shillo" nn<l slow or irngular it uidii itcs n
state of shock I nictitions puflmpaiuNoiighc'nving sighs art more common
m dnmkcimcss

Take the Pulse Hate V pulse rite of IJO or over gcncmll^ means llml the
patient is m a stale of shoe k I owe ring of the pidst rale to ( () or less gcnenillv
m(heatc*s a rising intrncrnmal pressure

loeaU III Paralysis as opposeil to pcnrml helplessness suggests a local
lesion and therefore strouglv suggests serious mjurv and not intoMcntion
Lj«»imcl/f ITrine Tins mas differentiate dudKlic eavmv it mas suggest
kidnev disease with hypertension and n cerebral lesion— or lira him The
presence of albumen or blixul will aid in tbe diagnosis the aJcoliol e“m be
mcisurcd and a relative blood level estimated
Ao/t tie 6c«<Tr7l ton lition of tie SI im J lushed and sweating prohal Iv
drunk cold and pale e< linpsc of n d interims character, tsild am! swealnig
suggests opium [xiisonmg

If tlic'se points arc cnrcfiiliv oittnded to m answer In oiir ipicslion lan
generallv bt obtaineel ^^e leave the iimltcr with the fi II nviiig rem irks 1 j
fav lor, which arc nceuralc lodav as when first penned

It Is to l>c fcnroil tint mtslieal witnesses arc o<t sullieientiv rarrful vn Uiesc
o*.*caslons to detennine wbdlwr 17 ere arc any signs ol intosii ill n nix ill aiilnjunst
iiersoii Siilisequciil promtlings mas rcwlir lliu a in.ileria1 isart cf the in jtiin
sinnv a Jinuv Eurgron of a liospilal has l»rcn «evcrrf% blamecl fo* on oinlMion to
Inquire and satlsfv himself whether, in nilditiun to tl c rtsiiUs of v4 1 o<t- n nun

30 C HE4D ]\OUSDS I^TRACRA^UL IhEMOJlflJUaE

Jjo has ]xen brouaht into hospital Im or im not been intoMcated «hen
The quwlion is of miportance the injunes to the head nn> have ansen from a
fall, and a drunken man may readilj meet vnHi such injuries from aciidcut Tliere
can be no excuse for not making a ftUl inquiry into the precise coiuhtio" Si inii^
jwrson and nrnring at best judgment of uhieli the case admits A sfUe of
intoxication renders it difRcult to form an accurate opinion m a case of allcecd
criminal wounding but it Is alvyaxs m the povxerof a witness to s.tisfv lumSv
close examination, (he use of the stomach pump, or simph wntching the patient,
whether lie is in a state of drunkenness or whether he is labouring under the cfTects
of dise^ or xnolence In several instances witliln a recent pfnod j^noas wlw
have been struck with incipient sjmnptoms of apoplexj in the streets luve been
wired and locked up as drunk and have soon afterwards been found dead or dvang
Othere, who have suffered from violence, have perished from neglect under a similvr
mistake made bv a medical man or b> the police Disease of the hram as well as
injuries to the brain from violence, maj give to a man a staggering gad and render
him helpless thej are also commonij accompanied b> stupefacljon and vowitir"
If It should happen that shorth before such on attack the person has taken l>eer,
wine, or spirits, sufTicient to give an alcoholic odour either to the breath or llic
matter v omited it is at once treated as a case of drunkenness, and tlie unfortunate
person is left to his fate

Intracranial Hamorrhafic — Violence or Disease The importance of
this question os well as the frequenev with winch it arises requires a
somewhat lengthj and exhaustive analysis of the problem

Blood nuij be found effused in various situation# within the skull Hie
hTmorrhnge ma\ be due to violence to disense, or m certun circumstances,
to violence aided b\ the presence of disease B\ careful eximinition m the
postmortem room it is possible to separate the lesions iiJneli are due to
violence nlone from tliose due to disease alone In coses m vvhicli Uie finil
effects of disease niav hive been precipilntcd bj violence, evidence other
thin tint found at the necrops) mi\ be required before n definite opinion
can be expressed ^

Spetn! attention must be guen to ttic following points m Ihe post morim
examumtion of the head

( 1 ) Cuts, lacerations or bmises of the st dp md face Ificse are of import*
ance in so fir as tliev throw light on the nature and degree of tlu violence
that has been inflicted

(2) Condition of the intracranial venous sinuses and hrge veins os seen
on rcrooiol of the sk.dl cap Enroine for Iioention or atilt ittorum tliroin
bosis The superior longitudinal sinus should be cjamiiied and opened
before rutting tbroiigh the dura for lemosal of the hraiii the mmining
sinuses and sans imniediatelt sBer rernenaJ of Uie brain Thrcmihosis
m the sinuses oceuts not onij as the result of rallammalion. hut m
wasting diseases (marasnuc thrombosis) espccialh m children It mat
cause petechial htmorrUages m the cerebral substance The tollouing
is an example of the importance of examination of the leiious smasin In
this case the question of legal interest was whether the condition n ns due to
disease or poisoning Had there been a bistort of a quarrel, t.olence might
w ell have been suspected

A girl, aged 18, was brought to

commenced suddenlj on the previous «lav -with . . j pro'W(‘«Mvc coma-

In hospital^e girl had

Death occurred on tlie third dav afteronset ti,c girl to a

liad an abortifacient ^mistered Al p-wf mor/rai there was

chemist to obtain rai^icme iSl hjleral sinuses, and

found a thrombosia of inferior longitudmaT, straiglit

« JefTerein G , 1031 S«»g Cynee ObsW 93. *

7/r JD T^OUADS I\TRACRA\iAL lIVMORIinAGr 30"

of tl e wn? of Galen and vein<« of corpora stnato small h-Tmorrliages and soft
cnlnRinbisalgnngl a tl c condition wascvidenth a natural thrombosPngencaphalo
meningitis

(3) Jhc etact site of tlie IiTmorringe which niaj be —

(n) Between llie bone and dura mater ic extradural
(ft) In tile ««& hirnf space that is between the dura matennd arich
noid niembrnne

(c) In the subarachnoid space

(d) In the substance of the brain matter i e infra cerebral

(4) Fractures of the shuil Tlie dura must be remo\ cd to prev cut fractures
escaping notice tiiose of the caK anum are more easiU found than those of
tlie base

(0) Condition of middle cars and mastoids sphenoidal in \ frontal sinuses
Open these with a chisel to sec whether acute or chrome indammatic n is
present

(( ) Condition of the tcrthral arteries Divscct up all the larger arteries
earcfullj Fxaniine for atheroma developmental or mvcotic aneurisms
ruptiirts ttc Open lumen of arteries with scissors to look for thronitosis
or emboli

