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DR. C.E.KIDDER

LOS ANGELES

ATLASES.

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ATLAS

LEGAL MEDICINE

N.A- BY

DR. E. VON HOFMANN

Professor of Legal Medicine and Director of the Medico-Legal Institute
at Vienna

AUTHORIZED TRANSLATION FROM THE GERMAN

EDITED BY

FREDERICK PETERSON, M. D.

Clinical Professor of Mental Diseases in the Woman's Medical College,

New York ; Chief of Clinic, Nervous Department, College

of Physicians and Surgeons, New York

ASSISTED BY

ALOYSIUS O. J. KELLY, M.D.

Instructor in Physical Diagnosis, University of Pennsylvania ; Adjunct Professor

of Pathology, Philadelphia Polyclinic ; Visiting Physician to St. Mary's and

St. Agnes' Hospitals; Pathologist to the German Hospital, Philadelphia

56 Plates !n Colors, and 193 Illustrations In Black

PHILADELPHIA
W. B. SAUNDERS

925 Walnut Street
1898

WA?oo

3 cc

(47/3

COPYKIGHT, 1898,

BY W. B. SAUNDERS.

ELECTROTYPED BY PRESS OF W. B. SAUNDERS.

WESTCOTT & THOMSON, PHILAOA. PHILAOA.

AUTHOR'S PREFACE.

In cheerfully complying with an expressed request of
the publishers, asking me to prepare a "Hand- Atlas of
Legal Medicine," I have been actuated by a variety
of motives. In legal medicine, as in other branches, the
desire for illustrations becomes daily more apparent, and
this desire can be complied with but in part within the
limits of the general text-books. Further, the hand-
atlases which have already been issued by this publish-
iug-firm exhibit evidences of decided progress in this
department of art, and in consequence, as also because of
their inherent qualities, have been accorded a widespread
recognition. Finally, an opportunity was for the first
time presented to provide a cheap book, and therefore
one of easy acquisition, which would enable the practis-
ing physician, as also the student of medicine, to become
acquainted graphically with the most important occur-
rences of medicolegal interest.

The illustrations are entirely original, and have been
prepared either from recent cases or from museum speci-
mens. A few have been reproduced from other publica-
tions, but they also are original observations.

In the preparation of the atlas my purpose has been
that it should serve for further illustration of a good text-
book— that it should be, to a certain extent, a supplement
to the latter. I have therefore limited the descriptive

3

4 AUTHOR'S PREFACE.

text, and have not considered a series of illustrations
such as are found in every good text-book of legal medi-
cine and in other widely distributed books, as, for instance,
blood-spectra, spermatozoa, etc. This, on the one hand,
diminishes the cost of the book, and, on the other, permits
of the introduction of other important illustrations.

An exhaustive account of the subject has not been
thought of, nor has it been considered possible. I have
rather striven, as far as space, opportunity, and a regard
to the cost permitted, to portray instructive instances of
at least the most important medicolegal occurrences.

The colored plates and the photographic reproductions
have been very ably executed by Mr. A. Schmitson, art-
ist, and, for a layman, with an accuracy of comprehension
worthy of commendation.

My two assistants, Drs. Haberda and Richter, privat-
docents, have heartily co-operated in the preparation of
the work, and to them, for their assistance, I express my
warmest thanks.

PREFACE TO THE TRANSLATION.

There is perhaps no field of science in which the
value of illustrations is greater than in forensic medicine.
The problems which confront the coroner, the post-mor-
tem examiner, and the courts of law must be solved by
the presentation of indisputable facts. Many of these
facts can be fully appreciated and understood only by the
medicolegal expert of years of experience. But a vol-
ume such as this, made up chiefly of photographs and
original drawings of various lesions and pathological con-
ditions, taken directly from actual cases, supplies to every
physician and student an enormous array of medicolegal
data, such as would take one many years to acquire alone
and unaided. This volume is a veritable treasure-house
of information, gained from the rich material of one of
the greatest institutes of legal medicine in the world, and
collected by one who, until his death a few months ago,
was perhaps the ablest living expert in his chosen domain
of work.

The text has been Englished by Dr. Kelly, and the
translation carefully compared with the original by the
Editor-in-chief. Every effort has been made, while pre-
serving so far as possible the difficult style of the author,
to make the statements explicit and clear. There are
some words in the text (such as lochbruch) which have no
good equivalents in our tongue, and these have been neces-
sarily rendered into literal English.

FREDERICK PETERSON.

New Yobk, April, 1898.

5

LIST OF PLATES AND FIGURES.

Fig. 1. Abnormal smallness of the penis ; incomplete cryptorchi-

dism.

Fig. 2. Cicatricial deformity of the penis.

Fig. 3. Union of the under surface of the penis and the scrotal skin

(synechia).

Fig. 4. Epispadias.

Fig. 5. Masculine pseudohermaphrodism.

Fig. 6. Unusual development of the clitoris.

Fig. 7. External masculine pseudohermaphrodism.

Figs. 8-13. Hymen annularis and semilunaris (circular and semilunar
hymens).

Figs. 14-24. Varieties of hymens with congenital notches.

Figs. 25-27. Hymeu fimbriatus.

Figs. 28-33. Divided hymens with symmetric openings.

Figs. 34-36. Divided hymens with asymmetric openings.

Fig. 37. Hymen of irregular form.

Figs. 38-44. Hymens with partial or rudimentary septa.

Figs. 45, 46. Hymens with two circular openings, situate one below the
other.

Fig. 47. Semilunar hymen with thinning of the right, and perfora-

tion of the left, lateral half. Indication of the formation
of a hymen cribriformis.

Fig. 48. Deflorated hymen annularis with congested and swollen

lacerated edges.

Figs. 49-52. Ordinary deflorated hymens.

Figs. 53-55. Caruncula? myrtifovmes.

Figs. 56-59. Hymen septus (divided hymen) after defloration and after
parturition.

Figs. 60-62. Traumatic injuries of the external genitalia.

Figs. 63-65. Os uteri of adult virgins.

Fig. 66. Os uteri (pathological ?) of a virgin of advanced age.

Fig. 67. Os uteri of a woman who has given birth.

Plate 1. Cervix and vagina directly after parturition.

7

8 LIST OF PLATES AND FIGURES.

Plate 2. Spontaneous rupture of the uterus.

Plate 3. Tubal pregnancy ; rupture of the sac ; internal hemorrhage.

Plate 4. Embryo found within an uninjured amniotic sac among blood-
clots, from a case of tubal pregnancy.

Fig. 68. Fatal hemorrhage from retention of a portion of the placenta.

Fig. 69. Retention of a portion of the placenta, with consecutive fatal
hemorrhage.

Figs. 70, 71. Two uteri in the very earliest stages of pregnancy.

Fig. 72. Human ovum of the eighth or tenth week.

Fig. 73. Rupture of the vagina through coitus or by the ringer.

Fig. 74. Acute sepsis following abortion. Punctured wound in the for-
nix of the vagina.

Fig. 75. Abortion induced by a probe-like instrument. Perforation of
the posterior wall of the uterus.

Fig. 76. Abortion induced by rupture of the membranes of the ovum.
Slit-like laceration above and below the internal os uteri.

Fig. 77. Abortion induced by injections. Perforation of the fornix of
the vagina and the fundus of the uterus.

Fig. 78. Divulsion of the cervix from the uterus. Abortion.

Plate 5. Respiratory organs and heart of a full-term child which died dur-
ing birth of " fetal suffocation " from premature respiration.

Fig. 79. The epiphyses of the lower extremity and of the humerus
of a mature, newly born child.

Fig. 80. Epiphyses and posterior tarsal bones of a premature, and of a
full-term newly born, and of a 3J-months-old child.

Figs. 81, 82. Suffocation of the newly born by intentional obstruction of
the pharynx.

Plate 6. Lungs of newly born infants.

Plate 7. Newly born child. Suffocation by a portion of the membranes.

Fig. 83. Congenital fissure-formation of the skull of the newly born.

Fig. 84. Defects of ossification in the skull of a newly born child.

Fig. 85. Pretended precipitate birth in a closet. Spoon-shaped depres-
sion of the left, compression-fracture of the right, parietal
bone.

Fig. 86. Fracture of the skull from a fall on the vertex.

Plate 8. Fracture of the base of the skull, with extradural hemorrhage.

Plate 9. Traumatic extradural hematoma.

Plate 10. Fracture of the base of the skull, with rupture of the middle
meningeal artery — after removal of the extradural hema-
toma.

Fig. 87. Fracture of the skull due to compression.

Fig. 88. Star-shaped fracture of the parietal region.

Plate 11. Recent contusions of the brain.

LIST OF PLATES AND FIGURES. 9

Fig. 89. Healed hole-fractures (Lochbriiche) produced by a black-
jack.

Figs. 90, 91. Fractures of the skull due to blows of a horse's hoof.

Plate 12. Healed contusions of the brain.

Fig. 92. Hole-fractures (lochfracturen).

Fig. 93. Fractures of the skull produced by blows with a round or so-
called French hammer.

Fig. 94. Skull of a man who was murdered and remained buried in a
manure-mound for four years.

Fig. 95. Circumscribed destruction of the right occipital region pro-
duced by a blow with a hatchet.

Fig. 96. Fracture of the frontal bone produced with a brick.

Fig. 97. Fracture of the skull produced with a mason's hammer.

Fig. 98. Fracture of the skull produced by a fragment of glass.

Fig. 99. Manslaughter by means of a long, angular bar of iron.

Plate 13. Contusion of the lung.

Plate 14. Peritonitis from traumatic rupture of the jejunum.

Fig. 100. Healed fracture of the right parietal region.

Figs. 102, 103. Injury of the lung the result of various fractures of the
ribs.

Plate 15. ] Murder the result of various blows inflicted with different

Fig. 101. i instruments.

Plate 16. Suicide by cutting the throat. Death through suffocation.

Figs. 104-106. Suicide by cutting the throat.

Fig. 107. Body of a 4-months-old child, perforated, to show the cleav-
age of the skin.

Fig. 108. Numerous punctured wounds of the stomach produced with
a conical instrument.

Plate 17. Suicide through stabbing.

Plate 18. Triple injury to the small intestine produced by a stab. Peri-
tonitis.

Fig. 109. Stab-wounds produced with a four-cornered picture-nail.

Fig. 110. Punctured wound in the parietal bone produced with a
knife.

Fig. 111. Punctured wounds of the skull.

Fig. 112. Punctured wounds produced with a sharpened three-cornered
file.

Figs. 113, 114. Punctured-incised wounds of the left hand received in
self-defence.

Figs. 115, 116. Murder produced with a fascine-knife.

Fig. 117. Saber-blow.

Fig. 118. Murder caused by numerous hatchet-blows.

Fig. 119. Murder caused by a saber-blow.

10 LIST OF PLATES AND FIGURES.

Fig. 120. Fracture of the skull produced by a blow with the cutting-
edge of a batchet.

Plate 19. Close-range gunshot-wound in the region of the heart pro-
duced with a revolver of 9 mm. caliber.

Fig. 121. Suicide with a carbine.

Fig. 122. Gunshot-wound of the right temporal region produced with a
double-barrelled rifle, which in shooting burst; suicide.

Fig. 123. Suicide by six shots in the cardiac region, four of which pen-
etrated the heart itself.

Fig. 124. Revolver-shot in the mouth.

Fig. 125. Suicide by a gunshot-wound in the mouth.

Fig. 126. Shot through the dependent mamma, with three external
openings.

Fig. 127. Suicide by a shot with a hunting-rifle and " spreading-car-
tridge" (Stauchpatrone).

Fig. 128. Grazing gunshot-wound of the right external ear, with scat-
tered grains of powder in its vicinity.

Fig. 129. Gunshot-wound transversely through the brain ; suicide.

Fig. 130. Simple punctured gunshot-wound of the frontal bone pro-
duced with an ordinary revolver.

Fig. 131. Close-range shot with a Mannlicher rifle; suicide.

Fig. 132. Wound of exit of the gunshot-injury produced with a Mann-
licher rifle, illustrated in Fig. 131.

Fig. 133. Revolver-shot in the frontal bone.

Fig. 134. Wound of exit at the right side of the occiput of a gunshot-
wound through the left frontal region ; suicide.

Fig. 135. Suicide by a shot with an army revolver into the right tem-
poral region.

Fig. 136. Suicide by a shot in the left temporal region with a moder-
ately large revolver loaded with broken lead.

Fig. 137. Murder by anarchists ; gunshot-wound.

Figs. 138, 139. Suicides by gunshots ; unusual situation of the wounds
of entrance.

Fig. 140. Gunshot-wound by a hunting-rifle.

Plate 20. Encircling gunshot-wound.

Figs. 141-169. Deformation of projectiles.

Plate 21. Burns produced by flames.

Fig. 170. Murder or suicide by burning.

Fig. 171. Right upper arm and scapula of a charred body, with the
muscles attached to them.

Fig. 172. Healed scald-wound of the esophagus.

Plate 22. Suicide by hanging; suspension of the body for several days ;
peculiar distribution of the hypostases.

LIST OF PLATES AND FIGURES. 11

Figs. 173-177. Various positions of the noose in cases of persons hanged.
Plate 23. Suicide by hanging with a double rope. Asymmetric position

of the noose.
Plate 24. Suicide by hanging with an old rope wound five times about

the nock.
Fig. 17S. Suicide by hanging in the kneeling posture.
Fig. 179. Suicide by hanging in a semi-sittiug posture.
Fig. 180. Suicide by hanging in the prone posture.
Fig. 181. Fracture of the larynx and of the hyoid bone in a person

hanged.
Fig. 182. Bilateral rupture of the sternocleidomastoid muscles in a

person hanged.
Fig. 183. Fracture of the thyroid and cricoid cartilages in a person

hanged.
Fig. 184. Self-strangulation.
Fig. 1S5. Newly born child killed by having its throat cut and by

being strangled.
Plate 25. Lungs of a dog which was drowned.
Plate 26. Left hand of a drowned day-laborer whose body remained in

the water twenty-four hours.
Plate 27. Left hand of a drowned person whose body had remained in

running water for several weeks.
Plates 28, 29. Fungus- (alga?-) formation on a cadaver found in water.
Plate 30. Alterations of the blood due to irritant poisons.
Plate 31. Poisoning by caustic soda.
Plate 32. Poisoning with concentrated sodium hydrate colored with

ultramarine-blue.
Plate 33. Suicidal poisoning with concentrated sulphuric acid.
Plate 34. Poisoning with dilute sulphuric acid.
Plate 35. Hydrochloric-acid poisoning.

Plate 36a. Duodenum from a case of hydrochloric-acid poisoning.
Plate 361). Spleen from a case of carbolic-acid poisoning.
Plate 37. Poisoning with concentrated nitric acid.
Plate 38. Poisoning with carbolic acid. Suicide or accident?
Plate 39. Poisoning with carbolic acid. Suicide.
Plate 40. Cauterization of the lips and the region about the mouth with

lysol.
Plate 41. Acute poisoning with corrosive sublimate.
Plate 42. Subacute poisoning with corrosive sublimate.
Plate 43. Corrosive-sublimate dysentery.

Plate 44. Kidney from a case of corrosive-sublimate poisoning.
Fig. 186. Stricture of the esophagus and cicatrix of the stomach the

result of poisoning with liquor potassse.

12 LIST OF PLATES AND FIGURES.

Fig. 187. Stricture of the esophagus following the ingestion of caustic

potash. Perforation of the esophagus with an esophageal

sound.
Plate 45. Potassium-cyanid poisoning.
Plate 46. Fauces, pharynx, and entrance to the larynx from a case of

potassium-cyanid poisoning.
Plate 47. Subacute phosphorus-poisoning.

Plate 48a. Liver from a case of subacute phosphorus-poisoning.
Plate 48b. Kidney from a case of subacute phosphorus-poisoning.
Plate 49. Stomach from a case of acute arsenical poisoning. Murder by

poison.
Plate 50. Small intestine from a case of acute arsenical poisoning.
Plate 51. Carbonic-oxid poisoning (charcoal-fumes).
Plate 52. Agonal injuries of the face.
Plate 53. Abnormal situation of postmortem lividity as a result of

the abdominal position of the body.
Plate 54. Lower extremity of a newly born child which remained sev-
eral mouths in running water; formation of adipocere.
Plate 55. Portion of the abdominal skin of a body which had been in

water two or three months, and which demonstrates the

formation of so-called adipocere.
Fig. 188. Larvae of flies in the angles of the eyelids and mouth.
Fig. 189. Lower extremity of a newly born child gnawed by rats.
Figs. 190, 191. Lower half of the body of a newly born child with nu-
merous puncture-like wounds of the skin.
Plate 56. Mummified cadaver.
Fig. 192. Excessively putrescent body of an old man — in great part

consumed by maggots — found sixteeu days after death.
Fig. 193. Skull of a five-year-old child, with all the temporary teeth

and the germinal deposits of the permanent teeth.

Fig. I.

i

FIGURE 1.

Abnormal Smallness • of the Penis; Incomplete Crypt-
orchidism.

The genitals are from an unmarried man, aged 46 years, who died sud-
denly of cerebral hemorrhage.

The corpse was fat and well developed ; the face, excepting a scanty
downy moustache, beardless; the larynx not prominent, completely carti-
laginous; the costal cartilages unossified ; the mamma' undeveloped ; the
pubic hair but moderately developed, limited above transversely.

The penis is present as a cylindrical-shaped body 1.5 cm. long, 12 mm.
thick. Its anterior half is formed by a correspondingly small glans with
exposed tip, but otherwise covered by the prepuce. The scrotum is a re-
laxed, shallow, wrinkled skin-pocket with distinct raphe. In it small
testicles are to be felt, which, on more careful dissection, are found as
soft, relaxed bodies the size of walnuts, situate in the anterior part of
the inguinal canal, and revealing distinct testicle and epididymis. The
seminal vesicles are very small and empty. Spermatozoa are demon-
strable neither in the latter nor in the testicles.

We have therefore to do witb a case of incomplete descent of the tes-
ticles, with their persistence in the inguinal canal and their consequent
atrophy, and with an abnormal smallness of the penis. The congenital
origin of this defective formation of the genitalia is indicated by the
imperfect development of the masculine habitus — similarly as occurs in
individuals castrated before puberty — by the abundant formation of fat,
absent beard, non-prominent larynx, and the completely soft and readily
cut laryngeal and costal cartilages, despite advanced age.

Under these circumstances, had the ability of the individual to beget
been in question, one should have been obliged to assert that he possessed
neither the power to copulate nor to impregnate.

FIGURE 2.
Cicatricial Deformity of the Penis.

The preparation is from a married man, aged 64 years, the father of a
son aged 20 years. As he was dressing he died suddenly on the morning
of November 14, 1880. To determine the cause of death, a necropsy was
performed November 15th. This revealed hypertrophy of the heart,
consequent upon a high grade of endarteritis deformans and nephritis.

In both inguinal regions, extensive white cutaneous cicatrices reach-
ing to the inner surfaces of both thighs, and to the outer surface also of
the right, with an undermined bridge of skin corresponding to the right
Poupart's ligament; the scars on both sides extending also to the upper
part of the scrotum. In addition, similar scars on the inner aspect of the
left knee, on the entire posterior surface of the left, and on the upper
third of that of the right thigh.

Of the penis, there remains but an irregular thick stump, the width
of two fingers in length. The skin-covering is everywhere cicatricial ; to
the right it is movable; to the left, posterior to the still apparent groove
of the glaus penis, it is united with the deeper tissues, whereby the en-
tire stump of the penis is curved toward the left. The glans is flat,
fungiform, as though compressed anteroposteriorly, and at the same time
twisted by a cicatrix toward the left. The urethral orifice is to the right
and below, forming an open transverse fissure with plump edges.

Concerning the production of this deformity, there was unfortunately
nothing to learn. It appears, however, to have been produced during
childhood, as neither the wife nor the son of the deceased knew any-
thing of it, and were unaware of any disease or injury having been sus-
tained by the man during the past decennium. The scars and the de-
formity of the penis most probably originated in the healing of wounds
produced by burns.

Despite the high grade of the deformity, it cannot be asserted that
the deceased was incapable of coitus, as the stump of the penis was the
breadth of two fingers in length and during erection was capable of
elongating, so that the introduction of the organ into the entrance of the
vagina at least was possible. In how far the scars, particularly the im-
movable ones of the left side, were capable of influencing erection can-
not be determined.

As, in addition, the testicles of the man, despite his advanced age,
were large and intact, and as the excretory passages for the semen showed
no abnormalities, in a given case there would be no justification for an
assertion that the aforementioned son could not have been begotten by
the deceased.

Fig. 2.

Fig. 3

Fig. 4.

FIGURES 3, 4.

Fig. 3.— Union of the Under Surface of the Penis with the
Scrotal Skin (Synechia).

This rare malformation befell a 4-year-old boy — otherwise normally
developed. The skin of the penis is — from its root to the prepuce —
united with the anterior surface of the scrotum, the skin of which along
the anterior part of the scrotal raphe is directly continuous with the
lateral surfaces of the penis. The genitalia are otherwise entirely
normal.

As regards sexual intercourse in later life, this malformation would
have been of importance, as it would probably have given rise to an
impediment in the erection and insertion of the penis. The hindrance
to erection would probably not have been great, as the corpora cavernosa
are normally developed, and the relaxation and elasticity of the skin,
both of the scrotum and the penis, permit of wide movement. On the
other hand, however, an impediment to the insertion of the penis would
probably have arisen ; but this could hardly have been designated an
essential obstacle to coition, as, firstly, an introduction into the vulva at
least would have been possible, and, secondly, by a small operation the
impediment could have been radically removed.

Fig. 4.— Epispadias.

The genitalia of a 5-months-old boy. The scrotum is normally devel-
oped, and contains both testicles. The penis is somewhat shortened,
and shows a club-shaped thickening of the extremity. This is depend-
ent externally upon the prepuce split open by the strikingly wide, ap-
parently anteroposteriorly flattened glans. The latter is split open from
the meatus urinarius, and this slit extends as a furrow along the dorsum
of the penis to beneath the symphysis ossium pubis, from which point
the bladder may be entered. Under the symphysis the skin forms an
arched elevation open below, beneath which the root of the penis is
concealed.

As the genitalia are otherwise normally formed, and as the corpora
cavernosa are well developed, coition later would not have been preju-
dicially affected. Nor could one entirely exclude the capability of im-
pregnating, as an ejaculation of semen, if not into the vagina itself,
would still have been possible into the introitus thereof, or at least into
the vulva.

FIGURES 5, 6.
F«g» 5- — Masculine Pseudohermaphrodism.

Female child, with normal internal and hermaphroditic external
genitalia. Of the latter, the labia majora and minora are normally
developed ; the clitoris, however, is excessively large, resembling a penis
with hypospadias. The latter is drawn markedly downward and reveals
on its under surface an open, furrowed urethra, running backward from
the tip of the glans, ending in the perineum, and leading into the
bladder. The vaginal orifice is greatly contracted, scarcely the size of a
lentil, but leads immediately into a vagina of normal caliber. A hymen
is not present.

Fig. 6.— Unusual Development of the Clitoris.

Female genitalia, with normal development of the labia majora and
minora, but with marked contraction of the orifice of the vagina. The
clitoris has a decidedly penis-like character, is 4.5 cm. long, 3 cm. thick,
and possesses a much wrinkled prepuce and a strongly developed but not
perforated glans. From the apex of the latter a furrowed groove runs
along the under surface of the clitoris to the symphysis, and above the
contracted orifice of the vagina enters the bladder.

During childhood the genitalia were thought to be those of a male,
but after repeated careful examinations were recognized as those of a
female.

Fig. 5-

Fig. 6.

Fig. 7.

FIGURE 7.
External Masculine Pseudohermaphrodism.

The illustrative case was that of an unmarried, supposedly female
peddler, aged 62 years, who was injured by falling from a wagon, and
whose real sex was first determined by the official necropsy.

The body was 153 cm. long, bony, poor in muscle, thin, and somewhat
iiiiirasmic. On the upper lip and on the chin were isolated, short, gray
hairs, The rest of the senile face was beardless. The pubic hair was
blond, moderately developed ; the limitation of the hair above was arched.

The penis is as large as the terminal phalanx of the thumb; the glans
is the size of a hazelnut and is partially covered by a short prepuce which
at its lower part is split, and which, with the intervening thickened and
likewise divided frenuiu, descends in the direction of the raphe a dis-
tance of 1.5 cm. It then unites with the latter to form a dense, tendin-
ous, protruding elevation, which after a course of 1.3 cm. divides again
and ends in a pointedly oval fissure, 1.5 cm. long, surrounded by promi-
nent, dense, tendinous margins. This fissure deepens as a funnel inward
and upward, whence one may enter the urethra and the bladder. The
fissure, even when the thighs were separated, was concealed by the much
dependent halves of the scrotum, between which there remained a large,
penetrating, funnel-shaped space, within whose depths the aforemen-
tioned fissure was situated. It was apparently because of this and be-
cause of the smallness of the penis, a vulva was simulated and the mis-
take as to the sex produced.

The testicles, situated within the scrotum, were of ordinary size, but
soft and, on section, cinnamon-brown. The vasa deferentia were patu-
lous; the verumontanuni in the posterior part of the urethra, with the
utriculus and the ejaculatory ducts, was normally formed ; the seminal
vesicles were small, slightly sacculated, and contained a quantity of
brownish fluid. Spermatozoa were nowhere demonstrable.

Of the relatives, no one supposed that the deceased had an abnormal-
ity of the genitalia, nor had the deceased herself ever made any declara-
tions in this regard ; still, she is said never to have menstruated and
never to have manifested sexual desires, and in consequence remained
unmarried.

FIGURES 8-13.

Hymen Annularis and Semilunaris (Circular and Semilunar
Hymens).

Fig. 8. — Circular hymen — hymen annularis — with wide opening and
circular, smooth-edged margin, of equable height throughout, surround-
ing the entrance to the vagina.

Fig. 9. — Circular hymen with margin somewhat notched above, but
otherwise with rather smooth edges ; on the posterior surface the poste-
rior columna rugarum directed to the left.

Figs. 10-12.— Transitions to semilunar hymens— in that the orifice
of the hyinen is no longer centrally situated, but is shifted upward,
whereby the lower margin of the hymen becomes wider than the upper.
In Fig. 12 is an indication of the keel-shaped appearance which the folds
of the hymen assume when the genitalia are closed.

Fig. 13.— Semilunar hymen — hymen semilunaris. — At the lower part
of the entrance to the vagina is a falciform, sharp-edged fold of mucous
membrane, the cornua of which terminate on both sides at the middle
of the introitus.

Fig. 9.

Fig. 8.

Fig. 10.

V-

*/'-~v --

el

Fig. 11.

m

[_

Fig. 13.

Fig. 12.

Fig. 14.

Fig. 15.

Fig. 17.

Fig. 18.

FIGURES 14-18.
Varieties of Hymens with Congenital Notches.

Fig. 14. — Hymen with exeentric opening toward the upper part»in
the lift upper quadrant UB a wide notch, with fimbriated edges reaching
to the wall of the entrance to the vagina.

Fig. 15. — Circular hymen with various smooth projections of the free
edge.

Fig. 16. — Hymen of a newly born child with deep notches to the
right and below.

Fig. 17. — Circular hymen with a deep congenital notch both below
and in the left upper part. All the edges smooth and rounded.

Fig. 18. — Hymen annularis of fleshy consistency with four deep
notches, which, similarly to the intervening hymenal tissue, possess
gradually thinning smooth edges.

FIGURES 19-24.

Varieties of Hymens with Congenital Notches.

Fig. 19. — Hymen with numerous shallow notches regularly arranged
equidistant from each other, giving to the free edge a dentate appearance.

Fig. 20. — Hymen semiluuaris with a notch situate in the middle of
both lateral aspects.

Figs. 21 and 22. — Deep irregular notching of the hymen of a newly
born child, whereby it assumes a dentate appearance.

Fig. 23. — Serrated hymen of a virgin at puberty. It possesses a wide
sinuous opening, does not form a tense diaphragm, and permits the
introduction of a voluminous body (speculum) without rupturing, — the
serrations simply receding.

Fig. 24. — Serrated hymen of an adult virgin. The hymen consists
of several flaps which have rounded edges, and which in part show
slight formation of fimbria and are readily displaced. As at the same
time the lower margin is strikingly narrower than the others, this
hymen represents a stage of transition to the so-called labial form of
hymen.

Fig. 19.

Fig. 20.

J

Fig. 21.

Fig. 23.

F^^

I'f

Fig. 22.

Fig. 24.

Fig. 26.

Fig. 25.

Fig. 28.

Fig. 27.

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Br. \

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Fig. 29.

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FIGURES 25-29.
Hymen Fimbriatus and Hymen Bipartitus or Septus.

In Fig. "25 we see at the middle of the right lateral aspect of the gen-
erally circular hymen of a 16-year-old virgin, a rather wide notch, and
in the left side two fissure-like radiating notches, all of which continue
ou the posterior wall of the hymen between the adjoining folds of the
vaginal mucous membrane. The free edge, both of these notches and
of the rest of the hymen, possesses delicate fimbriated papillae, which
are also scattered over the anterior surface of the hymen, on the inner
surface of the labia minora — especially at its upper part — and in the
region of the clitoris. We have, therefore, to do with an apparently
congenital papillary hyperplasia of the mucous membrane of the exter-
nal genitalia, but especially with that variety of hymen-formation
which, since Luschka, has been designated hymen fimbriatus.

Figs. 2(3 and 27 show two similar but much more marked cases. In
both the hymen is serrated, and the free edge of all the notches and pro-
jections possesses — in Fig. 26 cilia-like, and in Fig. 27 somewhat coarser,
processes, whereby both hymens present a corolliform appearance.

Figs. 28 and 29 furnish examples of so-called divided hymen — hymen
bipartitus or hymen septus. Both affect circular hymens, each with an
opening, situate toward the upper part, divided iuto two each of equal
size by a narrow band of mucous membrane directed from above down-
ward. This variety of hymen occurs frequently in varying combina-
tions with other vestiges of the former bifurcation of the genital tube,
so that there appears to exist a relationship between both of these
formations. Fig. 28 is further of interest, as the septum appears con-
stricted in the center.

FIGURES 30-34.

Varieties of Hymens with Divided Openings.

Figs. 30, 31, and 32 show similar septuin-forniation with symmetrical
openings of semilunar hymens. Especially interesting is the case
illustrated in Fig. 31, as the septum is as a fine thread coursing from the
center of the hymenal crescent to the superior periphery of the vaginal
entrance, giving to the hymen the appearance of an unfurled sail.

Fig. 33. — This hymen was that of an unmarried woman, aged 24 years.
It is of extraordinary dense almost tendinous consistency, and possesses
two almost beau-sized, laterally situated openings, separated from each
other by a dense, tendinous septum, 1 cm. wide and J cm. thick. There
is no doubt that this hymen, because of its unusual solidity — increased
by the septum-formation — would constitute a decided impediment to
coition, and in case of marriage might possibly have given rise on the
part of the husband to a s'uit-at-law for divorce or separation.

The medicolegal expert would have had to declare, 1, that a positive
impediment to coition was present ; 2, that it was present before mar-
riage; but, 3, that it could be removed by an operation. The possibility
of fecundation despite the impediment to coition could not be uncondi-
tionally denied, as even a coitus merely within the vulva may lead to
the entrance of semen into the vagina and subsequent fecundation, the
proof of which possibility is afforded by numerous actual occurrences.

Fig. 34.— Divided circular hymen of an adult woman, with a larger
opening to the right, and to the left a much smaller round opening with
smooth edges. In this case during coitus there would have been possible
but a unilateral rupture of the hymen, as the penis would have more
easily entered through the larger opening, probably leaving intact the
left opening and the septum.

Fig. 30.

Fig. 31

Fig. 32.

Fig. 34-

Fig. 33.

Fig. 35-

Fig. 36.

Fig. 37-

Fig. 38.

FIGURES 35-38.

Divided Hymens with Asymmetric Openings ; Hymen with
Partial Septum.

Fig. 35.— Divided hymen of a girl of marriageable age, with a large,
irregular triangular opening to the right, the base of which corresponds
to the septum and the apex to the wall of the right side of the vaginal
entrance. The left opening is irregularly round, the size of a lentil.
The hymen is entirely fleshy. In this case, also, the introduction of the
penis would have been effected through the larger opening to the right,
especially as this half of the hymen does not form a tense membrane,
but consists in reality of two flaps which may be readily displaced.

Fn;. 36.— Semilunar hymen of an infant with a large opening to the
left and a smaller higher-situated opening to the right.

Fig. 37. — Hymen annularis of an adult woman with multiple pouch-
like formations induced by the attachment of the vaginal rugae to the
posterior surface of the hymen, and with a narrow septum which pro-
ceeds from these ruga? posterior to the lower insertion of the hymen and
courses somewhat diagonally to the right and above, where behind the
hymen it likewise becomes again lost in a fold of mucous membrane.
In addition from the upper edge of the hymen there arises a conical-
shaped process projecting into its orifice.

Fig. 38.— Circular hymen of a girl aged 20 years. From the centre
of the lower border of the hymen there arises, as a continuation of the
more posteriorly situated support-pillars, a fleshy prominence, 1 cm. in
length, projecting pointedly into the orifice of the hymen. This is an
instance of the so-called hymen partim septus, in which only the lower
portion of the septum persists.

FIGURES 39-44.
Varieties of Hymens with Rudimentary Septa.

Fig. 39. — Circular hymen with a very narrow margin, from whose
lower periphery to the right there depends a fleshy flap about 1 cm. long
and £ cm. wide. This is to be looked upou as an instance of rudi-
mentary septum-formation.

Fig. 40 shows an almost similar case with a somewhat wider depen-
dent flap.

Fig. 41 is a divided hymen with two lateral, rather similar openings,
whose fleshy septum projects as a wedge and below becomes a conical
plug 1 cm. long, which hangs from the vulva.

Fig. 42. — Irregular circular hymen, with a round vermiform projec-
tion which arises from the support-pillars along the posterior wall of the
hymen and hangs dependent over the edge of the latter.

Fig. 43. — The hymen of an infant, consisting of three narrow flaps,
of which two are situated laterally, whereas the third, as a conical pro-
jection, is directed upward from the center of the posterior periphery
of the vaginal entrance, and as a continuation of the posterior columna
rugarum.

Fig. 44. — Semilunar hymen of a newly born child with a conical pro-
tuberance, which, independently of the hymenal crescent, arises beneath
the meatus urinarius and pointedly projects forward.

Fig. 39-

Fig. 40.

Fig. 41.

Fig. 42.

Fig. 43-

Fig. 44.

w \

I

Fig. 46.

Fig. 45-

Fig. 47-

Fig. 49-

Fig. 48.

FIGURES 45-49.
Abnormal Openings in the Hymen. Deflorated Hymen.

Fig. 45. — Cheater hymen of a 17-year-old girl, with perpendicular,
almost rectangular opening with slightly serrated edges; beneath this
and separated from it by a transverse, narrow septum is a second round
opening, the size of a lentil. This at first sight might be deemed to
have arisen through traumatism, but its congenital origin is demon-
strated by the fine and symmetrically fimbriated condition of its edges.

Fig. 46. — Compact hymen of an infant, the opening of which is
divided — by a transverse almost tendinous septum — into an upper smal-
ler, irregularly round, and a lower, larger, circular opening.

Fig. 47.— Wide semilunar hymen, in which, in addition to the ordi-
nary opening, a second smaller one is situate in the left half; this shows
attenuated translucent edges, corresponding to an attenuated, translu-
cent, but non-perforated spot in the other half of the hymen.

Fig. 48. — Deflorated circular hymen of a girl, aged 12 years, who
died of peritonitis as a sequence of virulent blennorrhea. The hymen
was congested, swollen, and showed four superficial radial tears— 2 mm.
deep — the free edges of which were besmeared with pus and revealed a
distinctly lacerated appearance. The defloration occurred ten days
before death, at which time the girl was infected by a man afflicted with
gonorrhea.

Fig. 49. — Wide semilunar hymen of a woman who died in the sixth
month of her first pregnancy, of valvular disease of the heart. The
anatomical lesion of the hymen ensued in a manner which can be desig-
nated as almost typical of semilunar hymens, that is, through — in the
present instance deep — tears in both sides of the deepest excavation of
the hymenal crescent, so that there result two lateral and a central
posterior irregular triangular flap. The last is so frequently preserved
because, as a rule, it possesses a special solidity.

FIGURES 50-55.
Deflorated Hymens. Carunculae Myrtiformes.

Fig. 50. — Incomplete semilunar hymen with two symmetrical, healed,
deep lacerations to either side of the lower part of the median line, giv-
ing rise to two lateral and a central flap.

FiG. 51. — Circular hymen with a wide, healed defloration-tear to the
right, and a smaller, narrower, higher-situated one to the left, both of
which reach to the vaginal wall.

Fig. 52. — Circular hymen with a wide laceration of the right lateral
aspect reaching to the vaginal wall.

Fig. 53. — External genitalia of a woman who six months previously
was delivered of a full-term child. The entrance to the vagina is much
dilated; the posterior commissure cicatricial. Of the hymen there are
present but partly triangular or conical-shaped, partly uneven or nodu-
lar vestiges. These have persisted after the laceration of the deflorated
hymen which occurs during parturition, and are known as oarunatlB
myrtiformeii.

Fig. 54. — External genitalia after several parturitions. The vaginal
entrance is much dilated, its posterior part smooth, its anterior reveal-
ing certain uneven hymenal vestiges — carunculae myrtiformes. The
posterior commissure without cicatrices, but much relaxed.

Fig. 55. — Hymen after several parturitions. Originally circular. At
present but partly uneven, partly notched, vestiges present. Along the
posterior periphery of the entrance to the vagina, at the situation of
the former support-pillars formed by the cohmna rugarum, is a plump,
cone-shaped protuberance directed inward.

Fig. 50.

Fig. 51.

Fig. 52.

Fig. 54

Fig. 55-

Fig. 56.

Fig. 57-

Fig. 59-

Fig. 58.

FIGURES 56-59.

Hymen Septus (Divided Hymen) after Defloration and after
Parturition.

Fig. 56. — Deflorated liyrueu septus of an 18-year-old prostitute. The
defloration and the subsequent coitions took place through the left,
probably originally the larger, opening in the hymen, which shows
below and internally a distinct cicatricially healed laceration. To the
outer side one notices also two superficial, non-cicatricial depressions.
The right opening in the hymen and the septum are intact.

Fig. 57. — Remains of a hymen septus persisting after defloration and
alter parturition. Of the septum there remain but a shorter upper and
a longer lower, narrow, spindle-shaped, peripherally pointed vestige,
whereas other parts of the hymen are entirely wanting. In conse-
quence not eveu indications of carunculae myrtiformes are to be seen on
the smooth wall of the dilated vaginal entrance. The woman had prob-
ably frequently given birth to children.

Fig. 58. — Deflorated hymen of a woman aged 29 years, who in the
fifth month of her pregnancy died of intermeningeal hemorrhage conse-
quent upon rupture of a small aneurysm of the arteria fossa Sylvii.
Originally the hymen was evidently circular, with a septum running
diagonally from the left above to the right below. This at the time of
defloration was either ruptured or rather partially torn from the rest
of the hymen.

Fig. 59. — External genitalia of an elderly woman who had frequently
had children. In the left upper part of the much dilated and smoothed
entrance to the vagina one notices a perpendicularly hanging vermi-
form loop of dense mucous membrane, with a bean-sized perforation, and
opposite thereto in the right lower part of the entrance a thick conical
portion of similar tissue with wide base, 1 cm. high, projecting into the
ostium riKjitiie. Evidently this was originally a hymen septus with a
larger opening to the right and a smaller and higher-situated opening
to the left. Of these, the latter persists despite repeated parturitions,
whereas the former, partly through the defloration partly through the
labors, was irregularly lacerated, or rather torn away from the septum.

FIGURES 60-62.
Traumatic Injuries of the External Genitalia.

Fig. 60. — Transverse, fissure-like wound, 1.5 cm. long, of the fossa
navicularis. The wound affects the mucous membrane directly in front
of the hymen, and, decreasing in size funnel-shaped posterior to the
posterior wall of the vagina, penetrates into the depths of the cellular
tissue 1.5 cm. The injury befell a child almost 2 years of age, andet
whom an earthen chamber broke, whereby a fragment penetrated the
genitalia. Death resulted from pyemia at the end of ten clays.