(7) Aotc the cAact positions ot softened infarcts or 1 nnorrlingcs in the
supcrfcial part of the brain subst nice tben after ineismg the brain note
their relation to the vessels in the deeper parts

(6) When hxmorrhago within tlie cranium is due to disease this is fit
quentU onij a part of a disease present elsewhere Ike hv perteiision or
puKnrtcntis which must not be ovcrlookcii

Wo niav now h\ down a few rules of cardinal importance regarding
lesions due to slotencc

(1) Fractures of the skull are found at and radiate (m the direction of

the causative force) from the point of impact upon the cranium with the
following rare e\ccptions due to the nature of the vaohnee \Mien a heav>
weight csjwciaUj an clastic weight such as llic pneumatic t\rc of a hea\j
aeliule passes over the hrovi or occiput thconlv Iraeturcs niaj be horizontal
cracks in the lateril region the skull has been compressed from before batk
has espanded latcrallv and cracked lalcrallv (.neks due in the same wnj
to over cspansion arc oeeaswmallj present in acUhtion to other fractures
m falls from a height llie impart and passage of a rifle hulltt maj cause
s.rvck.e. w. tt’A skvi'A vs/at?.tc'A (ewev the Cs'»/it«,sc.s cA, Uw. ewtev <ac ojA-

(2) Lesions to the soft parts within the skull nre more pronounced either
licncath the point of inipaet (awl anv frwelurcs radiating therefrom) or on
Uie opposite side of the cranial cavitj owing to pile up and rarefaction ’
(tide supra) Tlio>eon the side of impact arc usualJv slighter — unless fracture
IS jiresent

(3) ihc lesions on ll e opposite side (provided there he no fracture there)
nre clue to contrc-coup (see p 30 1) llie came of these lesions has been set
out above The movement of the brain upon impait lags behind the move
ment of the skull drawing the Inrun awnj from the opposite skIc tlius
stretching and tcaruv the perforating vessels * * C< i (re coup lesions alwnj s
he in the hue of tin. forte t f impact Thus if a man falls upon the back of
his head sinking the ground with his occiput a little to the right of the
middle hue the lc«ioii.s occur over the left frontal and temporal poles the

’Dptim llro»n U nn«tltusseQ » It lOll Drat 64 t*3
»lJoll»t)iim \ n & 19W XoMn-r 2 -IJS

308

/ \ TIiA-nVR IL If FM0UllIlA(.l

ripht frofin! nnd tcmpnnl poirs mv. nho 1* nfTcclMl but to a less drprrc
If tlic portion of tfie occiput struck lies oscr tin. ccntnl horironlal plan? of
the brain then the hn^cr Jispccts of these imlcs ttjJI W flfTorJrt), jf
then tlie upper aspects will tie nlTcctcd The imi>onatiee of thit ponhon
cotiirr-eoup lesmii camtel be enerestunated Xot on?\ ihx> it einl k oorJrt
coup lesions to be rccofnimtl with certainU aiul thus tliscnst to |>e esehiileil
Is n cause of them but it is frcipirntU of iisc m other wa\s Ttiiis if a man
has rontrr rou;i lesions in the sitea fjiveii nliosc no fracture of the skull and
a bruise upon llie forehend then these inlrairmnl lesions are ccrlninU
due to impact on tiie occiput, Ihej ait. not (he direct result of a blow on the
forehead though the bruise on the forehead ina\ be c\ idcncc of a blow which
caused the nmn to fall upon liis occiput

Torsional injuries »ua> occur oier the surlicc of (and withui) Ihehraui
w hen the licail lies on the ^jrouiul hut the forces of ‘ pile up and ‘ mref iction
wliith cause cotifrc coup cannot *fo so

Tins slatcmeiit is oIimousK of the hijjhest dejnr* of iiuportante m cases
of quarrels amonjjst dnmkcn men sshen the esidtnee rrpanhiifj blows pi\cn
or reeeii e<l is so disputable

Ctui/re roiip nui\ cause groups of bareh \isihlc pinlicnd hrniorrhaers
larger areas of disrupt is c h'euiorrliagt, ruptures of the pia araelinf 1 1 nirm
brants or actual laceration of the hnm siihsiamc
These cardinal rules m respect of lesions ihie to siolencc inns now be
supplemented h) a resiew* of (ht causes of h tinorrhagcs in tJte inciiwpet ond
brain as 111 jKiints for the iIifTercntiAl diignosis IkIwccm Iriiiina and ihseise
The question of trauma ji/i/r disease will rt'cci't ^eJ' irate disnission

Causes or ItxmorrhaHe mo the *' r„rt,m o' It

-»«„ h Mm rtorul ^ fmitore , r

skull, or n.pture ora nu.„n,'eol nrlerr m. all. iMl ll.r

to tcnnng of the scuous sinuses, also usualU n-ssorjaieu

bone ,, I III aKiTmt to the skull anl

In infant and old age he dura is more t gl d ^

extra-dural Jiamatoina is le« common, hut lu a l

SUBDLRAT II^MOnRUAGr 800

local blows may cause tears of the meniageal arteries (or concomitant \eins)
with or without fracture About half of tliese arc m the temporal rcgiou'
and arise from injury to the middle meningeal \cssel Tlie rate of dcxclop
nicnt of pressure symptoms laries according to the size and nature (arteia
or \em) of the \essel torn but is usually a course of some hours a lucid
interval may occur after the mjiirv to the head tending to dissociate that
incident from the hiemorrhage causing later svnnptoms and often death

A boy of eight plajmgwith fellow selKwIboys at 4 3f) p m was struck on the left
temple b\ a half brick He stap^red and fell momentarilv concussed but got to
Ills feet and ran home Ife ate liis ewn ng meat at 7 p m and went to Iwd at 8 30
without making any complaint. At 7 3ft next morning he was found f. ck m lied
and as he could not be roused he was removed to hospital but on arrival vras found
to be dead

(2) llcpmonhage uito the anb lural space Subtlural li'emorriiage is relativ clj
common after anj kind of violence to the head Such liTmorrhage mav
rarely be caused bv laceration of one of the vei ous sinuses wlien it is bkelj
to cause rapi 1 sv mptoms and death or more commonlv bj a ttanng of one
or more of the small perforating veins lictvvcen the pia and skull Ibis I itter
t3pc of bleeding is slow and the violence applied ma> have been rclativeli
trivial the IiTniatoma maj cause few sjmptoms The lajcr of blood clot
IS rapidlv encapsulated !)) a thin cellular mciiibrane— a process winch begins
wilbmafcw hours and which is completed within a few weeks Gramilahon
tissue IS found on the dural side and spontaneous bleeding tnaj occur from
time to time from the thin wallcil capillaries of tins tissue leading to pro
gressivc enlargement It ma^ be found as a c^st of Ii juid blood clot as a
brown mass more tlian an inch thick years later Tins condition known ns
pach> meningitis lucmorrlmgica mtemn fonnerl} lielicvcd to be due to an
inflammatorv process is now generally conceded to be ciused b> Iriiuma
since the classic work of! rotter * It is more liable to be found m tlie aged
in vvlioin it mav cause btlle thange— si ght confusion only lieing common