Fig. 61. — The genitalia of a young married woman pregnant for the
first time, who, while putting her room in order, fell, striking the geni-
talia against the angular edge of a bed. Immediately considerable hemor-
rhage, which it was attempted to stop by cold applications, but which could
not be controlled. After an hour a physician was called, who. instead of
immediately sewing the wound, had the woman removed to a hospital.
which she entered as a corpse. The legal necropsy revealed a high grade
of internal and external anemia, and marked soiling of the lower part
of the body with dried blood. Beneath the clitoris a triangular wound
with somewhat bruised sides 1 cm. long. It penetrates the mucous
membrane and continues funnel-shaped in the submucous tissue a dis-
tance of 1 cm. toward the symphysis. The connective tissue of the
wound and that in the vicinity are markedly suffused with blood ; the
injury of a large vessel was demonstrable.

Injuries to this region of the external genitalia are known as dan-
gerous because of the richness of the tissue in large vessels. In the pres-
ent case the injury was the more serious because of the pregnancy already
in the sixth month, and the consequent excessive filling of the vessels.
Interference in such cases is urgently indicated, and is most appropri-
ately effected by suturing.

Fig. 62. — The preparation is from a 20-months-old girl who was run
over by a tramcar. Various fractures of the ribs; laceration of the
lung and the diaphrngm ; rupture of the liver; suffusion of the perito-
neum in the pelvic region without fracture of the pelvis. The perineum
torn throughout its length. The vagina with the circular hymen torn
from the surrounding parts, lying free in the depths of the funnel-
shaped wound of the genitalia. Hymen and vagina otherwise unin-
jured.

Fig- 60.

Fig. 61.

Fig. 62.

Fig. 63.

Fig. 65

Fig. 64.

Fig. 66.

Fig. 67.

FIGURES 63-67.

Condition of the Os Uteri of Virgins and of those who
have given Birth to Children.

The external os uteri of adolesceut virgins is, as a rule, a transverse
oval opening, or a transverse fissure which gapes but slightly or not at
all, and whose edges, as also the cervix itself, are smooth (Figs. 63, 64,
and 65).

Iu advanced age the appearance frequently changes, in that one then
finds a small round opening, whose edges and vicinity, however, likewise
appear smooth (Fig. 66). The same condition can also arise through
pathologic processes and abortion.

If the woman has already had children, the external os uteri presents
itself either as a long, gaping, transverse fissure (Fig. 67), or as a gaping,
round opening of such size that one may introduce, as a rule, the finger-
tin. In both instances the edges are no longer smooth, but more or less
deeply and cicatricially notched. In the first-mentioned form these
notches are found especially at the end of the transverse fissure ; in the
second-mentioned form, at other places also about the opening.

PLATE 1.
Cervix and Vagina directly after Parturition.

M. V., aged 35 years, Ill-para, wife of a dairyman, was delivered by
a midwife, December 11th, at 8 p. M., of a 7-months-old child, and died
an hour later with symptoms of great dyspnea and violent coughing.
She is said to have suffered for years from cardiac palpitation.

The necropsy, performed December 12th, revealed the following:
edema of the lungs ; stenosis of the left auriculoventricular orifice ;
recrudescent verrucous endocarditis ; and a slight grade of generalized
edema. The uterus was as lai-ge as the head of a 4-year-old child,
well contracted, externally smooth, and very pale. Its cavity was the
size of a fist; its inner surface rough, and covered with decidua-shreds
and blood-coagula of recent date. The placental site was on the posterior
wall of the fundus. The wall of the uterus was 3.5 cm. thick, pale, with
gaping vessels. The external os uteri and the cervical canal were patu-
lous for four fiugers, markedly swollen, as though edematous, with super-
ficial and deeper fresh radial rents suffused with blood, and numerous
older cicatricial depressions, the result of previous labors.

The vagina was wide, moderately wrinkled. The vaginal entrance
with numerous superficial tears suffused with blood. The posterior com-
missure destroyed through cicatrices. Of the hymen, but vestiges of the
carunculsB myrtiformes present.

Tab. 1.

A

1

/

Tab. 2.

PLATE 2.
Spontaneous Rupture of the Uterus.

A. H., wife of a house-owner, 38 years of age, took to bed on account
of labor-pains on the morning of December 9th, and called a midwife,
who declared the labor to be a difficult one and sent for a physician.
The latter recognized nothing alarming. As the delivery of the woman,
despite severe labor-pains, did not advance, and as her condition during
the afternoon suddenly grew worse, the physician was called again. The
latter, after consultation with another physician, declared the conditiou
of the woman dangerous and ordered her removal to a maternity hospital.
Daring transportation she died. In the receiving- ward a Cesarean sec-
tion was performed, resulting in the delivery of a mature dead child,
which is said to have presented in the ordinary vertex position.

The legal necropsy, on December L2tb, showed that the body exter-
nally and internally was very anemic. The abdominal wall was divided
by a sutured incision, without reaction, reaching from the umbilicus
to the symphysis. In the abdominal cavity were blood-coagula the
size of three fists, and in the lower part thereof a large quantity of
fluid blood.

The uterus almost the size of a man's head, firm, pale, and smooth,
covered with clots. On its anterior surface, an opening with sharp
edges, united by interrupted sutures and showing no reaction, run-
ning from above downward and through the entire wall of the organ.
The cavity of the uterus the size of a fist, tilled with blood-clots: the
wall of the uterus 4.5 era. thick. The external os uteri readily patulous
for three fingers; much contused. To the left a dee]) laceration, 12 cm.
in length, continuing upward through the entire length of the cervix
and completely through its wall, and leading to a large cavity situate
between the layers of the uterine ligament. This cavity reaches below
to the left internal inguinal ring and extends to the neighboring mesen-
tery; its wall, as also the edges of the laceration of the cervix, appears
irregularly shredded.

The vagina wide and uninjured.

The pelvis visibly flattened anteroposterior^ and to the left. The
promontory of the sacrum distant 8 cm. from the symphysis. The trans-
verse diameter of the pelvis 1*2 cm. ; the left oblique 11 cm. ; the right
oblique 12 cm. Distinct funnel-shaped contraction of the pelvic cavity
toward the outlet.

The accompanying child is a male, well developed, 52 cm. long, and
weighs 3500 grams. The head relatively large, somewhat flattened to
the right anteriorly. The anteroposterior diameter of the head 12 cm. ;
the transverse 9 cm. ; the diagonal 13.5 cm. ; the circumference 36 cm.

The scalp over the right frontal and parietal bones very prominent and
with jelly-like infiltration.

The preliminary opinion ran as follows :

1. Mrs. A. H., in the first place, died of hemorrhage into the abdomi-
nal cavity.

2. The latter resulted from rupture of the uterus occurring during
parturition at full term.

3. As an instrumental or important manual operation was performed
neither by the physician in attendance nor by any one else, the case is
evidently one of spontaneous rupture of the uterus.

4. The development of this was occasioned, on the one hand, by the
large size of the child, and on the other, and especially, by the marked
contraction of the pelvis (flat pelvis).

5. As nothing is known concerning the time of the commencement of
the labor-pains and of their continuance prior to the rupture, nor con-
cerning the condition of the woman at the time of the arrival of the
first physician, nor of the symptoms developed during and after his
presence (or of those recognized by him), preliminarily the question can-
not be answered whether or not the difficulty in parturition could have
been recognized at the proper time, nor in how far the occurrence of the
rupture could have been prevented.

6. Cesarean section was performed on the deceased shortly after her
death.

The case was not further investigated by the judicial authorities.

PLATE 3.

Tubal Pregnancy. Rupture of the Sac. Internal Hemor-
rhage.

Antonia ML, aged 35 years, has suffered for the past two years with
pain in the abdomen. She has had two children, the last five years ago.
Recently menstruation is said to have been irregular. The occurrence
of a new pregnancy had not been suspected.

On May 7th, at 8 P. M., the woman complained suddenly of severe
pain in the abdomen, vomited five or six times during the night, and had
marked rectal tenesmus. A neighboring physician being called recog-
nized a high grade of anemia, cardiac weakness, and rapid loss of strength.
At 8 o'clock in the morning the patient died. As there was a supposition
of poisoning, a medicolegal autopsy was ordered.

By this there was found externally and internally marked anemia.
The abdomen was moderately distended and soft. It contained 2} liters
of partly fluid, partly freshly coagulated blood, which occupied especi-
ally the lower abdominal and pelvic cavities. At about its middle the
otherwise normal right Fallopian tube becomes dilated to form a sac the
size of an apple, which on its anterior surface shows a wide perforating
longitudinal rent almost 2 cm. in length, from which blood-coagula and
ruptured chorionic villi project. The entire sac is surrounded by huge
blood-clots, which are connected with those contained within the abdom-
inal cavity, and in which, on careful examination, there is found directly
above the point of rupture, in an unbroken amniotic sac, an embryo 2 cm. in
length. The latter is bent in a scaphoid manner, and still shows vestiges
of the germinal fissures and apparently of the abdominal cleft, but in
addition already articulated extremities, on which we may recognize the
still adherent fingers and toes. It belongs, therefore, to the middle of
the second month.

The further investigation of the genitalia revealed numerous cord-like
adhesions of the posteriorly displaced left tube with the posterior wall
of the uterus and the neighboring intestines, and a large corpus luteum
(corpus luteum verum) in the left ovary. There had, therefore, occurred
a so-called "migration of the ovum" from the left to the right. This
was induced by the adhesions and flexions of the left tube which re-
tarded the entrance of the ovum into the (left) tube, and which, also
preventing it reaching the uterus, caused it to remain in the tube, and
there further develop.

Worthy of mention are further the visible enlargement of the uterus
and the marked swelling and hyperemia of the uterine mucous mem-
brane (decidua vera), — phenomena regularly observed in cases of extra-
uterine pregnancy.

Tab. 3.

\-.F.ReifihoM Miitirtitt!

Tab. 4.

PLATE 4

represents the embryo about one and a half months old found within an
uninjured amniotic sac among the blood-clots of the tubal pregnancy
illustrated in Plate 3, where its peculiarities are described more in de-
tail.

FIGURE 68.

Fatal Hemorrhage from Retention of a Portion of the
Placenta.

W. M., aged 39 years, the wife of a locksmith, was delivered of her
third child January 8th, at 12.30 o'clock at night. The labor was easy.
The placenta was delivered by a midwife, who asserted that she examined
but observed nothing unusual about it, and therefore laid it aside. The
hemorrhage after delivery continued, but a physician was not sent for
until noon. For a long time one was sought in vaiu, who, when he
arrived, found the woman excessively anemic and already collapsed. He
diagnosed atony of the uterus, introduced a tampon, and had the woman
transferred to a maternity hospital, where immediately after her ad-
mission, before she could be examined, she died at 3.45 o'clock in the
afternoon.

The body externally and internally was remarkably anemic; the
external genitalia and the surrounding parts covered with fluid and co-
agulated blood.

The rather firm uterus, the size of a man's head, contained a large
quantity of recent blood-coagula, which were especially firmly adherent
to the fundus, and which when removed revealed the placental site. To
the upper part of this there was firmly adherent a pear-shaped portion of
the placenta with dependent apex, 6 cm. long and 3 cm. wide.

The other findings were such as were to be expected directly after
parturition ; the uterine vessels were, however, almost entirely empty
and the wall of the uterus very pale hut firm.

The opinion was deduced that the deceased died shortly after par-
turition of hemorrhage from the genitalia; that this was caused by the
retention of a large portion of the placenta, and that the removal of
this portion of placenta at the proper time, which the existing con-
traction of the uterus rendered diflicult, would have prevented the hem-
orrhage.

The culpability of the midwife consisted : 1. In that she neglected
to carefully examine the placenta, whereby the absence of such a large
portion of it could not have escaped her attention ; 2. In that she laid
aside the placenta before the arrival of the physician, so that the latter
could not inspect it ; and, 3. In that medical aid was not summoned
until the hemorrhage had persisted for hours and had assumed a critical
character.

Through the portion of retained placenta in the accompanying illus-
tration a sagittal section has been made.

Fig. 68.

Fig. 69.

FIGURE 69.

Another form of retention of a portion of the placenta with consecu-
tive hemorrhage, occurring four hours after an otherwise normal labor,
is illustrated in Fig. 69. The site of the placental insertion was on the
posterior wall of the uterus, and its lower border was scarcely one finger's
breadth above the internal os uteri. The retained portion of the pla-
centa was covered with a large blood-clot reaching into the vagina.
Alter the removal of the latter the portion of the placenta was found
to be almost as large as a goose-egg, its lower third intimately adherent
With the lower part of the placental site, its other two-thirds pro-
jecting flap-like into the dilated vagina, which had a width of four
fingers.

In this case also the midwife had not properly inspected the placenta,
and, in addition, had left the woman before the lapse of the prescribed
four hours.

FIGURES 70, 71.
Two Uteri in the Very Earliest Stages of Pregnancy.

Fig. 70. — The preparation is from a married woman, aged 35 years,
who killed herself by jumping from a second-story window. She had
frequently had children, and thought herself again pregnant, as she had
not menstruated at the last expected period.

There were found, as the cause of death, fractures of ribs and various
ruptures of the abdominal organs, with internal hemorrhage. The
uterus was uninjured, the size of an orange, thick-walled and contained
in its slightly dilated cavity some freshly coagulated blood, demon-
strable also in the cervix and in the vagina. The mucous membrane,
after irrigation, was found irregularly swollen, pale violet, as a decidua
vera, dilated — to the right and above — to form a sac the size of a bean.
This latter was ruptured in the direction of the greatest convexity,
filled with recent blood-clots, and revealed a finely rugose inner surface.

Despite careful examination of the blood-clot neither an ovum nor a
part thereof could be discovered. There can, however, scarcely be a
doubt that the sac was that of a decidua reflexa, which contained an
ovum in the earliest period of development, and, further, that the
violent concussion occasioned by the fall led to a rupture of the
decidual sac and a consequent extrusion from it of the therein con-
tained ovum either in toto or likewise injured, and that this latter was
carried off with the blood-clots. The right ovum contained a bean-
sized corpus luteum, with wide pale yellowish margin and violet jelly-
like contents.

Fig. 71 is from a woman, aged 35 years, who died suddenly in con-
sequence of mitral incompetency and pulmonary edema. Menstruation
had been absent during the past two months.

The necropsy revealed a pregnancy at the end of the first or the
beginning of the second month. The uterus is the size of an orange,
rather thick-walled, and contains an uninjured ovum attached to its
posterior wall. This, after opening of the decidua reflexa, is found the
size of a walnut, completely covered externally with regularly and closely
arranged chorionic villi. After slitting open the chorion and the amnion
one sees the embryo, about 2 cm. in length, to the left in breech pres-
entation. The latter is fastened to a short, relatively thick umbilical
cord proceeding from the posterior wall of the ovum ; it is markedly
scaphoid in shape, shows as yet no ossification, and reveals, in addition
to oral and nasal apertures already joined to form one cavity, the
genital clefts of the neck, the abdominal cleft, the umbilical vesicle,
and the as yet but articulate stumps suggestive of extremities, — findings
which indicate that the embryo belongs to a very early period and that
it has scarcely or but slightly passed the first month of pregnancy.

Fig. 71.

Fig. 72.

Fig- 73-

FIGURES 72, 73.
Fig. 72.— Human Ovum of the Eighth or Tenth Week.

The ovum, first separated from the blood-clots by continued irrigation
and then opened, is in toto the size of a goose-egg, and shows above and
to the left as its external covering vestiges of the decidua reflexa. The
incised chorion situate beneath is externally completely symmetrically
villous (chorion frondosum), and reveals as yet no placenta formation.
From the smooth inner surface of the incised chorion the unopened di-
aphanous amniotic sac, containing the embryo in a clear, watery-looking
fluid, protrudes. The embryo is about 5 cm. in length, and shows as yet
no differentiation of the sex, but already separated fingers. The genital
clefts and the abdominal fissure are already closed. The umbilical cord
is thick, about 2 cm. in length ; from its root on the inner surface of the
chorion there proceeds, between the latter and the external surface of
the amnion, a thin filament, about 3 cm. in length, which ends in an
oval, pea-sized, watery-looking vesicle, — the umbilical vesicle. In the
illustration this is represented as protruding through a rent in the
chorion to the right and below.

Fig- 73.— Rupture of the Vagina through Coitus or by the

Finger.

A coachman had sexual intercourse with a 19-year-old servant, in a
Stable, after he had previously examined her with his finger. On the
way home the girl became affected with pain in the genitalia and rather
severe hemorrhage. The same day she betook herself to the general
hospital, where a rupture of the vagina in its upper part was recognized
and an iodoform tampon introduced. Death ensued six days after the
injury, with the phenomena of sepsis.

The necropsy revealed general sepsis and septic pleuritis as the cause
of death.

The uterus somewhat enlarged, smooth, with eicatrieially notched os
uteri. The uterine cavity slightly dilated, containing a brownish blood-
coagula representing a cast thereof. The mucous membrane softened,
injected, with isolated lentil-sized blood-extravasations; everywhere
smooth.

In the vault of the vagina, beginning to the right posterior to the
posterior lip of the cervix and coursing obliquely to the right and
below, there is a slit-like tear of the mucous membrane, 4 cm. in length,
reaching to the suhmucosa. It has rather sharp edges joining in an
acute angle, and a flat, funnel-shaped, irregular bate, deepening above
and reaching to beneath the peritoneum, covered with discolored blood-

clots. The edges and base are infiltrated with blood ; the mucous mem-
brane in the inner part darkly congested and pervaded with small
fading blood-extravasations. In the upper part of the left vaginal wall
near to the fornix, affecting merely the upper layers of the mucous
membrane, there is a semilunar tear 8 mm. long and 1 mm. wide, with
its convexity to the front and above. Its edges are sharp, and approach
to form an acute angle ; its base discolored, and the immediate vicinity
slate-colored.

Regarding the latter finding, which reveals distinctly the impression
of a finger-nail, the opinion was expressed that the laceration of the
vagina in all probability was not induced by the coitus, but rather by
rough introduction of the finger.

FIGURE 74.

Acute Sepsis following Abortion. Punctured Wound in the
Fornix of the Vagina.

Having the day previously visited a midwife, A. Th., aged 30 years,
became ill November 8th, with vomiting, diarrhea, and colic, and died
the evening of the same day.

The necropsy revealed a high grade of puerperal sepsis and com-
mencing peritonitis.

The uterus is the size of a child's head, and contains discolored fluid.
The decidua vera is discolored, and shows abundant shred-like dis-
integration. Above the internal os uteri, attached to the posterior wall
of the uterus with a placenta 5 cm. in diameter, there is a discolored,
lacerated ovum, and from the middle of the placenta there hangs, as a
loop, a discolored filamentous umbilical cord which leads to an exces-
sively putrid and disintegrating embryo, about 6 cm. in length. The
latter is situate in the dilated cervix, patulous for two fingers, and
reaches to the externally cicatricially notched os uteri. One may recog-
nize the disassociated cranial bones, and higher upward the ribs and the
bones of the lower extremities.

In the apex of the right vault of the vagina, about 2.5 cm. from the
external os uteri, there is a round opening about 2 mm. in width, with
rather smooth edges, surrounded by an area of violet discoloration 3
mm. in width, whose base is suffused with blood. From this one may
follow a hemorrhagic canal of the same width which runs from below
upward and rather from without inward, through the mucous membrane
to the submucous connective tissue, where it ends in a rather sharply
defined suffusion larger than a lentil.

This injury is evidently a punctured wound produced with a wire
or sound-like instrument, and this discovery, together with the cir-
cumstances of the case and the other findings of the necropsy, permit
of no doubt that abortion by puncture of the membranes was attempted.

Fig. 74.

Fig. 75-

FIGURE 75.

Abortion Induced by a Probe=like Instrument; Perforation
of the Posterior Wall of the Uterus.

Uterus of a 29-year-old multipara, who died after fourteen days' ill-
ness, consisting of hemorrhage from the genitalia, fever, and abdominal
pain.

The necropsy revealed endometritis and septic peritonitis.

The uterus larger than a fist, empty, with distinct placental site.
The cervix patulous for the index finger, not lacerated, showiug cicatri-
cial notches of the external os uteri.

On the posterior wall of the uterus to the left and above there is a
bean-sized irregular opening covered with pus, which leads into an
equally wide canal witli softened walls, likewise covered with pus.
This penetrates the entire wall of the uterus anteroposterior^- from
below upward, and ends on its posterior surface in an irregular, triradiate,
foramen-like opening, with limbs 1.5-2 cm. in length, occluded with a
fibrinopurulent exudate.

This is manifestly a case of abortion induced by the introduction
into the uterus of, aud the perforation of its walls by, a probe-like in-
strument.

FIGURE 76.

Abortion Induced by Rupture of the Membranes of the
Ovum. Slit like Laceration above and below the In*
ternal Os Uteri.

K. M., aged 20 years, who had aborted once, for the purpose of pro-
ducing another abortion was " operated" upon three times by a surgeon,
who each time is said to have introduced a surgical instrument into the
genitalia, which procedure each time, but especially the last — June 15th
— caused pain. The abortion ensued during the night of the 15th-16th
of June. A 2-months-old embryo was delivered, which was shown to
and preserved by a midwife who was summoned to the case. On the
18th, because of fever and abdominal pain, the patient was brought to
the hospital, where she died on the 23d.

The legal necropsy revealed puerperal sepsis as the cause of death,
and in the uterus the three wounds illustrated in the cervical portion
thereof. The first of these wounds is situate directly above the internal
os uteri, the second to the left at the internal os uteri, the third on the
posterior wall of the cervix to the right of the median line between the
internal and external os uteri. All three wounds are irregular longi-
tudinal slits 1-1.5 cm. in length, with somewhat jagged edges, and a
wedge-shaped base — flat above — deepening 3-5 mm., discolored and
covered with pus. From the lower end of the lowest-situated slit there
projects a discolored shred of mucous membrane about 1 cm. square.

The physician denied the charge, but under the overwhelming
weight of the proofs was nevertheless condemned. To all appearance a
hook-like instrument was used, the employment of which would ex-
plain the recognized detachment of the mucous membrane hanging as a
flap from the lowermost wound.

Fig. 76.

Fig. 77.

FIGURE 77.

Abortion Induced by Injections. Perforation of the Fornix
of the Vagina and the Fundus of the Uterus.

The 39-year-old wife of au inn-keeper, who had already given birth to
seven children, and who considered herself again pregnant in the second
month, betook herself on September 23d to an advertised midwife to
have an abortion performed. The latter had the woman lie down upon
the floor and brought a glass enema-syringe filled with a clear fluid, to
which was attached a long, thin bony nozzle. This she introduced so
far into the genitalia of the woman that the latter suffered intense
pain, it seeming to her that the syringe must have penetrated to the
stomach, where she thought she felt the entering fluid. For this
operation the midwife demanded 30 marks, but was content to receive
15 marks. With effort the woman dragged herself home; she vomited
on the way, and was obliged to immediately take to bed and call a
physician. From the latter she originally concealed the true condition
of affairs, and only after violent symptoms of peritonitis developed, on
October 3d, confessed all, among other things that during the night of
the 24-25th she passed a blood-clot which was thrown into the closet.
Death ensued October 11th, after the imprisoned midwife had acknowl-
edged having given the woman merely pro forma an injection of warm
water into the vagina.

In the posterior fornix of the much dilated, smoothed-out, and thin-
walled vagina there was found a shredded, irregular, slit-like opening
agglutinated by pyofibrinous exudate. This opening communicated
with Douglas' cul-de-sac, where its edges were already rather firmly
adherent to portions of the intestines. In addition, there was in the
fundus of the uterus an opening the size of a half dollar, with discolored,
softened, shredded edges, through which from the uterus one might
enter the abdominal cavity, and the edges of which were likewise, by
means of an inspissated layer of pyofibrinous exudate, adherent to the
intestines. The opening in the vault of the vagina was without doubt
caused by the perforation of it by the inserted instrument, and very
probably also the perforation in the fundus of the uterus ; but it must
be acknowledged that the latter may have subsequently arisen or become
enlarged through septic softening.

FIGURE 78.
Divulsion of the Cervix from the Uterus. Abortion.

Uterus of a servant, aged 26 years, who on May 11th, on account of
pretended chills and fever lasting during the previous six days, was ad-
mitted to the hospital, where a whitlow on the distal phalanx of the in-
dex finger was recognized and in consequence pyemia diagnosed. There
was no suspicion of pregnancy, as the girl asserted that her menses had
always been regular — the last time April 25th. Death occurred on May
13th, and it was only at the pathological examination that septic perito-
nitis and injury of the uterus were discovered, aud in consequence sub-
sequently the legal necropsy resorted to.

The uterus, illustrated in full size, is as large as a fist, its cavity dilated
to almost the size of an orange, empty, its inner wall covered with dis-
colored decidual remains and blood-clots, uneven ; in the upper part of
the posterior wall the placental insertion — 3£ cm. wide — demonstrable.
The cervix, about 2 cm. in length, is, with the internal and external os
uteri, torn away from the left part of the uterus and the left vault of the
vagina, whereby a large opening patulous for two or three fingers is
formed, through which from the vagina one may directly enter the
cavity of the uterus. The edges of this opening are irregular, partly
shredded, discolored, and somewhat softened ; otherwise unaltered.

The divulsed cervix is displaced to the right, its canal patulous for a
moderately stout sound, the external os uteri oval transverse, somewhat
more than a half centimeter long, slightly open, and entirely smooth.

The vagina is markedly wrinkled, its entrance without cicatrices.
Of the hymen, still considerable remains present.

On the left index-finger a superficial cicatrizing whitlow, without
suppuration.

The opinion was expressed that the deceased was in the third
month of pregnancy (already distinct placental formation), and that a
few days prior to her death she had given birth (aborted) through the
large irregular opening in the left vault of the vagina. This opening,
looking as though perforated, was produced by the forcible intro-
duction of a blunt though rather narrow and long instrument, which
may have been a violently inserted finger. To all appearances the in-
troduction of the instrument — or of the finger— and the consequent lace-
ration had as their object the production of an abortion, and the manner
of its execution permits of the inference that it was performed by a lay-
person.

The case remained unexplained.

Fig. 78.

Tab. 5.

PLATE 5.

Respiratory Organs and Heart of a Full-term Child who died
during Birth of " Fetal Suffocation " from Premature
Respiration.

Probable compression of the umbilical cord.

Aspired meconium in the respiratory passages.

In the heart and lungs numerous ecchymoses of suffocation.

The lungs themselves still situated in the posterior part of the
thoracic cavity, but nevertheless somewhat enlarged, symmetrically very
dark violet, contain much blood and are heavy, completely void of air,
of fleshy consistency; aspirated meconium in the larger bronchi.

These are the usual findings after fetal suffocation, and permit, as
a rule, the diagnosis of such a process. Extra-uterine such a complex
of signs can only occur when the child — immediately from the maternal
genitalia— is deposited within the birth-fluids (as may occur after deliv-
ery over a vessel), but otherwise only when the child immediately after
birth comes to lie with its face in a layer of meconium or other of the
birth-fluids.

FIGURE 79.

The Epiphyses of the Lower Extremity and of the Humerus
of a Mature, Newly Born Child.

In determining whether or not a newly born child brought to necropsy
is to be looked upon as mature, in addition to ascertaining the weight,
length, and general development, it is of importance to determine the
condition of the centers of ossification in the epiphyses of the bones
forming the knee-joint, as also those in the tarsal bones.

The accompanying illustration of a longitudinal section through the
leg of a mature, well -developed child, who died during birth of asphyxia,
shows the conditions referred to in half size.

The upper epiphysis of the femur is still completely cartilaginous;
the lower, on the other hand, reveals within the epiphyseal cartilage
a pea-shaped center of ossification, which on section is seen as an al-
most spherical disk, 6 mm. in width, sharply circumscribed by white car-
tilage.

The upper epiphysis of the tibia shows a center of ossification one-
half the size of this, whilst the lower epiphysis as yet possesses none. The
earliest indication of the first-mentioned center appears during the
ninth, that of the second not before the beginning of the tenth lunar
month.

In the os calcis one notices an oval center of ossification 16 mm. from
before backward, 8 mm. from above downward ; in the astragalus a semi-
lunar center with the concavity upward, 12 mm. long and 6 mm. high ;
and in the os cuboideum a round center with a diameter of 3 mm. The
last-mentioned develops, as a rule, not until the second half of the tenth
lunar month ; the first before the seventh lunar month ; so that at the
time of viability (28th to 30th week) the center in the os calcis is already
the size of a pea, while that in the astragalus is half as large as a pea.

In the upper end of the humerus, at the end of normal pregnancy,
there is only exceptionally, and in strong children, a center the size of
a hempseed, as is indicated in the accompanying case.

Fig. 79-

!

FIGURE 80.

Epiphyses and Posterior Tarsal Bones of a Premature, and of
a Full-term Newly Born, and of a 3 .1 =Months=old Child.

I. Vertical Row. An eighth-month premature female child, 44 cm.
in length, weighing 1760 grams. The upper epiphysis of the humerus,
the upper and lower epiphyses of the femur, and the upper epiphysis
of the tibia show as yet no indication of centers of ossification. In
the astragalus, however, a pea-sized, and in the os calcis a bean-sized,
center.

II. Vertical Row. A full-term female child, 50 cm. in length, weigh-
ing 3030 grams. Of the first-mentioned epiphyses none but that of the
lower end of the femur possesses a center of ossification, and this is about
the size of a pea and has a diameter of 5 mm. The bony nucleus in the
astragalus is already the size of a bean ; that in the os calcis has the size
and shape of a sagittally placed almond.

III. Vertical Row. 3i-months-old child, 59 cm. in length. All the
epiphyses contain centers of ossification ; that of the upper end of the
humerus contains a pea-sized one in the head and an indication of a sec-
ond in the greater tuberosity ; that of the upper end of the humerus, one
the size of a poppy-seed in the head ; that of the lower end of the femur,
an oval one 11 mm. long and 8 mm. wide ; that of the upper end of the
tibia, a transverse one with a longitudinal diameter of 1.3 cm. and a
vertical diameter of 0.6 cm. The nucleus in the astragalus is 1.4 cm. in
length and 0.6 cm. in width (height) ; that in the os calcis, 1.6 cm. in
length and 0.8 cm. in width. *

Fig. 82.

Fig. 81.

FIGURES 81, 82.

Suffocation of the Newly Born by Intentional Obstruction
of the Pharynx.

The killing of newly born children by the introduction through the
mouth of a finger and the plugging by it of the fauces or the pharynx,
or by their obstruction with other objects, such as bits of cloth, earth,
and the like, is one of the not uncommon methods of infanticide. Ex-
ternally such killings are not always recognizable, but internally we
may distinguish them by the laceration of the fauces or the pharynx
which is almost always present, or by the discovery of the obstructing
object, or by both of these together.

Figs. 81 and 82 illustrate two instances of the latter kind.

Fig. 81. — P. G., a maid, asserted that she gave birth to her full-term
child in a closet. It is said to have fallen into the basin, from which
she immediately withdrew it, but it gave no indication of life. She
then placed it in a chest in a closet containing ashes and coal-dust and
covered it with these substances.

The child, found the same day, was 50.5 cm. in length, and much
soiled by the ashes and coal-dust, which substances were also found in
the mouth and nose. The face was markedly cyanotic, the conjunctivae
ecchymotic. To the outer side of the right angle of the mouth a linear
abrasion 5 mm. in length ; on the left cheek several lentil-sized, irregu-
lar, non-hemorrhagic excoriations. Beneath the angle of the right
lower jaw two such places, swollen and surrounded by an area of violet
discoloration. The skin of the anterior part of the neck, from the
upper edge of the larynx to the clavicles, of greenish, dirty-violet color,
swollen, revealing small scattered scratches.

The mouth, even to the recesses of the pharynx, almost completely
filled with ashes and small particles of coal-dust. After careful removal
of these foreign bodies the mucous membrane is found very much
excoriated; the pillars of both fauces, as likewise the pharynx on both
sides, irregularly lacerated. These lacerations to either side of the
esophagus penetrate deeply into the connective tissue and form cavity-
like spaces filled with blood-clots, ashes, and particles of coal.

The lungs crepitant, here and there containing aspired blood and
isolated particles of coal-dust. The stomach distended with air and
bloody mucus, but containing no foreign body. Punctiform ecchymo-
ses of the heart.

Fig. 82. — Likewise a child born in secret of a maid. The mother
asserted that the child was dead-born, and that she had hidden it in an
ash-chest until an opportunity afforded itself of her conveying it to the
graveyard.

The body was 50 cm. long in toto, soiled with blood and ashes.

After careful cleansing of the body the face was cyanotic and showed
various punctiform ecchymoses of the conjunctiva?. In the region of the
right angle of the mouth and on the right cheek several short, linear,
non-hemorrhagic scratches.

The pharynx obstructed by a firm plug the size of an apple, consist-
ing of rumpled white paper. In either side of the pharynx a longitudi-
nal laceration — 1.5 cm. long, revealing the pharyngeal muscles — with
slightly ragged edges, showing bloody infiltration and punctiform ec-
chymoses.

The lungs are crepitant throughout, with isolated ecchymoses the
size of hempseeds. The heart likewise ecchymotic. The stomach dis-
tended ; likewise the duodenum and the adjoining part of the jejunum.

PLATE 6.
Lungs of Newly Born Infants.

a. Lung after the Occurrence of Full Respiration. — The left lung of a
mature child, born living and crying, which immediately after its birth
was killed by its mother by blows upon the head with a block of wood.

The lung is completely distended, in consequence of the fractures of
the skull somewhat anemic, everywhere bright red, marbled, with
isolated punctiform ecchymoses on the diaphragmatic surface. The
edges are rounded, the interstitial vessels moderately injected. With
unaided eye the pulmonary vesicles are to be seen, but indistinctly : dis-
tinctly, however, with a weak lens (smaller illustration), whereby they
appear symmetrically distended with air. The entire organ feels as an
air-cushion, crepitates on section, and the section -surface when passed
over by the knife gives everywhere fine frothy fluid and a moderate
quantity of dark blood. The bronchi contain fine froth. The lungs
float on water both in their entirety, as in individual lobes, even when
cut into small, bean-sized pieces.

b. Air in a Lung in Consequence of Putrefaction.— The right lung of
an excessively putrid mature child found in the open air wrapped in
paper, behind a plank.

The body weighs 3320 grams, is 52 cm. in lengtb, everywhere mark-
edly turgid, the skin putrid green, with epidermis thai readily strips
off. Injuries are nowhere demonstrable. The brain a malodorous semi-
fluid mass ; the meninges with hemorrhagic imbibition. In the thoracic
and peritoneal cavities a moderate quantity of bloody transudate.

The lungs dirty brown-red, very soft, after removal collapsing. The
pleura covering elevated by isolated gas-vesicles the size of poppy-seeds
to beans, partly displaceable. The remainder of the pulmonary surface
smooth, the pulmonary acini in consequence of the fulness and hemor-
rhagic imbibition of the interstitial vessel-network distinctly demarcated.
Alveoli containing air are not demonstrable. The lungs in toto float. On
section the lung is a discolored, brownish-red, almost semisolid mass, in
which one may recognize isolated smaller and larger gas-vesicles, which
are readily expressed, after which the corresponding part of the lung
immediately sinks in water. Foreign substances are demonstrable
neither in the pulmonary parenchyma nor in the air-passages.

The stomach and intestine discolored, everywhere distended with
gas, floating upon water. The meconium pervaded by numerous air-
bubbles; the intestinal mucous membrane likewise abundantly elevated
by gas-vesicles.

The liver, spleen, and kidney, softened and discolored, pervaded by
numerous gas-vesicles, and floating upon water. We have therefore
apparently to deal either with an already dead-born — possibly even
macerated — child, or with a child which, although it may have been born
alive, never respired.

The presence of air in the individual organs and their consequent
floating were doubtless dependent upon the advanced putrefaction and
the coincident formation of putrefactive gases. We see here that lungs
devoid of air putrefy relatively slower than other organs, as the lungs
contained relatively few gas-vesicles, whereas the liver, spleen, etc.. as
likewise the subcutaneous and other connective tissues, were richly
supplied.

The child must have died several weeks before its discovery. Inter-
nally no indications of violence were found.

Tab. 6.

Lrih Ami v. F RrV-hhoW . MiinrtMi

PLATE 7.

Newly Born Child. Suffocation by a Portion of the
Membranes.

Among the causes which may hinder the respiration of a newly born
child, and thus, even without the co-operation of its mother, lead to its
death, must be counted its birth within unruptured membranes, or with
a portion thereof situate over its face or entire head.

Plate 7 refers to a medicolegal case of the latter variety.

The child — a female — was found November 30th, wrapped in white
linen, under a refuse-box in a gateway.

It was 46 cm. long, weighed 1820 grams, of a pale fleshy color, with
slight panniculus adiposus, uninjured. The entire head was covered
with a serous, transparent, in part dried membrane, which, leaving the
region about the left lower jaw exposed, covered the rest of the face,
being everywhere in close apposition to the skin, partly smoothly,
partly in small folds, closing both the eyes and the orifices of the respi-
ratory organs. Under the chin and running almost horizontally with
the upper part of the neck the membrane was irregularly torn, the torn
edge being much dried.

The necropsy revealed some air in the slightly ecchymotic lungs ;
some air in the stomach. The latter, as also the upper 4-5 cm. of the
duodenum, floats upon water. Otherwise no noteworthy discoveries.
In the lower epiphysis of the femur no center of ossification demon-
strable.

The opinion was expressed that the premature child was born alive,
and that it died of suffocation, manifestly due to closure of the orifices
of the respiratory organs by a portion of the membranes covering the
face. It is scarcely to be supposed that this portion of the membranes
was intentionally placed over the face of the child, as such a procedure
presupposes a certain special knowledge and much dexterity. It is
most probable that this portion of the membranes was torn away during
the process of birth by the advancing head, and that the child was
born with the head covered therewith, which occurrence has frequently
been observed, and is sometimes — however, without justification —
designated as "birth with a caul." The fact that air was found in the
lungs and in the stomach does not invalidate this assumption, as the
region about the left lower jaw was uncovered, whence some air might
reach the respiratory orifices. As the portion of membrane was trans-
parent and very thin, and while moist became closely applied to the
skin, it is not certain that this impediment to respiration was observed
by the mother, and in consequence it cannot be unconditionally asserted
that she intentionally permitted it to remain, and thus killed the child
by withholding the requisites of life.

As there was no caput succedaneum demonstrable, the labor must
have been rapid.

Tab. 7.

Fig. 83.

FIGURE 83.
Congenital Fissureformation of the Skull of the Newly

Born.

Certain congenital fissures of the skull of the newly born belong to
the ordinary findings. The most coustant are those of the occipital
bone, of which there are three. Of these, one proceeds from each lateral
angle of the pentagon which the tabular portion of the bone forms,
and ascends in the direction of the protuberance, while the third
descends from the apex of the tabular portion. They are usually 1-1.5
cm. in length, but may exceptionally reach to the protuberance and thus
divide the tabular portion of the bone into two or three parts, which
when there are an upper and a lower half may simulate a transverse
fracture.

In the parietal bone also one meets with congenital fissures in con-
stant situations, especially at the posterior third of the interparietal
suture. Here we find in each bone opposite to each other a fine or
coarse fissure which runs in the direction of the parietal eminence, a
distance of 1 to 2 cm. Not infrequently the inner ends of these fissures
by the separation of their edges form a rhombic or oval space — the so-
called accessory fontanelle.

A second situation is above the middle of the edge of the parietal
bone which forms the parieto-occipital suture, where on either side
there is usually a short fissure, sometimes 2-3 cm. in length, in the
parietal bone, which in very rare cases continues through the tuberosity
to the coronary suture, and thus causes a division of the bone into two
parts, which in the newly born and also in older individuals may simu-
late a fracture.

In the skull illustrated one notices all three varieties of congenital
fissures. In doubtful cases, in addition to the typical situation of the
fissures, the differential diagnosis may be made in the fresh skull by the
filling up of the fissure by a membrane, in skulls from which the soft
parts have been removed by the sharp or rounded condition of the edges.

FIGURES 84, 85.

Fig. 84.— Defects of Ossification in the Skull of a Newly
Born Child.

To either side of the interparietal suture, between this and its
eminence, there are in the parietal bone various perforations varying in
size from that of a lentil to that of a bean. They have irregular edges,
toward which the bone becomes remarkably thin, a fact which is 1 spe-
cially evident upon transmitted light. The portions of the parietal
bone between these openings are also as thin as paper and often trans-
lucent. Similar but smaller perforations are also present iu the poste-
rior part of the frontal bones.