Gardner’ suggests that tiic increase in size of these hicinatoinata is due to
osmosis of terebro s{ ma1 fl iid into (lie tumour caus(.d by the increase in
molecular concentration due to the disintegration of the clot I lie contents
of the lirematoma supjiort this theory for tlicj may be partly or wholly fluid
and the fluid may be black and viscous or brown and watery

( 3 ) Ilermorrl Opf into lie siibarachmtd ipree This may be due to trauma
to sjiread of hoMnorrliagts whicb originallv were m the cerebral substance
more commonly to rupture of aneurysms on tlie internal cirotid or mam
lercbrnl arteries* and rarely to inflammatory necrosis of these arteries
Lnccpbahtis or blood diseasci> like Icukicmia are v try occnsiomlly conccrnctl

1 rauina is a common cause of siibamcliiioid lixmorrbage. It is then usually
associated w ith contusion or laceration of tl e cortical substance flie bkeding
is rarely localized but lends to spread widely over tlic surf ice of the bram
into llic sulci anil mixes freely with (he ecrebro spmal II iid

riic spn ul of blood from the cerebral siilKlnncc may occur not only when
such ha.morrlia"e is near llic surface of tlie brnm but also vslicn bleciling
into the decj cr p irl of the brain matter has escaped into the vcntnelcs and
hnsal cisterns through tlic roof of the fourth ventricle
1 Ho \1>olluim, r I IJ19 Aeulc Injuries of llic lleocl 8rd JA p 10 Ed nborgti
I ieifipstone

* frotter Wilficl 1011 llril J Surg 2 JTl
*(tirdner \\ J 111. tref nntrol Isje/tat. 27 81"’

♦Helpem M uncinalson s M 1B30 UerJttrl Sc! 220 2r.

CbM USIO\ OF TIIF BI1AI\

Apirt from irregular aneur%smal dilalations m seierc atheroma cerel.ral
aneurjsms are due to congenital ne-itness or rarcli to . r cerebral
Aneiirjsnia due to infeetiie emholi are usually pre,e„t in tiTs'.k "on Z
eonveaitiea the aouree of the emboli aill be found eheal.ere m the "rlil
mijoritt of eases in on ulccratiie endocarditis in t oung subjects Conrailal
aneurisms arc a eoninioil though often otcrlookcd cause of liiru oXc
into the subarachnoid spacer Tlics iiuij occur smgb or niiillmh ,„id Iv
rupture alien Hie cerebral arteries arc otberaisc licaltlis and uben llicrc c.
no aWmaliti clseulierc m the body IMien Hicj rupture the l.lood fre-
qucntly escapes not onl> into the subirachnoid Npice but tears (/iroiif'/i
adjacent cerebral substance reaching the scntnclcs One of the comnioiiAl
sites IS at tlie junction of the anterior communicating arterj miHi one of the
anterior cerebral arteries in this site the\ mas onlj beresealcdbs sonaration
of the lips of the anterior cUremity of the great longitudinal fissure
Deselopment'il aneuiysnis are Uierefore of great medico-IcgaJ inifwrtance
for they ina> be the cause of death m eases in circumstances uhitli miTht
have gis-en rise to suspicion of foul plaj or tlicir sudden rupture m The
dri\ er of n veluole maj be tlie real cause of a serious accident

A car drnen b> a man of » swets-cd unaceounlal)!> into oncoming tralTic an 1
collided oath the offside of a cliarabanc No defect naefouri/iri Me steering ncih
nmsm nor atij reason for tlie swene Aotopsj, lowexcr mmhvl a rui lured
deselopmental cerebral aneurism bursting into tl e floor of M>e tJurd irntride

In everj case of subarachnoid liTniorrlnge a careful dissection of the
cerebral a essels cspectalU m the Circle of illis and brsnehes from it must
be earned out The dissection ma% be eametl out under water the clot J>cing
« ashed aw ay w itli the greatest care or injection of tlic v essels w ith a coloured
dye may help m finding the '•ourcc of the lucniorrhagc In Ilelpeni ami
Rabson’s senes no aneurasin could be found m 23% of cases of rupture m
spite of diligent search

Haimorrhage into the Cerebral Substance (1) Cnpillari haifnorrhngcs
are found in encephalitis in soneiimg due to arlcnal enibohmi fvin ranlv
fat embolism) to arterial tl rombosis or sums tlirombo is to d scasis of
the blood such as leukTinin anaemia and purpum to scpticicniia to toxiemia
of both endogenous and exogenous origin to fits to violent couglimg and
of course in asphj xial states

The causes of such hjrrnorrJiagcs arc rcxialctl by the examination of the
contents of the cranial caa ita for instance emboh m arteries or b\ cyamiiin
tion of the rest of tlie liody ^licroscopic examination is required to diagnose
fat embolism and encephalitis

(2) Large non traumatic hwmorrlmgea in the sites of ticclion in the
cerebral substances arc usually the result of rupture of a ilwp perforating
artery Large intra xentricular hJcmotThagcs occasioiialK occur in eases of
puerperal tov-cmia m nhieh there base been no fits TIicsc arc usually
situated m either the coqms structures or the jioiis when inlri cerebral
hicmorrhagcs are not so situatetf search should bemadeh r someoti rrcmisc

(3) A large iismorrhoge not mfrwjucnlh nnses from a glioinn or nngi >ma
of the brain it may also arise from a secondarx growth j articiilirh spon lo
blnstomata It has alrcads been slated that tlie cerebral substance max lie
tom up by blood from ruptures of mfeclixe or dcxclopnientnl aneurysms on
arteries in the subarachnoid space

»Sj-n>ond* C P 1824 tfaurf J

311

H BMOimUGE—DlSEASF OR MOLE\CL

W hen liTmorrlinges resnlt from rupture of a deep perfonting artery there
vs either e\ idence of extreme degeneration of the cerebral 'utenes or of high
blood pressure Usuall\ there vs c\idence of both coiidilions llie hremorr
hages usuaU\ occur vvilhin the basnl ganglia or pons rarely in the cerebellum
llieniorrhages arising in tumours are as i rule rcadiK recognized but large
btraorrhages are soinctiincs found nrising near tlic surf ite of the cerebellar
lobes in appartntlj healtln %oung people m whom there ms no naked eje
explanation of the lesion but m microscopic sections xaricosc angiomatous
\eins Milh imperfectU developed walls were found— part of the Linclau
syndrome

Traumatic hvcniorrhnges in the cerebral substance can be identified by
exclusion of other causes and particiilarlj b\ attention to the cardinal
rules for traumatic lesions given above It was mentioned that an exception
to these rules has been noted thus Sometimes hemorrhages within the
central parts of the brain substance particular)} splits in tlie pons result
directlv from trauma such pontine ln*moiTliages ire neither beneath a frac
ture nor in the position of a cotilre coup lesion In such coses thev are due to
torsion strains \\ hether an associate<l lesion m the scalp or skull is evidence
of trauma which caused the h'cmorrhagc or whether the scalp or skull were
injured bv a fall due to unconsciousness caused bj a non traumatic hremorr
hage is nlwajs a difficult decision to make but if the arteries are healthy
and the heart affords no evidence of a previous!} existing persistcntl} high
blood pressure, but there is evidence of trauma then such a hjcmorrhage vs
prcsumabl} traumatic If, however the vessels are degenerate and the}
often are in these caves otlier evidence than that obtained bj necropsy
nn} be rtquircvl before an opinion can be expressed

Disease plus Violence It is now neccssarv to sa} somellung concerning
hajinoirliagcs which could have resullctl from disease alone but m wluch
violence ma} have been or is alUgeil to have been the final ami actual
cause

An old man of "2 known b} his famllv doctor to be h}T>ertensive tottered to the
head of the st urs at the rear of a mov uig bus and ^Tas seen bj a fellow passenger on
the upper deck to swa}, make no attempt to clutch at the mil and crumple up on
the stairwav , Tolling out of sight he came to rest on the rear step of the bus head
dov\-n, feet projected up the staircvaj Autops} revealed a fractured skull with
heavy local ancl contre-coup bnusing of the bmin together walh a left corpus
stnatum hoimorrhage of the kind normal to hvpertensivc stroke lesions The
rommencement ol Ylie lah was aVtrfoatvdaoWcrs Wl aVicre -micnTO

a possibilitv that the whole of the injuries might have been due to the fall

ttlicn disease of the follownng kinds is found then a sudden nse of blood
pressure due to excitement however caused (alcohol scuflle assault etc)
mav be the actual cause of hjcmorrhage The disease conditions are cerebral
aneiiiysms degeneration of cerebral arteries ev idence of n prev lousl} existing
persistcntl} high blood pressure erosion by inflammation of a cerebral
arterv, pach} meningitis hTmorrliagica interna and cerebral tumours
cspcciallv angiomata If h-emorrliage arises from one of these disease con
ditions and there is cv idence of a scuffle or post mortem ev idence of \ lolence
such ns recent bruises on the bod> which cannot be explained bv a fall due to
unconsciousness then it is impossiblenottoadmitexcitcment oradisturbancc
b} trauma— as possible iiUimnte causes of the lixmoirhage Lxcitcment can
undoubtedlv cause rupture of vessels when such disease is present On the
other hand excitement and drunkenness are not sufficient to cause htimorrhage

312 B^AI^ 11 ^VOmmAGE—DlSF ISE OR UOLE\CE
'Vhen ,uch disease .s absent, nriess the eTcnement .s assocntcl «,tl. cM,en,e
ongestion In some prople intense anger orcxcileTnent maj eanse n rendition
len similar tot latcfa fit Patalcembril h-emorrleige is sen rare ho", el e"
es en Irec epileptie fits In medtenl et idence the cltcct of csrcitctncnt Ins
undouhtedlj been os errited tar too often ret 1 ns

,t 'I'i'*', ""=“"«h>nees and jxtl imrirm rondilions

It should be possible to amse at a definite eonelnsion in most esses In ^
remainder the pros and rom mas be scrs escnl> balaiieed and the nmlirel
sntncss mas be compelled to lease nmttets in doubt flic doctor nnest
remember tliat it is not Ids ipccMl )>u5iness to obtain n \crihct I tit to jnie
onh e\ulence tint seems fmr and leasctlieresulU to thej«r\ Tliefollo>Mn<»
propositi ms pros ide guiding pnnciplcs in tlus problem —

1 Tint multiple bruises of iJie brain arc iicier found as the result of
disease onh/ except uhen the disease causing them ts abnn laniJj inantfest
from nidenre tlrriiabfejront autopsy or from theliistoix, c g sciirvj piirj urn
liTmophilia leubarmn

2 That a definite hrcmorrhnge (mlh evident clot) m the substance of the
brain or m the \entnc/cs is pncfieirtv never the result of violence onhj
but it IS <1 V cr\ frequent result of disease alone or of disc'i<c phis csrilenicnt
or disease jilm slight violence such as a fall on soft earth eiusmg a fiirh
severe sfiaKe of the brain

8 That the vounger the patient (he rarer it is to find definite IiTiiiorrlnge
or capillarv oozing in the substance of the Iratn without violence but even m
vouiig subjects thev mis occur at times eg, from deep sulx»Ma or m
polv arteritis or from enecplnlitis or angioma Thev are not ven uncommon
in ncvTliom tluldrcn as the result of nnoxii during childbirth

4 Tliat sub ancluioid lucniorrhages arc usuallv the result of tnjiirv, lull
also commonU occur m disease, and often from spontaneous ruptures of
detcJopmental aneurv'snis

5 That a cortienl hccniotrlmgc from violcnccisahmvs found most nwrhcil
cither immediateh under the spot struck or on the opi«sile side bv contre
coup or at some point under cxteiitiou of a fricfurc tnuscil hv the violcnw
IMicn under the spot struck there should be either i siqjcrfitial bnijse uf
the scalp indicating the spot orarnctiircofthcl>onc.s or a tear in the vessel
causing the bleeding (usualb the middle nitiim^cal nrtirv or one of the
perforating vessels) IMien Irom cordre coup there slioiild l>c, m addition,
a bruise or liccmtion of the brain