These are defects of ossification which occur frequently, but in vary-
ing intensity, in the skulls of the newly born. They possess a forensic
importance in the first place, as locus minoris resistentiie, in that through
them blows are more readily transmitted to the brain and fractures of
the intervening portions of bone more readily occur than otherwise, —
as. for instance, through the compressiou of the skull during birth ; and
further, because such places— when examined through the scalp — as a
result of their flexibility and crepitation, simulate fractures of the skull
and may be considered such ; but after the removal of the scalp the
findings are so characteristic, especially when the skull is held toward
the light, that confusion with traumatic changes is scarcely possible.

Fig. 85.— Pretended Precipitate Birth in a Closet. Spoon=
shaped Depression of the Left, Compression=fracture of
the Right Parietal Bone.

The mother asserted that she had been taken unawares with partu-
rition in a closet, whereby the child fell from the second story to the
closet-well below. Here it was found still alive and taken to a found-
ling-hospital, where it died at the end of twenty-four hours.

The necropsy revealed externally a linear abrasion of the skin over
the left frontal protuberance, 1.5 cm. long, and a transverse trough-like
depression over the left parietal bone. After the removal of the scalp
there was found at the latter situation a so-called "spoon-shaped depres-
sion," whose point corresponded to the parietal eminence and whose
wider part reached almost to the interparietal suture. This depression
in the direction of its long axis is wedge-shaped and corresponds in
part on the inner surface of the skull with a fine fracture of the
inner table. The deepest part of this depression is situate near the

Fig. 84.

Fig. 85.

eminence, from which along the posterior edge of the spoon there runs
a fracture 2 cm. in length, toward the median line. In addition, there
was found a gaping fracture of the right parietal bone, which, beginning
at the middle of the interparietal suture, gradually grows wider in the
direction of the parietal eminence, then forming a very obtuse angle
runs backward and below to the base of the skull. The further exam-
ination revealed an extensive intermeningeal hemorrhage, which was
distributed over almost the entire brain, and circumscribed pneumonic
foci in the lower lobes of both lungs.

The opinion was expressed that the child died of intermeningeal
hemorrhage consequent upon the injuries to the skull. In regard to the
spoon-shaped depression, there was, of course, the distant possibility that
it arose through the fall down the closet, and at the same time as the
fracture of the rigbt parietal bone, — conceding in such case that the
child fell against a blunt and prominent object, striking that part of the
parietal bone between the eminence and the interparietal suture ; but
at the same time we must remark the infrequency of such an occurrence,
and that we know from experience that such depressions result rather
from less sudden blows against the skull. They may be produced during
birth by the pressure of the skull against the promontory of the sacrum
over which it passes or is drawn under great pressure, or after birth by
compression of that part of the skull by a blunt instrument.

As the parturition was easy, and as there existed no disproportion
between the size of the child's head and that of the mother's pelvis,
the supposition that the spoon-shaped depression occurred during labor
is not justified ; we must therefore conclude that the depression occurred
between the time of the completion of parturition and that of the fall
down the closet. It might have been produced by pressure exerted by
the hand on the head, but also by stepping thereon, or by the knee.
As, however, the accused later withdrew her earlier assertion that the
child without any co-operation on her part fell down the closet, and ac-
knowledged that she had pushed it down the closet-well, through a fun-
nel-shaped opening but 10 cm. in diameter, the most reasonable infer-
ence is that the depression was produced by this latter manipulation, and
that the fracture of the right parietal bone was caused by the fall down
the closet-well.

FIGURE 86.
Fracture of the Skull from a Fall on the Vertex.

A child, aged 18 months, during a moment when unguarded fell from
a first-story window to the courtyard below, striking, as witnesses assert,
upon the vertex, and died in a short time.

Externally no injuries were discovered. Under the scalp, however,
there was an extravasation of blood which extended from the vertex to
the temporal region of each side, where it attained its maximum size.
After its removal there were found to the right a double, to the left a
single, gaping fracture of the parietal bone. The upper parts of the
fractures of the right bone run parallel with the former radiations
of ossification almost to the middle of the interparietal suture, whereas
that in the left — originally pursuing the same course — divides between
the parietal eminence and the interparietal suture into two finer fractures.

Below, the fractures in each bone continue as an irregular shatter-
ing of the posterior part of the squamous portion of the temporal and
the underlying portion of the parietal bones. Both fractures gape
mostly at the parietal eminences, and open still more by pressure upon
the vertex — after removal of the pressure returning to their former con-
dition. The dura mater and the more internal meninges were torn along
these fractures, and through these lacerations on both sides there pro-
truded disintegrated brain-substance. The latter was also deeply lace-
rated, and the cortex both in the immediate vicinity and also in more
distant situations much contused. Everywhere extensive intermenin-
geal hemorrhage.

The method of the production of these fractures is easily understood.
By the fall on the vertex the vault of the cranium was suddenly much
compressed in the direction of the base of the skull, and much distended
in the direction of a line at right angles thereto. This had, as its result,
the fracturing of the parts the most distended — the parietal eminences,
from which situation, as the point of original fracture, the breaks con-
tinue on the one hand in the direction of the vertex, and on the other
of the temporal regions. The non-occurrence of a fracture of the base
of the skull in this case is due to the infantile age of the individual,
during which time of life the base of the skull, as a result of the still
defective ossification and the abundant cartilaginous symphyses, does
not yet possess that compact and at the same time brittle condition as is
the case in later life.

Fig. 86.

N

Tab. 8.

PLATE 8.

Fracture of the Base of the Skull with Extradural Hema-
toma.

The upper half of the skull and brain of a boy aged 9 years, upon
whom a necropsy was performed October 25, 1895. He had returned
home from a gymnasium the evening of October 22d, vomited, was car-
ried to bed, became immediately unconscious, and died the next day.
It was subsequently learned that he had fallen in the gymnasium, strik-
ing upon his head, and was in consequence sent home.

The necropsy revealed no external injury. Under the left temporal
muscle, however, there was an extensive suffusion of blood, and under
this a fine fracture of the bone, which began la the parietal bone, 2.5
cm. above its serrated edge and extended below to the inner part of the
left middle fossa of the skull. Here it gave off several branches and,
continuing into a slight diastasis of the adjoining sutures, ended in the
foramen spinosum.

The dura mater was as though dissected away from this fracture and
the vicinity, by a large lentil-shaped blood-coagulum, which occupied
the entire left temporal region, extending into the middle fossa of the
skull, pressing the dura inward, flattening the corresponding portion
of the brain-cortex, and displacing inward the latter with the lateral
ventricle. The extravasated blood came from a rupture of the principal
anterior branch of the middle meningeal artery, produced by the afore-
mentioned fracture of the skull which affected the sulcus in which the
artery runs.

We have, therefore, a typical external hematoma of the dura mater,
such as relatively frequently tends to develop, particularly after frac-
tures of the temporal region.

The fact that the boy was able to return home after the occurrence
of the injury is explicable, on the one hand, because there occurred no
marked concussion of the brain, and, on the other, because the hemor-
rhage did not take place suddenly, but rather gradually. The extrava-
sating blood had first to dissect up the dura mater from the bone, and
then overcome the resistance offered by the brain, before it attained a
size sufficient to give rise to symptoms of severe compression of the
brain.

PLATE 9.
Traumatic Extradural Hematoma.

The figure shows the lower half of the skull of the ease illustrated in
Plate 8, and reveals the lower part of the entire hematoma, with the
characteristic elevation of the dura mater, through which the extrava-
sated blood glimmers.

Tab. 9.

Tab. 10.

PLATE 10.

Fracture of the Base of the Skull, with Rupture of the
Middle Meningeal Artery— after Removal of the Extra-
dural Hematoma.

The plate shows the base of the skull of the case illustrated in
Plates 8 and 9 after removal of the blood-clot and further dissection of
the dura mater. On the one hand, there arc noticeable the branchings
of the fracture in the middle fossa of the skull and the slight diastasis
of the adjoining sutures, and, on the other, the ramifications of the
middle meningeal artery entering the cranial cavity through the fora-
men spinosum, and distributing itself over the external surface of the
dura mater. A bristle is introduced into the branch of the artery
ruptured by the fracture.

FIGURE 87.
Fracture of the Skull due to Compression.

Fig. 87 furnishes an instructive example of fracture of the skull due
to compression. The skull is that of a laborer, aged 32 years, who, while
building, was struck on the head by a mortar-shaft, and who died a few
hours later.

In the middle of the vertex there was an irregular wound 2.3 cm. in
length, markedly suffused with blood, and extending to the cranial
aponeurosis. After removal of the scalp there were found two isolated
fractures of the skull. The first begins at the posterior extremity of
the anterior tbhxl of the interparietal suture as a diastasis of the latter.
It then continues to the right of, and in the direction of, the former
frontal suture to the right upper orbital ridge, into the orbital fossa,
and ends in the os planum of the ethmoid bone. The second begins to
the right of the anterior extremity of the posterior third of the inter-
parietal suture as a flue, hair-like fracture. Posteriorly it becomes
wider and runs into a diastasis of the posterior part of the interparietal
suture, continues as a diastasis of the left parietooccipital suture, then
into the left posterior fossa of the skull, in the deepest part of which it
ends as it began, hair-like. The base of the skull is otherwise un-
injured, as is also the vault of the skull. Particularly is that part of the
vault above which the scalp-wound was situated, and which corresponds
with the middle third of the interparietal suture, both internally and
externally uninjured.

We have, therefore, to deal with an instance of double fracture of
the skull, which in a certain measure represents a type of fractures
dependent upon compression. These are caused by a sudden force
striking the skull, and causing a compression of it in the direction of
the force and a distention in the direction of a line at right angles
thereto. Thus the skull, similarly as a compressed hazelnut, fractures
at the point of greatest distention situated equatorially to the point of
impact of the force. On the one hand, then, the fracture ascends
meridianly toward the point of impact, and, on the other, continues
toward a point situated oppositely. Thus is explained why the fractures
gape mostly at a situation most distant from the point of impact and
toward the latter become hair-like, and why, as is particularly evident
in the present case, the fractures do not necessarily reach the point of
impact nor the opposite point of the skull.

Fig. 87.

PLATE 11.
Recent Contusions of the Brain.

A. G., aged 40 years, while at work April 11th, fell from a second-story
scafiblding, and died within a half hour.

The necropsy revealed two lacerated wounds of the occipital region
and a gaping fracture of the skull extending from the posterior end of
the interparietal suture through the squamous portion of the right tem-
poral bone to the base of the skull, where at the base of the petrous
portion of the right temporal bone it bifurcated. One limb of the bifur-
cation extended through the anterior surface of the pyramidal portion
of the bone to its apex,— opeuiug the tympanic cavity, whereas the other
ended in the occipital foramen.

Between the dura mater and the inner meninges throughout the
entire base and lateral aspects of the brain freshly coagulated blood in
thick, irregular layers.

After partial removal of the internal meninges and washing away of
the blood-coagula beneath, one notices on the base of both frontal and
temporal lobes — as also to a less degree on other portions of the surface
of the brain — isolated, dark-violet spots as large as a bean or larger.
They affect mostly the brain-cortex, but here and there also the adjoin-
ing area of medullary substance. On more careful examination they
are found to be made up of small — some veiy small — extravasations of
blood. Between them and about their periphery the brain-substance —
through imbibition — has assumed a diffuse and pale-violet color, and is
somewhat softened.

On section of these spots, but more frequently on the surface, one
notices punctiform or larger-sized disintegrations of the brain-substance.

These changes are designated contusions of the brain. They are
common after great shocks or agitations of the head, and affect either
the part of the brain nearest the seat of injury or — and, indeed, much
more frequently and extensively — the opposite part of the brain through
contrecoup.

They are supposed to be caused by the impact of the brain-cortex
against the inner surface of the skull, or to be due to localized destruc-
tion of the cortex induced by the disturbed and agitated cerebrospinal
fluid. But a part in their production may also be played by the dis-
turbing and agitation of the blood circulating in the numerous aud very
fine blood-vessels of the cortex. Further, all three causes may be
simultaneously operative.

Tab. 11.

FIGURE 89.

Healed Hole-fractures (Lochbriiche) Produced by a
Blackjack.

F. P., aged 44 years, had killed his mistress, June 14, 1892, with
numerous stabs of the broken blade of a sword, which he had fastened in
a wooden hilt, and a few hours thereafter had killed himself by shoot-
ing with a revolver through his right temporal region. The shot pro-
duced a simple opening above the right wing of the sphenoid bone, and
the channel of the wound penetrated transversely the bases of both
frontal lobes of the brain and ended blindly on the inner surface of the
squamous portion of the left temporal bone. On the uninjured inner
surface of this latter bone a slightly misshapen conoidal bullet, 6 mm.
in width on the base, was found.

In addition, there were discovered two almost circular depressions of
the left frontal bone, situated one above the other, and having a diam-
eter of 3.5-4 cm. Of these, the lower, somewhat larger, is situate
directly over, and is bisected by, the outer part of the coronary suture ;
whereas of the upper, but its posterior part includes the suture. The
almost circular edges of these depressions are rounded throughout, and
toward the inner side show a circumvallate excavation. The enclosed
plate of bone is flat, with a funnel-shaped depression, and shows several
healed fractures. The vitreous table corresponding to the lower depres-
sion is slightly prominent to the inner side, revealing three scarcely
discernible healed fractures extending from the middle of the depres-
sion to the edge ; whereas that corresponding to the upper depression —
about 3.5 cm. in extent — projects as a blunt cone 6-8 mm. in height,
from the apex of which five healed fractures radiate. The dura mater is
adherent to this cone, and here and there reveals rusty-brown pigment —
otherwise uninjured. In the brain no indication of a healed injury.

Anamnestic, it was learned that eight years previously F. P., during
a quarrel, had received two blows upon the head with a blackjack, in
consequence of which he was sick for a long time, and that since then
there had been a depression on his head which he was wont to exhibit.
Since this injury he is said to have been of a changed nature; to have
been irritable and passionate, in consequence of which his wife secured
a divorce. On account of excesses he was frequently arrested. It is
asserted that after indulgence in alcoholics he was much more excited
and violent than usually.

Before the killing of his mistress and himself he is said to have
been very much excited, and to have complained of his head. Among
his effects there was found a letter addressed to the authorities, in which
he informed them that his mistress had already caused much misfortune
to many, but that he would be the last.

From the above, therefore, it follows that, as a consequence of the
injury received eight years previously, the man had been for a long
time mentally unsound, and that both the homicide and the suicide
were committed during a period of insanity.

Fig. 89.

PLATE 12.
Healed Contusions of the Brain.

Having become acquainted — in Plate 11 — with the appearances of
recent contusions of the surface of the brain, the present plate will
stive to illustrate the appearances of such contusions after healing.

The preparation is from a woman, aged 56 years — for years addicted
to intemperance — who, in the beginning of August, 1896, while intoxi-
cated, fell down four of a steep flight of steps to a stone pavement below,
where she remained prostrate and unconscious. She did not return
to consciousness for two days, and was obliged to remain in bed for two
weeks. Since then she is said to have been feeble-minded and forgetful,
and bo have been more addicted to intemperance than previously.

November 18, 1§96, she was found dead.

The necropsy revealed chronic alcoholism as the cause of death, and
in addition the following conditions of the head :

The scalp uninjured. The skull thick-walled, showing a completely
healed penetrating fracture of the left parietal bone, running from the
posterior part of the interparietal suture to the parietal eminence, there
forming an obtuse angle and coursing directly forward almost to the
coronal suture; from about the parietal eminence it gives off a limb
which is directed downward. The inner surface of the dura mater — to
the left in part, to the right throughout— reveals rusty-brown spots, and,
in addition, to the right the dura mater is covered with an extensive,
very thin membrane which strips readily. The latter is pervaded in
part with rusty-brown pigment-spots, in part with brownish, inspissated
blood-extravasations, and shows here and there fine vascularization
(healed internum ingeal hemorrhage).

On the base of the brain on both sides, in front of the olfactory
bulbs, there are found brownish-yellow, irregularly depressed areas,
the size of a quarter-dollar piece. They affect only the brain-cortex,
and are united with the inner meninges. They consist in part of
brownish cicatricial tissue, in part of a rusty-brown, jelly-like mass,
in which microscopically numerous, rhombic, reddish-brown crystals
(hematoidin-crystals) are demonstrable, as in the smaller illustration of
Plate 12. There are also similar areas on the forward part of the bases
of both temporal lobes. Of these, however, only that of the left could be
figured.

These areas are the residua of contusions of these parts of the brain
received a long time previously. Their traumatic nature is indicated
by the remains of the intermeningeal hemorrhage, and especially by the
healed fracture of the skull, in addition to their typical situation, their
multiplicity, and their symmetric location.

It was evidently the fall sustained while intoxicated three months
previously that gave rise to these injuries, a fact proved not only by
their nature and the symptoms that developed subsequently, but also
by the present findings. In addition to remains of inspissated blood in
the membrane attached to the dura mater, there was found still an ac-
tive congestion of that part of the brain posterior to the area in the
left frontal lobe — conditions which preclude the possibility of the
injuries having been sustained many months or years previously.

FIGURE 92.
Hole-fractures (Lochfracturen).

A hole-fracture (lochfractur) — in process of repair — of the left parietal
bone, produced with a four-cornered locksmith's hammer. The fracture
is almost circular, and has a diameter on the external surface of the
skull of 4 cm. and on the internal surface of 4.5 cm. It surrounds a
disk-shaped, depressed piece of bone, which gave rise to no laceration of
the dura mater, but which shows partly radiate, partly semicircular
fractures, most of which are already in process of healing. The circular
form of the fracture, despite the four-cornered shape of the hammer,
is accounted for by the fact that long use caused a rounding of the
edges and corners of the hammer, but especially because of the thick
growth of hair of the deceased, and by the fact that at the time of
injury the head was covered with a cap.

Fig. 92.

Fig. 93-

FIGURE 93.
Murder Produced by Blows with a Round Hammer.

There are noticeable, in the first place, in the vault of the skull illus-
trated iu the figure, two injuries of the anterior frontal region, both of
which resemble each other in form, that in the left half of the frontal
bone, however, being larger than that in the right. Both are incom-
plete hole-fractures (lochbriiche), oval in shape, with their long axes
running diagonally. The posterior edges of both are more arched and
also sharper than the anterior. The portion of bone enclosed in these
arched fissures is, in both instances, depressed at its posterior part, so
that its edge is 1 mm. lower than the posterior edge of the fracture.
From the middle of the posterior edge of the left-sided fracture there
commences a gaping fracture of the bone which courses through the
frontoparietal suture to the middle of the interparietal suture, thence
to the right posterior fossa of the skull, where it ends.

Still within, and in advance of the middle of the separated right
frontoparietal suture, there is a fracture the size of a dollar, irregularly
circular in shape, with edges partly serrated, partly irregularly broken.
The enclosed portion of bone is shattered and the fragments driven
deeply into the cranial cavity, lacerating the meninges and bruising
the upper layers of the brain-cortex.

After replacement of these fragments one notices, as shown in the
illustration, that the fracture in question consists of arched, terrace-
like fragments, with their concavity directed backward, and that
between the individual fragments bits of hair of the head are inter-
posed.

From the form and other conditions of these fractures one may con-
clude that they were produced by a tool or implement which must have
had a circumscribed striking-surface with circular edges; and we recall
the fact that blows with a round hammer (shoemaker's hammer, etc.)
are particularly likely to produce such injuries. And, in addition, from
the distinct depression of the posterior part of the plate of bone of the
first two fractures, and the sharper and more marked convexity of their
posterior edge, as likewise from the terrace-like, arched fissures with
concavity posterior of the third fracture, one may say that all the blows
were produced from behind and by the edge (lower) of the implement
directed toward the perpetrator.

The perpetrator was not discovered for some days, and then
acknowledged that he caused the murder with a so-called French ham-
mer, which had a circular, rather sharp-edged striking-surface, 2.5 cm.
in diameter.

FIGURE 94.

Skull of a Man who was Murdered and Remained Buried
in a Manure=mound for Four Years.

A peasant, much addicted to intemperance, disappeared suddenly
four years ago. As his absence became remarked, his wife asserted that
he had probably gone to America. The case appeared suspicious ; all the
more so as the couple had lived in continuous discord. The investiga-
tions, however, and excavations in the garden of the house were with-
out result. Finally, at the eud of four years a skeleton was found
under a manure-mound, and the wife then acknowledged that she
had violently killed her husbaud and buried the corpse to escape dis-
covery. The husband is said to have returned home very much intoxi-
cated, to have abused and threatened his wife, whereat she struck him.
As a consequence of this he is said to have lost his balance, to have
fallen striking his forehead agaiust a bedpost, to have remained pros-
trate breathing stertorously, and to have died iu a few moments. His
wife is said to have then dragged the corpse through the door to the
courtyard and to have buried it iu the manure.

On the skull there was in reality found — as the illustration shows—
an injury to the left frontal bone, which reveals an almost equilateral
triangular perforation, 1.5 cm. iu width. This may have been produced
by a triangular-shaped object, — possibly by heavily falling against the
triangular corner of the bedpost. There was found, however, posterior
to this perforation in the frontal bone, a second likewise triangular frac-
ture affecting only the outer table of the skull ; and in addition a
destruction of both malar bones and an incomplete fracture — almost the
size of the palm of the hand — of the left temporal region, the latter of
which was surrounded by an irregular circular fissure. It follows,
therefore, that there must have occurred at least two violent blows with
an angular, and at least additional blows with a more blunt instrument.
These facts positively disprove the assertions of the woman that all the
injuries occurred at one time, and clearly demonstrate that the deceased
was killed by several — at least four — injuries to the head; and, further,
that these occurred not simultaneously, but in direct sequence, and that
one and the same implement, if it possessed both varieties of edges,
may have been employed. The most likely supposition was that the
triangular fractures had been produced with the cutting-edge, the
others with the flat surface of the back of a hatchet. The truth of
these suppositions was proved by the subsequent confession of the
accused.

Fig. 94-

Fig. 95-

FIGURES 98, 99.

Fig. 98.— HoIe=fracture (Lochbruch) Produced by a
Fragment of Glass.

The hole-fracture in the left froutal bone — remarkable because of its
regular rectangular form — was produced by a fall from an upper story of
a house to a skylight below. The panes of glass, which were 1 cm. in
thickness, were broken through by the falling body. The fragment of
glass which was found firmly wedged in the fracture had with its inner
end lacerated the meninges and the brain-cortex, and had given rise to
a considerable intermeningeal hemorrhage.

Fig. 99.— Manslaughter by means of a Long, Angular Bar
of Iron.

The fracture, directed anteroposteriorly, affects the left frontal bone
and has an irregular oval form, 5.5 cm. in length and 3 cm. in width.
The fractured and depressed portion of bone is scaphoid in shape. This
is caused by a keel-like depression which runs through the long axis of
the oval, and which corresponds with a fracture both of the outer and
of the inner table of the skull — findings which indicate the influence
of the longitudinal edge of the instrument employed.

Fig. 98.

Fig. 99.

##

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PLATE 13.
Contusio Pulmonum. Contusion of the Lung.

Figs, a and b. — Upper and lower lobes of the left lung of a woman,
aged 24 years, who killed herself during the night by jumping from the
fourth story of a house to the street below, and who died immediately
in consequence of extensive fracturing of the bones of the skull.

In addition, all the ribs of the left side and the sixth to the eighth
of the right side were found broken. There were further partial lacera-
tion of the right lung at the hilus, and various ruptures of the capsule
of the liver, but only slight hemorrhage into the thoracic and abdominal
cavities.

The left lung revealed the peculiar conditions here depicted. Both
lobes are visibly inflated and do not collapse after their removal from
the body. The surface of both lobes, especially the external surface of
the upper lobe (Fig. a) and the interlobar surface of the lower lobe
(Fig. b), are rendered marmorate by subserous extravasations of bright-
red blood the size of a half-dollar or smaller. Over the latter the pleura
is elevated in vesicles in part the size of beans or larger, in part smaller.
The subpleural extravasations are rather larger than walnuts, penetrate
the pulmonary parenchyma in an irregular wedge-shaped manner, and, as
is especially evident in Fig. a, are likewise pervaded by air-bubbles. In
the deeper parts of the lung on section one notices also isolated, hemor-
rhagic, bean-sized spots, in which here and there minute air-bubbles are
to be found.

Such lesions may develop in one of three ways: 1, through simple
aspiration of blood; 2, through direct, or, 3, indirect contusion of the
lung.

Aspiration of blood into the lungs is not uncommon in death either
from natural causes (hemoptysis) or from violence (cutting of the throat,
fracture of the base of the skull, etc.). In such cases the lungs, both
their external surface as well as the surface of section, are rendered
marmorate by the aspirated blood, and the bronchi are more or less filled
with it. Rupture of certain alveoli, and consecutive interstitial emphy-
sema, may also develop, but occur rarely, similarly as in the analogous
death from drowning. In this form of death I have never yet seen air-
bubbles as large as those observed in the case under discussion.

A direct contusion of the lung occurs especially in cases of fracture
of the ribs, but is usually accompanied by laceration of the pleura, and
even extensive laceration of the pulmonary parenchyma, but may take
place without such associate lesions.

Most frequently, however, such lesions appear to develop indirectly —
that is, not at the place where the force was applied, but at some distant
point, thus : from that part of the lung which becomes suddenly com-
pressed by the external force the air and the blood contained within the

vessels are suddenly driven toward the peripheral parts of the lung.
There thus results a more or less extensive laceration of the lung-tissue,
with hemorrhage and interstitial emphysema.

In the present case the lesions described probably developed indirectly.
The fall from a great height directly upon the head, the resultant exten-
sive fracturing of the skull, and the numerous fractures of the ribs led
to a sudden compression of the thorax and a simultaneous displacement
of the intrathoracic organs, especially the contents of the lungs, which
in turn gave rise to the above-mentioned effects.

PLATE 14.
Peritonitis from Traumatic Rupture of the Jejunum.

M. H., aged 40 years, was taken to the general hospital the evening
of January 12, 1896, where he died the same night. According to his
owu declarations, a large block of ice fell upon his abdomen two days
previously.

The necropsy .revealed no external injury. Internally within the
abdominal cavity extensive fibropurulent exudate, uniting the various
intra-abdominal viscera, especially the intestines, with each other and
with the abdominal walls. The peritoneum throughout spotted, injected,
and lusterless. At about the middle of the jejunum opposite the verte-
bral column a transverse laceration through the entire wall and about
the entire periphery of the intestine, even to a small portion of the
mesenteric attachment. The edges of the laceration with the mucous
membrane are everted, swollen, congested, and covered with discolored
extravasated blood, which latter is also found under the neighboring
peritoneum. The area of laceration is adherent to the surrounding parts
by means of exudate, which is here accumulated in large amount.

The causation of the rupture is explained upon the assumption that
the affected area of the intestine was suddenly compressed against the
vertebral column — a hard base — by the heavy falling block of ice, and
thus brought to rupture.

Tab. 14.

Fig. ioo.

FIGURE 100.

Healed Hole-fracture (Lochbruch) of the Right Parietal
Region.

G. W., aged 18 years, on July 8th, in sport, was struck a blow with
the open hand by a companion, in the right parietal region. He became
immediately vertiginous, vomited frequently, and began to have epilep-
tic attacks, which, in the course of the following days, recurred at irreg-
ular intervals in increasing intensity and severity, and led to death on
the tenth day.

The medicolegal necropsy revealed externally in the right parietal
region a bean-sized, shining, somewhat retracted, adherent cicatrix.
Beneath this a rather circular opening in the bone 18-20 mm. in diam-
eter, with rounded, non-reactive edges. The aperture occupied by a firm
cicatrix united, on the one hand, with the scalp, and, on the other, with
the inner edge of the opening, the inner meninges, and the area of
brain-cortex beneath. At the forward part of the inner side of this
opening there are two almost bean-sized elevations of the vitreous table,
one of which projects into t lie lumen of the opening and is depressed
inward. The fragments are firmly united, and reveal no indication of
recent fracturing. The portion of the brain-cortex immediately beneath
and united with the opening is of roundish form, with a diameter up-
ward of JO mm., and includes almost the entire extent of the right
parietal lobe. Otherwise there are no chauges either of the brain or of
the skull.

The other lesions at the necropsy were markedly hyperemic and
edematous lungs, with extensive aspiration-pneumonia.

Inquiries revealed the fact that the healed fracture had been pro-
duced by a blow with a potato-trowel, which the deceased had received
when a schoolboy. At that time he is said to have been sick for a long
time, and a physician is said to have removed several fragments of bone.
Since then the boy suffered from epileptic attacks, which, however, dur-
ing recent years are said to have occurred infrequently.

Between the death of G. and the blow on the right parietal region
suffered ten days previously, or the defect of bone at that situation,
there existed doubtless a causative connection, as the blow induced
severe and unusually frequent epileptic seizures, which in turn led to
the extensive aspiration-pneumonia, the recognized direct cause of
death. It must, however, be remarked that this blow caused the death
of the deceased, not because of its general character, but because of the
pre-existent defect of the bone at that situation, consequently because
of a morbid condition of the body unkuown to the perpetrator of the
blow.

PLATE 15, FIGURE 101.

Murder the Result of Various Injuries Inflicted with Dif-
ferent Instruments.

On January 5th, at midday, B. K., aged 38 years, after having been
heard screaming, was found in her room lying in a pool of blood and
dying. Beside her stood her lover, with a bloody carving-knife in his
hand. On the floor beside the body was a freshly broken tailor's flat-
iron, completely besmeared with blood. The immediately imprisoned
culprit acknowledged that he threw the flat-iron at his mistress' head
because she would give him no money and insulted him, and then, as
she lay dying on the floor, that he cut her throat with the knife.

The necropsy revealed : —

1. On the hairy part of the head a large number (upward of twenty) of
partly irregularly star-shaped, partly irregularly slit-like wounds, which
crossed each other frequently, affected especially the occipital region,
and most of which penetrated to the bones of the skull. In two situa-
tions over the parietal vault there are rectangular fractures, with ter-
race-like gradations directed to the left and forward. Their limbs are
1-1.5 cm. in length, and have a form as depicted in Fig. 101. Beneath
them the inner table of the skull reveals rectangular fractures.

2. Three parallel, rather sharp-edged, slit-like lacerations of the scalp
over the frontal bone. They have the length of a finger, and are directed
anteroposteriorly. Of them the middle is noticeable because of its length
and because its edges are loosened from the underlying tissues, particu-
larly at its posterior part. Corresponding to this wound there is found
a pointedly oval fracture, 4 cm. in length, and in the middle upward
of 1 cm. in width. Its edges are arched and directed apart. It has a
scaphoid depression in the direction of its long axis which corresponds
to a somewhat longer, finely dentate fracture of the inner table pursuing
the same course (Fig. 101).

3. A large number of irregular, slit-like wounds of varying length
on the upper part of the face, with bases composed of irregular, un-
covered soft parts. One of them, situate in advance of the left ear, con-
tinues as a dried linear abrasion transversely across the malar bone. In
addition diffuse suffusion and scratches.

4. A destruction of the left external ear, the posterior border of which
is almost completely separated from the remainder of the ear.

5. On the neck a transverse, widely gaping, sharp-edged wound, reach-
ing from one sterno-cleido-mastoid muscle to the other, dividing the
skin and various soft parts of the neck, and exposing the vertebral
column. It runs parallel with the hyoid bone through the upper part
of the larynx, sharply cutting the upper border of the thyroid cartilage,
so that the larynx and the pharynx divided at the same height, are
situate in the lower, and the epiglottis, the hyoid bone, and the upper
anterior border of the thyroid cartilage in the upper part of the wound.
At the level of the wound both thyroid arteries, and the left carotid
with the vagus below the bifurcation, are transversely and completely
divided, and the jugular vein of each side incised.

On the anterior surface of the vertebral column, corresponding to
the bodies or the intervertebral cartilages of the second and third cer-

Tab. 15.

vical vertebra, there are six deep, sharp-edged incisions, affecting the
entire width of the bodies of the vertebrae, and distant from each other
2-3 mm. At the edge of the wound near the end on both sides there
are notches as though incised, and from the angle of the wound on both
sides one may follow — in the same direction externally as these — long,
superficial breaks in the skin, looking like incisions.

6. Ou the anterior surface of the chest and on both upper extremities
numerous ecchymoses, upward of the size of a dollar.

7. Contusion of the cortex of the outer surface of the temporal lobe,
and also— and associated with rather marked intermeningeal hemor-
rhag< — of the base of the right occipital lobe and of the under surface
of both halves of the cerebellum.

8. Ou both sides, especially the left, various fractures of the ribs. Of
these, oue penetrated the pleura, lacerated the left lung, aud gave rise to
an extravasatiou of blood — about 100 c.c. — into the left pleural cavity.
Circumscribed contusion of the right lung. A contusion the size of a
half-dollar, of the upper external part of the left ventricle of the heart,
with rupture of the epicardium. On the anterior wall of the stomach,
directly under the cardia, a ragged rupture of the mucous membrane
with a suffusion of coagulated blood half the size of the palm of the
hand.

The body was almost completely, but especially the head and the
upper part of the body, besmeared, aud the clothes thoroughly saturated
with blood. Everywhere marked anemia; the lungs rendered niar-
morate by aspired blood.

The opinion was expressed that the process of killing was by no
means so simple as the accused asserted, but that the deceased had been
killed by a large number of brutal injuries produced with different in-
struments, and that, in general, three varieties of injuries could be dis-
tinguished : those of the head, those of the neck, and those of the trunk
and upper extremities.

Those of the head were evidently produced by the flat-iron — not by a
single throwing of it, but by repeated violent blows with it. Of these,
at hast three — that is, those causing the rectangular terrace-like frac-
tures of the skull — were made with a corner, the others probably with
the edge of the implement. It was doubtless with the latter that the
long sagittal injury over the hairy part of the frontal region was pro-
duced, as it is only thus that the elongated scaphoid fracture of the
frontal bone can be explained, and not through a possible blow with the
carving-knife.

The intermeningeal hemorrhages and- the contusions of the brain-
cortex were the results of these numerous blows.

The injuries to the neck were produced by a cutting-instrument,
which was employed at least six times and always in the same direction
— transversely across the anterior part of the neck. The carving-knife
found on the accused was appropriate for this purpose. As, however,
the knife was heavy, unwieldy, and not especially sharp (it was used in
the house for splitting wood), it is not to be assumed that it was
employed as another knife would be, by drawing it across the throat.
It is much more probable that the injuries were produced by various
blows made with the cutting-edge of the knife. This latter assumption
was confirmed by experiments upon a body, which showed that it was
impossible, with the knife in question, to cut through the throat, but
that the latter could be readily divided by blows with the cutting-edge
of the knife ; and further, that — similarly as was the case with the
deceased woman — one was able in cutting through the skin and soft

parts to produce a sharp-edged wound and precisely similar parallel
incisions into the cervical vertebrae.

The various fractures of the ribs and the contusions of the internal
organs (the lungs, the heart, and the stomach) permit the conclusion
that in their production a third form of violence was used. They are
readily accounted for by the supposition that the accused knelt upon
the already prostrate woman, or, what is more probable, that he mal-
treated by kicking her.

The nature of these latter injuries, the multiplicity of the others,
and the numerous contusions of the face and the upper extremities,
demonstrate that without doubt the murder was performed with great
rage and brutality.

As regards the sequence of the injuries, one can conclude from the
marked hemorrhage and suffusion of the injuries of the head, in con-
junction with the associated iutermeuingeal hemorrhage, that they were
produced before the cutting of the throat. Were the contrary the case,
the rapidly fatal hemorrhage from the cervical vessels would either have
prevented their development or permitted of their development to a
much less marked degree. The production during life of the wounds of
the neck is indicated by the great amount of blood found externally
and in the vicinity of the corpse, the marked external and internal
anemia, and the marmorate appearance of the lungs caused by the
aspiration of blood. As, in addition, the fractures of the ribs and the
associated contusions of the internal organs were suffused with blood,
and as the left pleural cavity contained 100 c.c. of blood, these injuries
were produced either before, or simultaneously with, the cutting of the
throat.

The evidence collectively considered justifies the assumption that the
deceased was first felled with a flat-iron, and that as she lay prostrate
upon the floor she was struck numerous additional blows with it ; that at
the same time her ribs were fractured by her chest being knelt upon or
by her being kicked; that directly thereafter the injuries to the neck
were produced by blows with the carving-knife ; and that death resulted
from hemorrhage.

The culprit was condemned to death by hanging, but his sentence
was commuted to imprisonment for life.

Fig. 101.

FIGURES 102, 103.

Injury of the Lung the Result of Various Fractures of the

Ribs.

A man, aged 44 years, with suicidal intent, jumped from the second-
story of a house to the street and died immediately of internal hemor-
rhage.

At the necropsy there was found over a half liter of extravasated
slightly coagulated blood in the left pleural cavity; a fracture of the
sternum and of the pelvis ; fractures of various ribs of the left side in
the scapular line (Fig. 103) ; corresponding with this latter a deep longi-
tudinal, almost slit-like laceration of the posterior surface of the lower
lobe of the left lung (Fig. 102) ; an irregular laceration of the pericar-
dium; a rupture of the left auricle; and numerous ruptures of both
ventricles affecting only the endocardium and the adjojning layers of
the muscular substance— one of which, however, extended to the epi-
cardium.

The man evidently fell upon the anterior surface of the left side of
his chest, whereby, on the one hand, the heart was compressed between
the sternum and the thoracic vertebrae and thus ruptured, and, on the
other, the already mentioned fractures of the ribs — all in one line —
were produced. The outer pointed ends of the fractured ribs — as is
visible in the illustration — perforated the pleura as the teeth of a giant-
comb and penetrated deeply into the posterior surface of the lower lobe
of the left lung, giving rise to the large slit-like laceration.

Developed to a less degree one sees injuries of the lungs — generally
punctured wounds — produced by penetration of the broken ends of
fractured ribs. These may sometimes be of very great depth.

Fig. 102.

Fig. 103.

-*M

>

PLATE 16.
Suicide by Cutting the Throat.

The case was that of a young man in his twentieth year, who cut his
throat in his room with a sharpened pocket-knife. He was found dead,
OD his back, iu a moderate-sized pool of blood, his right hand covered
with blood, and beside this a bloody pocket-knife.

After cleansing the body the skin was not especially anemic, the post-
mortem lividity fairly well developed, the visible mucous membranes
not particularly pale, the wound of the neck running transversely from
the middle of one sterno-cleido-mastoid muscle to the other. The edges
of the skin-wound were sharp and joined on both sides to form an acute
angle. In the upper, as well as in the lower edge, one notices near the
median line a shallow notch — an indication that at least two incisions
must have been made. The entire cartilaginous larynx in the direction
of the longitudinal axis of the wound is cut through twice above the
middle of the thyroid cartilage, the upper incision being transverse, the
lower somewhat depressed to the left. The section (evidently the
lower) then runs transversely between the upper and lower vocal cords,
and divides the arytenoid cartilages of both sides, behind which it opens
the pharynx.

Of the arteries, only a branch of the poorly developed thyroid artery
of the right side and the right internal jugular vein are divided. The
throat, the esophagus, the larynx, and the trachea are filled with a con-
siderable quantity of recent blood -coagula, which extend on both sides
deep into the bronchi. Both lungs are turgid, and on section reveal
numerous marmorate areas due to aspirated blood.

From the preceding it follows that in the present case death was not
due to a fatal hemorrhage, but resulted from suffocation consequent
upon entrance of the blood from the wound into the larynx and the
lower respiratory passages.

Worthy of note is the distinct prominence of the lateral portions of
the neck about the ends of the large wound. These were produced
intra ritam by the retraction and the consecutive thickening of the
stumps of the sterno-cleido-mastoid muscles, which were in great part
divided.

FIGURES 104, 105.
Suicide by Cutting the Throat.

Fig. 104. — One can distinguish on this suicide, aged 43 years, four
transverse wounds which are situate closely together and parallel, in the
region of the laryux. Two incisions are superficial, scratch-like; the
third, evidently due to the union of two, gaping and deep. The section
of skin in question, in order to render visible the deeper injuries, is dis-
placed upward and there fastened. The larynx thus exposed shows,
about the angle of the ossified thyroid cartilage, four transverse in-
cisions close together, penetrating into the lumen of the larynx. Of
these, the lowest to the right goes through the entire thyroid cartilage,
and divides the deep cervical vessels with the vagus nerve. Six in-
cisions were therefore made; of these, two affected only the skin, and
four the larynx ; and of the latter, the lowest the deep vessels of the
neck.

The body revealed the characteristic signs of death from hemor-
rhage. The instrument employed was a rather sharp, strong pocket-
knife.

Fig. 105. — Larynx of a man, aged 50 years, who had cut his throat.
Three parallel incisions, symmetrically arranged, transversely above the
thyroid cartilage. Of these, the highest penetrates between the larynx
and the hyoid bone, partly dividing the epiglottis ; the second extends
into the upper vocal cords ; while the third, and lowermost, does not
open the larynx at all. The band of tissue, but £ cm. wide between the
uppermost and the second incision, is divided irregularly and obliquely
in the middle. This may have been due to a fracture produced by ex-
cessive pressure of the not especially sharp blade.

The deep vessels of the neck were uninjured ; but, on the other hand,
on both sides the external jugular vein and the superior thyroid artery
were divided and there was blood in the larynx and trachea.

Fig. 104.

Fig. 105.

Fig. 106.

FIGURE 106.
Suicide by Cutting the Throat.

J. E., aged 28 years, a medical student, was found dead in a restau-
rant in a room closed from within, with his throat cut. The body lay
in a large pool of blood and was already rigid.

In the neck there was found a transverse, sharp-edged wound,
which extended from one sterno-cleido-mastoid muscle to the other, and
the upper edge of which, to the left, revealed an incision 3 cm. in length.
The larynx, situate in the bottom of the wound, shows immediately
above the vocal cords a sharp-edged, transverse incision extending to
the mucous membrane of the posterior wall, and in addition six partly
transverse, but mostly oblique incisions running from the left below to
the right above. They have sharp edges and penetrate into the lumen
of the larynx.

Both sterno-cleido-mastoid muscles are divided — the left completely,
the right all but a small portion. To the right the superior thyroid
artery, to the left the large deep veins of the neck, and on both sides
the jugular veins are cut. The entire body is markedly anemic, the
larynx and the bronchi contain some coagulated blood, and the lungs
are here and there rendered marmorate by aspirated blood.

The case is of interest, because, had the circumstances been suspicious,
the numerous incisions into the larynx and their varying direction
might have led to a supposition of murder.

FIGURE 107.

The figure shows the body of a 4-inouths-old, vigorous child, which
was experimentally pierced with a pointed conical instrument having a
width of i cm. at its base. The wounds were made, in the first place, to
show the regular cleavage of the skin ; and, in the second place, to de-
monstrate the important fact that a conical instrument docs not — as
one might suppose, and was formerly taught— produce round punctures,
but slit-like openings. These latter are distinguished from those pro-
duced by knives only by their determinate direction — corresponding to
the local cleavage of the skin — and by their limited extent.

The regular cleavage of the skin is recognized in the regularity of
the curves in which the wounds encircle the body and its extremities.
To the second rule there is an exception only inasmuch as at those
places where the curves join to form parabolic triangles the openings
have not a slit-like form, but rather a shape like an arrow-point or a
triradiate, star-like form.

FIGURE 108.

Numerous Punctured Wounds of the Stomach Produced
with a Conical=shaped Instrument.

The figure in question is intended to demonstrate that — similarly as
the skin — other organs, especially the stomach and the intestines, pos-
sess a regularity of cleavage. This becomes manifest upon puncturing
the organs with conical or blunt-edged instruments, and indicates that
the wounds were caused by such, and not by a cutting-instrument
(knife). This latter, without regard to the local cleavage, divides the
tissues only in a line with its cuttiug-edge.

The stomach was filled with liquid tallow, and, after this had become
stiff, was pierced with a conical instrument 5.5 cm. in length and 5 mm.
in width at its base. No choice whatever of the points of puncture was
made. It was found that the punctures produced had arranged them-
selves into regular curves, and that each puncture was made up of three
slit-like openings corresponding with the coats of the wall of the stomach.
Of these, the most external — that appertaining to the peritoneum —
assumed a direction parallel with the course of the curvatures of the
stomach ; that beneath — in the muscular coat — a direction at right angles
to this, and that in the mucous membrane still another direction.
Hence it follows that a regular cleavage is possessed by each coat of the
stomach, and that when a non-cutting instrument penetrates the wall
of the organ the division of each coat follows in a different but constant
direction.

Fig. 107.

Fig. 108.

PLATE 17.
Suicide through Stabbing.

This case is that of a physician who had taken his life in a hotel.
His body was found lying upon the left side, behind and across the door-
way of the room, so that at first it was not possible to open the barred
door. The body was almost entirely covered with freshly coagulated
blood, and clothed only with a shirt, which was saturated with blood,
opened from the front, and thrown backward. Extensive blood-marks
reached from the body to the bed, the covering of which latter was like-
wise saturated with blood, and beside which a large, open pocket-knife
lay.

The position of the arms and hands is evident from the illustration.

After cleansing the body six stab-wounds were recoguized. Of these,
one was situated in the right side of the neck, the other five on the
anterior surface of the chest. All of the wounds had a slit-like form,
and showed throughout sharp, arched, separated edges, which on both
sides joined to form acute angles and between which there was a collec-
tion of coagulated blood. This latter was continued to the left beyond
the wound as a dried streak, in which direction the blood had probably
flowed at the first turning of the body.

The wound of the right side of the neck was transverse, 3 cm. in
length, with its edges apposed. It continued into the depths of the
neck as a wedge-shaped canal gradually decreasing in size, which, begin-
ning at the middle of the inner edge of the sterno-cleido-mastoid mus-
cle, continued from before backward and somewhat from within out-
ward directly to the transverse processes of the middle cervical ver-
tebra. It opened in its course the outer wall of the right carotid artery,
and cut the jugular vein transversely, without injuring the vagus nerve.

Of the wounds of the chest, the uppermost one was situated three
fingers' breadth below the middle of the left clavicle. It penetrated
directly anteroposteriorly the second intercostal space and ended in the
lung, which was tuberculous and, at this point, partly adherent to the
pleura.

The other four wounds were confined to an area of the chest half the
size of the palm of the hand in the region of the left nipple, and corre-
sponded with the previously mentioned one in that they were almost
transverse. They also penetrated in the direction from before backward,
partly with injuries to the ribs, the chest-wall, or the intercostal spaces,
and ended in the antero-external part of the upper lobe of the left lung,
into which, as six slit-like openings 4-7 mm. in length, they penetrated
a distance of 1-3 cm. In the left pleural cavity there were about 300 c.c.
of partly fluid, partly coagulated blood. Closer investigation revealed
that the external openings of two of the wounds showed notches in

their edges, and that one of them corresponded with a double slit-like
opening in the pleura. It follows therefore that these openings were
punctured twice; and, further, that with five punctured openings in the
skin, seven were fouud in the lung.

That it was a case of suicide was demonstrated by the external cir-
cumstances and all the postmortem findings. It was clear that the de-
ceased had produced the wounds while in bed, and that he had then
attempted to arise and go to the door, where he fell. Excluding these
facts, the opened and uninjured shirt, the symmetric disposition of the
openings of the stab-wounds and of the course of the canal of the
wounds, and the proximity of the wounds of the chest, as likewise the
fact that into two of the wounds punctures were made twice, were more
indicative of suicide than of murder.

The course of the puncture-canals, especially that of the neck, permit
the supposition that the stabs were done with the left hand, and in-
quiries revealed that in reality the deceased was left-handed.

The motive for committing the deed may have been the tuberculous
disease.

r

Tab. 18.

PLATE 18.

Triple Injury to the Small Intestine Produced by a Stab.
Peritonitis.

Sch. J., aged 49 years, the evening of October 21st, during a quarrel
before a brandy-shop, was stabbed with a pocket-knife in the abdomen,
and died two days later, having declined an operation.

The necropsy, performed ( Jctobcr 25th. revealed externally, one finger's
breadth to tbe inner side of the right anterior iliac spine and three fin-
gers' breadth above Poupart's ligament, running parallel with the latter,
a slit-like, gaping, sharp-edged wound, 3.5 cm. long and 11 mm. wide.
Its outer end is pointed, its inner rather blunt. Its upper edge is rather
straight, its lower arched outward. The base of the wound is formed by
somewhat discolored musculature, and the wound itself grows deeper
beneath its inner edge. Following in this latter direction, one discovers
that the wound penetrates the entire abdominal wall, and that — corre-
sponding with the external wound— there is in the peritoneum a sharp-
edged, acute-angled slit, 17 mm. in length.

In the abdominal cavity there is a large quantity of discolored, opaque
fluid containing flooouli ; the peritoneum throughout, but especially in
the lower portion, markedly injected in spots; and the viscera — particu-
larly those in tbe right lower quadrant — united with each other and with
the peritoneum by means of pyofibrinous exudate.

Opposite the wound in the abdominal wall there is a coil of small
intestine about 1 in. from the cecum, which is sharply and transversely
divided on its convexity, so that there remains but a bridge of intestine
— 2.5 cm. in width — posteriorly, corresponding with the insertion of the
mesentery. About 15 cm. above this point the intestine is pierced by
two likewise transverse, sharp-edged slits, situate opposite to each
other. Of these the lower measures 2 cm., the upper 1.5 cm. Again,
15 cm. above the latter point there is a longitudinal opening in the lower
wall of the intestine, 1.5 cm. in length. The wounds— from all of which
the intestinal contents escape — are situate in one direction, and show
edges covered with exudate and discolored blood-coagula. The mucous
membrane throughout is cloudy, congested, swollen and everted, as is
the rule iu recent penetratious of the intestine aud in those occurring
during life.

We recognize, therefore, in this case three injuries to the intestine
produced by a single stab with a knife. They are at the same time
instances of the three most common stab-wounds of the intestine : the
division of the wall of the intestine, the single aud the double per-
foration.

FIGURES 109, 110.

Fig. 109.— Stab-wounds Produced with a Four-cornered
Picture=nail.

The vault of the skull of a woman, aged 77 years, who was found
dead, lying in a pool of blood, August 3, 1882. The body revealed in
toto 38 stab-wounds, of which 32 were on the head and face. Of the
latter, 11 extended to the bones of the skull, 4 penetrated the external
table, and 3 the entire thickness of the bones of the cranium. These
latter corresponded in situation with penetrations of the meninges and
injuries to the brain-cortex, with extensive extravasation of blood. One
situated in the occipital region penetrated even to the pons Varolii.

The stab-wounds of the skin were partly slit-like, partly star-shaped,
whereas those of the bones of the skull were quadrate and sharp-edged.
The largest was situated in the posterior portion of the left temporal
region and had a diameter of 4 cm.

It was therefore evident that the perforations had been made with a
four-cornered instrument. And in reality there was found in the blood
beside the body a large iron nail, a so-called mirror-hook, such as is
used for hanging heavy pictures. It had a length of 17 cm. and was
1 cm. in width at the base. It was four-cornered, pointed at one end,
and fitted exactly into the openings in the skull, so that there was no
doubt that the nail was the instrument employed in causing the injuries.

That the woman had been murdered there could be no question, as
most of the stab-wounds affected the occipital region, and as, further,
there were stab-wounds of the face and of both hands; in addition, the
inferior maxilla was fractured.

The culprit was not discovered.

Fig. no.— Punctured Wound in the Parietal Bone Pro-
duced with a Knife.

The wound was produced with a large pocket-knife. It shows dis-
tinctly the form of a transverse section of the knife-blade, and indicates
in which direction the cutting-edge and that in which the back of the
knife were held. Of the edges of the fracture in the external table of
the skull, the anterior one, at the wide end of the wedge, is somewhat
indented ; the others, as also the back of the wedge, are sharp. On the
other hand, the vitreous table was broken off along both edges.

Death resulted from intermeuingeal hemorrhage.

Fig. 109.

Fig. no.

Fig. in.

Fig. 112.

FIGURES 111, 112.

Fig. 111. — Vault of the skull of a young man, who, with suicidal
intent, drove into his head two heavy bolts (designed for hanging
lamps) and then threw himself from a window. Death resulted from
internal hemorrhage consequent upon rupture of the liver.

The punctured wounds are almost 1 cm. in width and completely
round. The meninges were penetrated on both sides and the brain-
cortex injured.

Fig. ii2.— Punctured Wounds Produced with a Sharpened
Three=cornered File.

Three of the wounds have the form of a triradiate star, produced
because each of the cutting-edges of the file had cut into the skin.
Two others, although produced by the same instrument, are irregular,
either because folds of the skin were punctured, or because several
punctures were made into these places.

FIGURES 113, 114.

Punctured=incised Wounds of the Left Hand Received in
Self=defence.

The wounds were found on a man, aged 47 years, who was killed in a
brawl, having received twenty-four stab-wounds with a knife on the
head and nine on the thorax.

The dorsal surface of the left hand and the adjoining portion of the
forearm, illustrated in Fig. 113, show six punctured incised wounds.
Of these, three are slit-like and affect the dorsal surface of the hand,
and one .the extensor side of the forearm, whereas the other two are
tangential slits of the skin, one being situate on the ulnar side of the
first phalanx of the middle finger, the other above the head of the
ulna.

On the palmar surface of the hand — Fig. 114 — in addition to the
continuations of the two last-mentioned tangential slits, one sees three
slit-like wounds upward of 1 cm. in length in the palm of the hand,
and three similar, rather shorter wounds at the junction of the hand
with the forearm.

All of these wounds are situate without regularity and penetrate
deeply into the subcutaneous connective tissue, without there being
demonstrable any coniniuuication between the wounds on the dorsal
and those on the palmar surfaces of the hand.

They are evidently stab-wounds made by a knife, received in self-
defence. Their presence in such number is accounted for by the great
number of other wounds on the head and chest with which they are in
relationship.

Fig. 113.

Fig. 114.

Fig. 115.

FIGURES 115, 116, 117.
Murder Produced with a Fascine=knife.

Fig. 115. — During the night of October 27, 1885, M. S., a prostitute,
aged 23 years, was found dead and apparently murdered.

After cleansing the head, which was entirely covered with blood,
there were found externally the injuries evident from the accompanying
illustration, which was prepared in accordance with the skin of the head,
which had beeu preserved. The injuries are: 1. A slit-like incision
with sharp edges, 4.5 cm. in length, directed anteroposteriorly over the
left frontal protuberance. Extending to the bone beneath — which is
fractured in the same direction — half of it affects the non-hairy, half
the hairy, portion of the forehead. 2. Three almost slit-like incisions
transversely through the left temporal region. They have sharp edges
and upward the length of a linger; they are equidistant from each
other 2 cm.; they are directed through the external ear and pene-
trate to the bone. The middle and lowermost oiks divide the tragus
and the antitragus. The uppermost one. after an intermission of 1.5 cm.,
continues as an incision — 1 cm. in length, affecting only the upper layers
of the skin — which courses over the cheek beneath the malar bone.
3. A slit-like wound along the lower border of the inferior maxilla. It
has sharp edges, is 3 cm. in length, and penetrates to the bone.

Fig. 116 shows the fractures of the skull corresponding to the ex-
ternal wounds. In the first place, beneath the first-mentioned wound,
there is a gaping fracture of the frontal bone 4.5 cm. in length and 3-4
mm. in width. Like the wound, it is directed anteroposteriorly, and its
edges at both extremities approximate to form acute angles. For a short
distance beyond this gaping fracture there is a fissured fracture of the
frontal bone which runs in the same direction. There is no associated
laceration of the dura mater, but there are contusion and suffusion of
the inner meninges and those frontal convolutions situated beneath.
The inner edges of the fracture are bevelled and in the middle broken
off; the external are sharp and pointed. There is a partial fragmenta-
tion of the inner table.

The temporal muscle beneath the second-mentioned wounds is much
incised, some of the incisions revealing a slit-like character. The tem-
poral bone throughout its entire extent and th» parietal bone in its
lower part are extensively fractured. Among the fractures, however,
there are three principal ones which panne courses similar to those of
the cutaneous wounds, and which in part have a distinct fissure-like
character. There are much laceration and contusion of the meninges
and of the brain beneath, with extensive blood-coagula.

From the form, length, and course of the cutaneous wounds and of
the fractures of the bones it was concluded that they had been produced

by blows with a weighty instrument having a rather blunt edge, and
that this instrument might have been — that it even probably was — a
saber, or a similar instrument. It was also inferred that in all proba-
bility the blow over the forehead was the first, and that the others were
inflicted upon the already prostrate and unconscious woman. The latter
supposition is borne out by the number and the parallel course of the
wounds.

There could be no possible doubt that the case was one of murder, as
in addition to the above-mentioned injuries the first phalanx of the left
thumb with the nail was almost completely severed. This injury was
probably received in endeavoring to ward off a blow.

Numerous spermatozoa were found in the vaginal secretion ; but from
this fact — because of the occupation of the woman — one may not with
certainty draw the inference that the murderer had coitus with her
immediately before killing her.

Fig. 117.— Saber=blow.

F. N., aged 43 years, during a labor-strife, received a blow with a saber
from a gendarm, and died of encephalitis and meningitis as a consequence
thereof, at the end of 14 days. Of the injury to the skull one can readily
distinguish the fracture due to the blow, and in addition, proceeding
from the latter, a lamelliform separation of a large section of the parietal
bone. The fracture due to the blow is arched, with the convexity for-
ward. It extends from the anterior temporal portion of the right
parietal bone to the parietal eminence, a distance of 10 cm. The charac-
teristics of the fracture are most marked at its central portion, where
one can distinctly recognize the anterior smooth bevelled and the poste-
rior pointed edges. Posterior to this fracture there is an oval plate of
bone the entire thickness of the skull — 10 cm. in length and 5.5 cm. in
width — which is separated and can be thrown back as a flap. Thus,
through an elongated oval opening of the same size as this section of
bone, one may view the interior of the skull. The anterior edge of the
opening is smooth and bevelled, the posterior irregularly fractured.
This separated plate of bone is transversely fractured at its upper part,
while at the middle of its anterior edge — at that part where the charac-
teristics of the saber-fracture are best developed — there is a small, iso-
lated, oval fracture of the margin of the bone. It is 4 cm. in length and
1.3 cm. in width, and affects only the outer table.

Fig. 1 1 6.

Fig. 117.

Fig. 118.

Fig. 119.

FIGURES 118, 119.
Fig. 1 1 8. —Murder Caused by Numerous Hatchet-blows.

The vault of the skull of a woman, aged 43 years, who with her four
children was murdered by her husband, who at the time was in a state of
delirium tremens. The woman was killed by blows with the cutting-
edge of the hatchet and subsequent cutting of her throat, the children
simply by cutting their throats with a kitchen-knife. The murderer,
who also cut himself in the left thoracic region, died a few months sub-
sequently in an insane asylum.

One notices on the right side of the skull four almost parallel frac-
tures caused by the blows. The three anterior ones are rather simple
fissures. Of these, the middle and at the same time the uppermost one
penetrates obliquely from behind forward, and at its anterior part is
associated with an elevation of the bone. The fourth fracture, situate
in the region of the parietal eminence, penetrates the entire thickness
of the bone obliquely from before backward. Its forward edge is arched,
with the convexity anterior, and is sharp, smooth, and bevelled. Its
posterior edge is pointed, and, with an oval plate of bone the thickness
of the skull, is broken off and can be displaced backward as a flap.

Fig. 119. — Vault of the skull of a man, aged 54 years, who died in
consequence of a saber-blow received from a policeman.

Two and a half fingers' breadth behind and running parallel with the
left coronary suture there is a linear fracture with sharp edges, 3.5 cm.
in length ; and posterior to this a pointedly oval fracture of the same
length and 1 cm. in width at its center. The latter is depressed ante-
riorly 1-2 mm. The vitreous table is fractured beneath to a somewhat
greater extent, but in similar form. A fragment of bone from the ante-
rior edge of the fracture had lacerated the middle meningeal artery,
giving rise to an extensive flat extravasation of blood between the dura
mater and the bone. The saber was not sharp, and in consequence did
not produce a fissured fracture, but such an injury as would an angular
instrument.

FIGURE 120.

Hole-fracture (Lochbruch) Produced by a Blow with the
Cutting-edge of a Hatchet.

In Vienua, in 1884, a banker and his two-children were killed by
anarchists. On the body of one boy there was found a roundish frac-
ture in the occipital region ; on that of the other a regular rectangular
fracture (lochbruch) with dentate edges, in the middle of the frontal
bone (illustrated in my textbook, seventh edition, page 457). Ou the
body of the father, however, there was found the wedge-shaped frac-
ture of the right parietal bone depicted in the accompanying figure.
It has a length of 4.5 cm. and, at the base of the wedge, a width of 1.1
cm. Its apex is directed to the right and below. The forward edge of
the fracture is sharp, the posterior in its upper part indented ; the inner
table on both sides broken off. The fragments of the latter, as also the
section of bone from the larger fracture, were driven deeply into a
fissure-like laceration of the braiu-substance. From the base of the
fracture another extends to the interparietal suture, and from the apex
still another, which latter runs forward and below to the middle fossa
of the skull.

It was evident that the injury was produced by the cutting-edge of a
hatchet-like implement, and as the fractures of the skulls of the two
boys were of a totally different character, one might readily suppose
that two or three implements had been employed, or that the murders
had been committed by two or three persons. There occur, however,
hatchet-like instruments (so-called beilstocke) which are commonly
employed in the households of Vienna. They possess, in addition to a
cutting-edge, a prominent back with a circumscribed four-cornered
striking-surface. One must, therefore, concede the possibility of all
three injuries having been produced with the one instrument and by
the one person — the cutting-edge being used in one instance, the back
of the implement in killing the boys. As a matter of fact, it was sub-
sequently determined that one anarchist was the murderer. As others
kept a lookout, he committed all three murders with a so-called fokos
(a short beilstock or hatchet). He first killed the banker with the cut-
ting-edge of the implement, and then, as the boys came running to their
father, he felled each with a blow with the back of the hatchet.

Fig. 120.

Tab. 19.

PLATE 19.

Close-range Gunshot-wound in the Region of the Heart Pro-
duced with a Revolver of o mm. Caliber. Natural Size.

Two fingers' breadth to the inner side and a little above the left
nipple there is a circular opening, 4 mm. in diameter — looking as though
produced with a puncb. It has blackened edges and a black base, and
to the right of it there is a dried streak of blood. The perforation is
situate in the middle of a likewise circular, dried, leather-like, brown-
ish-black area, which latter in turn is surrounded by an irregularly
round and indistinctly limited zone, about the size of a dollar. The
latter is much excoriated and is beginning to become dried. The entire
region was originally covered with powder-dust, after the removal of
which a second discoloration persisted. This latter is especially marked
in the upper half of the outer excoriated zone, and consists of numer-
ous black points which cannot be washed away, and which have been
produced by unexploded or but partially exploded grains of powder.
Finally, one notices, after cleansing the wound of entrance and the
adjoining parts, still a third — the most external— zone. It is the size
of the palm of the hand and extends to the left, beyond the nipple.
The skin over it is slightly prominent ; it is doughy to the touch and
bluish in color.

Examining the individual details of this gunshot-injury more care-
fully, one finds that the circular perforation was without doubt caused
by the bullet; but as the opening measures only 4 mm. in diameter,
while the bullet measures 9 mm., the wound of entrance is much smaller
than the projectile. This is only to be explained by assuming that the
skin retracted after the occurrence of the perforation, occasioning a
diminution in the size of the opening. When there does not occur a
laceration of the wound, due to the direct force of the explosion— such
as happen* in shots from the immediate vicinity with large weapons —
the bullet causes a funnel-shaped inversion or stretching of the skin.
At the same instant it perforates the apex of the funnel, permitting
retraction of the remainder of the stretched skin. By this procedure
the inner surface of the cone-shaped inverted portion of the skin
becomes abraded and forms, after the occurrence of the perforation, the
inner leather-like dried zone, which one generally, though incorrectly,
designates the "burnt margin." The circular form of its limitation
corresponds with the extent of the skin which was inverted, and
approximately, therefore, with the caliber of the bullet. Of the occur-
rence of these phenomena one can satisfy himself by shooting through
a tense plate of India-rubber.

The edges of the " burnt margin " in close-range shots arc usually
undermined to a considerable extent, particularly when the weapon
is held in close apposition to the body. In addition, the edges of the
perforation are blackened with powder, this being an important charac-
teristic of close-range shots. The undermining is due to the direct

action of the exploding gas, which penetrates between the skin and the
firmer structures beneath (the wall of the thorax, the skull, etc.).

The zone surrounding the "burnt margin " is the result of the con-
tusions of the skin produced by the exploding gas, being possibly also
due to singeing of the tissues. The blackening on and in this area is
caused by the powder, that which could be washed away being due to
the powder-dust, that which is scattered and punctiform being due to
inclusion within the skin of grains of powder.

On the other hand, the external bluish area, the size of the palm of
the hand and doughy to the touch, is due to the suffusion of blood which
had collected in the subcutaneous and intermuscular tissue in the
neighborhood of the wound.

FIGURES 121, 122.

Fig. 121. — Suicide with a Carbine.

The perforation, situate in the region of the heart, is au irregular
opening 12 mm. in diameter. It has somewhat serrated edges and is
blackened both externally and in its depths. Quite an extensive area
about the wound is diffusely blackened, and the adjoining hairs are
singed.

The channel of the gunshot-wound is directed from before backward
and penetrates the heart, extending to the thoracic vertebrae. In one
of the latter a conoidal shot, but slightly deformed, was found. This gun-
shot-injury is therefore not essentially different from that produced with
a revolver of moderate caliber.

Fig. i22. — (iunshot=wound of the Right Temporal Region
Produced with a Double=barrelIed Rifle, which in Shoot=
ing Burst ; Suicide.

Blackening of an area of the skin the size of the palm of the hand
in the temporal region. In the middle of the discoloration there is an
irregular opening, 2.5 cm. in length and upward of 1 cm. in width, with
blackened edges. The hair in the vicinity is singed. Directly in front
of this opening there is a ring with double contour, respectively 1.5 cm.
and 1.3 cm. in diameter. This is evidently an impression of the orifice
of the second barrel of the gun.

In addition there is a portion of the skin of the right thoracic wall.
It reveals a curved wound, 2 cm. in length, situate between the anterior
extremities of the second and third ribs. In the subcutaneous connective
tissue of the wound there was found a section of the burst barrel of the
gun, 2.5 cm. in length and upward of 1 cm. in width. One could distin-
guish the touch-hole and portions of the chamber of this barrel.

Fig. 121.

Fig. 122.

person may be able to perform various activities. He may particularly,
as in the present case, occasion several additional gunshot-wounds even
of the heart itself. This happens especially in cases of gunshot-wounds
produced with a revolver, as the shots follow in rapid succession, and
because the direct destructive force of the explosion is but slight and
the projectiles produce relatively small openings, particularly the small-
est varieties of revolvers, such as was used in the present case.

Fig. 124.— Revolver-shot in the Mouth.

Irregular angular opening, the size of a bean in the left posterior part
of the hard palate. It has blackened base and ragged edges, in the
vicinity of which grains of powder are scattered.

Fig. 125.— Suicide by a Gunshot-wound in the Mouth.

Externally nothing was to be noted but hemorrhage from the mouth
and nose; internally, however, in the forward part of the oral cavity
extensive blackening due to powder.

On the dorsum of the tongue to the left, behind the apex, there is an
irregular, bean-sized, slit-like, markedly blackened opening. From this
there courses posteriorly through the left half of the tongue a canal
having the breadth of a small finger. The wound of exit from the
tongue is at its base, but the wound itself continues posteriorly, destroy-
ing the left half of the epiglottis, the fold of mucous membrane above
the left greater cornu of the larynx ; thence through the posterior
pharyngeal wall to the disintegrated transverse processes of the upper-
most cervical vertebrae. Here, in an extensive suffusion of blood, there
was found a conoidal bullet, 9 mm. in width, somewhat flattened at the
apex. The large vessels of the anterior part of the neck were uninjured,
but the left vertebral artery at about the situation of the destruction of
the lateral mass of the atlas was irregularly lacerated.

The skull was uninjured. There was some extravasation of blood
between the inner meninges, especially to the right below in the par-
ietal region, and beneath these extravasations small contusions of the
brain-cortex. The medulla and the cord were uninjured. There was a
considerable quantity of aspirated blood in both lungs.

Death was therefore in part due to the contusion of the brain and its
consequences, in part to suffocation the result of the aspiration of blood
coming from the lacerated vertebral artery.

Fig. 125.

Fig. 126.

FIGURE 126.

Shot through the Dependent Mamma with Three External
Openings.

During a fight in an inn, as it became necessary to forcibly eject one
of the most boisterous of the combatants — having a loaded revolver of
7 mm. caliber — the latter is said to have been accidentally discharged. A
female pedler sitting at a table one meter distant was struck with the
bullet and killed. The physician first summoned found the woman
already dead, and declared that the two upper wounds had been pro-
duced by the bullet, but that the lowermost on account of its slit-like
form might have been caused by a stab. This opinion appeared not im-
probable, as the fight took place in the neighborhood of the woman and
had become very furious, and as knives were said to have been drawn.

The necropsy, however, demonstrated that the third wound was also
a gunshot-wound, and that all three wounds were produced by a single
shot. The bullet had penetrated the dependent mamma, from above
downward, and then entered the chest, where it opened up the apex of
the left ventricle of the heart. There was therefore produced in the
skin by one shot two wounds of entrance and one of exit. The first
wound (of entrance) is irregularly circular and shows an area of contu-
sion corresponding with the dimensions of the bullet; the second (a
wound of exit), situate at the lower fold of the mammary gland, is slit-
like, but without a ring of contusion ; the third and lowermost opening
has also a slit-like form, but shows at least in its upper part an abrasion
of the epidermis, and thus permits of its recognition as a wound of en-
trance. (The figure should be inverted.)

FIGURE 127.

Suicide by a Shot with a Hunting=rifle and "Spreading
Cartridge" i Stauc h pat rone >.

The case was that of an officer's valet who shot himself with his
master's huuting-rifle. He had probably shot into his mouth or under
his chin, pressing the trigger with his foot, as his boot had been re-
moved from one foot.

The destruction is so excessive that there remain but fragments of
bone and unrecognizable soft parts. Included among the parts destroyed
are the lower and upper maxillae, the entire base of the skull, the organs
of the upper part of the neck, and the upper cervical vertebrae.

As the cartridge employed contained 6.5 grams of powder, the exten-
sive destruction of tissue is accounted for by the direct force of the ex-
plosion, the more so as experiments with large firearms have shown
that similar destructions may be produced by shots into the mouth of
powder alone. In case of such injuries, therefore, it is unnecessary to
immediately think of some special form of projectile, such, for instance,
as an explosive-shot or a hydraulic-shot (wasserschuss). In the present
case, however, there was another factor capable of increasing the effect
of the shot; that is, the peculiar conformation of the cartridge. The
latter was provided with a "spreading mechanism" (stauchvorrich-
tung) ; that is, a copper pin was let into the conical point of the soft
leaden projectile, so that when a bone or other hard object is struck it
drives the same asunder.

Fig. 127.

Fig. 129

FIGURES 128, 129, 130, 131.

Fig. 128.— Grazing (iunshot wound of the Right External
Ear, with Scattered Grains of Powder in its Vicinity.

This case is one of so-called double murder, such as occurs annually in
large cities, and not infrequently several times during the year.

In a hotel, a young man, having shot his mistress, shot himself and
jumped from a window. He died immediately as the result of rupture
of the right lung and various fractures of the ribs.

On his body there was found above the right zygomatic process a
blackened opening the size of a pea. This led directly inward to a short
canal, destroying the roof of the right orbit. A misshapen conoidal
bullet was found wedged in the right side of the crista galli. The dura
mater and the inner meninges above the bullet were lacerated, suffused
with blood, and contained scattered grains of powder. There was a con-
tusion of the brain the size of a dollar.

This case itself is of interest, as it demonstrates that even after a
gunshot-wound of the head, whereby the brain itself may be injured,
the ability of the individual to act may persist — that is, the person
injured may impart a second shot or cause another injury, or, as iu the
present case, end his life by jumping from a height.

The girl died while being transported to a hospital. There were
found a gunshot-wound of the head and another of the chest.

The first commenced as a semicircular, furrowed splitting of the
upper edge of the helix of the right external ear. It is 0.5 cm. in width,
and shows black punctiform spots. In the vicinity of the wound dis-
tributed over an area about the size of a dollar in the upper half of the
ear there are various blackish points. These decrease in number toward
the periphery of this area, but are found also in the scalp behind the
upper margin of the ear. There, one notices also a blackened opening
the size of a pea, which leads into a canal which, entering the cranial
cavity above the base of the petrous portion of the temporal bone, pene-
trates both ventricles of the brain and ends in the left temporal region,
without injury to the dura. Here, imbedded in a blood-clot between
the inner meninges, a misshapen conoidal bullet, of 7 mm. caliber, was
found.

The wound of the chest, which was the size of a pea, was situated at
the inner part of the right mamma. The clothing over it was closed,
perforated, and blackened. Neither the wound in the skin nor the
hands were blackened. The wound— directed from before backward
and from right to left — penetrated the anterior wTall of the chest, the
anterior mediastinum, and the right auricle of the heart — all of which
parts were markedly suffused with blood — and ended in the left side of
the vertebral column. Lodged in this latter situation a misshapen bul-

let of 7 mm. caliber was found. There were no spermatozoa in the
vaginal secretion.

That the girl was shot by the man there can be no doubt, but whether
or not this occurred with her consent, in the absence of any positive in-
formation, cannot be determined. The suspicion, however, is aroused that
the shooting may have occurred without the previous knowledge or con-
sent of the deceased because of the fact that the shot was directed
toward the right side of her chest and penetrated her clothing, and
because of the fact that in shooting through the right temporal region
the mouth of the weapon was not placed in direct apposition with the
skin, but was held at a distance of about 5 cm. from the body. This latter
fact was inferred from the distribution of the powder-grains and con-
firmed by experiments with the revolver employed.

Fig. 129.— Qunshot=wound Transversely through the Brain ;
Suicide.

Wound of entrance in the right temporal region ; the track of the
shot transversely through both striate bodies ; both lateral ventricles
filled with disintegrated brain-substance and blood-clots; discoloration
produced by the powder diminishing in grade toward the left.

Fig. 130.— Simple Punctured (iunshot=\vound of the Frontal
Bone Produced with an Ordinary Revolver.

Circular wound of entrance 12 mm. in diameter, with sharp edges
bevelled internally. No wound of exit. Suicide.

Fig. 131. — Close=range Shot with a Mannlicher Rifle;
Suicide.

Circular wound of entrance at the glabella. From this there proceed
in a star-like fashion three fractures. Two course outward into the
orbits, where they end with destruction of the vault of the skull. The
third extends posteriorly from the wound of entrance through the
middle of the left coronary suture to the left parietal eminence. Here
it divides into two. The external descends into the left posterior fossa
of the skull, whereas the internal courses almost transversely and in an
arched manner through the posterior third of the interparietal suture to
the separated squamous portion of the right temporal bone. That part
of the occipital bone situate between these two fractures is very much
splintered.

Fig. 130.

Fig. 131.

Fig. 132.

Fig. 133.

FIGURES 132, 133.

Fig. 132.— Wound of Exit of the Gunshot=injury Produced
with a Man nl iclier Rifle, Illustrated in Fig. 131.

The wound of exit is a roundish opening in the occipital region,
2 cm. in diameter. Its edges externally are bevelled, internally sharp.
The bones about the opening originally appeared irregularly shattered,
but after replacement of the fragments are found to make up an irregu-
lar plate of bone occupying almost the entire occipital region, in the
lower part of which the wound of exit is situate. About this as a center
there is a smaller roundisli plate of bone, which forms externally a
slightly prominent cone, and which reveals four fractures radiating
from the perforation.

Fig. 133. — Suicide by a shot with a revolver of moderate caliber in
the forehead. Inner side of the wound of entrance with bevelled edges.
From the posterior periphery of the perforation there begins a fracture
which courses along the obliterated interparietal suture to its middle,
where, forming a very obtuse angle, it divides into two long limbs.

FIGURES 134, 135.

Fig. 134 •— Wound of Exit at the Right Side of the Occiput
of a Qunshot=wound through the Left Frontal Region,
Produced with an Army Revolver of 9 mm. Caliber;
Suicide.

A plate of bone half the size of the palm of the hand has been shot
out. It is much shattered, and shows in the center an irregular perfora-
tion, rather larger than a beau, through which the bullet made its way.

The opening, corresponding in size with the fractured plate of bone,
is irregularly round and has a notch at its lower part. Its edges to the
inner side of the skull are sharp, to the outer side bevelled. Thus, despite
the marked destruction of the skull, one can still distinctly recognize
indications that the force came from within the cranial cavity ; that the
opening is therefore a wound of exit.

Fig. 135.— Suicide by a Shot with an Army Revolver (12
mm.) into the Right Temporal Region.

In the anterior lower part of the right temporal region there is the
inferior half of the circular wound of entrance, 1.5 cm. in diameter.
The upper half, including a portion of the parietal bone the size of a
hand, is absent, and was not near the body. As a consequence of the
force of the explosion it had probably been thrown a considerable dis-
tance and was not to be found. The skull shows, in addition, various
long fractures. Some of these begin at the wound of entrance, some at
either of the narrow ends of the large oval defect of bone, the long axis
of which latter is in the direction of the long axis of the skull. Some
of these fractures extend to the base of the skull. A portion of the
brain was absent, the remainder much disintegrated, and in it there
was found a much deformed conoidal bullet, 12 mm. in diameter.

The excessive destruction is accounted for by the great force of the
exploding gas, and presupposes a large charge of powder, and inferentially
a large weapon. That the fracturing of the skull ensued from within
is evident from the edges of the large opening, which internally are
sharp, externally markedly bevelled throughout.

Fig. 134-

Fig. 135-

Fig. 136.

Fig. 137.

FIGURES 136, 137.

Fig. 136.— Suicide by a Shot in the Left Temporal Region
with a Moderately Large Revolver Loaded with Broken
Lead.

Skull of a man aged 21 years. Excessive destruction of the entire
skull ; perforations and fractures of all the bones, partial upward dis-
placement of the vault of the crauiuin, aud diastasis of the right coro-
nary suture.

F«g- 137.— Murder by Anarchists.

Shot from the immediate vicinity directed at one lying prostrate
on the floor. Wound of entrance about the inner third of the left
coronary suture. From the perforation there proceed two fractures.
Of these, the anterior is directed through the frontal bone to the left
frontal protuberance; the second courses posteriorly to the interparietal
suture, through this to the inner posterior part of the right parietal
bone, thence below to the posterior fossa of the skull. The projectile
penetrated perpendicularly through the anterior part of the left lateral
ventricle and was found deformed at the base of the skull.

FIGURES 138, 139.

Suicides by Gunshots. Unusual Situation of the Wounds
of Entrance.

Fig. 138. — The wound of entrance — represented by a circular open-
ing— is situate in the parietal bone, in the angle formed by the inter-
parietal and the right parietofrontal sutures. The frontal bone is
fractured through its center. The fracture begins in front of the wound
of entrance at the middle of the parietofrontal suture and gradually
widens toward the base of the skull, ending in the sella turcica. The
fracture was evidently due to the sudden vertical compression of the
skull exerted by the shot.

Fig. 139. — Skull of a man, aged 30 years, who one evening, while
sitting in a crowded Prater-cafe, shot himself. After the report he was
seen to fall from the bench, holding a double-barrelled gun of 9 mm.
caliber in his hand. On his person other cartridges and a card were
found. In the latter of these he announced poverty as the cause of the
suicide. The wound of entrance had a most remarkable situation, being
found in the occip.ital region, directly above the apex of the tabular
portion of the occipital bone. Externally it was blackened with powder.

The perforation of the bone is circular, 12 mm. in diameter. Exter-
nally its edges are sharp, internally bevelled. From the right periphery
of the opening there begins a diastasis of the parieto-occipital suture
which continues into a fracture of the bones of the skull, with coarsely
serrated edges. The latter encircles the skull in about the direction in
which one is accustomed to open the skull postmortem, and ends at the
left side of the skull in a diastasis of the suture between the occipital
bone and the petrous portion of the temporal bone The vault of the
skull can thus be lifted up as one would a flap. In addition, there are
isolated fractures of the roofs of both orbital cavities.

The markedly misshapen conoidal shot was found at the much shat-
tered apex of the petrous portion of the temporal bone.

The case is noteworthy because of the very unusual situation of the
wound of entrance. Had the suicide not occurred in full view of the
people and under otherwise very manifest circumstances, the unusual
situation of the wound might readily have awakened the suspicion that
the deceased had been shot by others.

Fig. 138.

Fig. 139.

Fig. 140.

FIGURE 140.

Small shot from a hunting-rifle, at a distance of three paces, into
the left frontal region. Elderly man shot while stealing wood. Marked
destruction of the skull, especially of the left frontal and temporal
regions, with absence of certain portions of the bone.