V medical witness mi\ be asked whether vessels ini\ be nipfuntl hv
evcitcment If he agrees without nn\ qualiOeition the court mav iissiime
that excitement miv done be responsible in the partu-uhr case on whicli
he IS being c-xammed Tins impression on the court is not alwavs rcmovwi
even bv a careful re cMraiintion lie should not unlevs it In. consislrnt

witli his own views allow his iiiswcr to o gcHcrol qu«»l»oii to W nndo np) a

able to a partieufnr case If nskcif whether vcsvcK rm"ht m t

and blood extrav isitcd bv mere eretteiient he should Hn'‘"er n lou^ i

such 111 effect might undoubtwll> follow it was Ins opinion tliat it was lut

the whole truth m this pirticuhr case . , ..,.1 ,.f tl.^

The following cases are illustrations of tins kind «f ‘•d» ’

chtnciiUies that iinv ansc

In a tnal f u manslaughter it was proved tliat tf e pp-a ncr
tod bren >,T«ltos TT.ap™Mrl,adlhraTOlla.lma^' „ma, a-a.wl

floor he then «e«ed him b> the throat and beat 1 1 » nrau sc

niiAis iLTMomai Asr on MOLrwn iia

the floor The dcceisid died 1ft hours oflcrwiirds On inspecting the bod\ o great
qiinntits of cmgiiHted blood Mas fnuiul beneath the scalp Tiiere mus a vound
o\cr the right parietal bone an Inch and a half in length, penetrating through
thesealp but no fracture of the skull TliercMasaquantitj of e\tra\asaled blood
on Iht opposite or left side of the head and a rupture of son« s psscIh on the insulc.
of the skull On the neck «crc tv\o dtscolourutions to the left of llic windpipe
apparently occasioned by tlie pressure of two lingers

The doctor after giving this dcsenptioii of the jiosl mortem appear inccs
was asked whether in his opinion death was cKcasiontd h\ the injiirv lie
replied “Death might or might not hi\c been occasioned h\ it This is
the sort of answer that brings themcdual profession into ridicule In another
case the judge was stmng enough to expose such nonsense 1 he judge snnl

If It were prosed that two people were fighting together blows were struck
one fell to the ground and tlieij and aflerwaids intern il Injuries were found cor
responding wath the external marks of \aotenec no power on e irth c nut 1 per inde
him that such blows were not the raiise of death Ihe prisoner wus found guilty

There is n clinical point of interest in tonnec tion with intra cram il h itnorr
Imge, \i7 that when a natural stroke lesion seizes n person who is it the
moment pursuing an ordimrv vcKnlion without excitement or drink cr
unusual exertion, it frecpicntU clears uji so lar that the patient docs nnt du
hut lives for months or years m a more or less paralvsed condition In those
cases jn which violence plavs n part n fatal result is imirh more frequent
Ilcntc jf It were proved that the violemc was not great and that there,
were signs of previous hemorrhage such a fact might he pleaded m iiiiti
gntion of pumshment

In this respect v .Su/lucm* was of sonic interest —

On April Htli an apparently hcdtliv man was knocked dowm by the prisoner
and fell watli his head u|ion the ground Allhoiiji he suffered from pain in the
lirad he had no medicnl advice until May IJtli and had in 11 c ineantiiiu |>c rfi rmed
hts ciulrts Ofi tlie 2'ltli May lie einie under medjc-nl rare Jhere were marks of
1 nit»es on the head impaimicut <»f vimou a fallcnng gait ntnl other fivniptoins
ludieativo of (I lisinn <if the bnin AlioutJum IJII)hcl>e( mic mstne IFe rcxovired
so fir that lie vins about to lie discharged four mmlhi after the infliction of the
violence when the svinploms Ik came aggriv ilctl ojid ihath look pi ice On mspcc
tion a riot of blood uriiniintiiig to two llui I oiiiK-rs was f luiid helwcrn lavers of an
rndothehil tissue ocrupving the subdural spii'C met tic left hemlspUen The
clot laid rsidcntlv laeii then for sonic tunc and the surfaet if lie hraiii hid
Ihcii indeiitpil bv it* pressure \nollicr clot of old st indiiig vnis fi iiiiil in the jKins
Tlie incdienl wiiius-ses eonciirrcil mnflrihiltiiv elcath t» the effiisioii of htood on the
briin and the erfiisuMi to the Moicntx Inflicted bv the prisoner ultlioii^li thiy
stated that sonu nddlliomi effusion had pnilntily taken plnc'c jusl Ik fi rc 11 c fast
n < urn ncc of sy mptoms The prisoner was com iclcd of imnst inghlc r

Such cases today do not present quite so mucli dilheiiUv for recurring
svmploms and delavtd dcatli in cases of subdural liteiiiorrliagi and other
pathological roiiditicuis of the hniii nre wtll Rcognized ctiiisiqiuiiecs of mjiirv
totlichiai] Dcitliiinv occur after a pcruMl of npparvnt rcroverv itiswell
reeogm/cil Ih it a pirsnii iinv receive nii uijurv to the lieml which mn\
ivenlunllv lead to a fatal issue hut which nnj not pmduit grave svinjitoms
at the time

'Jlic (hanges tint time jmidiiecs in cITusions of blood within the cmninin
and the histological changc-s in the tertbral tissues nft< r damngt to the brain
form an inijiortnnt h isis to sound opinmn * *

• r C.tk, Sepieni1>er, 18^

• IKnny Ilroww n ami lliis««ll U It. lOtl Brain 6t 01,

•llowlKJtliam t. 1 , Iftja \rtitc TajiinrsofUic llsvl Jrd Id l.*lii 1 ur^I I iMii'r^tonr

314 nnAJ\ IXJnRi—LVUn KSTFRIAI

lieccnt cITusions of Wood nre rccognizcd hj Ihcir red colour »od llir con
sistenoj and npi.earance of II, c clot or longulum After some dots tl'c clots
f O'xl ll«t P .'scs (traduolli .„f„ „„ «.|
t.nt w„ch m,j he nict n,t)„n from 18 to .'o ,h,^ ,|,c „olc„cc Clot,

of stiMiinl blood undergo sloocr clniigcs ,n structure Olid consistcnct- iilicn
old the\ are firmer and disposed in nicmbraiiotis lasers or lieisinic esstk
tlicj are ndlicrciit to the dura mater and the Ijmin and the surface of Hies
orRui presents in indent indtcalnc of pressure

The folloniiig ease lioncver, slimis the neeess,t> for eaillioii in statin"
tile exict dite of nn elTusion of Wood