PLATE 20.
Encircling Gunshot wound.

An interesting example of deflection of the projectile from the direc-
tion of the shot, or of the so-called ricochet-shot, within the hody, is the
so-called encircling-shot. This is produced when a shot, striking an
arched bone obliquely, travels around it. Such gunshot-wounds have
been observed not only on the convexity of arched bones — as, for in-
stance, those of the vault of the skull or the ribs — but also on their con-
cavity.

The case illustrated in Plate 20 belongs to the latter category.

The case was that of a young man who had killed himself with a
shot from a revolver of 7 mm. caliber. The projectile perforated the
skin of the right temporal region directly in front of the line of the
growth of the hair, making a pea-sized blackened opening. It then
coursed obliquely upward and backward through the temporal muscle
and the great wing of the sphenoid bone into the outer part of the right
Sylvian fissure ; thence to the concavity of the right frontal vault.
From this point it became directed anteroposteriorly around the entire
convexity of the brain, between the dura firmly attached to the bone
and the upper surface of the brain-substance, as far as the anterior part
of the inferior occipital convolution, where it lodged. During its course
it gave rise to a fissure-like laceration of the cerebral convolutions and
the superjacent inner meninges.

Such deflections of bullets render quite difficult the following of the
channel of a gunshot-wound and the discovery of the bullet ; they merit,
therefore, attention. In cases of this sort it is better at first to remove
the brain in toto, to carefully wash away the intermeningeal extravasa-
tion, and then to proceed to the further examination of the brain.

Angular deflections of the bullet are much more commonly met with
than such arched ones, and almost always at the end of the track of the
gunshot-wound. The bullet, striking the skull obliquely, is deflected
at either an acute or obtuse angle into the brain again, forming a new
bullet-track which is usually short.

Tab. 20.

Fig. 141-155-

141

142

143

144

145

146

147

148

149

150

151

€>

152

153

154

155

FIGURES 141-155.
Deformation of Projectiles.

Projectiles commonly become deformed, especially if they come into
contact with bone. Such deformation renders difficult the recogni-
tion of the variety of the projectile (whether ordinary or conoidal or
broken lead), and the answering of the question as to whether it was
fired from a particular firearm ; it is further of influence upon the char-
acter of the wouud, as the greater the deformation of the projectile the
wider and the more irregular the wouud, whether bone or soft parts be
affected.

The extent of the deformation depends especially upon the softness
of the material of which the projectile is made. It is a well-known fact
that, other things being equal, shots made of soft lead are subject to the
most marked changes. In addition, the deformation is the more
marked the greater the force with which the shot is propelled from the
gun and the more resistent the bone ; for instance, long bones are more
resistent than flat bones. The character of the deformation is particularly
dependent upon the direction in which the projectile meets the bone;
upon whether or not the point struck is a flat or sloping surface, or an
edge or a prominence. If the projectile strike the surface of the bone
perpendicularly, it becomes flattened, and may remain as a thiu disk
attached to the bone. If, however, it enters or penetrates the bone, it
becomes subject to a fungiform flattening, the edges being at the same
time everted. The principal change afl'ects the forward end of the pro-
jectile— of conoidal bullets, the apex. The posterior end is usually
preserved, and, as a rule, even in case of absolute flattening of the pro-
jectile, permits of the recognition of its former conoidal character.
Figs. 142, 145, 153, 151. and 102 show such shots. If the shot strike
obliquely, not only is its anterior part more or less obliquely deformed,
but also its posterior part. Despite this, however, the latter is usually
discernible, Fig. 141; military shot (long lead), Fig. 143; Italian or
French conoidal shot, from the battle of Solferino, Fig. 144; Russian,
from the Turko-Russian war, Figs. 148 and 160.

If the bullet strike the edge of a bone or solid rough surfaces, it may
be irregularly deformed in toto, or it may be in part or completely splint-
ered, and portions of it, being broken off, may give rise to additional
gunshot-tracks — Figs. 151, 152, 155.

FIGURES 156-169.

As is well known, in an endeavor to prevent the disastrous conse-
quences of the deformation of the bullet in military operations, so-called
covered shots were introduced. These are long, narrow bullets of lead,
covered with a mantel of hard metal — nickel or steel. Fig. 163 shows
such a shot completely intact, although it had penetrated the skull of
a man who committed suicide. That the protection afforded by the
mantel is not absolute is evident from Figs. 164, 165, 166, 167, and 169.
In these we notice various fragmentations of the mantels and deforma-
tions of the enclosed lead of bullets which struck distant stones and
walls. Fig. 168 reveals a similar deformation of a bullet which remained
in the greater trochanter of a person accidentally shot.

156

159

163

167

Fig. 156 - i6g.

157

160

161

164

fSC

168

158

§ i f

162

166

169

#

Tub. 21

PLATE 21.
Burns Produced by Flames.

The case is one of those relatively common in large cities during
the winter. A child, aged 2 years, being left without attendants in
a small apartment, approached too near the stove. Its clothes caught
fire and the child was extensively burned. It was still alive when
found, but soon became unconscious, and died at the end of four hours.

But even without this history, there could be no doubt that the burns
were produced by flames. There were found burns of minor grades of
the upper part of the body, especially of the face ; the hair of the frontal
and temporal regions, the eyebrows, and the eyelashes were singed ; in
addition, the skin and the respiratory orifices were blackened, many of
the burnt areas were as though roasted and of a brownish-black color,
and finally the distribution of the burns was extremely characteristic —
resembling swimming-breeches. This distribution of the burns occurs
especially in the case of women and children when the clothing of the
lower portion of the body catches fire and is quickly consumed. This
latter is favored by the air which intervenes between the clothing and
the body and by the light fabrics of which the clothing is made. This
sort of burn is not so likely to be met with in the case of men because
of the closer apposition of their clothing to the body, and because of the
more substantial materials of which it is usually made. The latter may
even afford a certain protection against burning, of which in the pres-
ent case one may see an indication in the limitation of the burn at the
waistband, and at the areas above the knees corresponding to the former
situations of the garters.

One may distinguish four grades of burns: 1. Erythemas, narrow
margins of redness at the periphery of areas of the more intensely burnt
skin. 2. The separation of the epidermis, with the formation of vesicles
filled with pale serum at both wrists, as a vesicle the size of a nut on
the back of the right thumb, and as a ragged, almost glove-like detach-
ment of the upper layers of the skin of the left hand. 3. Extensive
denudation of the corium with coagulation-necrosis of the upper layers
of the cutis. It is this which forms the greatest part of the burn, and it
is here that the reactive hyperemia and edema are most marked, and it
is this tissue which, when the body is exposed to the air, becomes
dried, forming hard, leather-like, brownish-red coverings. 4. Extensive
brownish areas as though roasted and rendered black by smoke ; to
these the epidermis is closely adherent, and with the cutis appears
coagulated. Such areas are those between the umbilicus and the sym-
physis pubis and on the inner surface of both thighs; therefore those
areas which the flame must have affected early and intensely. In this
case recovery would have been possible only after complete desquama-
tion of the roasted-like cutis.

There are further to be noticed several ruptures of the cutis along the
inguinal folds and the left genitocrural fold. Their white color and the
non-reactiveness indicate that they were produced postmortem by ex-
tension of the thighs and consequent rupturing of the parched skin of
those regions.

FIGURE 170.
Murder or Suicide by Burning.

The case was published in the Intern, photogr. Monatsschrift fiir Medi-
zin und Naturwissenschaften (III.), Jahregang 1896, by Dr. Franz Neuge-
bauer, of Warschau, who has graciously permitted me to republish it.

The body of a man, who remained unidentified, was found in the
knee-elbow position excessively burnt, beside some railroad-tracks. The
body had about it an odor of petroleum, and near by was an empty
petroleum-can. No injuries to the body were discovered. On the other
hand, however, there was found aspirated soot in the air-passages, and
from this latter it was concluded that the burning had occurred hsbra
vitam. All vestiges of hair had disappeared ; the clothing, with the ex-
ception of one shoe, had been completely consumed. The surface of the
body was blackened and appeared as though roasted ; here and there the
skin was burst.

The burning was evidently the result of applying a light to the
clothes previously saturated with petroleum. Whether the case was
one of suicide or murder could not be positively determined. As similar
cases of suicide have occurred (especially in Vienna), this possibility
cannot be excluded. Dr. Neugebauer considers the case more likely
one of murder, and believes that the deceased might have been intoxi-
cated at the time of the deed ; thus the absence' of any injuries or indi-
cations of strangulation is accounted for.

According to Dr. Neugebauer, the peculiar position of the body
developed postmortem, and was due to the contractions of the burnt
skin and the musculature drawing up the extended body. Similar
abnormal positions have often been observed in cases of deaths from
burns, as, for instance, in the burning of the Ring Theater and of the
Opera Comique; they were also known to Devergie, who designated
them " fencing-postures."

Fig. 170.

Fig. 171.

FIGURE 171.

Right Upper Arm and Scapula of a Charred Body, with the
Muscles Attached to Them.

The charred remains of an unidentified man, aged about 50 years,
which were extracted from the ruins of a hay-barn destroyed by fire.
The man had probably hidden himself in the hay and started the con-
flagration by smoking.

The illustration shows the slightly burnt right humerus and the
therewith articulated scapula, and the superficially charred but other-
wise roasted like musculature of the upper arm and shoulder; the skin
is missing. The muscles are loosened from the periphery of the scapula
and from the distal end of the humerus, and retracted toward the.
shoulder-joint, where they form a thick swelling. At the peripheral
ends of the retracted muscles the tendons — separated from the bones,
especially the biceps tendon — are discernible. The latter has been con-
verted into a viscous substance, its point of insertion separated from the
bone and retracted, leaving the lower half of the humerus bare.

This retraction and separation of the musculature is of common
occurrence in semi-charred bodies. It depends, on the one hand, upon
the contraction of the burnt muscles, and, on the other, upon the con-
version of the tendons into a viscous substance and their consecutive
loosening from the bone. This possesses a forensic importance in so far
as such contractions may give rise to mistakes in the determination of
the age or the condition of the nutrition of the deceased, and as pos-
sibly— though erroneously — from such contractions the inference may
be drawn that the individual was burnt while alive.

FIGURE 172.
Healed Scald-wound of the Esophagus.

The preparation illustrated in the figure was found at the necropsy
of an emaciated foundling, aged 8 weeks, which died of bilateral lobular
pneumonia.

The esophagus in its lower half is dilated to triple its normal size.
The intact mucous membrane of the pharynx is limited transversely at
the entrance of the esophagus by pale, rounded, overhanging margins.
At the middle of the esophagus the mucous membrane continues into a
white cicatrix of its anterior wall. It is made up of dense fibers, and
thei-efore resembles striated tissue. It extends to the lower third of the
esophagus, in which situation a portion of it is undermined as a bridge.
The gastric mucous membrane was unchanged.

The lesion was originally considered the consequence of the caustic
action of sodium hydrate or some similar substance. But inquiries
revealed no confirmatory evidence of this supposition. On the other
hand, the fact was elicited that in the early days of its life the child
may have been given tea entirely too hot ; that, therefore, the lesion
was the result of a scald. This assumption is confirmed by the striated
appearance of the cicatrix, which I have heretofore observed after
wounds due to burns, but never as the result of the action of caustics.

Fig. 172.

Tab. 22.

PLATE 22.

Suicide by Hanging; Suspension of the Body for Several
Days; Peculiar Distribution of the Hypostases.

Body of an unknown man, aged about 60 years, found hanging to a
tree in the Dornbacli forest, October 30, 1896.

The normally brunette skin, through the imbibition of bloody serum,
has assumed a dirty violet color. The skin of the face, of the neck, and
of the upper part of the body as far as the waist is pale ; below this
region, increasing in intensity downward, it is of a dirty violet color —
the discoloration reaching its highest grade in the feet. The discolora-
tion is diffuse ; only here and there can one distinguish fading, puncti-
form, reddish spots. These are made up of the minutest ecchyinoses,
and because of their small size are not depicted in the illustration. A
similar discoloration is also discernible in the dependent arms. The
skin of the upper arms is pale, but below it becomes more and more
livid, so that the hands and fingers show a markedly dirty violet color.

This bilateral, symmetrically distributed discoloration of the skin
is the result of the long-continued perpendicular position of the body.
As a consequence of this the external hypostases (the so-called post-
mortem lividity) have not developed (as usually) on the posterior sur-
face of the body, but in the lower dependent portions thereof.

Such distribution of the postmortem lividity, when found in a body,
by no means indicates that the deceased died as a result of hanging; it
may also develop when a body is hung up. It merely indicates that
the body was hanging for a long time. But from the degree of the
development of this phenomenon, in connection with other postmortem
findings, one may approximately conclude how long the body was sus-
pended.

In the present case, despite the low temperature in the forest, the
abdomen was already putrescent— green ; the serosanguinolent imbibi-
tion of the hypostatically discolored parts, as well as of the rest of the
skin, was well advanced ; the eyeballs were much depressed and relaxed.
It was in consequence concluded that the body must have been hanging
about a week or at least several days.

There was no question as to the case being one of suicide by banging.
The groove produced by the rope, which was 1 cm. thick and old, is
dried and leather-like. At the front of the neck it is directed trans-
versely between the larynx and the hyoid bone ; on both sides alike it
ascends behind the mastoid processes of the temporal bones to the nape
of the neck, where it terminates in the hair. Excepting this groove,
no injury was found either internally or externally ; in particular no
indications of violence could be discovered.

To the right side of the neck in its lower part, however, there were
found three brownish, dried, irregular, linear spots. They affect only
the upper layers of the skin, are not associated with any deeper injuries,
reveal no indications of reactive phenomena, and may therefore be
looked upon as having probably developed postmortem.

There were no striking evidences of congestion or ecchymoses of the
face. This is readily explicable because of the symmetric arrangement
of the rope, which gave rise to a sudden, equable compression of the
various vessels of the anterior part of the neck.

FIGURES 173, 174.

Position of Noose in Cases of Persons Hanged.

In Fig. 173 an instance of the typical position of the noose is repre-
sented. The rope encircles the anterior part of the neck between the
larynx and the hyoid bone, and on both sides ascends below and behind
the mastoid process to the nape of the neck, where at the margin of the
growth of the hair it joins a little to the left of the median line. The
head is inclined forward, and as a consequence the chin approaches the
chest.

In Fig. 174 there is depicted that position of the noose which occurs
next in frequency to the aforementioned typical position — that is, the
noose is situate behind the ear — more commonly the left. The head is
inclined forward and to the right ; the groove made by the rope is more
marked at the right side of the neck.

Fig. 173.

Fig. 174.

Fig. 175-

Fig. 176.

FIGURES 175, 176.
Position of Noose in Cases of Persons Hanged.

In Fig. 175 the knot is situate, and the end of the rope is directed
upward, between the left ear and the left angle of the inferior maxilla.
The head is inclined to the right, and the groove made by the rope is
more marked at the right side of the neck.

In Fig. 17<) we sec a most abnormal, though repeatedly observed,
course of the rope. The rope is first placed at the nape of the neck, its
two ends brought horizontally forward and crossed, and on either side
posterior to the angles of the inferior maxilla carried upward to the
point of suspension. The neck is markedly elongated, and as a conse-
quence of the horizontal course of the rope greatly and symmetrically
constricted. Thus the folds of the skin of the nick of the much ema-
ciated individual converge toward the constriction. The head is erect
and held fast by the rope ascending behind the angles of the inferior
maxilla.

FIGURE 177.
Abnomal Position of Noose in a Hanging.

The figure illustrates a most unusual case in which the noose is placed
in a position directly opposite to the common or typical situation. The
knot is found at the anterior part of the neck directly under the chin.
The rope encircles the nape of the neck, in which situation the groove
made by it is most marked. It ascends toward the front of the neck
beneath the angles of the lower jaw and joins under the floor of the
mouth, between the larynx and the chin. It then ascends perpen-
dicularly over the chin to the point of suspension. The head is inclined
excessively backward, the anterior part of the neck markedly stretched,
and on both sides beneath the inferior maxilla greatly constricted. It
is thus evident that both the respiratory passages and the larger vessels
of the neck may be compressed until they are completely occluded by
the rope in this position.

Fig. 177.

mi

PLATE 23.

Suicide by Hanging with a Double Rope. Asymmetric
Position of the Noose.

The case was that of a cabinetmaker, aged 36 years, who hanged him-
self, and whose body had been given to students for dissection.

The face is especially cyanotic, and shows numerous punctiform
ecchymoses of the skin of the eyelids and surrounding parts, and also
minute isolated eochymoses in the skin of the rest of the face. Larger
ecchymoses, nearly the size of a hempseed, are also present in the
markedly injected conjunctivae and in the mucous membrane of the
lips.

The groove made by the rope is situate asymmetrically. Encircling
the right side of the neck, both extremities of it ascend behind the
angle of the left inferior maxilla, forming an incomplete angle, open
below. As a consequence, the head is inclined somewhat to the right
and the groove is more marked to the right — the extremities of it be-
coming less marked as they ascend.

The groove, as is particularly evident to the right, is a double one.
It consists of two furrows with parallel edges joining to form oue.
Each furrow is as wide as an ordinary rope. They are separated from
each other by a narrow band of skin, which also has parallel edges. The
base of the furrows is pale and reveals indentations of the twists of the
rope. The edges of the furrows, as also the intervening portion of the
skin, are very red, and reveal macroscopically, as also on examination
with a low-power lens, a marked and almost uniform injection of the
cutaneous vessels, and in addition numerous minute ecchymoses.

These lesions, which are explained by the constriction of, and by
the embarrassment of the circulation in, the affected portion of the
skin, when as marked as in the present case, possess a diagnostic im-
portance in so far as they indicate that the suspension occurred during
life. The correctness of this latter assumption, in the present case, is
further enhanced by the fact that there are present no signs which
would warrant the supposition that a hypostatic hyperemia was present
before the adjustment of the rope, nor the possible view that the marked
cyanosis and ecchymoses of the face and neck occurred before the sus-
pension as a result of death from another mode of suffocation.

The reason that in the present case such a marked cyanosis devel-
oped, whereas in persons hanged the face usually shows the ordinary
death-pallor, is found in the asymmetric situation of the noose. As a
result of this, in contradistinction to cases in which the rope is placed
typically and in which all the vessels of the anterior part of the neck
are compressed, in the present case only those of the right side of the
neck were obstructed — a circumstance which naturally led to marked
congestion.

PLATE 24.

Suicide by Hanging with an Old Rope Wound Five Times
about the Neck.

On the forward part of the neck between the larynx and the hyoid
bone five furrows are discernible. Of these the two uppermost are in
part close together with an intervening reddened ridge, in part over-
lapping. The lowermost are separated from each other by a spindle-
shaped prominent area of skin, which appears as though hemmed in by
the two grooves. Its edges are markedly injected and pervaded by
minute ecchymoses. Both sections of skin are divided by another fur-
row, which, proceeding from beneath the right half of the upper, courses
obliquely to the left half of the lower, where it becomes lost. This
diagonal groove is somewhat wider than the others, and reveals about
the middle of its base a narrow reddened elevation. It is, therefore,
likewise a double furrow.

The face and neck of the body show no remarkable cyanosis; neither
were ecchymoses to be seen either in the skin or in the visible mucous
membranes. Under these circumstances one would be justified in con-
cluding, from the marked injection and ecchymoses of the ridges or
areas of skin between the various furrows produced by the rope, that
the deceased was hanged or hanged himself while still alive.

Tab. 24.

Fig. 178.

FIGURE 178.
Suicide by Hanging in the Kneeling Posture.

The illustration of the case was sent to me by Dr. Vucetic of Slavonia.
The case was that of an epileptic who, during an attack of insanity,
hanged himself to the door-hinge in his cell. Strangulation was pro-
duced by a torn piece of his clothing, which encircles symmetrically the
anterior part of his neck and the knot of which is found at the middle
of the nape of his neck. The head is inclined markedly forward. The
body in the kneeling posture is in contact with the floor — at least
there is found to be no interval between the latter and the knees. The
constricting band around the neck is nevertheless very tense. The
hands are crossed in his lap.

P^IGURES 179, 180.
Fig. 179.— Suicide by Hanging in a Semi -sitting Posture.

The deceased was found hanging in the open air and dead. The rope
forming the noose was wound about a clothes-line-pole stuck perpendicu-
larly into the ground. The knot of the noose was placed at the anterior
part of the neck, from which location one end of the rope ascended over
the chin to the point of attachment. The head was inclined markedly
backward. The nates were removed about 30 cm. from the ground, the
legs outstretched and somewhat abducted, the heels resting upon the
ground. The abnormal posture has arisen, on the one hand, as a result
of the length of the noose; probably also, on the other hand, because, as
a consequence of the weight of the body, the rope wound about the pole
slipped down.

Fig. 180. — Suicide by Hanging in the Prone Posture.

{After Bollinger.)

The case, published by O. Bollinger, of Munich, in Friedreich's Blat-
ter fur gerichtliche Medizin, Part I., 1889, and graciously allowed me for
illustration in this atlas, was that of an insane patient affected also
with disease of the spinal cord, who hanged himself by means of a long
noose, formed by twisting together his sleeping-gown, which he had
fastened to a bedpost. The noose was of just such length that, when
the patient withdrew it somewhat from the foot of the bed, he was
enabled to insert his head between it and the lower edge of the bed.
As a result partly of the weight of the body, partly of the compression
of the neck between the noose and the edge of the bed, strangulation
ensued.

Fig. 179.

Fig. 180.

Fig. 181.

Fig. 182.

FIGURES 181, 182, 183.

Fig. 181.— Fracture of the Larynx and of the Hyoid Bone
in a Person Hanged.

Larynx of a man, aged 43 years, who hanged himself in a typical
manner. The furrow made by the rope coursed, as usual, between the
larynx and the hyoid bone. The cornuaof the latter are fractured near
the extremities on both sides, and the fractured ends directed down-
ward. The laryngeal cartilages are uninjured; on the other hand,
however, the upper eornua of the thyroid cartilage are fractured — the
left at its base, the right somewhat above this — and both likewise
directed downward.'

Fig. 182.— Bilateral Rupture of the Sterno=cleido=mastoid
Muscles in a Person Hanged.

The illustration shows the soft parts of the auterior part of the neck
and the larynx of an elderly man who was found hanged. The body
was large and muscular and showed marked postmortem rigidity. The
larynx was ossified and very prominent. The furrow produced by the
DOOM was situated beneath " Adam's apple" and was quite deep.

Both sterno-cleido-mastoid muscles at the level of the ligamentum
cricothyreoidcum were lacerated transversely from before backward. A
portion of the muscular sheath and a few of the muscular fibers were
preserved intact ; certain of the muscular vessels were lacerated and
exuded some fluid blood, which was readily washed away. The muscu-
lar stumps were otherwise pale, and revealed no sign whatever of suffu-
sion. From one point of rupture to the other, transversely across the
cricothyroid ligament, there was a furrow-like depression. The larynx
itself was uninjured.

The case was evidently an instance of postmortem rupture of the
muscles, produced by stretching of the neck while rigid, and occurring
at the points of constriction of the sterno-cleido-mastoid muscles caused
by the noose.

Fig. 183.— Fracture of the Thyroid and Cricoid Cartilages
in a Person Hanged.

A man, aged about 50 years, hanged himself with a wide strap in such
a manner that the latter was placed over the lower part of the promi-
nent thyroid cartilage and the cricothyroid ligament. As a result
there occurred a single fracture of the thyroid cartilage and a double

fracture of the anterior portion of the cricoid cartilage. The former
occurred along the anterior angle of the laryux, as a consequence of the
compression of the larynx from before backward, and the consecutive
flattening of the angle of the thyroid cartilage and the separation of its
alse ; the double fracture of the cricoid cartilage was the result of the
dragging inward of the ligamentum cricothyreoideum by the super-
imposed portion of the strap, which had as a consequence the fracturing
of the middle portion of the cricoid cartilage.

FIGURES 184, 185.

Fig. 184.— Self ^strangulation.

(After Bollinger.)

An insane patient, upon whom Bollinger (Friedreich's Blatter fur
gerichtliche Medizin, Part I, 1889) had performed a necropsy, ended his
life by strangulation in a very peculiar manner. The body was found,
as the illustration (kindly loaned me by Professor Bollinger) shows,
prostrate, with almost the entire back in contact with the floor, the
right foot pressed against a bedpost. About the neck was a loop-knot
made of a bed-sheet torn in two, one end of which was attached to the
forward bedpost. The deceased, by pressing his foot against the hind
bedpost, had drawn the noose tight, and thus brought about the stran-
gulation.

Fig. 185 Newly Born Child Killed by Having Its Throat

Cut and by being Strangled.

On January 23, 1892, there was found on the street, between two
heaps of paving-stones, the body of an immature, newly born child,
wrapped in rags.

The body was very much decomposed ; in part it was of a greenish
discoloration, in part as though it had been soaked in water, boggy,
greasy and moist to the touch, malodorous ; in places the epidermis was
absent, in places it could be readily stripped ofl*.

The neck, below its middle, is tightly bound and thereby reduced in
size by a gray band, 3 mm. in width, which doubled encircles it, and
which to the right of the anterior median line is tied in a single knot
and one loop. The areas of skin between the encircling bands are
slightly elevated and spindle-shaped ; that to the left side of the nick is
1 cm., that to the right 2 cm. in width. The protruding skin is with-
out epidermis and of a dirty, pale violet color. The band is 53J cm. in
length. The ends forming the loop hang over the chest. After removal
of the band there are found on the neck two deep pale furrows, with
palo edges. They are of the same width as the constricting band, and
cross on both sides of the neck.

Fig. 183.

Fig. 184.

Fig. 185.

Tab. 25.

In addition, there is seen in the neck an arched incision which has
its convexity directed to the right, and which is partly covered by the
band. It lias rather sharp edges, which have become softened by putre-
faction. It begins beneath the angle of the left inferior maxilla, form-
ing an acute angle with its lower border ; thence coursing obliquely to
the right and below across the anterior aspect of the neck, it ends about
one and a half finger's breadth above the middle of the right clavicle,
with which it also forms an acute angle. It penetrates to the cervical
vertebrae, which it exposes, and divides the muscles of the anterior part
of the neck, as also the trachea and the esophagus immediately below
the larynx. All the wounds have sharp edges. An injury of the caro-
tid arteries is not demonstrable. The right jugular vein, on the other
hand, appears incised ; but of this one cannot be positive on account of
the softening of the tissues. There is no extravasation of blood in the
wound. All the parts of the latter, however, appear as though soaked
in water. About £ cm. above and parallel with this wound there is a
second. It likewise has sharp edges, is 4.5 cm. in length, but penetrates
only to the subcutaneous connective tissue. It is softened as the other
wouud, and shows no extravasation of blood.

The necropsy, in addition, revealed only advanced putrefaction of
almost all the organs — they even floated, — and general anemia. In the
lungs, in addition to numerous air-bubbles of irregular size beneath the
pleura, there were still recognizable larger areas, in which the pulmon-
ary air- vesicles were preserved and unifoinnly filled with air.

Although symptoms of vital activity were not discovered — a fact
naturally accounted for by the advanced putrefaction, and although the
anemia may have been in part due to the putrefaction, in part to the
imbibition by the tissues of fluid, it was nevertheless clear that an
attempt had been made to kill the child by cutting its throat, and that,
as it did not die immediately, it was subsequently strangled. This is a
natural inference, as both injuries would have been superfluous had the
child been already dead, and the strangulation itself would have been
uncalled for, if the throat-cutting had already caused the death of the
child.

PLATE 25.
Lungs of a Dog which was Drowned.

The direct demonstration of the fluid in which a person has been
drowned and its distribution are rarely possible in human beings, as the
drowning occurs usually in water, and this, when present in the lungs,
does not differ much from other watery fluids, especially from that of
edema. It is much better as regards definite results when the drown-
ing occurs in a closet-well or in any other fluid containing morphologic
elements, as the latter may sometimes be detected both macroscopically
and microscopically within the minutest bronchi and even within the

alveoli. The most instructive pictures are, however, furnished when
the drowning occurs in a colored watery fluid and the necropsy is per-
formed soon after death — that is, before manifestations of imbibition
supervene.

Such occurrences in human beings are of the greatest rarity. On the
other hand, one may readily cause drowning of animals in such fluids
and thus study the manner in which, in cases of drowning, the fluid in
which the drowning occurred distributes itself in the affected lungs.
Plate 25 illustrates an instructive example of this.

In the first place, by such experimentation one may demonstrate
that the fluid in which the drowning occurs always enters the lungs;
and, secondly, that less enters with the first inspiration than with the
inspirations which take place after unconsciousness has developed,
especially with those inspirations occurring during the so-called "ter-
minal respiratory movements," those which ensue after the violent
manifestations of suffocation have subsided and asphyxia has super-
vened. The reason for this is that the fluid which at first enters is for
the greater part expelled by the expiratory cough which immediately
takes place.

The more healthy and the stronger the animal experimented with,
the larger the quantity of aspirated fluid. On the other hand, the more
emaciated and the weaker the animal the less the quantity of fluid that
reaches the lungs.

It is a priori to be expected that even in favorable cases the lungs
should not be completely filled with the aspirated fluid, as some of the
residual air in the lungs remains and hinders the further entrance of
the fluid. We find, therefore, in all cases, both on the external surface
and on the surface of section, a mottled appearance, revealing various
grades of development and transitional stages. The darkest areas con-
tain the most fluid, the paler areas less, and the uncolored areas very
little or none at all.

Even in the very darkest areas one may, on very careful observation,
especially with a low-power lens, recognize groups of pulmonary alveoli
containing air. Between these, however, there are frequently others,
in which the pulmonary alveoli have ruptured into the interstitial tis-
sue. It is in this manner that interstitial extravasation of the fluid
causing the drowning occurs.

The distribution of the fluid in the individual lungs and parts
thereof is not constant. The right lung appears to aspire more than
the left, the lower lobe more than the upper, the periphery, especially
the edges of the lung, less than the more centrally located portions.

The filling up of large portions of the pulmonary tissue with fluid,
and as it appears frequently also its infiltration into the interstitial
tissue, prevent the collapse of the lungs, and lead to that distention of
them to which, for such a long time, such diagnostic importance has
been attached, and which has been designated balloon-like inflation of
the lungs.

Tab. 26.

I.ith-ta si v. I Re ichhold . Munchm

PLATE 26.

Left Hand of a Drowned Day-laborer whose Body Remained
in the Water 24 Hours.

The epidermis of the tips of the fingers already show changes due to
the imbibition of water. The epidermis has become pale ; it is swollen
and markedly wrinkled. The rest of the epidermis is, as is usual with
day -laborers, thickened, in part callous, but not otherwise altered.

Had the body remained two to four daya in the water, the epidermis
of the thenar and hypothcnar eminences would have shown changes
similar to those of the tips of the fingers, and these, in the course of a
few days more, would have spread over the entire palmar surface of the
hand.

PLATE 27.

Left Hand of a Drowned Person whose Body had Remained
in Running Water for Several Weeks.

Necropsy February 23, 1884. The epidermis is markedly swollen,
wrinkled, pale, and in part detached from the hand like a glove. The
epidermis and the nail of the index-finger are still adherent, but the
nails and the epidermis of the other fingers have become entirely
loosened and have been washed away.

The parts thus exposed have the appearance of a gracile and well-
cared-for hand. Such appearances, when the coarse epidermis and the
nails have become entirely detached, may all the more readily give rise
to misconceptions in respect to the social position and occupation of an
unknown individual, as the matrices of the nails present a deceptive
resemblance to still preserved and well-cared-for nails.

A somewhat similar appearance may also arise when, through putre-
faction or scalding or burning, the epidermis and the nails become
detached in a glove-like fashion.

Tab. 27.

\.

PLATE 28.
Fungus- (Algae-) formation on a Cadaver found in Water.

Cadavers which have remained a long time in water show generally,
on those parts not protected by clothing, a more or less well-developed
unctuous covering, which is usually taken to be slime or mire. On more
careful investigation, however, this covering is found to consist of fungi
belonging to the class phycomyces. These develop very early on
the cadaver, increase very rapidly, and in a few weeks may cover the
exposed port ions, or, if it be altogether naked, the entire body.

Plate 28 illustrates the first stage of this process. The body is that
of a newly born, immature child, which had remained fourteen days in
running water. The appearances under water are depicted. The body
is somewhat swollen, and of a slightly red tint, dependent upon the low
temperature of the water. It is entirely covered with a colorless en-
velope, 1-1. ;■> cm. in thickness, which consists of closely interwoven fila-
ments which Boat in the water and which are made up of algaj. This
formation is especially well marked at the more angular portions of the
body. In certain situations, as, for instance, in the popliteal spaces,
about the hands and the feet, it has developed into large masses which
conceal the contour of the affected parts. On the removal of the cadaver
from the water this algas-formation collapses and forms a covering much
resembling moist cotton.

PLATE 29.

Plate 29 represents the same child after it had remained four weeks
in the same water. The body is completely covered with a thick coat-
ing of algae, so that the general form of the cadaver is scarcely discern-
ible. The algae formation is not only more extensive and thicker and
the algae-filaments longer, but they have also become discolored. This is
due, on the one hand, to degeneration of numerous portions of the algae-
formation, and, on the other, to various precipitates. These are par-
ticularly the ferri oxidum hydratum, from the iron sewer-pipes ; but,
in addition, various kinds of filth which readily become deposited upon
a cadaver immersed in running water. These, when the body is re-
moved from the water and the algae-formation collapses, give to the
entire covering more and more the appearance of ordinary mire.

Upon the extent of the development of this formation of algae — dur-
ing the first week at least — an opinion may be based as to how long the
cadaver has been in the water. Particularly is one justified in the con-
clusion that the body has been in the water but a few (at the most six
or seven) days, when as yet no development of algae is found. The
development takes place somewhat slower during the winter than dur-
ing summer, but occurs in water of 8° C. and even lower temperature.

PLATE 30.
Alterations of the Blood due to Irritant Poisons.

As is well known, the irritant poisons are divided into two groups
according to the manner in which they disturb the organic tissues at
their point of application ; that is, upon whether they produce but slight
cauterization or a deeper eschar. In the first group are those which
give rise to eschar-formation through coagulation of the albuminous
bodies; in the second, those which cause, as a result of their application,
solution, swelling, and softening of the tissues.

The first group comprises the mineral acids, carbolic acid, oxalic
acid, and the metallic irritant poisons, especially mercuric bichlorid ;
the second, caustic potash and caustic soda— potassium and sodium
hydrate. Wo obtain, as a primary result of the application of the sub-
stances of the first-mentioned category to a mucous membrane or to an
organ, a grayish-white, cloudy, dried alteration of the affected surface;
in contradistinction to this, the application of a solution of potassium or
sodium hydrate results in a clearing up of the affected tissues, which
assume a swollen appearance. As a consequence of the solution of the
blood which occurs at the same time, through imbibition, they later
become darker in color.

Nor does the primary picture produced by the coagulating irritant
poisons always persist. Subsequently it not uncommonly chan.ges, the
change being especially dependent upon the manner in which the blood
of the affected part and its immediate vicinity becomes altered as a
further effect of the irritant.

In this respect the coagulating irritant poisons vary. Sulphuric acid,
hydrochloric acid, and oxalic acid not only coagulate the blood, but
after a short time change the hemoglobin in part into hematin. As a
consequence, there subsequently ensues a brownish-black or black im-
bibition of the region the scat of the eschar-formation. On the other
hand, carbolic acid and mercuric bichlorid produce only a coagulation
of the blood, but no solution of the hemoglobin. There occurs, there-
fore, no hemorrhagic imbibition of the eschar, and the latter, even after
prolonged application of the irritant, presents its original white or
grayish-white appearance.

In Plate 30 we see these processes depicted as they occur in a test-
tube. In a we see blood after the addition of moderately concentrated
sulphuric acid. We see in the lower third of the test-tube the blackish
coagulum, and above this the acid, brownish-black solution of hematin.
The same appearances, but in a darker shade, are seen in b, which shows
the effect of the addition of hydrochloric acid to blood.

In c we find a complete solution of the entire blood produced by a
solution of sodium hydrate. The fibrin was not only early dissolved,
but the hemoglobin was also changed to hematin in alkaline solution.

On the other hand, in d and e (carbolic acid and mercuric bichlorid)
we see the blood only coagulated, and above this a deep layer of almost
colorless fluid, which evidently contains none of the coloring-matter of
the blood. We observe, in addition, that the color of the blood-coagula
differs from the color of the coagula or of the solutions of the blood pro-
duced by the addition of sulphuric or hydrochloric acid; that is, they
are not black or brownish-black, but after the addition of carbolic acid
the coagulum is of a bright brick-red color, whereas after the addition

of mercuric bichlorid it is of a grayish-violet color. In case of poisoning
with these irritants these colors glimmer through the white epithelial
eschar, and thus independently of other peculiarities assist in the diag-
nosis or differential diagnosis of the variety of poisoning.

PLATE 81.
Poisoning by Caustic Soda.

M. C, aged 21 years, with suicidal intent, swallowed a large quantity
of a so-called solution of sodium hydrate (about 40 per cent, sodium
hydrate). He became immediately ill with symptoms of violent gastro-
enteritis; he vomited blackish masses, and revealed on examination a
" swollen mouth." A neighboring physician, being summoned, ad-
ministered vinegar as an antidote, and ordered the removal of the
patient to a neighboring hospital. Here, despite copious vomiting and
lavage of the stomach, he died at the end of two days.

The body revealed marked congestion and swelling of the entire
mucous membrane of the mouth. The epithelium was in part separated
from the underlying structures; in part it was still attached in the
form of soft, white, turbid shreds. The epithelium was absent from the
mucous membrane of the entire esophagus. The mucous membrane
itself was softened throughout, swollen, markedly congested, and of a
brown color, iucreasing in intensity below.

The stomach contains coffee-colored, turbid fluid. The epithelium is
absent from the entire mucous membrane, The mucous membrane
itself is soft throughout, markedly swollen, and arranged in coarse folds,
of a brownish-black color. This discoloration is especially marked at
the crests of the rugse, at which situations fading ecchymoses and small
superficial areas of loss of substance are also to be noticed. On section
the mucous membrane is of a brownish-black color, dependent upon
imbibition of hematin in solution. This color diminishes in intensity
in the depths of the mucous membrane, but here and there extends to
the submucosa. In addition, the mucous membrane is injected and
shows in places hemorrhagic infiltration. The submucous cellular
tissue is edematous. The blood in the vessels is coagulated, but the
coagula are soft.

The mucous membrane of the duodenum is relaxed, and shows slight
imbibition of bile, but no other changes.

PLATE 32.

Poisoning with Concentrated Sodium Hydrate Colored with

Ultramarine-blue.

The preparation is from a man, aged 50 years, who was brought to
the hospital during the night with the history that he had purposely
poisoned himself with a solution of caustic soda colored with ultra-
marine-blue, which he had for sale in his shop.

Externally no blue discoloration was to he noticed ; but there were
marked congestion and swelling of the lips, with partial desquamation
of the swollen epithelium. On the other hand, the epithelium of the
base of the tongue was of a blue color, cloudy, and could he readily
removed. The mucous membrane of the mouth and pharynx was con-
gested and swollen. On account of edema of the glottis tracheotomy
was performed, but the patient died the next morning.

The necropsy revealed, in addition to the changes in the mouth and
pharynx already mentioned, a marked edema of the glottis and of the
lungs. In addition, there was an intense blue discoloration of the
epithelium throughout the length of the esophagus. The epithelium
was also much swollen and cloudy, and arranged in coarse folds; the
mucous membrane beneath was congested and swollen. The stomach
was moderately contracted and filled with a blackish, turbid, alkaline
material, which was soapy and slippery to the tomb, and in which
there were demonstrable soft ragged particles (shreds of desquamated
epithelium) which were of a blue color and appeared as though coagu-
lated. The mucous membrane is throughout wanting in epithelium; it.
is markedly swollen, arranged in coarse rugSB, and colored almost uni-
formly black. The swelling and the blackish discoloration affect the
entire thickness of the bemorrhagically infiltrated mucous membrane,
and also reach into the hyperemic ami edematous submucous cellular
tissue. The larger vessels of this latter, as also the coronary vessels of
tiie stomach, contain soft blood-coagula.

In the region of the pylorus, and from here for a distance of about
50 cm. into the jejunum, the mucous membrane is somewhat altered:
it is flabby, as though edematous, and throughout of a bright blue color,
which color diminishes in Intensity toward the lower part.