A woman arl 70 thren hcnelf from n window The fall i rmhipcd a v\cn
lawnted nouncl of the sralp laying hire the skull and caiising n smii.lt fmctiin.
of the sternum and lihn Slie died 31 di>snn<.r tlie injur\ On insp« tion Ihcrr was
a fracture of the left parietal bone, and betWTen tlicdiimnutcr and inner siirfare of
the skull near the left temple, there was n la\cr of miipil ded blwal i nc-si\th of
an inch in thiokncss and about two inches in breadth In one phee the cl .t Imd n
bronmsh hue but the greater part of it was stiU rather dirk-<-o!ouml On tlu. rt lit
Ride there mis a similar cfrusion of coagulited bl«K>fl hut this mo-s insidL th( dura
mater and on theanchno/d eosermgortlie bniin «r within the m\H\ of Ihcunich
noid Tilts con^ilum Mas cserjaihere of a ehoa^aU fcrtria coh tir shomng Hint tit
process of absorption Mas much more advanced tlan on tla? hfl snlc \ large
quantity of coagulated blood bad been elfusid into the crlJuhr thsut near Hit
fracture of the tibia flus mus still crimson and had the nj iwamnce of a recent
effusion A sin Ul quantit> of fresh hhod wits alMi found near the stcnium hIiIcIi
had been fractured Tlie fractured ends of the Imnts had betn firmh iiniteil
riiere Mas doubt Mhcther these effusions IluI taken place at the same tune frum the
same accident — le dl dass liefore denlli— for tlic\ prt“scntrd serj difftrcnt
appearances on the inner surface of the serous membrane tluin in the oilier stnictun s
in which blood mis effused fn estimating time lu Inilicatcfl b\ tluitgi of folniir
in the clot mc must then fore iilwasscoitsidtr tlie scat of Ihceffush n the absorl mg
poMcr of tlie tissues and the povsilnht> iifpresious injurj

Lucid Intersa) In rases of injuries to the Jicnd ciusiug extradural
lia morringe a person mas rccoxcr from (oncussion and npp irciitlj be k''*bS
on Mcll Mhen la tna> uimocouutnblv detenornte and dii 1 iTiision likes
place griclufllij, and after a i/inslde jicriod irnspr/l»ier>f fhej>crsnn hnug
excited or disturbed the bleeding svill mcintc lift li\ mcrmsing compression
IIoM long IS rcqmrcil in order that su< li nii effusion should dt\i lop after tin
ncculcnt it is impossililt to saj but in most c ises it is gciicnillv obserscil
to folloM the injiirj Mitliiii n fess hours

This ‘ lucid interval is m fact one of the rci-ogiiired niclhods iif thslin
guishiiig bctMccn mere concussion, extn dural and intm crnbril hnmorr
linge In the former unconstimisncss appears at once and graihmll} <hs
appears ns the patient recovers in extradural liTmorrlngc, on the other
hand there mav be a monientarv iineonsciousuess fnllnwnl b\ Apparent
rccovcrj so miicli so that tin. patient resumes Ins rwcupation for a longer
or shorter period imimtes or hours and then unconsc loimiess returns mid
death follows Tniik contusions of the bmin on the other hand wWom
permit immediate rccsivirv of consciousness (ns dots mere et r iiissinn)
the subject either remaining unconscious until drulh or imkiiv a si .w return
to full consciousness and rceoverv

Tu) lor rcporlnl llio coir of n grnllcniiiii «lio »tu tlirooTi out
moti his head ii ilJi swell v jc Jenee ns li> stun bun Xftcr a short Imie lie rresis c reit h
ris ami fell much tetter tlint be cntvml the ol.u* aiadn of n

113 father 8 house bv a companion lie alUmptwl t« lilt be was obh i<l m

nvkil nature, but be soon began to feel Iicovj and drownj, that was ouugwi

FliACTl RFS or THE SKULL SI'S

go to bed Ills s^TlptOfns became more nKtming and he dud m about an hour from
effusion of blood on the bmin (Whether evtra or sub dural is not clear from the
account )

A nomaii of "0 stumbled and fell on n sfairwaa at her home striking her head on
tliecarpeted floor She was dared and shaken and retired to bed Next morning she
appeared to hase recoaered and ai-as able to attend her house duties She -was
noticed lionever, to be unaccountablj \ague and forgetful and tended to sit and
do 2 e cjuite a lot Her condition became averse and fournecks later she vas removed
to an observation ward on a Receiving Order dving tliree days after Aiitopsj
revealed a large eortual subdural hematoma gelatinoas uid pliinlv some wxeks
old

The follow ing case is interesting nnd to the point tlioiigh the autopsy data
were somewhat restricted —

A man of about >0 worked m the morning and from about midilay till 1 10
he sat in n public house chatting nnd liaxang an ocuision i1 drink \bout 4 30 he
mounted his cart to drive home He drove m such a manner as to attract two
neighbours from their work to stop the horse tliey stopped it somewliat suildenlj
nnd the man fell off the shafts on his face in the roa 1 Vfter this he had two or
possibly three more falls but finally was pul into his cart with the local poheerrum
to dnye him The policeman left him about 5 oO as be then seemed more himself
and capable of driying Witlun a few minutes he met a traction engine He waved
to tlie driver of the engine to stop and then got down and walked with his horse
which got more and more restive and rmall> bolted pulling the deceased over
and throwing him Molentlj to (he ground thecartpassingoverhim Hewaspicked
up dead by the men on the traction engine

A post niorfewi exammation was made wath the following results Tf ere vras an
abrasion on one malar bone quite supcriicial there wen. no other e\ternal injuncs
at all internallj there was found a clot of liloo<! Iietwcen the dura and the brain
Nothing else was found to which death could lie attributed

Damages were claimed bj the widow against the owners of t1 e traction engine
The evnclenee for the vndow was that the man was somewhat under tlie influence
of alcohol tint he was violently shaken bj lus final fall and died at once of shock
from this fall

The eyadenec for the owners of the cnpnc was tliat the man w is soinewl at
under the influence of alcoliol and excitement that these combine 1 with the
adm tied falls (antecedent to the fatal one) starterl a meningeal hann rrhage w Inch
after re iclnng a certain degree ceased at that degree until tl c cxtitcincnt of the
attempt to stop Ins horse and the violence of his fill caused it to rccommeii e and
increase and so br ng about death bj compression

The judge nwarded the widow £100 damages but he gJ'e no reasons for
his decision Blood requires time to accumulate and there was an inttry il
of two hours between the first fall and death whereas death is stated to liave
yiftmrrt'd TifnntdiaVdv alter ttie second taW A f\t*Triri tAw/p. KK'R

clot and injured hrain tissue and pf the ccrvieal spine might have enabled
the examiner to give a decisive opinion but in the absence of such evidence
it was impossible to be sure and the judge no doubt gave the benefit of
tlie doubt to the injured part)

Fractures of the Skull

There arc certain points about fracture!, of the skull with whicli it is ncccs
sarv for a niednal witness to be familiar for thej will throw much light
on tilt nature of the weapon useil the method of infliction of the iiijurj, and
whether it was due to accident suicide or litimicidc ^

I \\ ith small weapons the striking surface of which is small in proportion
to the momentum of impact such as the blunt end of a hammer the shape of
the depression on the outer surface frequently corresponds prettj closcl> to
* Gunljian P S Webster J E.Lcssner^ll R 10^ J \euTotirg 7 KW

FRACTDRES OF TIIF SKVIL

™ ""I”" » '■>“> ''"ml rrnolurc ,s

pioduced Mliichnmi orina-i not rtlrad) c\ond (lie tirra of .(qinssion

2 Splintering of the Tables In loril frsctnri-. the Inhle of tlie shall
Mh.cli at the moment of imp let is iiljieent to 11, c forte is sal ntercl In a
lesser evtent than tlie table further anas muiig to tile fuel II, at n„ all
sorbed force sprcitU aiul tbe jnntr table unvu/fjxjrtcd

rjiis fact ennbks us to ascertain the clircctioij m nliich n snjid object has
passed tlirough the stull the fracture of entrance ltnvui„ sti.-iller dmicns.oi.s
the fracture of e\it having the larger aiHl more cvtcnsivcK splintered H c
direction too m whicli the splinters ire Ijent-corroboratcs the infcrrnic

3 If such Iccnl fricfures hive nsstirrs estendmg from the locahtj. such

lines will follow tl c rule m the next paragraph *

-1 ^^lth forces of which the contact area is broader— falls on the head
crushes of cart wheels, blows of bludgeons fills on the feet {the eonMes
being the points of transmission of the forte) are ninojig (he more loimnnji
examples the rule is tint the line of fracture is continued along the
line of direction of the crushing force, most frcqiicnth starling from
the point of contact Thus a blow on the side of the head prod iccs a fnirturc
running across tlie base and over tie vertex fnim side to side Similnrlv an
antero-posterioe fracture either sagittal or ohhqiic i? produced hv a force
acting m the saggital or oblique piano as the case m vv be
5 If tlie head be supported ami so prevented from moving the fracture
may start at the point of contact of the blow or at the opposite point
vvliere the head was supjvorted for example in falls on the vertex the fracture
mav have begun either at the vertex or at the base

It IS obvious the greater the violence ns in tram and otlicr smashes the
more difTieult it is to trace these lines of fracture
W hen the force causing the fracture has a broad area of contact it is
important to remenil or that then, mav 1 c extcnsiv e fni turc and sc; aration
of the bones of the head without anv laceration of tht skin

i blow on the bead maj pnxluct n fracture or displaremcnt of the inner
table of the skull and cause death l»v local compression or hv cfTiisiin of
blood (ii le supra) without (he whole thickness being iinoivtd

Inf? V Jladirn ihcj nsoner struck n Iwv o severe t ton cm tte J end lie hecame
sick and unconscious fdl into a statcof colbpsc and d c i U c next d u On Inspcc
tion the inner table of the skull was found to lie fracliirwl and there wws effusion
of Woe f <71 er liie }/rai!3

The orbits are striking but uncommon situations for direct j cnctrating
violence stick a gimlet a pair <»f scissors aiircUhnow umbrella n
tobacco pij c a pcnlioldir havcall been rcconled ns producing such fractur^
More common arc the hammer Intclicl mn bar and spanner injuries of the
V ault plates lii all cases of fracture the tliickness of ll e skull slioni 1 I c

noted for thoiigli It cannot inlaw ever absolve an assailant from re's) on

sibilitv the fact that the skull was unusuallv fliin mav a/Tcct the mct/i aJ
watnesss opinion as to the seventv of the violcmt wJicthcr criminal or
accidental

M as the Fracture due to a DIotv or to a Fall ?— li ,> I” "'t has ii,i|K,rl»,,t
npplicolioiis in legal ntedicine for then! too man, ra.^ in "hKh lint it
principal tiiallcr tested in court Injurj mat occur from tiolcncc ttill, r
tt.lhout rraclutc and ,t mat lolc pi.™ »ltl.oul 1 c.n" nccompamcd bt .m
external marks

FUACTVRES OF THE ShClL > 5 ' ■

It „ ,n,e th-,t the Offences ajn.nsl the Pcson A,cS ^

he ane other means ahalsoeecr raiisa gncioio. bodile harm . nee crlliol^

in ftere .S e" ,dcnec s.mpK of a ffcncral sc„nic the pnmshmenl rnn.e «1
,e hkel' to he n.jterialle ii.llnenccil br the answer to llie hea.lin| ‘I""'™"
atoee rake llie follonang not unusual eireumstanc-ari The llece ised is annos
,„E an.1 folloiims the ..reused the neeuse.1 tjns around

strikes (sftss the prosecution) the decensed who falls nnd htcr dies from
held injtin \lthoiJodi the cMdence of o Wow or p«sl» nm be connictme,,

it lies cr\ material for the purjiose of proper trial

The answer is b> no means cas% and hi general the medical witness will
be found m nil lairncss to admit tint the injur> wns such ns could well has e
urisen from the fall The following points ma\, howeser, help matcmilj to

a conclusion ,, ,

1 Ihc nattin of ihc nren of grouni upon which the head wns alleged to
ha\e fallen soft earth, for instance or a lianl llagstonc If on soft e^th
w as tlicrc d sharp stone or brick or other liard substance with w Inch the head
could liaA e come in contnet^

i U(it 3 fhd ihe fall occur—uas tt pitching or nof* Does the position of
the mjur> on the head correspond with direct violent e winch might has e been
snslametl l)\ a blow eitlier of a fist or weapon or does it more ncarl> corres
pond with the direction of the alleged fall’

8 The {lositiun niuHlicr aiul nature of the injuries If a fight is admitted
main hruiscs maj be seen but if oul\ one blow or none is admitted then
the fall jin> be sutbrient to account for the injuries Almost all fall injuries’
art to tlie sides and back of the head

III 7i s ConotCCC iyo 2 ) deceased was stnitk in the face whilst standing in a
<1 wrwai he was thrown ng-Unst a projcctinj, door haiiiHc, striking Ins head lie
felt rough foi a hit but made lits w-aj home and got into bed partlj undressed At
2 nni lie was heard RiwmTig nnd at 0 am he was found dead m his bed Tsso
heas) hruiscs as from a (lit were foun 1 on the right side of the fact and an injur)
from a hcaw blunt object on the left side of iJic head aboias the ear fiie skull
was depressed and Incturcd oser an areal inch in diameter shaped like the surface
of tl e door liandle