To avoid accidents, the coloring with ultramarine-blue of solutions
of caustic soda, commonly for sale in the shops, is extensively and with
reason recommended and employed. The color to which this gives rise
in the viscera can. in a given case, be made use of in the diagnosis of a
ease of poisoning by caustic soda, or in differentiating this from similar
poisonings, such, for instance, as poisoning with sulphuric or hydrochlo-
ric acid. If one add ultramarine-blue to such acids, the color becomes
dissipated, with the liberation of sulphur and sulphuretted hydrogen.
The blue color in such poisonings would therefore not be present.

PLATE 33.
Suicidal Poisoning with Concentrated Sulphuric Acid.

A. M., aged 33 years, a day-laborer, was found groaning and vomiting
in a city park, lie could speak with difficulty, and asserted that a short
time previously, because of a satietv of life, he had drunk a poisonous
fluid.

In the hospital he vomited a blackish material, which was markedly
acid in reaction and in which free sulphuric acid was demonstrable.
He sank rapidly, and died an hour after his admission.

The body revealed extensive, brown, leather-like, dried areas on ami
about the lips. On both sides these extended from the angles of the
mouth to the lower jaw, and on the right side also to the middle of the
neck. The oral epithelium was grayish-white, dry, and extensively sen-

arated in shreds; the mucous membrane beneath was congested and
swollen, the superficial vessels injected and black. The mucous mem-
brane of the entire esophagus showed similar alterations, and was at the
same time arranged in rigid folds, and appeared superficially as though
cooked.

On opening the peritoneal cavity there was found therein a brownish,
turbid fluid, which was very acid in reaction and which contained
crumbling flocculi and vestiges of food. Both layers of the peritoneum
were of a dirty gray color, cloudy, and stiff, — as though cooked. The
vessels were injected and black, and from them could be expressed
black, friable blood-cylinders. These changes extended over all the
abdominal viscera, affecting some superficially, others more deeply. In
particular, the greater part of the intestines appeared as though cooked,
cloudy, rigid, and completely filled with black cylinders of blood. The
mesentery showed similar changes.

The stomach is contracted ; appears externally as though cooked.
The coronary vessels are black and distended ; from them blackish dried
blood may be expressed. At the fundus of the stomach there is a per-
foration— patulous for two fingers— with thinned, ragged edges. Through
this the brownish acid masses found in the abdominal cavity escaped
from the stomach, and engendered the above described lesions.

The mucous membrane of the stomach is wanting in epithelium
throughout; it has been converted into a black, hemorrhagica! ly infil-
trated eschar. In many places it is entirely absent, so that the swollen
connective tissue, discolored brown by imbibition and pervaded by a
network of black vessels, here and there even exposes the peritoneum.
The latter is particularly the case at the fundus of the stomach in the
neighborhood of the perforation, toward which the walls of the stomach
become very much thinned and the ragged margins of which are finally
formed by the perforated peritoneum.

The perforation of the stomach must have occurred soon after the
ingestion of the acid, which fact explains the rapid course of the case,
especially the rapid collapse of the patient. At all events, it occurred
during life, as otherwise the tense injection of the vessels of the mesen-
tery with rigid, coagulated masses of blood is inexplicable.

In view of the large quantity and the concentration of the sulphuric
acid employed, as indicated by the anatomical lesions, there can be no
doubt as to the case being one of suicide; and this fact is made clear
by the attendant circumstances of the case.

Tab. 54.

PLATE 34.
Poisoning with Dilute Sulphuric Acid.

A servant, aged 20 years, after an nnploaoontness with her mistress,
drank about 50 grams of dilate (about 20 per cent, i sulphuric acid. Having
vomited violently at home and complained of intense pain in the organs
of deglutition and in the abdomen, she was immediately taken to a hos-
pital. Oil admission, examination revealed whitish-gray eseharosis of
the entire surface of the mouth, and of the skin below the angles of the
mouth; in addition, pain and tenderness in the region of the stomach,
vomiting of blackish masses— acid in reaction, and manifestations of col-
lapse. Despite the employment of antidotes the girl died the following
day. twenty-four hours after she had taken the poison.

The necropsy revealed whitish-gray eseharosis throughout the mouth ;
partial desquamation of the epithelium of the oral mucous membrane ;
inflammatory congestion and swelling of the mucous membrane itself;
yellowish-brown, dried, leather-like streaks coursing from the angles of
the mouth; coil'ee colored contents of the stomach ; and, in addition,
the appearances depicted in the accompanying illustration.

The mucous membrane of the esophagus is swollen and arranged in
very rigid longitudinal folds. The epithelium is grayish-white, cloudy,
thickened, appears as though cooked, and shows at the crests of the
folds tine transverse tears.

On the inner aspect of the wall of the stomach one can distinguish
two areas, one of which is colored brownish-black to black, the other
being dirty pale violet in color, with here and there scattered blackish
points. The first, affecting more particularly the left half of the stom-
ach, especially the posterior and lower wall, radiates along the coarse
ruga- of the stomach toward the right half. These are the portions of
the stomach which the sulphuric acid first met. and with which it
remained longest in contact. Here in varying degree, through coagula-
tion, the mucous membrane has become the seat of eschar-formation,
and shows extensive hemorrhagic infiltration and imbibition. The
hemoglobin of the blood, both that within and that without the ves-
sels, has been converted into heinatin in acid solution, and has given
rise to the brownish-black to black discoloration of the eschar. This
eschar-formation affects especially the crests of the rugse. The blood in
the small vessels of the affected mucous membrane is almost completely
coagulated, and through the withdrawal of its watery constituents has
been converted into friable blood-cylinders. The cellular tissue beneath
the eschar is swollen and edematous, and shows here and there hemor-
rhagic infiltration.

The mucous membrane between the rugn? the seat of eschar"
also the mucous membrane of the entire right side of the stomach with
the exception of certain small brownish-black areas, is. with the sub-
mucous cellular tissue, markedly swollen, turgid, and projects above the
eschars.

The mucous membrane of the duodenum is likewise swollen, mark-
edly injected, aud reveals slight grayish-white cloudiness of the epi-
thelium.

PLATE 35.
Hydrochloric=acid Poisoning.

F. P., a servant, aged 46 years, was brought to the hospital, January
23d, with contusions of both ears and a fracture of the inferior maxilla.
He asserted that he had received these injuries eight days previously by
falling from a wagon. He was markedly dyspneic, and died at the end
of three days, with tetanic convulsions.

The necropsy revealed healing contused wounds of both auricles
and a diagonal fracture of the inferior maxilla. This was situate
between the middle incisor teeth and showed some suppuration in the
neighborhood. In addition there was extensive escharosis of the mucous
membrane of all the organs of deglutition, the stomach, and the upper
part of the small intestine. These lesions had evidently been produced
by the ingestion of hydrochloric acid, as the filtrate of the contents of
the stomach produced no precipitation of barium chlorid, but gave rise
to a marked precipitate when added to a solution of nitrate of silver.

The epithelium of the oral cavity and of the esophagus is in great
part desquamated, but here and there still attached as grayish-white
shreds. The mucous membrane is congested, swollen, slate-colored,
cloudy, and pervaded by a network of blood-vessels injected with coft'ee-
colored blood.

In the stomach there was coffee-colored fluid, markedly acid in
reaction, and containing particles of food. The mucous membrane of
the entire fundus, as also that along the greater curvature as far as the
pylorus, is desquamated. The submucosa is black, flabby, ragged, and
its vessels filled with thickened blood. The muscularis and the perito-
neum beneath in many places are as though cooked. The remainder of
the mucous membrane is pale, cloudy, and edematous.

Of especial interest are the inner aspect of the duodenum and the
adjoining portion of the jejunum. Here one notices a rather coarse
black network, and between the meshes of this, roughened mucous mem-
brane which appears as though cooked. The network corresponds with
the crests of the folds of mucous membrane — the valvulfe conniventes —
the seat of the most marked escharosis. The mucous membrane is
absent from certain areas, so that the submucosa is exposed. This shows
hemorrhagic infiltration and discoloration due to imbibition of hematin
in solution. The grayish-yellow areas within this network correspond
with the depressions between the valvulse couniventes — that is, with
the less affected portions of the wall of the bowel. To these portions
the mucous membrane with its glands, though the seat of eschar-forma-
tion and coagulation, is still attached.

The organs adjoining the stomach appeared superficially as though
cooked, and the blood in the portal vein, as also that in the aorta, was

Tab. 35.

Tab. 36.

LithJnsi.v. t. Reidihold , Miiitchm

coagulated to a friable dried mass. From the latter finding, as also
from the distribution of the escharosis, which could have been produced
only by a large quantity of the poison, the conclusion was warranted
that the poison had been taken shortly before death, probably in the
hospital, and evidently with suicidal intent. This supposition is in
accord with the statements of the hospital attendants, that the patient
had not vomited, and that having been to the closet during the evening,
lie was found dead in bed the following morning.

No additional information could be ascertained concerning the frac-
ture of the inferior maxilla nor the injuries to the external ears, Their
condition agreed with the assertion of the deceased that they occurred
eight days prior to his admission to the hospital, but whether he was
the victim of another or whether he produced them himself — possibly
with suicidal intent — is incapable of elucidation.

PLATE 36.

Fig. a. — A portion of the duodenum from the case of hydrochloric-
acid poisoning illustrated in Plate 35 — somewhat enlarged. It illus-
trates, on the one hand, the grayish-white escharosis of the mucous
membrane and its glands, and, on the other, the black, injected, stained
(with hematiii' submucosa, corresponding with the crests of the val-
vule conniventes. This has been exposed by the destruction of the
mucous membrane, and presents itself as a black network.

Fig. b. — Diffusion of the irritant poison through the wall of the
stomach to the adjoining organs. A case of carbolic-acid poisoning, in
which the poison diffused itself through the fundus of the stomach to
the inner surface of the spleen.

The fundus of the stomach appeared throughout its entire thickness
as though cooked; it was rigid, and of a pale reddish color. Similar
changes are also noticeable on the inner surface of the spleen and for a
distance of h cm. into the substance of the organ. These can have arisen
only through diffusion of the poison through the wall of the fundus of
the stomach.

PLATE 37.
Poisoning with Concentrated Nitric Acid.

P. B., a servant, aged 36 years, on November 21st, at 9 a. m., swal-
lowed a "large quantity " of nitric acid. At 11 A. M. she was brought
to the hospital vomiting, and died the same day at 4 p. M. The
motive prompting the deed is said to have been a very painful affection
of the head, but particulars could not be ascertained.

The body revealed a remarkable yellow discoloration of the skin
about the mouth, with streaks of similar discoloration radiating toward
the lower jaw. In addition, the epithelium of the oral mucous mem-
brane was in great part yellowish in color, cloudy, thickened, and could
be readly removed. The mucous membrane was pale yellow in color,
and appeared as though cooked.

The epithelium of the esophagus is of a uniform bright yellow color
throughout; it is arranged in rigid longitudinal folds, is thickened,
cloudy, friable, and readily detachable. The mucous membrane beneath
appeal's as though cooked ; it has a pale yellowish tinge, and is pervaded
with black injected vessels.

The stomach is markedly contracted, and contains yellowish, friable,
crumbling material with which are mixed numerous, small, blackish,
crumbling blood-coagula. The entire mucous membrane of the stomach
has been converted into a bright yellow, dried, fissured eschar. Its sur-
face is irregular; in many situations it is desquamated or becoming
detached. The submucosa which is thus exposed is ragged, in part it is
yellow in color, in part blackish through imbibition. It presents numer-
ous friable, cylindrical blood-coagula, some of which are contained
within the vessels, some project from the vessels, while others are free.
The deeper layers of the wall of the stomach are thickened, appear as
though cooked, but are without especial yellow discoloration. The
coronary vessels of the stomach are distended with firm blood-coagula.
In the neighborhood of, and along the entire course of the greater cur-
vature of the stomach, beneath the peritoneum, there are numerous,
bean-sized extravasations of blood.

The duodenum is also rigid — as though cooked. Its mucous mem-
brane has also been converted into a bright yellow eschar; it is thick-
ened, and arranged in coarse folds, at the crests of which the mucous
membrane is wanting, thus exposing the ragged, hemorrhagically infil-
trated submucosa.

The organs adjoining the stomach appear superficially as though
cooked, and are of a pale yellowish color.

This yellowish discoloration is a special characteristic of eschar-for-
mation dependent upon the application of nitric acid. According to the
generally accepted view, it is due to the formation of xanthoproteic and
is especially noticeable on epidermal and epithelial structures. It is
produced, however, only by the concentrated acid, the application of
the dilute acid being followed by its development to a slight extent
only or not at all. There may, therefore, occur instances of nitric-acid
poisoning without any yellowish discoloration.

Tab. 37.

■ • - -

,4

•^•^r^ey^

***** «■» ^ Hr^w ' i K-wi ***3*k,

• -^^i <w

7^ 7«>-j^jjMr* i.

Wfl

/

PLATE 38.
Poisoning with Carbolic Acid. Suicide or Accident?

J. M., a laborer, aged 51 years, at 5.45 A. M., drank from a bottle labelled
"Vdslauer Goldeck," but which, however, contained fluid (90 percent.)
carbolic acid. The bottle is said to have been filled to the height of the
label, lmt after the draught to have contained but about a teaspoonful,
so that about 80 c.c. of carbolic acid must have been swallowed. The
bottle and its contents belonged to a woman who employed the carbolic
acid for the extermination of vermin. On the other hand, it was ascer-
tained that the deceased had frequently spoken of a surfeit of life, and
had latterly been an assistant to an apothecary. M. vomited imme-
diately, became unconscious, and died at the end of about a half hour.

At the necropsy the lips were found of a reddish-brown color and
dried. The epithelium of the mouth and pharynx was grayish-white,
cloudy, and thickened, in part detachable as small, grayish-white shreds.
The epithelium of the entire esophagus was arranged in longitudinal
folds, pure white in color, rigid, and opaque. The mucous membrane
itself, glimmering through, was pale red in color.

The stomach is much distended and flabby ; its mucous membrane is
pale reddish in color and shows prominent, rather excessively filled
vessels. The organ contains about 500 c.c. of a watery, whey-like fluid,
which is markedly acid in reaction and has a distinct odor of carbolic
acid. The fundus of the stomach is without indications of marked
alteration; the mucous membrane is grayish-red, soft, and rather
irregular. In the region of the pylorus, however, as also along the les-
ser curvature, the mucous membrane is arranged in rigid folds, thick-
ened, of a grayish-red color, with milky-white, cloudy epithelium.
This cauterization, giving an appearance as though the tissue were
cooked, in the neighborhood of the pylorus affects the entire thickness
of the wall of the stomach, at certain diffuse areas penetrating to the
peritoneum, which in these situations appears congested. It affects also
the superficial portion of the adjoining surface of the liver. It increases
in intensity toward the pylorus and continues uniformly through the
entire duodenum to the beginning of the jejunum, where the mucous
membrane becomes again soft and relaxed. For a distance of 30 cm.
further, however, it is congested and flabby, and reveals here and there
at the crests of the ruga? slight superficial necroses.

From these lesions it is evident, despite the slight cauterization of
the stomach, a circumstance readily accounted for by the fact of the
stomach being filled at the time of the taking the poison, that a large
quantity of carbolic acid, at all events more than a single mouthful, was
taken. The fact of such a quantity being swallowed of itself renders
probable the supposition that the poison, which even on the lips engen-
ders intense buruing, was taken intentionally.

As, in addition, carbolic acid, because of its peculiarities, is well
known to the laity, and as the deceased haviug served for a time as
assistant to an apothecary, must have been especially well acquainted
with it, it is extremely likely that he attempted to terminate his life in
this manner. Confirmatory evidence of this view is furnished in the
repeated expressions of a satiety of life of the deceased, and in the tuber-
culosis of the apices of both lungs with which he had been for a long
time affected.

PLATE 39.
Poisoning with Carbolic Acid. Suicide.

A man, aged 20 years, was found dead before the door of the general
hospital at 2 A. M. Beside him was a bottle which had the odor of car-
bolic acid.

The lips were brownish-red, dried. The epithelium of the mouth
and pharynx was throughout white and slightly cauterized ; here and
there it could be detached. The mucous membrane beneath was pale ;
that about the arytenoid cartilages aud the uvula edematous. The
mucous membrane of the esophagus to the cardia was whitish, cloudy.
and arranged in longitudinal folds; the epithelium readily detachable.

The stomach is contracted, firm to the touch. Externally it is partly
pale, partly, especially the fundus, violet in color, with bright-red,
markedly injected vessels. It contains about 100 c.c. of a bright-red,
whey-like, turbid fluid, which is slightly acid in reaction and has a
strong odor of carbolic acid. The mucous membrane throughout almost
the entire stomach is arranged in rigid folds and appears as though
cooked. It is pure white in color, except in the recesses of the ruga?,
especially toward the pylorus, where it is better preserved. In these
situations it is of a red color, which color is even transmitted through
the markedly cauterized areas. In certain situations, especially at the
crests of the rugae, the otherwise milky-white, cauterized epithelium
has become desquamated and exposes the bright-red, hemorrhagically
infiltrated mucous membrane.

There were no further alterations either in the intestines nor in any
of the other organs.

Tab.

fab. 40.

I

PLATE 40.

Cauterization of the Lips and the Region about the Mouth
with Lysol.

During an evening, a decrepit woman, aged 70 years, administered to
her grandchild, aged 6 months, a teaspoonful of concentrated lysol, in-
stead of some medicine. The child began immediately to cry ; he
became restless and dyspneic, and died the following day. The external
examination revealed on the lips and about the mouth the appearances
depicted in the illustration, and which of themselves indicate the inges-
tion of an irritant fluid. The external margin of the lips is congested
and swollen ; the inner, as also the epithelium of the entire anterior
part of the oral mucous membrane, grayish-white and cloudy. The skin
about the mouth, and from the lower lip and angles of the mouth to the
chin and at the left side also to the neck, is of a brownish-yellow color
and of leathery consistency. These changes affect in general the upper
layers, only here and there the deeper layers of the skin. Beneath them
there is no marked congestion nor swelling. These alterations in the
Sjkin are not essentially different from those observed after the applica-
tion of liquor potassse, but are to be distinguished from those produced
by sulphuric acid by their greater softness, by their more brownish
color, and by the absence of injected vessels filled with dried black
blood.

The internal examination revealed the epithelium of the mucous
membrane of the mouth, the pharynx, the esophagus, and the entrance
to the larynx, whitish gray and cloudy ; and, in addition, a bilateral
lobular pneumonia.

PLATE 41.
Acute Poisoning with Corrosive Sublimate.

The stomach of a hospital midwife who had poisoned herself with a
concentrated solution of corrosive sublimate and who, with manifesta-
tions of rapid collapse, died at the end of four hours. Prior to deatli she
had vomited grayish-white, turbid, odorless masses which resembled
coagulated albumin, and the mucous membrane of the lips, mouth, and
pharynx presented a diffuse, grayish-white escharotic appearance.

The necropsy revealed, in addition to this latter described condition,
a grayish-white, cloudy appearance of the mucous membrane of the
entire esophagus. These changes affected not only the epithelium,
which was arranged in rigid folds, but also the deeper layers of the
mucous membrane, beneath which there was a moderate hyperemia,
but otherwise no alterations.

The stomach was contracted, firm to the touch, of grayish-white
color on the right postero-external surface and at the fundus, and
appeared as though cooked. These changes extended also to the inner
surface of the spleen. The remainder of the peritoneal covering was
pale and smooth.

The stomach contained a large quantity of coagulated mucus. The
gastric mucous membrane is, as appears from the illustration, of a
peculiar and uniform pale violet color, rigid, thickened, dried, and
arranged in coarse folds. These alterations extend through the entire
mucous membrane, here and there also to the submucosa, and at the
fundus of the stomach, especially at its posterior aspect, even through
the entire wall of the organ. It is thus apparent on the peritoneal sur-
face of the organ and even in the superficial portion of the spleen. The
changes are those of coagulation-necrosis of the tissues, which latter
macroscopically and microscopically appear as though hardened, pre-
serving their histologic structure.

The peculiar color of the inner wall of the stomach results from the
association of the white color of the escharotic tissue, particularly the
epithelium, and the mouse-gray color — glimmering through the upper
strata — of the blood in the vessels of the mucous membrane which has
been coagulated by the sublimate.

Unfortunately this color did not persist long. On the following day
the preparation was more of a bluish-gray color, and became even
darker when placed in alcohol.

The changes described may remain limited to the stomach, but not
rarely may be followed a short distance in the intestine, — gradually
diminishing in intensity.

Had the chemical been taken in the form of corrosive sublimate pas-
tilles, both the stomach-contents and the escharotic gastric mucous
membrane, especially the epithelial layer, would have presented a strik-
ing anilin-red discoloration (because of the coloring-matter added to
the pastilles. — Ed.).

Tab. 42.

PLATE 42.
Subacute Poisoning with Corrosive Sublimate.

J. J., a porter, aged 42 years, on the morning of April 30th, drank a
solution of corrosive sublimate which had been prescribed for a skin
affection from which he suffered. There soon ensued hematemesis and
later hemorrhagic stools, both of which continued until his death, on
the morning of May 4th.

At the necropsy the mucous membrane of the pharynx and the
esophagus was found congested and injected, deprived of epithelium, —
in the lower part with bilious imbibition and readily stripping.

The stomach is much dilated, livid, and has rather rigid walls. In
the subserosa, in the region of the pylorus at the smaller curvature,
there is an area of suffusion. In the stomach there was a quantity of
bilious, hemorrhagic, mucous fluid. The gastric mucous membrane is,
in general, swollen and edematous. It is of a grayish-greenish color,
and pervaded by various extravasations of blood, which are situate
closer together toward the fundus and are arranged in rows correspond-
ing with the ruga1. In the fundus itself there is a fungiform projection
of the mucous membrane, which has been converted into a rigid gray
elevation almost the thickness of a finger. It is escharated throughout,
of a grayish-white color, cloudy, and appears as though cooked. Beneath
it the submucosa shows hemorrhagic infiltration and imbibition, as does
also the swollen muscularis.

From various irregular, bean-sized areas of the escharated prominence
(he nucous membrane has been thrown off, thus exposing the somewhat
ragged submucosa, the seat of fading hemorrhagic infiltrations. The
edges of these areas are partly rounded, partly ragged, partly under-
mined. Similar but more extensive areas of desquamation and under-
mining are present along the periphery of a large escharated prominence
the size of the palm of the hand. It is possible to introduce the probe
a distance of 2 cm. beneath the eschar, which is evidently in process of
desquamation. Suppuration is nowhere demonstrable. On the other
hand, there is a delicate fibrinous exudate covering the peritoneum
beneath. Over portions of the dysenteric intestine there are evidences
of beginning peritonitis.

In the lower portion of the small intestine, but especially in the
large intestine, there are evidences of marked dysentery, that is, exten-
sive diphtheric necrosis and ulceration of the crests of the ruga?.

PLATE 43.

Corrosive=sublimate Dysentery.

The preparation is from a woman, aged 25 years, who died of puer-
peral sepsis and diffuse suppuration of the pelvic connective tissue, six
days after parturition. In the endeavor which was made outside the
hospital to extract the child with forceps, a laceration, 6 cm. in length,
of the left vaginal wall was produced. In the hospital the child
was delivered with forceps, and the rent in the vagina was sutured.
Before the instrumental delivery the vagina was irrigated with a 1 : 1000
corrosive-sublimate solution. By this procedure the fluid gaining an
entrance through the laceration evidently invaded the pelvic connective
tissue.

The mucous membrane of the large intestine is throughout markedly
congested and flabby, at the crests of certain rugse much injected, and
pervaded by groups of minute ecchymoses. In the upper part, especially
at the crests of the rugae, there is a formation of discolored and mal-
odorous pseudomembrane.

Tab. 43.

V

I

m

Luh.Anst.v. F RryhhoM . Muiiften

Tab. 44.

Lith.Am.v. F. R*i«WioM . Miinrhen

PLATE 44.
Kidney from a Case of Corrosive-sublimate Poisoning.

The illustration and the text are taken from Professor O. Bollinger's
Atlas der pathologischen Anatomie, Part II. Plate 7. The case was that of
a girl, aged 9 years, who three days prior to her death, with suicidal
intent, swallowed a corrosive-sublimate pastil (1 gram). The greater
part of the poison was promptly ejected. Complete anuria ensued. At
tlie necropsy the gastric mucous membrane was unchanged ; there was a
moderate degree of catarrhal inflammation of the intestine; there were
subpleural ecchymoses over both lungs and hypostatic pneumonia of the
lower lobes.

The kidneys, on the other hand, revealed the appearances of toxic
parenchymatous nephritis. The kidney is much increased in size, the
capsule strips readily, the surface is smooth, the tissue soft and friable.
The cortex is increased in size, of a pale grayish-white color, the normal
appearances indistinct. The pyramids are of a dark, bluish-red color
and slightly swollen. Microscopically : parenchymatous degeneration
and partial necrosis of the epithelium, with calcareous infarction.

FIGURE 186.

Stricture of the Esophagus and Cicatrix of the Stomach,
the result of Poisoning with Liquor Potassas.

A boy, aged 14 years, is said to have accidentally swallowed a solution
of caustic potash three years ago, and since that time to have been
troubled with cough and dysphagia. During the later months of his
life he was treated in the hospital for an affection of the lungs. He
died suddenly in the hospital.

The necropsy revealed pulmonary tuberculosis and bronchiectasis as
the cause of death. To the right side of the stomach and along the
greater curvature there is a flat, smooth cicatrix the size of a dollar,
toward which the gastric rugae converge. In the lower third of the
esophagus there is a cicatricial stricture, 3 cm. in length. It has thick-
ened and very dense walls, and permits the ready passage through its
lumen of a probe, 2 mm. in diameter. Above the stricture the esoph-
agus is dilated, and its mucous membrane is here and there the seat of
superficial cicatricial striae.

Fig. 1 86.

Fig. 187.

FIGURE 187.

Stricture of the Esophagus following the Ingestion of
Caustic Potash. Perforation of the Esophagus with
an Esophageal Sound.

A child, aged lj years, five weeks prior to its death, drank a solution
of caustic potash which had been left on a bench by the child's mother.
A physician was not summoned, but the child was given milk, oil, etc.
Following the exhibition of these vomiting ceased, and the condition
of the child is said to have improved. Latterly, however, the ingestion
of food became more and more difficult, so that finally fluids only could
be swallowed. At this time the child was taken by its parents to a
hospital, when ulcers of the tongue and a stricture of the esophagus
were recognized. The lumen of the latter was so narrow that only
after repeated attempts could a sound be passed.

Immediately after the probing the child became restless, sank rapidly,
and died the following day with manifestations of suffocation.

The necropsy revealed a much emaciated child. In the mouth, aside
from two small superficial ulcers on the tongue, there were no note-
worthy lesions. The right side of the diaphragm was depressed dome-
like toward the abdominal cavity and, in addition, was relaxed. The
right pleural cavity contained about 200 grams of a yellowish, whey-
like, turbid fluid, which was found to consist mostly of milk. The
lung was compressed and thickened; the pleural covering was cloudy.
The left lung was crepitant. The stomach showed no marked altera-
tions. Its mucous membrane was pale; there were no cicatrices.

The esophagus is somewhat dilated in its upper part. Its mucous
membrane is pale, its epithelium thickened, and in the lower part of
this area is pervaded with superficial cicatricial striae. From this region
downward the esophagus is rather uniformly cicatricially thickened and
diminished in caliber, so that only the blunt extremity of a small pair
of scissors can be introduced therein. At the commencement of this
area of contraction there is a transverse laceration of the mucous mem-
brane of the right wall of the esophagus, 1 cm. in length. It has rather
sharp edges, which are congested but not suffused. It leads into a canal
4 cm. in length, which is directed anteriorly, and which has the thick-
ness of a lead-pencil. It courses beneath the mucous membrane in the
submucosa, in the direction of the esophagus downward, terminating in
a bean-sized, ragged, discolored aperture, which opens into the right
pleural cavity, beneath the hilus of the right lung.

The opinion was expressed :

1. That the child had suffered a cauterization of its esophagus some
considerable time prior to its death, and that there was no evidence

opposed to the view that this may haVe been produced by accidental
drinking of a solution of caustic potash.

2. As a consequence of this cauterization there developed a very
marked cicatricial diminution in the caliber of the esophagus.

3. In an attempt to relieve this stenosis by the introduction of a
sound the esophagus was perforated. Directly above the commencement
of the stricture the probe penetrated the mucous membrane and finally
entered the right pleural cavity. As a result of this perforation, the
fluid which was subsequently swallowed or otherwise introduced found
its way into the right pleural cavity and thus brought about the death
of the child by suffocation.

4. It cannot be asserted, in the present case, that the perforation of
the esophagus was the result of culpable negligence or malpractice. On
the one hand, the stenosis was excessive and the introduction of an
instrument through the stricture would have been very difficult even
for one experienced, and was absolutely necessary; and, on the other
hand, the dilatation of the esophagus above the stricture and the soften-
ing of its wall consequent upon the stagnation of food may have favored
the rupture.

5. It must be declared that the child was certainly neglected, and
that this neglect, especially in view of the fact that it was not given the
benefit of medicinal treatment until the end of five weeks, contributed
to the fatal termination. This is evident because, had the child been
properly treated in time, the stenosis of the esophagus would not have
attained such a high grade as was really the fact.

Tab. 45,

PLATE 45.
Potassium=cyanid Poisoning.

By the combination of cyanogen with potassium hydroxid to form
potassium cyauid the latter loses noue of its well-known qualities. It
is in consequence of this that potassium cyanid retains the alkaline taste
and markedly alkaline reaction of caustic potash ; and that, like the
latter, it gives rise to solution of albuminous bodies, causes the tissues to
swell and to become cleared, and not only produces disintegration of the
blood, but also solution of the hemoglobin, and as a consequence hemor-
rhagic imbibition of the swollen structures. There is, however, this
difference between the two : the solution of the blood produced by potas-
sium cyanid, does not present, as does that which follows the action of
caustic potash, a brown or brownish-black color, but a striking red or
brownish-red color. This is the result of the specific action of cyanogen,
and depends upon the formation of cyanohematiu.

As the result of this action, the appearance of the stomach at the
necropsy, in a case of typical potassium-cyauid poisoning, is very char-
acteristic and remarkable, as shown in the accompanying illustration.

We find the stomach generally contracted, with walls apparently
thickened to the touch. As a rule, the organ contains a large quantity
of soapy, slimy, hemorrhagic, rather tenacious mucus of alkaline reac-
tion. The mucous membrane throughout, but especially in the depen-
dent portions, is of a diffuse blood-red or brownish-red color, markedly
swollen, at the crests of the rugae transparent, and throughout soapy
and slimy to the touch. These alterations may affect the entire thick-
ness of the mucous membrane and even invade the submucosa. At
times they may also be followed into the duodenum, less frequently
beyond it, and sometimes also into the esophagus and the pharynx (vide
Plate 46).

The first of these alterations, and that which certainly occurs during
life, is the marked hyperemia of the gastric mucous membrane; and
this is probably associated with the formation of ecchymoses. The other
lesions, especially the solution of the hemoglobin, and the imbibition of
this by the inner wall of the stomach, as also the swelling of the latter,
because of their nature, do not develop until after the death of the indi-
vidual. They are the consequence of the long-continued action of the
solution of the potassium cyanid on the hyperemic stomach. They are
therefore not found at the necropsy performed immediately after death
of animals experimentally killed by the poison. One may also satisfy
himself that this diffuse hyperemia and swelling likewise ensue, if a
hyperemic stomach be filled with a solution of potassium cyanid and
examined the following day.

On the other hand, from jvhat has been said, it follows that the above-
mentioned remarkable and characteristic lesions develop only when un-
decomposed potassium cyanid exerts its action. The changes may be
wanting when, as may readily occur, the chemical has been decomposed
either by the vehicle or by the contents of the stomach.

The affinity of cyanogen for potassium hydroxid in combination
with it is so slight that even the weakest acids, as, for instance, carbonic
acid, tartaric acid, acetic acid, disturb it and cause the liberation of
cyanogen, with the formation of a salt by the combination of the potas-
sium hydroxid with the acid employed. This resultant salt does not
possess the above-mentioned peculiarities of the alkali. Similar decom-
position will result if the poison be taken in an acid vehicle, or if at the
time of its ingestion the stomach contain acid contents. The develop-
ment of the above-described lesions, therefore, will be the more incom-
plete the greater the decomposition.

Under such circumstances, despite the fact that potassium cyanid was
taken, the case becomes one of hydrocyanic-acid poisoning. As is well
known, this gives rise to no especial organic changes, and is only to be
detected by the peculiar odor and the chemical investigation.

PLATE 46.

Fauces, Pharynx, and Entrance to the Larynx from a Case
of Potassium=cyanid Poisoning.

The mucous membrane throughout is uniformly suffused with blood,
with here and there a yellowish tint, probably dependent upon bile ; it
is markedly swollen and relaxed, and was covered with a clear, soapy,
slimy mucus, markedly acid in reaction.

This lesion is common in cases of typical poisoning with potassium
cyanid ; that is, in those in which the poison has not been decomposed
by an acid. Its occurrence is accounted for by the fact that through
vomiting or retching a portion of the very alkaline contents of the
stomach reaches the pharynx and may even extend into the lungs. In
these situations it produces postmortem changes similar to those which
develop in the gastric mucous membrane in cases of typical potassium-
cyan id poisoning.

Tab. 46.

Tab

PLATE 47.
Subacute Phosphorus=poisoning.

A woman, aged 46 years, the wife of a shoemaker, had latterly ex-
hibited indications of mental aberration; she cried considerably, and
manifested an exaggerated piety. She had also repeatedly said that she
desired to die and that she would take her life. On February 3d,
appearing indisposed and being questioned, she asserted that, although
she was well, "one could not foretell what might happen within an
hour." At noon she ordered her repast. Into this when it was brought
she introduced some substance, but denied that fact to her husband.
Since then she lias been ill and is said to have repeatedly vomited. On
February 5th, a physician being summoned, found the woman much
emaciated, and examining her lungs he detected the presence of rales.
He advised the removal of the patient to a hospital. Here examina-
tion revealed jaundice, muscular and cardiac weakness, dyspnea and
rales, vomiting of coffee-colored material, and constipation. Expression
was given to a supposition of phosphorus- poisoning, and although the
woman denied that she had taken anything unusual, phosphorus was
demonstrated, not in the vomited material, it is true, but in the stools
which were passed after the injection of enemata. With increasing
collapse, the woman died February 7th.

The necropsy, performed February 10th, revealed icterus, and, after
making an incision along the vertebral column, infiltration of the cell-
ular tissues with icteric serum. In addition there were numerous
ecchymoses upward the size of a dollar in the subcutaneous connective
tissue and intermuscular septa. About the nose and the mouth there
was some coflee-colored fluid, acid in reaction ; similar fluid also in the
stomach and in the upper part of the small intestine. The mucous
membrane of the organs of deglutition were without especial altera-
tions. That of the stomach was cloudy, swollen, and covered with
numerous coffee-colored flocculi. The mucous membrane of the upper
part of the small intestine presented similar changes: that of the lower
part and of the large intestine was unaltered. In the large intestine
there was a considerable quantity of clay-colored fecal masses.

The musculature of the trunk and the extremities was in great part
softened and pale. Microscopical examination revealed it to be in part
granular, in part the seat of fatty degeneration. In the subcutaneous
connective tissue and intermuscular septa, especially in the dependent
portions, there were numerous extravasations of blood the size of a bean
and larger.

The dura mater contained a considerable quantity of blood and was
icteric. On its inner surface there was a delicate, vascularized pseudo-
membrane. It was pervaded by numerous recent blood-extravasatious

and was readily detachable. The inner meninges on the convexity of
the brain were thickened and infiltrated with yellowish serum. The
brain was dense, and its parietal convolutions were diminished in size.

The left lung was free, the right partly adherent. Both revealed
ecchymoses upward the size of a bean about the hilus and beneath the
posterior pleural covering. On section the lungs contained a consider-
able quantity of blood, and they crepitated throughout ; there was con-
siderable mucus in the bronchi.

In the anterior, but especially in the posterior mediastinal space,
there were numerous extravasations of blood upward the size of a bean,
in great part confluent.

The heart was of ordinary size, softened externally, and on section
clay colored. Beneath the epicardium and the adventitia of the larger
vessels there were numerous beau-sized ecchymoses. The valves of the
heart and the intima of the aorta were normal. The cardiac muscle
was in a state of fatty degeneration and was readily lacerated. Beneath
the left endocardium there were also lentil-sized ecchymoses.

The liver and the kidneys were enlarged and showed uniform fatty
degeneration (see next plate).

In the omentum and the mesentery, especially in the posterior part
of the latter, there were numerous ecchymoses the size of a half-dollar.

The postmortem lesions above described (jaundice, acute fatty degene-
ration of the organs, parenchymatous degeneration of the mucous mem-
brane of the stomach with coffee-colored gastric contents, and extensive
ecchymoses in various areolar connective tissues, especially in the
dependent portions of the body) are characteristic of subacute phos-
phorus-poisoning— that is, of phosphorus-poisoning leading to death
several days after the poison has been taken. By themselves alone they
permit the diagnosis of such a condition even when, as in the present
case, after death no phosphorus can be detected in the intestinal con-
tents.

The poison was evidently taken in the form of match-heads on the
third of February. The duration of the illness was thus four days. There
was no question that the case was one. of suicide, and the supposition
that the deceased was insane found also its confirmation in the dis-
covery of a pachymeningitis vasculosa and indications of cerebral
atrophy.

Tab. 48.

t

1

/■

t'r

V

" J hi

Luhiiisi .v. F Reichhold Mfinchen

PLATE 48.

Fig. a.— Liver from a Case of Subacute Phosphorus=
poisoning.

The liver is enlarged, externally somewhat doughy to the touch,
almost uniformly fatty-yellow with injected vessels. On section it is
also fatty-yellow; the acini are enlarged, and in their center there are
discernible the intni-aoinous vessels and vestiges of still persistent
brownish liver-substance.

Under the microscope the liver-cells were enlarged, globular, and
filled with larger and smaller fat-droplets.

Fig. b.— Kidney from a Case of Subacute Phosphorus-
poisoning.

The kidney is enlarged and pale yellowish. The cortical substance
is visibly increased in breadth, almost uniformly fatty-yellow, here
and there the injected interstitial vessels and glomeruli are discernible.
The pyramids are pale yellow with reddish striatums and are likewise
increased in width. In the connective tissue of the pelvis of the kidney
there are numerous fading ecchymoses.

Microscopically there was found a high grade of acute fatty degenera-
tion of the entire epithelium of the organ.

PLATE 49.

Stomach from a Case of Acute Arsenical Poisoning. Mur-
der by Poison.

On June 5, 1896, for the purpose of determining the cause of death,
a medicolegal necropsy was performed upon the body of Marie S., aged
29 years, the wife of a timber-merchant. According to information fur-
nished by the police, the deceased and her two children are said to have
been taken ill, on May 26th, after partaking of some sausage. Whereas
the children, after vomiting and suffering with headache, rapidly re-
covered, the illness of the woman continued with vomiting and diar-
rhea, and eventuated in her death, on June 4th.

Systematic medical attention was not afforded her, and there was
therefore no history of her illness.

The necropsy revealed slight but distinct jaundice and hypostatic
congestion of the lungs, but no especial changes in the throat or the
esophagus. There were moderate hyperemia and swelling of the mucous
membrane of the larynx and the trachea. The heart was flabby and
dilated, the musculature of a yellowish-brown color, and friable. Micro-
scopically the normal striation was absent, the muscular substance
showing marked cloudy swelling. The liver and the kidney likewise
showed a high grade of parenchymatous degeneration.

The stomach was moderately distended, flabby, and mai'kedly injected
along the curvatures; otherwise there were no noteworthy changes
externally. It contained about 180 c.c. of a watery, turbid, slightly
hemorrhagic, unctuous fluid without especial odor and without any
particular contaminations. The inner wall of the stomach, as shown in
the accompanying illustration, is throughout markedly swollen, soft-
ened, and congested. The congestion on closer investigation is found
to consist of injection of the minutest vessels, especially of those situate
at the crests of the rugae, where it is in great part combined with closely
aggregated punctiform ecchymoses. Especially noticeable are both the
congestion and the swelling of the fundus of the stomach, of the pos-
terior wall, and about the middle of the greater curvature. In the
latter situation there are circumscribed areas, upward the size of a bean,
composed of compact and in great part confluent ecchymoses, which
have been deprived of their epithelium. Covering these areas and the
immediate vicinity there is a fine, soft, bright-yellowish substance,
which is unctuous to the touch, and which on microscopic examination
reveals neither sand-like nor crystalline particles. Nor were such par-
ticles demonstrable either in the gastric contents nor its sediment after
precipitation in a conical glass.

Not less remarkable were the lesions on and in the intestines, espe-
cially the small intestine, represented in Plate 50. (See next Plate.)

49.

Tab. 50.

PLATE 50.
Small Intestine from a Case of Acute Arsenical Poisoning.

The small intestine appears very flabby and contains throughout its
entire length a large quantity of watery, turbid, whey-like contents,
resembling rice-water. The wall of the intestine appears — as is evident
from the constricted portion of the intestine in the illustration — exter-
nally smooth, but slightly cloudy, and of a very pale violet color. This
color is in part dependent upon a fine and compact injection of the intes-
tinal, especially the subperitoneal, vessels, and in part upon a serous
infiltration of the coats of the bowel. After opening the intestine
the mucous membrane is also found to be of a pale-violet color and to
be finely injected. Its epithelium is desquamating, and throughout it
is flabby, edematous, and somewhat cloudy. In the large intestine
there is a moderate amount of seromucous contents ; the mucous mem-
brane is likewise flabby. The intestinal glands are swollen, but not
infiltrated.

Of the remaining lesions, there are still to mention the tar-like char-
acter (inspissation) of the blood, the dryness of the tissues, and the
absence of urine in the bladder.

The anatomical lesions, therefore, are those of an acute diffuse gastro-
enteritis— such form as may occur after so-called sausage-poisoning or
in arsenical poisoning, in cholera asiatica and cholera nostras. A pos-
itive distinction in one or the other direction could only be made by
bacteriological and chemical investigation. But bearing in mind the
rather characteristic necropsy-findings, the opinion was expressed that
the case might be one of arsenical poisoning.

As a matter of fact, bacteriological examination of the reserved por-
tions of the intestine proved negative, the chemical investigation, on
the other hand, revealing a "considerable quantity" of arsenic. This,
although no quantitative estimation was made, permits of no doubt that
the case was one of arsenical poisoning. And this view is further con-
firmed because of the fact that, although the patient was ill seven days
and during this time vomited considei*ably and had marked diarrhea,
a " considerable quantity" of arsenic was nevertheless detected.

Imbedded in certain of the flakes from the sediment of the rice-
water contents of the intestiue, there were also found upon microscopic
examination white, octahedral crystals with blunt edges (smaller illus-
tration, Plate 50). These revealed the microscopic appearances of crystals
of arsenic and upon chemical examination were found to be such.

Upon further inquiry it was elicited that the assertion that the
woman and her two children became ill on May 26th, after partaking of
sausage, originated with the husband, and was not based upon truth;
that the sausage had been partaken of on the day previous and without

evil consequences ; that the aforementioned persons became ill on the
following day after the midday meal ; that the man had been married
thrice ; that both the former wives had died suddenly and under sus-
picious circumstances ; and that he was again engaged in courtship with
a relative whom he had already promised to marry after the death of
his wife. In addition, the police inspectors found, hidden beneath a
stone in the residence of the accused, a small package which upon ex-
amination was found to contain arsenic. Finally the husband acknowl-
edged that on May 27th he had sprinkled arsenic upon some meat, that
as his wife and children subsequently demanded some, they were given
of it to eat, and that he had been unable to prevent their partaking of it.

The husband subsequently withdrew this confession. In the exhumed
body of his second wife, who died three years previously, arsenic was dis-
covered. But to this one must not attach too much importance, as the
earth of the cemetery was found to contain a large quantity of arsenic.

The husband was condemned to death because of murder by poison.

Tab. 51.

PLATE 51.
Carbonic =oxid Poisoning Charcoal=fumes).

On the morning of November 6th, the woman the subject of the
present illustration, clothed only in a chemise and petticoat, was found
dead before her bed, lying with her face downward. In her small room
there was a basin containing half-consumed charcoal, by burning which
she had been accustomed to warm herself.

At first view the peculiar color of the body is remarkable. As a con-
sequence of the abdominal posture, in which the body had doubtless
remained for a considerable period of time, this color has developed more
especially on its anterior surface. But certain portions of it, as, for
instance, various prominent areas of the face, as also the anterior sur-
face of the shoulders and the mamma?, which had been in direct contact
with the floor and therefore subject to greater pressure, are distinguished
from the surrounding areas by their pale color.

The skin is bright red in color and has a tinge of carmine, remind-
ing one somewhat of the color of rouge. In addition the visible mucous
membranes, especially the conjunctiva? and the lips, are of a remarkably
bright-red color. In order to show this better in the illustration, they
are somewhat everted. Similarly to the skin, the internal organs are
bright red in color, particularly those which normally are of a lighter
hue. The blood within the vessels is cherry-red in color and fluid.
This is especially noticeable in the meninges and the brain. The former
are bright red and injected. Both the white and the gray matter of the
brain are manifestly reddened ; on section blood exudes from the ves-
sels in the form of bright-red droplets.

These lesions, especially when considered in association with the
other circumstances of the case, rendered clear the diagnosis of ear-
bonic-oxid poisoning; and this diagnosis was continued by an examina-
tion of the blood. Spectroscopic examination of the blood diluted with
water revealed indeed two absorption-lines in the green part of the
spectrum, and these were not essentially different from those of oxy-
hemoglobin. They differed from the latter, however, in that they did
not, as do the latter, unite to form one after the addition of ammonium
sulphid ; they persist, as is the rule with carbonic oxid-hemoglobin. In
addition, when a few drops of the blood were added to a few drops of
sodium hydrate in a white dish the former retained its beautiful red
color. Ordinary blood, after such addition, loses its red color and
becomes greenish.

That the poisoning was the result of charcoal-fumes, and was not due
to illuminating-gas, is further indicated by the half-consumed charcoal
found in the room, and by the absence of the odor of illuminating-gas.

On the bridge of the nose near its root there, is an irregular slit-like
laceration of the skin, 2' cm. in length. It has contused edges and an
irregular base. The latter is suffused with bright-red blood, although
there is no deeper injury. From this, as also from the mouth and nose,
blood had exuded and flown to the right, where it became dried in the
form of partly branching streaks. This is evidently a so-called agonal
injury, which has been caused by falling upon the face at the moment
of the supervention of unconsciousness.

Tab. 52.

PLATE 52.
Agonal Injuries of the Face.

This plate illustrates an instructive instance of so-called agonal in-
juries ; that is, those produced by a fall the result of other causes lead-
ing to death. These injuries possess a forensic importance, because of
the fact that they may be looked upon as the consequences of traumata
sustained during life at the hands of others, and because they may even
be considered the real cause of death.

In the present case the appearances of the face are in reality such as
would incline one to the belief that various traumata had been sustained
during life; in other words, that the deceased had met with a violent
death. This view would be considered especially likely in the case of
an unknown individual or of one dying under suspicious circumstances.

One finds about the nose and the mouth a considerable quantity of co-
agulated, partly recent, partly dried blood, and, in addition, the region of
the face about the mouth and nose seems as though sprinkled with blood.
The bridge of the nose is swollen ; toward the nasal bones it is promi-
nent, of a bluish-red color, doughy to the touch, and on section is found
to be markedly suffused with freshly coagulated blood. Beneath the
suffusion the anterior ends of the nasal bones are splintered. On the
left cheek there is an irregular, dried, bluish-red abrasion of the skin
rather larger than a bean. On section of this area an extravasation of
coagulated blood, almost as large as a dollar, is detected in the subcu-
taneous tissue. The lower lip is swollen and suffused. At about its
center, corresponding in position with the incisor teeth, there is on the
external margin of the lip one, and on its inner surface two, irregular
lacerations of the mucous membrane, about 4 cm. in length. They have
contused edges and irregular hemorrhagic bases. Finally, to the outer
side of the left frontal protuberance there are two contused, slightly
suffused areas about the size of beans.

Despite the rather remarkable nature of these lesions, they are but
accidental injuries resulting from a fall engendered by a "natural
cause" of death.

The man, a janitor, aged 53 years, at midday on a crowded thorough-
fare, suddenly fell to the ground. As witnesses assert, he struck the
ground with his face and died in a few moments. The anamnesis dis-
closed the facts that he had been ill for three years, and that he had
suffered three strokes of apoplexy with consequent right-sided hemi-
plegia.

The necropsy revealed a recent apoplectic focus, the size of a goose-
egg, destroying the right lenticular nucleus and the internal capsule,
and invading the lateral ventricle. There was also a large apoplectic
cicatrix in the left lenticular nucleus. It affected almost the entire
length of the latter, and at its center was the seat of a transverse en-
largement.

In addition, there were found arteriosclerosis, chronic nephritis, and
a well-marked hypertrophy of the left ventricle of the heart.

Had the man been overtaken by sudden death while standing on a
height, even more serious injuries might have resulted from the fall;
as, for instance, fractures of the skull. In such cases the more severe
the secondary or agonal injuries and the more they overshadow the real
cause of death, the more likely are they to be taken for the latter.
This possibility is further increased by the fact that such agonal in-
juries are, as a rule, associated with distinct suffusion and other mani-
festations of vital activity, and, therefore, simulate injuries occurring
during life.

PLATE 53.

Abnormal Situation of Postmortem Lividity as a Result of
the Abdominal Position of the Body.

The body of a young woman, clothed, rigid, and in the abdominal
position, was found in the room of the deceased. The woman resided
alone, and had not been seen during the preceding twenty-four hours.
She is said to have appeared ill and to have complained of gastric pain
during the two weeks prior to her death. She had, nevertheless, been
able to repeatedly leave her room.

The body attracted attention because of the violet color of its ante-
rior surface ; the posterior surface revealed the ordinary cadaveric pallor.
The violet color was, in general, diffuse. All over the chest, however,
and on the upper part of the abdomen, and to a less degree on the an-
terior surface of the thighs, it was pervaded by numerous, longer and
shorter, pale striations. These crossed each other frequently and irregu-
larly, were rather sharply limited, and in marked contrast to the ad-
joining livid areas. They exhibited no other alterations of the skin.
The livid areas were darkest on the anterior surface of the body. Later-
ally and posteriorly they decreased in intensity until they approached
the cadaveric pallor of the posterior surface of the body. This is not
evident in the illustration because of the shadow, which is depicted too
intensely. These livid cutaneous areas were pervaded by various,
scarcely discernible punctiform ecchymoses, which diminished in inten-
sity from the thorax and abdomen toward the lateral portions of the
body. The face, especially the left side, was also of a dirty violet color.
The conjunctivae were markedly injected, but without ecchymoses.

The case is, therefore, an instance of abnormal distribution of the
postmortem lividity. This has arisen in consequence of the body hav-
ing remained for a certain time (twelve to twenty hours) in the abdom-
inal position (abdomen downward). This fact could have been recog-
nized from the above-mentioned findings, even had there been no posi-
tive evidence in support of it. The pale and intercrossing streaks have
been produced by the folds of the clothing, and suggest, to a certain ex-
tent, the articles of apparel worn at the time of death.

The necropsy revealed a circumscribed pneumonia of the right upper
lobe, acute splenic tumor, marked hyperplasia of the mesenteric glands
and Peyer's plaques, with beginning necrosis of the latter, parenchy-
matous degeneration (cloudy swelling) of the parenchymatous organs —
therefore typhoid fever — as the cause of death. According to the ana-
tomical lesions, the disease was in about the second week of its course,
and clinicallv was that form known as ambulatory typhoid fever.

Tab. 53.

Tab. 54.

PLATE 54.

Lower Extremity of a Newly Born Child which Remained
Several Months in Running Water; Formation of Adi-
pocere.

The external conformation of the extremity is preserved. On closer
inspection, however, it is seen that this is dependent upon the subcuta-
neous fat, which has been converted into a calcareous, friable mass, and
which presents itself cuirass-like or as a rigid tube. This contains but
the denuded, freely movable bones and vestiges of tendons and liga-
ments ; the musculature is wanting, and has evidently been removed
through maceration.

The external surface of this hollow tube appears slightly irregular.
On more caieful examination the cutaneous covering is discovered to be
entirely absent. The fine irregularities correspond with the exposed
and external layer of the subcutaneous adipose tissue. The external
surface of this mass is dirty yellowish-white in color; the surface when
broken is pure white. Microscopical and chemical examination shows
it to consist of crystalline fatty acids ; they float on water and they
liquefy upon being heated.

This substance, designated adipocere, is, therefore, nothing but the
original fat of the parts, which, becoming rancid, decomposed into gly-
cerin and fatty acids. Of the decomposition-products, the glycerin and
the fluid fatty acids have been washed away, while the solid fatty acids
remain.

PLATE 55.

Portion of the Abdominal Skin of a Body which had been
in Water Two or Three Months, and which Demon-
strates the Formation of so=ca!led Adipocere.

One notices distinctly in the upper, especially in the upper left-hand
section of the illustration, portions of the macerated cutis still preserved-
To the left above, only the deeper layers of the cutis are present. In
these we can distinctly recognize hair or glandular follicles.

The cutis is entirely absent from the remainder of the preparation.
This part of it is formed by the subcutaneous fat, which reveals a
coarsely granular but rather uniform surface, and already a certain
rigidity. This, on microscopical examination, is found dependent upon
the separation of the fatty acids in the original adipose tissue.

Tab. 55.

Fig. 1 88.

I

Fig. 189.

FIGURES 188, 189.

Fig. 188.— Larvae of Flies in the Angles of the Eyelids and

Mouth.

Iu Fig. 188 we see the head of a few-weeks-old child, whose body was
exposed to the air, in August, for but a half-day. In the various angles
of the eyelids and mouth there are whitish deposits which resemble
sawdust. On closer inspection, however, these are found to consist of
numerous delicate, smooth, oval, compressible bodies, about 1 mm. iu
length. They make up little conglomerate masses, and are loosely
attached to the affected areas. These are the larva? of flies, which are
deposited on the human body by iiies, especially by the musca carnaria,
a carrion-fly. During the warm season this occurs early, frequently
immediately after death, sometimes even during the agony. The flies
seem instinctively to deposit their larvae on mucous membranes or in the
immediate vicinity thereof, as in these situations the larva1 most readily
find nutriment. Hence the maggots crawling from the larvre may pene-
trate into the deeper tissues.

The maggots, originally 1 to li mm. in length, commonly develop the
following day. They are very active and multiply with great rapid-
ity. As new larvie are constantly deposited and new maggots develop,
within ten to fourteen days they may consume a child's body, with the
exception of the skin, &8CUB, and other resistent tissues. Iu from three
to four weeks they may likewise consume the body of an adult exposed
to the air. The mature maggots crawl into the earth and beneath the
body. They change into chrysalids at the end of about eight or ten
days, and at the end of about another eight or ten days new flies de-
velop from the chrysalids.

Fig. 189.— Lower Extremity of a Newly Born Child Gnawed
by Rats.

The left leg of a mature, newly born child, withdrawn from a closet-
well five hours after a pretended precipitate labor. The foot, leg, knee,
and lower epiphyseal end of the femur appear as a skeleton, this appear-
ance being due to rats having consumed the soft parts.

The rest of the body was entirely fresh, and the stump of the soft
parts of the left thigh limited transversely, with pale, finally dentate
edges, appearing as though gnawed.

In addition, there were found refuse of the closet-well deep in the
bronchi, in the stomach, and in the duodenum, and ecchymoses of the
lungs and heart. From these findings it was concluded that the child
was alive when it came into the fluid, and that it was drowned therein.

It is worthy of note, in the present case, that the gnawing by the
rats was limited to the left leg; that it was so uniform; and that it
occurred within such a short time — somewhat over four hours. The
two latter facts are explicable from the voracity and probably large nuni-

ber of the rodents ; the first, because the rest of the body being immersed
in the filth, the left leg alone projected, and was thus accessible to
these animals.

FIGURES 190, 191.

Lower Half of the Body of a Newly Born Child with Nu=
merous Puncture=like Wounds of the Skin.

December 19th, in a large yew-tree, in the Belvedere garden, the
decomposed body of a newly born, female child, 47 cm. in length, was
found. It was wrapped in paper which had been softened by rain, and
bound with a cord, but in such a manner that only the upper part of
the body was covered, the lower part to above the genitalia being ex-
posed.

On the anterior surface (Fig. 190) and on the posterior surface (Fig.
191; of the lower portion of the body there are numerous incisions in
the skin, 3 .to 4 mm. in length. They are mostly slit-like, run in the
direction of the cleavage of the skin, and have rather sharp edges,
which are in part dried, in part pale and non-reactive. Most of them
penetrate the skin of the left thigh, many of them on its posterior
aspect reaching to the muscles. Immediately above and below the
popliteal space and at about the middle of the thigh there are, in addi-
tion, various obliquely directed lacerations of the skin. They are 1£ to
2 cm. in length, likewise non-reactive, and from them in part discolored
tissues protrude. These incisions are deepest in the popliteal space,
where they expose the vessels.

The necropsy revealed, in addition, rather fresh internal organs,
crepitant lungs, and air-bubbles in the stomach. The cause of death
was not ascertainable. In the lower epiphyseal cartilage of the femur
there was a center of ossification, 5 mm. in diameter.

In respect to the numerous slit-like incisions of the skin of the lower
extremities, as they exhibited no evidences of vital reaction, it was, in
the first place, clear that they were produced postmortem ; and it was
further clear that they were a form of punctured wounds produced
with a pointed and not with a cutting instrument. This latter fact is
evident from the character and arrangement of the wounds, which much
resemble those depicted in Fig. 107, and which were produced with a
conical instrument. The first thought was that they were produced at
the time the body was thrown among the branches of the yew-tree. In
view, however, of the fact that analogous lesions have repeatedly been
observed in decomposed bodies floating on water, it became quite certain
that these wounds had been produced by birds with hard beaks (black-
birds, ravens, sparrows), which had attacked the lower portions of the
body not covered by the paper. The formation of such wounds produced
by the birds through repeated thrusts with their beaks was favored, on
the one hand, by the cleavage of the skin, and, on the other, by the
advanced putrefaction of the body.

***,

<r. F. RHchhnld . Miinchen

PLATE 56. '

Mummified Cadaver.

The mummified cadaver of a man, aged 50 years, who hanged him-
self in an airy attic of a family vault, and was not discovered until the
lapse of ten years.

The illustration is taken from the Handbuche zum Gebrauche bei
aerirhtlichen Ausgrabungen unci Aushebnuy (Manual for Use at Legal
Exhumations), by Orfila and Lesueur, Part II, 1835. It presents an in-
structive example of so-called natural tnununitication of a human body.

The body was found in a sitting posture hanging by a pocket hand-
kerchief, and covered with cobwebs and dust. Of the clothing there
remained but crumbling vestiges. The arms were placed as are a drum-
mer's in action, and were in great measure deprived of soft parts. The
form of the body was in general maintained. This was dependent upon
the preservation of the hard, leather-like, shrunken skin, which was earth-
colored, deprived of epithelium, and resonant when tapped. The pan-
niculus adiposus and musculature, with the exception of the shrunken
and dried tendons, were wanting. They were in great part replaced
by dust-like detritus and a quantity of the excrement, dried larvae,
and chrysalis-remains of the beetle — dermestes lardarius. Of the in-
ternal organs there were found only dried vestiges of the lungs. On
the head, there were only withered remains of skin, to which hairs of
the head and beard were still attached. On the neck the groove pro-
duced by the strangulation-band was still discernible.

The man disappeared during Xovember; that is, at a time of the
year when conditions favorable for the processes of putrefaction were
not present. This and the fact that the cadaver remained in an airy
space protected from rain had induced a gradual drying of the entire
body, although putrefaction had begun, but had been arrested in con-
sequence of the absence of moisture. This drying was followed in the
course of time by destruction of the musculature and of the organs by
carrion-insects and their larvae, until finally only the resistent skin
remained as an empty dried envelope encircling the skeletal frame-
work. This latter, with the remains of the tendons and the fasciae*,
had not the body been discovered, would probably have lasted for many
years to come.

FIGURE 192.

Excessively Putrescent Body of an Old Man— in Great Part
Consumed by Maggots— found Sixteen Days after Death.

H. D., aged 78 years, an eccentric man, living alone, was found dead
in his villa, on July 6th. He was sitting in his armchair, his arms
hanging. He had been observed in the theater on June 19th, and was
seen for the last time alive in his garden June 20th.

The body is clothed, the soft parts in great part even to the bones
missing. The body is markedly putrescent, and is covered throughout
with very active maggots and numerous chrysalids, which are also pres-
ent in great number in the putrefying matter about the body.

The skin of the head is completely dried and leather-like, dirty
brownish-black, anteriorly bald, posteriorly covered with a plentiful
supply of whitish hair. The face is unrecognizable ; the small amount
of persistent soft parts, dried. The eyeballs are undiscernible; the
orbital cavities, swarming with maggots.

At the situation of the mouth there is a wide opening surrounded by
everted, dried soft parts. The jaw is without teeth and atrophic ; the
alveolar cavities have disappeared.

The soft parts of the neck are absent, thus exposing the vertebrae,
which are disarticulated.

The thorax is covered with a thick shirt. Within the shirt there are
found the disarticulated ribs entirely deprived of soft parts, and putrid
and softened tissues covering the thoracic vertebrae. The thoracic and
abdominal viscera are present only as unrecognizable, unctuous, highly
malodorous remains, pervaded by a large number of maggots. The
lumbar and sacral vertebrae are also exposed ; in the pelvic cavity there
is a brownish, unctuous, pulpy mass.

The bones of the upper extremities are in great part exposed ; on the
distal extremities of the forearm and on the hands there are still dirty
reddish, moist remains of the soft parts, with here and there vestiges
of the epidermis. The lower extremities, covered by trousers, are moist
and unctuous. The anterior surfaces of the thighs are less moist and
of a dirty brown color ; here and there dried and leather-like. Of the
feet, which are contained within shoes, the soft parts are almost entirely
preserved. They are moist, and the true skin is exposed ; in part, it is
dirty red, in part green and undermined with numerous maggots. The
nails of the fingers and toes, including the epidermis, have been strip-
ped off; the external genitalia are no longer recognizable.

There is no injury to the bones; nor are there any indications of
violence having been employed. The cause of death was not determin-
able.

Fig ig2.

In addition to a great number of maggots, there is a rather large
quantity of chrysalis-forms, but none as yet empty. From these chrys-
alids, which were preserved in a glass, the first flies flew during the
night of July 14th-15th, and the last on July 16th. The last was recog-
nized as the lucilia regina.

We perceive, therefore, in the preseut case, in what a remarkably
short time the destruction of a body exposed to the air is accomplished,
and that under favorable circumstances the body of an adult may be
deprived of the soft parts, leaving the bones exposed, within sixteen
days This rapid destruction is due less to putrefaction as such — that
is, to the bacteria of putrefaction — than it is to maggots. These, dur-
ing the warm season of the year, develop early from masses of larvae
deposited by flies (vide Fig. 188). They multiply rapidly and invade
the soft parts, and, as new ones are continuously generated, they quickly
consume the body.

As the growth, the change into chrysalis-forms of these maggots, and
the development of new flies from the chrysalids, occur with consider-
able regularity (vide Fig. 188), these conditions may be employed to a
certain extent to determine the time of death of a deceased person.
This is well illustrated in the reported case.

FIGURE 193.

Skull of a Five-year=old Child, with all the Temporary
Teeth and the Germinal Deposits of the Permanent Teeth.

This preparation is intended to illustrate important processes in the
shedding of the temporary teeth which are of value in determining the
age of the individual. It has been prepared by removing the anterior
walls of the alveolar processes from a skull which possesses the twenty
temporary teeth in situ. The germinal deposits of the permanent teeth
which are already present are thus apparent.

As all the temporary teeth are present and their eruption complete,
a condition which, as is well known, is found at the end of the second
year of life, and as none of the permanent teeth have as yet appeared,
it must be concluded that the skull is that of a child between the ages
of two and six or seven years. Further, the good condition of the set
of temporary teeth as a whole, and the appearances of the individual
teeth as though they had been but little used, are evidences that the
skull belongs to a period of life some years prior to the age at which the
temporary teeth are shed.

As is also well known, the eruption of the permanent teeth, like
that of the temporary teeth, ensues in a certain rather constant
sequence, and, as a rule, the lower precede the upper. The first per-
manent teeth to appear are the first molars, in the' sixth and seventh
years ; then follow, in the eighth year, the central incisors ; in the
ninth year, the outer incisors; in the tenth year, the bicuspids or pre-
molars ; in from the eleventh to the thirteenth year, the canines ; in
from the thirteenth to the sixteenth year, the second molars ; and
finally, in the eighteenth year or even much later, the third molars.

As is evident from the illustration, one may detect this sequence
of the future eruption of the permanent teeth in their germinal deposits.
It is manifest from the relatively marked development of the left lower
first molar that this tooth will be the first to erupt, and that but the
roof of the alveolar cavity prevents this. Next in readiness are the
central incisors. The outer incisors are less prominent, though more so
than the germs of the bicuspids or premolars. The canine teeth,
especially the upper, are well developed, but they are situate so high
that it is self-evident they cannot make their appearance until a long
time subsequent to the other front teeth. The late eruption of the two
posterior molar teeth is indicated by the fact that their germinal de-
posits are scarcely discernible.

Fig. 193.

INDEX.

Carunculse myrtiformes, Figs. 53-55
Caustic potash, poisoning by, Figs.
186, 187
soda, poisoning by, Pis. 31, 32
Centers of ossification, child (3£
months), Fig. 80
premature fetus, Fig. 80
mature fetus, Figs. 79, 80
Cervix, after parturition, PI. 1

divulsion of, from uterus, Fig. 78
Charcoal - fumes, blood - alterations
due to, PI. 51
poisoning by, PI. 51
Charred body, Fig. 171
Chorion frondosum, Fig. 72
Chorionic villi, Figs. 71, 72
Chrysalids, PI. 56 ; Figs. 188, 192
Cicatrix of esophagus, Figs. 172, 186

of stomach, Fig. 186
Cleavage of skin, Figs. 107, 190, 191
Clitoris, enlarged, Figs. 5, 6
Close-range gunshot-wound, PI. 19
Contusion of brain, healed, PI. 12
recent, Pis. 11, 15; Figs. 115-
117, 128
of lung, PI. 13
of viscera, PI. 15
Corpus luteum, PI. 3
Corrosive sublimate, blood-altera-
tions due to, PI. 30
poisoning by, Pis. 41-44
Cryptorchidism, incomplete, Fig. 1
Cutting of throat, PI. 16 ; Figs. 104-
106, 118, 185

D.

Decidua reflexa, Figs. 70-72

vera, PI. 3; Fig. 74
Defects of ossification in fetal skull,

Fig. 84
Deflection of projectiles, PI. 20
Deformation of projectiles, Figs.

141-169

Deformity of penis, Fig. 2
Descent of testicles, incomplete,

Fig. 1
Divulsion of cervix from uterus,

Fig. 78
Drowning, hand after, Pis. 26, 27
lungs after, PI. 25

E.

Ear, gunshot-wound of, Fig. 128
Embryo, Pis. 3, 4 ; Figs. 71, 72, 74,

76
Encircling gunshot-wound, PI. 20
Epiphyses of child (3£ months),
Fig. 80
of mature fetus, Figs. 79, 80
of premature fetus, Fig. 80
Epispadias, Fig. 4

Esophagus, cicatrix of, Figs. 172,
186
perforation of, Fig. 187
scald-wound of, Fig. 172
stricture of, Figs. 172, 186, 187
Extradural hematoma, Pis. 8, 9, 10
Extra-uterine pregnancy, Pis. 3, 4

F.

Fetal skull, defects of ossification
in, Fig. 84
suffocation, PI. 5
Fetus, mature, bones of, Figs. 79, 80

premature, bones of, Fig. 80
Fissures, congenital, in skull of ma-
ture fetus, Fig. 83
Flames, burns due to, PI. 21 ; Figs.

170, 171
Flies, larvae of, Figs. 188, 192
Fracture of hyoid bone in person
hanged, Fig. 181
of larynx in person hanged, Figs.

181, 183
of ribs, Pis. 13, 15 ; Figs. 102, 103,
128

INDEX.

Fracture of skull, Pis. 8, 10 ; Figs.

85-101, 109-111, 115-120
Fungus-formation on cadaver in

water, Pis. 28, 29

G.

Genitalia, external, traumata of,

Figs. 60-62
Gunshot-wound, close-range, PI. 19

encircling, PI. 20

of brain, Figs. 128, 129 ; PI. 20

of ear, Fig. 128

of heart, PI. 19 ; Figs. 121, 123, 128

of lung, Fig. 123

of mamma, Fig. 126

of mouth, Figs. 124, 125, 127

of skin, PI. 19; Figs. 121, 122

of skull, Figs. 89, 121, 122, 128,
130-140

of tongue, Fig. 125

H.

Hand after drowning, Pis. 26, 27
Hanging in kneeling posture, Fig.
178
in prone posture. Fig. 180
in semi-sitting posture, Fig. 179
lesions subsequent to, Pis. 22-24 ;
Figs. 173-185
Heart, gunshot-wound of, PI. 19;

Figs. 121, 123, 128
Hematoma, extradural, Pis. 8, 9, 10
Hemorrhage, iutermeningeal, trau-
matic, Pis. 11, 12, 15; Figs.
85, 86, 91, 101, 110, 115, 116
Hermaphrodism, masculine-pseudo,

Figs. 5, 7
Hydrochloric acid, blood-alterations
due to, PI. 30
poisoning, Pis. 35, 36
Hymen after parturition, Fig. 59
annularis, Figs. 8, 9, 15, 17, 18
bipartitus, Figs. 28-38, 45-47

Hymen, circular, Figs. 8, 9, 15, 17, 18
deflorated, Figs. 45-58
dentate, Figs. 21-24
divided, Figs. 28-38, 45-47
fimbriatus. Figs. 25-27
irregular, Fig. 37
labial form of, Fig. 24
partim septus, Fig. 38
semilunar. Figs. 10-13, 20
septus, Figs. 28-38, 45-47

after defloration, Figs. 56-58
serrated, Figs. 21-24
with congenital notches, Figs.

14-24
with rudimentary septa, Figs.

39-44
Hyoid bone, fracture of, in person

hanged, Fig. 181

I.

Incised wounds, PI. 15 ; Figs. 113-
116

Infanticide, Fig. 81

Infant, lungs of, PI. 6

Injuries, agonal, Pis. 51, 52

Iutermeningeal hemorrhage, trau-
matic, Pis. 11, 12, 15; Figs.
85, 86, 91, 101, 110, 115, 116

Intestine, rupture of, PI. 14
stab-wound of, PI. 18

Irritant poisons, blood-alterations
due to, PI. 30

J.

Jejunum, rupture of, PI. 14

JL.

Lacerated wounds, PI. 15
Laceration of lungs, Figs. 102, 103,
128

of meninges, Fig. 128

of uterus, Fig. 76

of vagina, Fig. 73

INDEX.

Larvae of dermestes lardarius, PI. 56
of flies, Figs. 188, 192

Larynx, fracture of, in person
hanged, Figs. 181, 183

Liver, rupture of, Fig. Ill

Li vidity, postmortem, abnormal po-
sition of, Pis. 22, 53

Lungs after drowning, PI. 25
contusion of, PI. 13
gunshot-wound of, Fig. 123
of newly born infant, Fig. 6
laceration of, Figs. 102, 103, 128
putrefaction of, PI. 6

Lysol-poisoning, PI. 40

M.

Maggots, Figs. 188, 192

Mamma, gunshot-wound of, Fig. 126

Masculine pseudohermaphrodism,
Figs. 5, 7

Meconium in respiratory passages,
PI. 5

Membranes, unruptured, causing
suffocation, PI. 7

Mercuric bichlorid, blood-altera-
tions due to, PI. 30
poisoning by, Pis. 41-44

Migration of ovum, PI. 3

Mouth, gunshot-wound of, Fig. 124,
125, 127

Mummified cadaver, PI. 56

Muscle, sternocleidomastoid, rup-
ture of, Fig. 182

N.
Newly born, centers of ossification
in bones of, Fig. 80
lungs of, PI. 6
skull of, Fig. 83
suffocation of, Fig. 81
Nitric acid, poisoning by, PI. 37
Noose, position of, in hangings, Figs,
173-180 ; Pis. 23, 24

O.

Obstruction of pharnyx, Figs. 81, 82
Organs, putrefaction of, PI. 6
Ossification, centers of, in newly
born, Fig. 79
defects of, in skull, Fig. 84
Os uteri after parturition, Fig. 67

of virgins, Figs. 63-66
Ovum, Pis. 3, 4 ; Figs. 71, 72, 74, 76
migration of, PI. 3

P.

Parturition, cervix after, PI. 1
os uteri after, Fig. 67
uterus after, PI. 1
vagina after, PI. 1
Pelvis, flattened, PI. 2
Penis, abnormal smallness of, Fig. 1

deformity of, Fig. 2

synechia of, Fig. 3
Perforation of esophagus, Fig. 187

of uterus, Fig. 74
Peritonitis, septic, Figs. 73, 77, 78

traumatic, Figs. 14, 18
Pharynx, obstruction of, Figs. 81, 82
Phosphorus-poisoning, Pis. 47, 48
Placenta, retention of, Figs. 68, 69
Poisoning by arsenic, Pis. 49, 50

by carbolic acid, Pis. 36, 38, 39

by carbonic oxid, PI. 51

by charcoal-fumes, PI. 51

by hydrochloric acid, Pis. 35, 36

by lysol, PI. 40

by mercuric bichlorid, Pis. 41-44

by nitric acid, PI. 37

by phosphorus, PI. 47, 48

by potassium cyanid, Pis. 45, 46

by potassium hydrate, Figs. 186,
187

by sodium hydrate, Pis. 31, 32

by sulphuric acid, Pis. 33, 34
Poisons, irritant, blood-alterations
due to, PI. 30

INDEX.

Postmortem injuries of the skin,
PI. 22
lividity, abnormal position of, Pis.
22, 53
Potassium cyauid, poisoning by,
PI. 45, 46
hydrate, poisoning by, Figs. 186,
187
Precipitate birth, pretended, Fig. 85
Pregnancy, uterus in early, Figs.
70,71
extra-uterine (tubal), Pis. 3, 4
Premature respiration, Pi. 5
Projectiles, deflection of, PI. 20
deformation of, Figs. 141-169
Pseudohermaphrodism, masculine,

Figs. 5, 7
Punctured wounds of skin, Figs.
107, 112-114, 190, 191
of stomach, Fig. 108
Putrefaction of body, Fig. 192
of viscera, PI. 6; Fig. 192

R.

Rats, lesions due to gnawing of,

Fig. 189
Eespiration, premature, PI. 5
Retention of placenta, Figs. 68, 69
Ribs, fracture of, Pis. 13, 15 ; Figs.

102, 103, 128
Ricochet-shot, PI. 20
Rupture of intestine, PI. 14
of liver, Fig. Ill
of sternocleidomastoid muscle,

Fig. 182
of uterus, spontaneous, PI. 2
of vagina, Fig. 73

S.

Sac, amniotic, Pis. 3, 4 ; Figs. 71 , 72
Scald-wound of esophagus, Fig. 172
Scrotal synechia, Fig. 3
Sepsis after abortion, Figs. 74-78

Skin, cleavage of, Fig. 107
gunshot-wound of, PI. 19; Figs.

121, 122
punctured wound of, Figs. 107,

112, 190, 191

Skull, fracture of, Pis. 8, 10 ; Figs.
85-101, 109-111, 115-120
gunshot-wound of, Pi. 20; Figs.

89, 122, 128, 130-140
of newly born, Fig. 83

defects of ossification in, Fig. 84
Smallness of penis, Fig. 1
Sodium hydrate, blood-alterations
due to, PI. 30
poisoning by, Pis. 31, 32
Stab-wounds, PI. 17; Figs. 109, 110,

113, 114

of intestine, PI. 18
Sternocleidomastoid muscle, rup-
ture of, Fig. 182
Stomach, cicatrix of, Fig. 186

punctured wounds of, Fig. 107
Stricture of esophagus, Figs. 172,

186, 187
Suffocation, fetal, PI. 5

of newly born, PI. 7; Figs. 81, 82
Sulphuric acid, blood-alterations
due to, PI. 30
poisoning by, Pis. 33, 34

T.

Teeth, permanent, Fig. 193

temporary, Fig. 193
Testicles, atrophy of, Fig. 1

incomplete descent of, Fig. 1
Throat-cutting, PI. 16; Figs. 104-

106, 118, 185
Tongue, gunshot-wound of, Fig. 125
Traumatic extradural hematoma,
Pis. 8, 9, 10
intermeningeal hemorrhage, Pis.
11, 12, 15: Figs. 85, 86, 91,
101, 110, 115, 116

INDEX.

Traumatic peritonitis, Pis. 14, 18
Tubal pregnancy, Pis. 3, 4

U.

Umbilical vesicle, Fig. 72
Unruptured membranes (suffoca-
tion), PI. 7
Uterus, after parturition, PI. 1

divulsion of cervix from, Fig. 78

in early pregnancy, Figs. 70, 71

in virgins, Figs. 63-66

laceration of, Fig. 76

mouth of, after parturition, Fig.
67

perforation of, Figs. 75, 77

spontaneous rupture of, PI. 2

V.

Vagina after parturition, PI. 1

laceration of, Fig. 73

perforation of, Fig. 77

punctured wound of, Fig. 74
Vesicle, umbilical, Fig. 72
Villi, chorionic, Fig. 71
Viscera, contusion of, PI. 15

putrefaction of, PI. 6; Fig. 192

W.

Wound, gunshot-, at close range,
PI. 19
encircling, PI. 20
of brain, PI. 20; Figs. 128, 129
of ear, Fig. 128
of heart, PI. 19 ; Figs. 121, 123,

128
of lung, Fig. 123
of mamma, Fig. 126
of mouth, Figs. 124, 125, 127
of skin, Fig. 122
of skull, PI. 20; Figs. 89, 122,

128, 130-140
of tongue, Fig. 125
incised, PI. 15; Figs. 113-116
lacerated, PI. 15

punctured, of skin, Figs. 107, 112-
114, 190, 191
of stomach, Fig. 108
of vagina, Fig. 74
scald-, of esophagus, Fig. 172
stab-, PI. 17; Figs. 109, 110, 113,
114
of intestine, PI. 18

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office ; they are not for sale by booksellers. All other books
in our catalogue can be procured of any bookseller at the
advertised prices, or directly from us. We handle only our own
publications, and cannot supply second-hand books nor the
publications of other houses.

In every instance the latest revised edition is sent.

In ordering, be careful to state the style of binding desired —
Cloth, Sheep, or Half-Morocco.

A complete descriptive circular, giving table of contents, etc.
of any book sold by subscription only, will be sent free on
application.

CATALOGUE OF MEDICAL WORKS.

For Sale by Subscription.

AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. Edited by
William H. Howell, Ph. D., M. D., Professor of Physiology in the
Johns Hopkins University, Baltimore, Md. One handsome octavo volume
of 1052 pages, fully illustrated. Prices : Cloth, $6.00 net; Sheep or Half-
Morocco, $7.00 net.

This work is the most notable attempt yet made in America to combine in
one volume the entire subject of Human Physiology by well-known teachers
who have given especial study to that part of the subject upon which they write.
The completed work represents the present status of the science of Physiology,
particularly from the standpoint of the student of medicine and of the medical
practitioner.

The collaboration of several teachers in the preparation of an elementary text-
book of physiology is unusual, the almost invariable rule heretofore having been
for a single author to write the entire book. One of the advantages to be derived
from this collaboration method is that the more limited literature necessary for
consultation by each author has enabled him to base his elementary account
upon a comprehensive knowledge of the subject assigned to him ; another, and
perhaps the most important, advantage is that the student gains the point of view
of a number of teachers. In a measure he reaps the same benefit as would be
obtained by following courses of instruction under different teachers. The
different standpoints assumed, and the differences in emphasis laid upon the
various lines of procedure, chemical, physical, and anatomical, should give the
student a better insight into the methods of the science as it exists to-day. The
work will also be found useful to many medical practitioners who may wish to
keep in touch with the development of modern physiology.

The main divisions of the subject-matter are as follows : General Physiology
of Muscle and Nerve — Secretion — Chemistry of Digestion and Nutrition —
Movements of the Alimentary Canal, Bladder, and Ureter — Blood and Lymph
— Circulation — Respiration — Animal Heat — Central Nervous System — Special
Senses — Special Muscular Mechanisms — Reproduction — Chemistry of the
Animal Body.