\ iium last seen quarrelling with a fellcm workman at a gateway was 1 \ter fi und
dead on tin. same spit Ilcboreaslmiieejosallmnsc to the side of the I cadnnd adc
I ressed fmclure that wus at first thought to be llic impression of the toe of n boot
It was I Iter howeser, si owa\ to Ime | resisels Uie same contour and dimensions
HSacortiorof Uieornaiiunt d waJlbi aslwcJi liclisd liceii standing \utopsy rcicalcd
^ nchanccd heart disease sunicienl to cause collapse and fall (during which llie head
« 111 I haw struck the vrwU)

Injt y / **rjr Do/&s nnd/t inj/ordfC C C 1042) a gang of \oulhs assaulted a bo\

of 1 , at tU 1 Uphant and Castle m the block out fhe hO) \tos felled to the
l^nund and dkd m bospiinl some Z hours later At the autoiis) a bruise 2 inches m
13 fhci\nTn"" of the upper I p o\er n camne

HmI. r« f" 1 ^ ‘ n ’’'"'I t V* ossocialotl w i tli a split m the scalp prob ibU

due to a fall Uic skull was fracturwl under this and hta\y bruising of the bram
(mninh oicr the frontal £)( Ics) h\ mi/re eowp laid j recipitatul death

llie following cases nre inserted logitesonie warning of the gross lesions
whKh lun) sometimes be mdiclcd without causing c\cu the immediate
imcousuousncsb far less death of the patient

weiLhinrt lai^^ ^ "idles long ni d 1} uiclies in diameter, has ing a tapering point und

i rn!?

entered the skull In tl c temporal fossa anduneigtd where the two

*318

^^oL^D*» or Tin h ici

bones join the frontal bone Tlien. much hTmorrh-i-. an 1 Mcaiv* of
b^n matter The patient spoke a few minutes nfler iJic nceiiJent. iml fruo nn

tS^rhl 'Tr I'lappcned lie lad a ion^^lliis"'hiu7dnVI^

„ ,V ’ “"i iri-uscmi nil ins noiiiiKs of Itoch nml mlnil

of thraccideiit)7 e\e(n: llic left, wlmli ms prolnHeil at It e lime

Slnh » omirf nj Ihf Jimm* A case oceurrcl m Mmtns in nhn I. n man ms slablnl
m the forcticail \vitli a knife with such force tliat the enlin librtc 4} inct.es Ion •
penetrated tlie head The stab wound s\ns situates! afK)\ c tJit inner end of tl c n ht
esebrow, and the blade had passed dreph into the l.min siirsnsnl secimsl imiM^,«iru
tlioiiRli ttie man when admitted to hospital was t ilkm? rdionalK Tin knih was
remosedonU with prcit difTicnlts at the end of lialf nii hour Vftrr licme tmtnl
for 40 da>s full recoserj resulted

Penclrahfin of lirnin by Iron Itort* \ Ims asinl 14 scars was ninniii" nl ng n
workshop with a long iron roil in his liaiid when be tn|ij«-il nnd fill mil the twl
|)cnetrated his check Ife piilleil it out liinLscIf

TJie wound was elrcssod b\ a medical man, ssho nfirml him ti tic mnrnnin
for subsequent treatment he secmeil mcrel> dared after the ncei lent On the m \t
d n he prcsentctl himself at the rasiialtj «lep irtnieiit with ti septic (nil inwsl wi im I
111 the right cheek and whilst wailing to be attendid hi scciikmI iiiiaMe b> k*’e|'
awake Tlus attracted the attention of Hit. casiialu f Ihtt r an I Ihi Im v w is admit
teil IlcMiiid a slight clesation of lempeniture and markid doimini-ss ll iit was
an entire absence of sjinploms When rou-ei! he woiil I Mt up ami uiswcr inti !h
gcnlh but m an apathetu wn\ anv questions nd Iresscd to him nn 1 a-* s/M>n a'
thej were discontinued he would dnp ilown m bed nn I fall asleep at fiiei He
would feed himself but woul 1 go to slcqi Iielween moufhfuN I < ur i! ivs later lie
was sent home hut a connibion oeeuncil and the lad died the next da\

It was found that the hkI after fieiittritiiig tl e rheik Im I pisscil mu h tin.
7>gomatic arch anil through the great wing of the s| lienoid It enltred the hr iiii
near the npe\ of the right temporo splieiioidal lobe and wilhnn ineluntl ii inwnr Is
passed through the posterior part of the froiitfil Jobs nti 1 en lid on tl e lanrteMls
close to tlie longitudinal fissure

riiis nspcct of sescrc penetrating head tnjiirj is nlso refimal lo in Hit
section on rireunn w-ounds (p “ISI)

n OUiNDS OF THE FACE. MOUTH AND TEETH
When ssoiinds of tlic face nn. mon. limn skin deep thti an jmIiMiiIIi
serinus and iisunlls folioned b\ disfigurement, nnd nlicii this {>iii<lndc Ih* ^
casilics m wliiili theorjransof till senses iirt Mtiiafcd tliiv often prmt fitnl
cither li\ ins oh ing the limn and its iiiciiibracRS or b\ gix iii„ n e to inllnmm i
tion of the Mimses nnd laltr of the mimiiges \inimn«is nr 1 linduess is ru
occasional sequel of blows of the fare pminblj due U> rupture of the rtlitmp
^\ ar has pros idcd numerous exampits of hhndiiess wjHioiit nbi ions extern i!
injurj, but with h-emorrhage into the Mlrcms rsipturvs of the retina and
choroid, etc to account for it flic explanation npp^irs to be lint the deep
injurj IS line to compression of llic oebaM bs force of explosions or blows ou
the face

Wounds of the nose arc gcncmih sptaking of a simple nature
of dangerous bleeding into the throat and hnincliml tree ni rar^ ' 1,,,..
wise gti mg nsc lo serious s> mptoms Thtx nre often fo lowcrl bv
If the injurs is n contusion and, at the sunc time, t' eiwm

ii me injurs is n coniusiuii uuu, uv

sense of smell maj result A penetfntmg wxmnil of ic j

pa.ssing n sharp pointed instrument up Uie n^trih 'J^TiL'bmtn

oerfomtinif the cnbnform plalc of the ethmoid bone anc ij o

perforating the cnbnform plalc

•HJirelow \ J 18^ Amrr J werf » - . , ,
itoifUnJ \ J aalNoItwi II irr-i llntmeJ J 3
*Knapg», It

JMUIillS 70 TIIF ^PI^E -JtO

SuchaMound itis obvious nii^bt be producwl without leav mg nnj extcmni
marhs of injun Infection of the meninges nia\ follow either rapidlj or
after remarkablv long mterv nM

INJURIES TO THE SPINE

Injuries to the spine and spinal marrow seldom involve criminal enquirj
but thov are verv common in civil cases both under the older l^orknnn s
Compensation and the National Insurance (Industrial Injuries) Vets llie
spinal