CONTRIBUTORS :

HENRY P. BOW-DITCH, M. D.,

Professor of Physiology, Harvard Medi-
cal School.

JOHN G. CURTIS, M. D.,

Professor of Physiology, Columbia Uni-
versity, N. Y. (College of Physicians
and Surgeons).

HENRY H. DONALDSON, Ph.D.,

Head-Professor of Neurology, Univer-
sity of Chicago.
W. H. HOWELL, Ph. D., M. D.,

Professor of Physiology, Johns Hopkins
University.

FREDERIC S. LEE, Ph. D.,

Adjunct Professor of Physiology, Colum-
bia University, N. Y. (College of
Physicians and Surgeons).

WARREN P. LOMBARD, M. D.,

Professor of Physiology, University of
Michigan.

GRAHAM LUSK, Ph. D.,

Professor of Physiology, Yale Medica'
School.

W. T. PORTER, M.D.,

Assistant Professor of Physiology, Har-
vard Medical School.

EDWARD T. REICHERT, M.D.,

Professor of Physiology, University of
Pennsylvania.

HENRY SEW ALL, Ph.D., M. D..

Professorof Physiology, Medical Depart
ment, University of Denver.

W. B. SAUNDERS'

For Sale by Subscription.

AN AMERICAN TEXT-BOOK OF APPLIED THERAPEU-
TICS. For the Use of Practitioners and Students. Edited by
James C. Wilson, M. D., Professor of the Practice of Medicine and of
Clinical Medicine in the Jefferson Medical College. One handsome octavo
volume of 1326 pages. Illustrated. Prices: Cloth, $7.00 net; Sheep or
Half-Morocco, $8.00 net.

The arrangement of this volume has been based, so far as possible, upon
modern pathologic doctrines, beginning with the intoxications, and following
with infections, diseases due to internal parasites, diseases of undetermined
origin, and finally the disorders of the several bodily systems — digestive, re-
spiratory, circulatory, renal, nervous, and cutaneous. It was thought proper to
include also a consideration of the disorders of pregnancy.

The list of contributors comprises the names of many who have acquired dis-
tinction as practitioners and teachers of practice, of clinical medicine, and of
the specialties.

CONTRIBUTORS :

Dr. I. E. Atkinson, Baltimore, Md.
Sanger Brown, Chicago, Til.
John B. Chapin, Philadelphia, Pa.
William C. Dabney, Charlottesville, Va.
John Chalmers DaCosta, Philada., Pa.
I. N. Uanforth, Chicago, 111.
John L. Dawson, Jr., Charleston, S. C.
F. X. Dercum, Philadelphia, Pa.
George Dock, Ann Arbor, Mich.
Robert T. Edes, Jamaica Plain, Mass.
Augustus A. Eshner, Philadelphia, Pa.
J. T. Eskridge, Denver, Col.
F. Forchheimer, Cincinnati, O.
Carl Frese, Philadelphia, Pa.
Edwin E. Graham, Philadelphia, Pa.
John Guiteras, Philadelphia, Pa.
Frederick P. Henry, Philadelphia, Pa.
Guy Hinsdale, Philadelphia, Pa.
Orville Horwitz, Philadelphia, Pa.
W. W. Johnston, Washington, D. C.
Ernest Laplace, Philadelphia, Pa.
A. Laveran, Paris, France.

Dr. James Hendrie Lloyd, Philadelphia, Pa.
John Noland Mackenzie, Baltimore, Md.
J. W. McLaughlin, Austin, Texas.
A. Lawrence Mason, Boston, Mass.
Charles K. Mills, Philadelphia, Pa.
John K. Mitchell. Philadelphia, Pa.
W. P. Northrup. New York City.
William Osier, Baltimore, Md.
Frederick A. Packard, Philadelphia, Pa.
Theophilus Parvin, Philadelphia, Pa.
Beaven Rake, London, England.
E. O. Shakespeare, Philadelphia, Pa.
Wharton Sinkler, Philadelphia, Pa.
Louis Starr, Philadelphia, Pa.
Henry W. Stelwagon, Philadelphia, Pa.
James Stewart, Montreal, Canada.
Charles G. Stockton, Buffalo, N. Y.
James Tyson, Philadelphia, Pa.
Victor C. Vaughan, Ann Arbor, Mich.

James T. Whittaker, Cincinnati, O.
. C. Wilson, Philadelphia, Pa.

The articles, with two exceptions, are the contributions of American writers.
Written from the standpoint of the practitioner, the aim of the work is to facili-
tate the application of knowledge to the prevention, the cure, and the allevia-
tion of disease. The endeavor throughout has been to conform to the title of
the book — Applied Therapeutics — to indicate the course of treatment to be
pursued at the bedside, rather than to name a list of drugs that have been used
at one time or another.

While the scientific superiority and the practical desirability of the metric
system of weights and measures is admitted, it has not been deemed best to
discard entirely the older system of figures, so that both sets have been given
where occasion demanded.

CATALOGUE OF MEDICAL WORKS.

For Sale by Subscription.

AN AMERICAN TEXT-BOOK OF OBSTETRICS. Edited by
Richard C. Norris, M. D. ; Art Editor, Robert L. Dickinson, M. D.
One handsome octavo volume of over iooo pages, with nearly 900 colored
and half-tone illustrations. Prices : Cloth, $7.00 ; Sheep or Half-Morocco,
$8.00.

The advent of each successive volume of the series of the American Text-
Books has been signalized by the most flattering comment from both the Press
and the Profession. The high consideration received by these text-books, and
their attainment to an authoritative position in current medical literature, have
been matters of deep international interest, which finds its fullest expression in
the demand for these publications from all parts of the civilized world.

In the preparation of the " American Text-Book of Obstetrics " the
editor has called to his aid proficient collaborators whose professional prominence
entitles them to recognition, and whose disquisitions exemplify Practical
Obstetrics. While these writers were each assigned special themes for dis-
cussion, the correlation of the subject-matter is, nevertheless, such as ensures
logical connection in treatment, the deductions of which thoroughly represent
the latest advances in the science, and which elucidate the best modern methods
of procedure.

The more conspicuous feature of the treatise is its wealth of illustrative
matter. The production of the illustrations had been in progress for several
years, under the personal supervision of Robert L. Dickinson, M. D., to whose
artistic judgment and professional experience is due the most sumptuously
illustrated work of the period. By means of the photographic art, combined
with the skill of the artist and draughtsman, conventional illustration is super-
seded by rational methods of delineation.

Furthermore, the volume is a revelation as to the possibilities that may be
reached in mechanical execution, through the unsparing hand of its publisher.

CONTRIBUTORS 1

Dr. James C. Cameron.
Edward P. Davis.
Robert L. Dickinson.
Charles Warrington Earle.
James H. Etheridge.
Henry J. Garrigues.
Barton Cooke Hirst.
Charles Jewett.

Dr. Howard A. Kelly.
Richard C. Norris.
Chauncey D. Palmer.
Theophilus Parvin.
George A. Piersol.
Edward Reynolds.
Henry Schwarz.

" At first glance we are overwhelmed by the magnitude of this work in several respects,
viz. : First, by the size of the volume, then by the array of eminent teachers in this depart-
ment who have taken part in its production, then by the profuseness and character of the
illustrations, and last, but not least, the conciseness and clearness with which the text is ren-
dered. This is an entirely new composition, embodying the highest knowledge of the art as
it stands to-day by authors who occupy the front rank in their specialty, and there are many
of them. We cannot turn over these pages without being struck by the superb illustrations
which adorn so many of them. We are confident that this most practical work will find
instant appreciation by practitioners as well as students." — New York Medical Times.

Permit me to say that your American Text-Book of Obstetrics is the most magnificent
medical work that 1 have ever seen. I congratulate you and thank you for this superb work,
which alone is sufficient to place you first in the ranks of medical publishers.

With profound respect I am sincerely yours, Alex. J. C. Skene.

W. B. SAUNDERS'

For Sale by Subscription.

AN AMERICAN TEXT-BOOK ON THE THEORY AND
PRACTICE OF MEDICINE. By American Teachers. Edited
by William Pepper, M. D., LL.D., Provost and Professor of the Theory
and Practice of Medicine and of Clinical Medicine in the University of
Pennsylvania. Complete in two handsome royal-octavo volumes of about
iooo pages each, with illustrations to elucidate the text wherever necessary.
Price per Volume : Cloth, $5.00 net; Sheep or Half-Morocco, $6.00 net.

VOLUME I. CONTAINS:

Hygiene. — Fevers (Ephemeral, Simple Con-
tinued, Typhus, Typhoid, Epidemic Cerebro-
spinal Meningitis, and Relapsing). — Scarla-
tina, Measles, Rotheln, Variola, Varioloid,
Vaccinia, Varicella, Mumps,Whooping-cough,
Anthrax, Hydrophobia, Trichinosis, Actino-

mycosis, Glanders, and Tetanus. — Tubercu-
losis, Scrofula, Syphilis, Diphtheria, Erysipe-
las, Malaria, Cholera, and Yellow Fever. —
Nervous, Muscular, and Mental Diseases etc.

VOLUME II. CONTAINS:

Urine (Chemistry and Microscopy). — Kid-
ney and Lungs. — Air-passages (Larynx and
Bronchi) and Pleura. — Pharynx, CEsophagus,
Stomach and Intestines (including Intestinal
Parasites), Heart, Aorta, Arteries and Veins.

— Peritoneum, Liver, and Pancreas. — Diathet-
ic Diseases (Rheumatism, Rheumatoid Ar-
thritis, Gout, Lithaemia, and Diabetes.) —
Blood and Spleen. — Inflammation, Embolism,
Thrombosis, Fever, and Bacteriology.

The articles are not written as though addressed to students in lectures, but
are exhaustive descriptions of diseases, with the newest facts as regards Causa-
tion, Symptomatology, Diagnosis, Prognosis, and Treatment, including a large
number of approved formulae. The recent advances made in the study
of the bacterial origin of various diseases are fully described, as well as the
bearing of the knowledge so gained upon prevention and cure. The subjects
of Bacteriology as a whole and of Immunity are fully considered in a separate
section.

Methods of diagnosis are given the most minute and careful attention, thus
enabling the reader to learn the very latest methods of investigation without
consulting works specially devoted to the subject.

CONTRIBUTORS :

Dr. J. S. Billings, Philadelphia.
Francis Delafield, New York.
Reginald H. Fitz, Boston.
James W. Holland, Philadelphia.
Henry M. Lyman, Chicago.
William Osier, Baltimore.

Dr. William Pepper, Philadelphia.
W. Gilman Thompson, New York.
W. H. Welch, Baltimore.
James T. Whittaker, Cincinnati.
James C. Wilson, Philadelphia.
Horatio C. Wood, Philadelphia.

" We reviewed the first volume of this work, and said: ' It is undoubtedly one of the best
text-books on the practice of medicine which we possess.' A consideration of the second
*nd last volume leads us to modify that verdict and to say that the completed work is, in our
opinion, the best of its kind it has ever been our fortune to see. It is complete, thorough,
accurate, and clear. It is well written, well arranged, well printed, well illustrated, and well
bound. It is a model of what the modern text-book should be." — Neiv York Medical yournal.

" A library upon modern medical art. The work must promote the wider diffusion of
sound knowledge." — American Lancet.

" A trusty counsellor for the practitioner or senior student, on which he may implicitly
rely." — Edinburgh Medical yournal.

CATALOGUE OF MEDICAL WORK'S.

For Sale by Subscription.

AN AMERICAN TEXT-BOOK OF SURGERY. Edited by Wil-
liam W. Keen, M. D., LL.D., and J. William White, M. D., Ph. D.
Forming one handsome royal-octavo volume of 1250 pages (10x7 inches),
with 500 wood-cuts in text, and 37 colored and half-tone plates, many of
them engraved from original photographs and drawings furnished by the
authors. Prices: Cloth, $7.00 net; Sheep or Half- Morocco, £8.00 net.

SECOND EDITION, REVISED AND ENLARGED,

With a Section devoted to " The Use of the Rdntgen Rays in Surgery."

The want of a text-book which could be used by the practitioner and at the
same time be recommended to the medical student has been deeply felt, espe-
cially by teachers of surgery; hence, when it was suggested to a num6er of
these that it would be well to unite in preparing a text-book of this description,
great unanimity of opinion was found to exist, and the gentlemen below named
gladly consented to join in its production. While there is no distinctive Amer-
ican Surgery, yet America has contributed very largely to the progress of modern
surgery, and among the foremost of those who have aided in developing this art
and science will be found the authors of the present volume. All of them are
teachers of surgery in leading medical schools and hospitals in the United States
and Canada.

Especial prominence has been given to Surgical Bacteriology, a feature which
is believed to be unique in a surgical text-book in the English language. Asep-
sis and Antisepsis have received particular attention. The text is brought well
up to date in such important branches as cerebral, spinal, intestinal, and pelvic
surgery, the most important and newest operations in these departments being
described and illustrated.

The text of the entire book has been submitted to all the authors for their
mutual criticism and revision — an idea in book- making that is entirely new and
original. The book as a whole, therefore, expresses on all the important sur-
gical topics of the day the consensus of opinion of the eminent surgeons who
have joined in its preparation.

One of the most attractive features of the book is its illustrations. Very
many of them are original and faithful reproductions of photographs taken
directly from patients or from specimens.

CONTRIBUTORS :

Dr. Charles H. Burnett, Philadelphia.
Phineas S. Conner, Cincinnati.
Frederic S. Dennis, New York.
William W. Keen, Philadelphia.
Charles B. Nancrede, Ann Arbor, Mich.
Roswell Park, Buffalo, N. Y.
Lewis S. Pilcher, New York.

Dr. Nicholas Senn, Chicago.

Francis J. Shepherd, Montreal, Canada.
Lewis A. Stimson, New York.
William Thomson, Philadelphia.

J. Collins Warren, Boston.
. William White, Philadelphia.

, ". . t'?,s te*'-book is a fair reflex of the present position of American surgery, we must
admit it is of a very high order of merit, and that English surgeons will have to look very
carefully to their laurels if they are to preserve a position in the van of surgical practice."—
London Lancet.

W. B. SAUNDERS'

For Sale by Subscription.

AN AMERICAN TEXT-BOOK OF GYNECOLOGY, MEDICAL
AND SURGICAL, for the use of Students and Practitioners.
Edited by J. M. Baldy, M. D. Forming a handsome royal-octavo volume,
with 341 illustrations in text and 38 colored and half-tone plates. Prices :
Cloth, $6.00 net; Sheep or Half- Morocco, $7.00 net.

SECOND EDITION, THOROUGHLY REVISED.

In this volume all anatomical descriptions, excepting those essential to a clear
understanding of the text, have been omitted, the illustrations being largely de-
pended upon to elucidate the anatomy of the parts. This work, which is
thoroughly practical in its teachings, is intended, as its title implies, to be a
working text-book for physicians and students. A clear line of treatment has
been laid down in every case, and although no attempt has been made to dis-
cuss mooted points, still the most important of these have been noted and ex-
plained. The operations recommended are fully illustrated, so that the reader,
having a picture of the procedure described in the text under his eye, cannot fail
to grasp the idea. All extraneous matter and discussions have been carefully
excluded, the attempt being made to allow no unnecessary details to cumber
the text. The subject-matter is brought up to date at every point, and the
work is as nearly as possible the combined opinions of the ten specialists who
figure as the authors.

CONTRIBUTORS

Dr. Henry T. Byford.
John M. Baldy.
Edwin Cragin.
I. H. Etheridge.
William Goodell.

Dr. Howard A. Kelly.
Florian Krug.
E. E. Montgomery.
William R. Pryor.
George M. Tuttle.

"The most notable contribution to gynecological literature since 1887, .... and the most
complete exponent of gynecology which we have. No subject seems to have been neglected,
.... and the gynecologist and surgeon, and the general practitioner who has any desire
to practise diseases of women, will find it of practical value. In the matter of illustrations
and plates the book surpasses anything we have seen." — Boston Medical and Surgical
Journal.

" A valuable addition to the literature of Gynecology. The writers are progressive,
aggressive, and earnest in their convictions." — Medical News, Philadelphia.

" A thoroughly modern text-book, and gives reliable and well-tempered advice and in
struction." — Edinburgh Medical Journal.

" The harmony of its conclusions and the homogeneity of its style give it an individuality
which suggests a single rather than a multiple authorship." — Annals of Surgery.

" It must command attention and respect as a worthy representation of our advanced
clinical teaching." — American Journal 0/ Medical Sciences.

CATALOGUE OF MEDICAL WORKS.

For Sale by Subscription.

AN AMERICAN TEXT-BOOK OF THE DISEASES OF CHIL-
DREN. By American Teachers. Edited by Louis Starr, M. D.,
assisted by Thompson S. Westcott, M. D. In one handsome royal-8vo
volume of 1250 pages, profusely illustrated with wood-cuts, half-tone and
colored plates. Net Prices: Clotb, $7.00; Sheep or Half-Morocco, 58.00.

SECOND EDITION, REVISED AND ENLARGED.

The plan of this work embraces a series of original articles written by some
sixty well-known podiatrists, representing collectively the teachings of the most
prominent medical schools and colleges of America. The work is intended to
be a practical book, suitable for constant and handy reference by the practi-
tioner and the advanced student.

Especial attention has been given to the latest accepted teachings upon the
etiology, symptoms, pathology, diagnosis, and treatment of the disorders of chil-
dren, with the introduction of many special formulae and therapeutic procedures.
Special chapters embrace at unusual length the Diseases of the Eye, Ear,
Nose and Throat, and the Skin ; while the introductory chapters cover fully the
important subjects of Diet, Hygiene, Exercise, Bathing, and the Chemistry of
Food. Tracheotomy, Intubation, Circumcision, and such minor surgical pro-
cedures coming within the province of the medical practitioner are carefully
considered.

CONTRIBUTORS :
Dr. S. S. Adams, Washington.

John Ashhurst, Jr., Philadelphia.

A. D. Blackader, Montreal, Canada.

David Bovaird, New York.

Dillon Brown, New York.

Edward M. Buckingham, Boston.

Charles W. Burr, Philadelphia.

W. E. Casselberry, Chicago.

Henry Dwight Chapin, New York.

W. S. Christopher, Chicago.

Archibald Church, Chicago.

Floyd M. Crandall, New York.

Andrew F. Currier, New York.

Roland G. Curtin, Philadelphia
J. M. DaCosta, Philadelphia.
I. N. Danforth, Chicago.
Edward P. Davis, Philadelphia.
John B. Deaver, Philadelphia.
G. E. de Schwcinitz, Philadelphia.
John Doming, New York.
Charles Warrington Earle, Chicago.
Wm. A. Edwards, San Diego, Cal.
F. Forchheimer, Cincinnati.

t Henry Fruitnight, New York.
P. Crozer Griffith, Philadelphia.
. A. Hardaway. St. Louis.
M. P Hatfield, Chicago.
Barton Cooke Hirst, Philadelphia.
H. Illoway, Cincinnati.
Henry Jackson, Boston.
Charles G. Jennings, Detroit.
Henry Koplik. New York.

Dr. Thomas S. Latimer, Baltimore.
Albert R. Leeds, Hoboken, N. J.
J. Hendrie Lloyd, Philadelphia.
George Roe Lockwood, New York.
Henry M. Lyman, Chicago.
Francis T. Miles, Baltimore.
Charles K Mills, Philadelphia.
James E. Moore, Minneapolis.
F. Gordon Morrill, Boston.
John H. Musser, Philadelphia.
Thomas H

R. Neilson, Philadelphia.
W. P. Northrup, New York.
William Osier, Baltimore.
Frederick A. Packard, Philadelphia.
William Pepper, Philadelphia.
Frederick Peterson, New York.
W. T. Plant, Syracuse, New York.
William M. Powell, Atlantic City.
B. Alexander Randall, Philadelphia.
Edward O. Shakespeare, Philadelphia
F. C. Shattuck, Boston.
J. Lewis Smith, New York.
Louis Starr, Philadelphia.
M. Allen Starr, New York.
Charles W. Townsend, Boston.
James Tyson, Philadelphia.
W. S. Thayer, Baltimore.
Victor C. Vaughan, Ann Arbor, Mich
Thompson S. Westcott, Philadelphia.
Henry R. Wharton, Philadelphia.
J. William White, Philadelphia.
J. C. Wilson, Philadelphia.

IO IV. B. SAUNDERS'

A NEW PRONOUNCING DICTIONARY OF MEDICINE, with
Phonetic Pronunciation, Accentuation, Etymology, etc. By John
M. Keating, M. D., LL.D., Fellow of the College of Physicians of Phila-
delphia; Vice-President of the American Paediatric Society; Ex-President
of the Association of Life Insurance Medical Directors ; Editor " Cyclo-
paedia of the Diseases of Children," etc. ; and Henry Hamilton, author
of " A New Translation of Virgil's ^Eneid into English Rhyme ;" co-
author of " Saunders' Medical Lexicon," etc. ; with the Collaboration of
J. Chalmers DaCosta, M. D., and Frederick A. Packard, M. D.
With an Appendix containing important Tables of Bacilli, Micrococci,
Leucomalnes, Ptomaines, Drugs and Materials used in Antiseptic Sur-
gery, Poisons and their Antidotes, Weights and Measures, Thermometric
Scales, New Official and Unofficial Drugs, etc. One very attractive volume
of over 800 pages. Second Revised Edition. Prices : Cloth, #5.00 net ;
Sheep or Half- Morocco, $6.00 net ; with Denison's Patent Ready- Refer-
ence Index ; without patent index, Cloth, $4.00 net ; Sheep or Half-
Morocco, $5.00 net.

PROFESSIONAL OPINIONS.

" I am much pleased with Keating's Dictionary, and shall take pleasure in recommending
it to my classes."

Hbnrv M. Lyman, M. D/,
Professor of Principles and Practice of Medicine, Rush Medical College, Chicago, III.

" I am convinced that it will be a very valuable adjunct to my study-table, convenient in
size and sufficiently full for ordinary use."

C. A. Lindsley, M. D.,
Professor of Theory and Practice of Medicine, Medical Deft. Vale University :

Secretary Connecticut State Board of Health, New Haven, Conn,

AUTOBIOGRAPHY OF SAMUEL D. GROSS, M. D., Emeritus Pro-
fessor of Surgery in the Jefferson Medical College of Philadelphia, with
Reminiscences of His Times and Contemporaries. Edited by his sons,
Samuel W. Gross, M. D., LL.D., late Professor of Principles of Surgery
and of Clinical Surgery in the Jefferson Medical College, and A. Haller
Gross, A. M., of the Philadelphia Bar. Preceded by a Memoir of Dr.
Gross, by the late Austin Flint, M. D., LL.D. In two handsome volumes,
each containing over 400 pages, demy 8vo, extra cloth, gilt tops, with fine
Frontispiece engraved on steel. Price per Volume, $2.50 net.
This autobiography, which was continued by the late eminent surgeon until
within three months of his death, contains a full and accurate history of his
early struggles, trials, and subsequent successes, told in a singularly interesting
and charming manner, and embraces short and graphic pen-portraits of many
of the most distinguished men — surgeons, physicians, divines, lawyers, states-
men, scientists, etc. — with whom he was brought in contact in America and in
Europe ; the whole forming a retrospect of more than three-quarters of a century.

CATALOGUE OF MEDICAL WORKS. II

SURGICAL PATHOLOGY AND THERAPEUTICS. By John
Collins Warren, M. D., LL.D., Professor of Surgery, Medical Depart-
ment Harvard University ; Surgeon to the Massachusetts General Hospital,
etc. A handsome octavo volume of 832 pages, with 136 relief and litho-
graphic illustrations, 33 of which are printed in colors, and all of which
were drawn by William J. Kaula from original specimens. Prices : Cloth,
#6.00 net ; Half-Morocco, $7.00 net.

" The volume is for the bedside, the amphitheatre, and the ward. It deals
with things not as we see them through the microscope alone, but as the prac-
titioner sees their effect in his patients ; not only as they appear in and affect
culture-media, but also as they influence the human body ; and, following up
the demonstrations of the nature of diseases, the author points out their logical
treatment.". (New York Medical Journal). " It is the handsomest specimen
of book-making * * * that has ever been issued from the American medical
press " (American Journal of the Medical Sciences, Philadelphia).

"Without Exception, the Illustrations are the Best ever Seen in a
"Work of this Kind.

" A most striking and very excellent feature of this book is its illustrations. Without ex-
ception, from the point of accuracy and artistic merit, they are the best ever seen in a work
of this kind. * * * Many of those representing microscopic pictures are so perfect in their
coloring and detail as almost to give the beholder the impression that he is looking down the
barrel of a microscope at a well-mounted section. " — Annals of Surgery, Philadelphia.

PATHOLOGY AND SURGICAL TREATMENT OF TUMORS.

By N. Senn, M. D., Ph. D., LL. D., Professor of Practice of Surgery and
of Clinical Surgery, Rush Medical College ; Professor of Surgery, Chicago
Polyclinic ; Attending Surgeon to Presbyterian Hospital ; Surgeon-in-Chief,
St. Joseph's Hospital, Chicago. One volume of 710 pages, with 515
engravings, including full-page colored plates. Prices: Cloth, $6.00 net.;
Half-Morocco, $7.00 net.

Books specially devoted to this subject are few, and in our text-books and
systems of surgery this part of surgical pathology is usually condensed to a de-
gree incompatible with its scientific and clinical importance. The author spent
many years in collecting the material for this work, and has taken great pains
to present it in a manner that should prove useful as a text-book for the student,
a work of reference for the busy practitioner, and a reliable, safe guide for the
surgeon. The more difficult operations are fully described and illustrated. More
than one hundred of the illustrations are original, while the remainder were
selected from books and medical journals not readily accessible.

" The most exhaustive of any recent book in English on this subject. It is well illus-
trated, and will doubtless remain as the principal monograph on the subject in our language
for some years. The book is handsomely illustrated and printed, .... and the author has
given a notable and lasting contribution to surgery." — four nal of American Medical Asso-
ciation, Chicago.

12 W. B. SAUNDERS

MEDICAL DIAGNOSIS. By Dr. Oswald Vierordt, Professor of
Medicine at the University of Heidelberg. Translated, with additions,
from the Fifth Enlarged German Edition, with the author's permission, by
Francis H. Stuart, A. M., M. D. In one handsome royal-octavo volume
of 600 pages. 194 fine wood-cuts in the text, many of them in colors.
Prices: Cloth, $4.00 net; Sheep or Half- Morocco, $5.00 net.

FOURTH AMERICAN EDITION, FROM THE FIFTH REVISED AND
ENLARGED GERMAN EDITION.

In this work, as in no other hitherto published, are given full and accurate
explanations of the phenomena observed at the bedside. It is distinctly a clin-
ical work by a master teacher, characterized by thoroughness, fulness, and accu-
racy. It is a mine of information upon the points that are so often passed over
without explanation. Especial attention has been given to the germ-theory as a
factor in the origin of disease.

This valuable work is now published in German, English, Russian, and
Italian. The issue of a third American edition within two years indicates the
favor with which it has been received by the profession.

THE PICTORIAL ATLAS OF SKIN DISEASES AND SYPHI-
LITIC AFFECTIONS. (American Edition.) Translation from
the French. Edited by J. J. Pringle, M. B., F. R. C. P., Assistant Phy-
sician to, and Physician to the department for Diseases of the Skin at, the
Middlesex Hospital, London. Photo-lithochromes from the famous models
of dermatological and syphilitic cases in the Museum of the Saint-Louis
Hospital, Paris, with explanatory wood-cuts and letter-press. In 12 Parts,
at $3.00 per Part. Parts 1 to 8 now ready.

" The plates are beautifully executed." — Jonathan Hutchinson, M. D. (London
Hospital).

" The plates in this Atlas are remarkably accurate and artistic reproductions of typical
examples of skin disease. The work will be of great value to the practitioner and student."
— William Anderson, M. D. (St. Thomas Hospital).

" If the succeeding parts of this Atlas are to be similar to Part 1, now before us, we have
no hesitation in cordially recommending it to the favorable notice of our readers as one of
the finest dermatological atlases with which we are acquainted." — Glasgow Medical Journal,
Aug., 1895.

" Of all the atlases of skin diseases which have been published in recent years, the present
one promises to be of greatest interest and value, especially from the standpoint of the
general practitioner." — American Medico-Surgical Bulletin, Feb. 22, 1896.

"The introduction of explanatory wood-cuts in the text is a novel and most important
feature which greatly furthers the easier understanding of the excellent plates, than which
nothing, we venture to say, has been seen better in point of correctness, beauty, and general
merit." — New York Medical Journal , Feb. 15, 1896.

" An interesting feature of the Atlas is the descriptive text, which is written for each picture
by the physician who treated the case or at whose instigation the models have been made.
We predict for this truly beautiful work a large circulation in all parts of the medical world
where the names St. Louis and Baretta have preceded it." — Medical Record, N. Y., Feb. 1,
1896.

CATALOGUE OF MEDICAL WORKS. 1 3

PRACTICAL POINTS IN NURSING. For Nurses in Private
Practice. By Emily A. M. Stoney, Graduate of the Training-School
for Nurses, Lawrence, Mass. ; Superintendent of the Training-School for
Nurses, Carney Hospital, South Boston, Mass. 456 pages, handsomely
illustrated with 73 engravings in the text, and 9 colored and half-tone
plates. Cloth. Price, $1.75 net.

SECOND EDITION, THOROUGHLY REVISED.

In this volume the author explains, in popular language and in the shortest
possible form, the entire range of private nursing as distinguished from hospital
nursing, and the nurse is instructed how best to meet the various emergencies of
medical and surgical cases when distant from medical or surgical aid or when
thrown on her own resources.

An especially valuable feature of the work will be found in the directions to
the nurse how to improvise everything ordinarily needed in the sick-room, where
the embarrassment of the nurse, owing to the want of proper appliances, is fre-
quently extreme.

The work has been logically divided into the following sections :

I. The Nurse : her responsibilities, qualifications, equipment, etc.
II. The Sick-Room: its selection, preparation, and management.

III. The Patient : duties of the nurse in medical, surgical, obstetric, and gyne-

cologic cases.

IV. Nursing in Accidents and Emergencies.
V. Nursing in Special Medical Cases.

VI. Nursing of the New-born and Sick Children.
VII. Physiology and Descriptive Anatomy.

The Appendix contains much information in compact form that will be found
of great value to the nurse, including Rules for Feeding the Sick ; Recipes for
Invalid Foods and Beverages; Tables of Weights and Measures; Table for
Computing the Date of Labor; List of Abbreviations ; Dose-List; and a full
and complete Glossary of Medical Terms and Nursing Treatment.

"This is a well-written, eminently practical volume, which covers the entire range of
private nursing as distinguished from hospital nursing, and instructs the nurse how best to
meet the various emergencies which may arise and how to prepare everything ordinarily
needed in the illness of her patient." — American Journal of Obstetrics and Diseases of
Womun and Children, Aug., 1896.

A TEXT-BOOK OF BACTERIOLOGY, including the Etiology and
Prevention of Infective Diseases and an account of Yeasts and Moulds,
Hsematozoa, and Psorosperms. By Edgar M. Crookshank, M. B., Pro-
fessor of Comparative Pathology and Bacteriology, King's College, London.
A handsome octavo volume of 700 pages, with 273 engravings in the text,
and 22 original and colored plates. Price, $6.50 net.

This book, though nominally a Fourth Edition of Professor Crookshank's
" Manual of Bacteriology," is practically a new work, the old one having
been reconstructed, greatly enlarged, revised throughout, and largely rewritten,
forming a text-book for the Bacteriological Laboratory, for Medical Ofticers of
Health, and for Veterinary Inspectors.

14 W. B. SAUNDERS

A TEXT-BOOK OF HISTOLOGY, DESCRIPTIVE AND PRAC-
TICAL. For the Use of Students. By Arthur Clarkson, M. B.,
C. M., Edin., formerly Demonstrator of Physiology in the Owen's College,
Manchester; late Demonstrator of Physiology in the Yorkshire College,
Leeds. Large 8vo, 554 pages, with 22 engravings in the text, and 174
beautifully colored original illustrations. Price, strongly bound in Cloth,
$6.00 net.

The purpose of the writer in this work has been to furnish the student of His-
tology, in one volume, with both the descriptive and the practical part of the
science. The first two chapters are devoted to the consideration of the general
methods of Histology ; subsequently, in each chapter, the structure of the tissue
or organ is first systematically described, the student is then taken tutorially over
the specimens illustrating it, and, finally, an appendix affords a short note of the
methods of preparation.

" We would most cordially recommend it to all students of histology." — Dublin Medical
yournal.

" It is pleasant to give unqualified praise to the colored illustrations ; . . . the standard is
high, and many of them are not only extremely beautiful, but very clear and demonstra-
tive. . . . The plan of the book is excellent." — Liverpool Medical Journal.

ARCHIVES OF CLINICAL SKIAGRAPHY. By Sydney Rowland,
B. A., Camb. A series of collotype illustrations, with descriptive text,
illustrating the applications of the New Photography to Medicine and Sur-
gery. Price, per Part, $1.00. Parts I. to V. now ready.

The object of this publication is to put on record in permanent form some of
the most striking applications of the new photography to the needs of Medicine
and Surgery.

The progress of this new art has been so rapid that, although Prof. Rontgen's
discovery is only a thing of yesterday, it has already taken its place among the
approved and accepted aids to diagnosis.

WATER AND WATER SUPPLIES. By John C. Thresh, D. Sc,
M. B., D. P. H., Lecturer on Public Health, King's College, London ;
Editor of the "Journal of State Medicine," etc. i2mo, 438 pages, illus-
trated. Handsomely bound in Cloth, with gold side and back stamps.
Price, $2.25 net.

This work will furnish any one interested in public health the information
requisite for forming an opinion as to whether any supply or proposed supply
is sufficiently wholesome and abundant, and whether the cost can be considered
reasonable.

The work does not pretend to be a treatise on Engineering, yet it contains
sufficient detail to enable any one who has studied it to consider intelligently any
scheme which may be submitted for supplying a community with water.

CATALOGUE OF MEDICAL WORKS. 1 5

DISEASES OF THE EYE. A Hand-Book of Ophthalmic Prac-
tice. By G. E. de Schweinitz, M. D., Professor of Ophthalmology in
the Jefferson Medical College, Philadelphia, etc. A handsome royal-
octavo volume of 679 pages, with 256 fine illustrations, many of which are
original, and 2 chromo-lithographic plates. Prices : Cloth, $4.00 net ;
Sheep or Half- Morocco, $5.00 net.

The object of this work is to present to the student, and to the practitioner
who is beginning work in the fields of ophthalmology, a plain description of the
optical defects and diseases of the eye. To this end special attention has been
paid to the clinical side of the question ; and the method of examination, the
symptomatology leading to a diagnosis, and the treatment of the various ocular
defects have been brought into prominence.

THIRD EDITION, THOROUGHLY REVISED.

The entire book has been thoroughly revised. In addition to this general
revision, special paragraphs on the following new matter have been introduced :
Filamentous Keratitis, Blood -staining of the Cornea, Essential Phthisis Bulbi,
Foreign Bodies in the Lens, Circinate Retinitis, Symmetrical Changes at the
Macula Lutea in Infancy, Hyaline Bodies in the Papilla, Monocular Diplopia,
Subconjunctival Injections of Germicides, Infiltration-Anaesthesia, and Steriliza-
tion of Collyria. Brief mention of Ophthalmia Nodosa, Electric Ophthalmia,
and Angioid Streaks in the Retina also finds place. An Appendix has been
added, containing a full description of the method of determining the corneal
astigmatism with the ophthalmometer of Javal and Schi5tz, and the rotations
of the eyes with the tropometer of Stevens. The chapter on Operations has
been enlarged and rewritten.

"A clearly written, comprehensive manual. . . . One which we can commend to students
as a reliable text-book, written with an evident knowledge of the wants of those enteringupon
the study of this special branch of medical science."— British Medical Journal.

" The work is characterized by a lucidity of expression which leaves the reader in no
doubt as to the meaning of the language employed. . . . We know of no work in which
these diseases are dealt with more satisfactorily, and indications for treatment more clearly
given, and in harmony with the practice of the most advanced ophthalmologists." — Mari-
time Medical News.

" It is hardly too much to say that for the student and practitioner beginning the study of
Ophthalmology, it is the best single volume at present published." — Medical News.

" The latest and one of the best books on Ophthalmology. The book is thoroughly up to
date, and is certainly a work which not only commends itself to the student, but is a ready
reference for the busy practitioner." — International Medical Review.

PROFESSIONAL OPINIONS.

"A work that will meet the requirements not only of the specialist, but of the general
practitioner in a rare degree. I am satisfied that unusual success awaits it."

William Pepper, M. D.
Provost and Professor of Theory and Practice of Medicine and Clinical Medicine
in the University of Pennsylvania.

" Contains in concise and reliable form the accepted views of Ophthalmic Science."

William Thomson, M. D.,
Professor of Ophthalmology, Jefferson Medical College, Philadelphia, Pa.

1 6 W. B. SAUNDERS1

TEXT-BOOK UPON THE PATHOGENIC BACTERIA. Spe-
cially written for Students of Medicine. By Joseph McFarland,
M. D., Professor of Pathology and Bacteriology in the Medico-Chirurgical
College of Philadelphia, etc. 497 pages, finely illustrated. Price, Cloth,
$2.50 net.

SECOND EDITION, REVISED AND GREATLY ENLARGED.
The work is intended to be a text-book for the medical student and for the
practitioner who has had no recent laboratory training in this department of medi-
cal science. The instructions given as to needed apparatus, cultures, stainings,
microscopic examinations, etc. are ample for the student's needs, and will afford
to the physician much information that will interest and profit him relative to a
subject which modern science shows to go far in explaining the etiology of many
diseased conditions.

In this second edition the work has been brought up to date in all depart-
ments of the subject, and numerous additions have been made to the technique
in the endeavor to make the book fulfil the double purpose of a systematic work
upon bacteria and a laboratory guide.

" It is excellently adapted for the medical students and practitioners for whom it is avowedly
written. . . . The descriptions given are accurate and readable, and the book should prove
useful to those for whom it is written. — London Lancet, Aug. 29, 1896.

" The author has succeded admirably in presenting the essential details of bacteriological
technics, together with a judiciously chosen summary of our present knowledge of pathogenic
bacteria. . . . The work, we think, should have a wide circulation among English-speaking
students of medicine." — N. Y. Medical Journal, April 4, 1896.

" The book will be found of considerable use by medical men who have not had a special
bacteriological training, and who desire to understand this important branch of medical
science." — Edinburgh Medical "Journal, July, 1896.

LABORATORY GUIDE FOR THE BACTERIOLOGIST. By

Langdon Frothingham, M. D. V., Assistant in Bacteriology and Veteri-
nary Science, Sheffield Scientific School, Yale University. Illustrated.
Price, Cloth, 75 cents.

The technical methods involved in bacteria-culture, methods of staining, and
microscopical study are fully described and arranged as simply and concisely as
possible. The book is especially intended for use in laboratory work

" It is a convenient and useful little work, and will more than repay the outlay necessary
for its purchase in the saving of time which would otherwise be consumed in looking up the
various points of technique so clearly and concisely laid down in its pages." — American Med.-
Surg. Bulletin.

FEEDING IN EARLY INFANCY. By Arthur V. Meigs, M. D.
Bound in limp cloth, flush edges. Price, 25 cents net.

Synopsis: Analyses of Milk — Importance of the Subject of Feeding in Early
Infancy — Proportion of Casein and Sugar in Human Milk — Time to Begin Arti-
ficial Feeding of Infants — Amount of Food to be Administered at Each Feed-
ing— Intervals between Feedings — Increase in Amount of Food at Different
Periods of Infant Development — Unsuitableness of Condensed Milk as a Sub-
stitute for Mother's Milk — Objections to Sterilization or "Pasteurization" of
Milk — Advances made in the Method of Artificial Feeding of Infants.

CATALOGUE OF MEDICAL WORKS. \J

ESSENTIALS OF ANATOMY AND MANUAL OF PRACTI-
CAL DISSECTION, containing " Hints on Dissection " By Charles
B. Nancrede, M. D., Professor of Surgery and Clinical Surgery in the
University of Michigan, Ann Arbor ; Corresponding Member of the Royal
Academy of Medicine, Rome, Italy ; late Surgeon Jefferson Medical Col-
lege, etc. Fourth and revised edition. Post 8vo, over 500 pages, with
handsome full-page lithographic plates in colors, and over 200 illustrations.
Price : Extra Cloth or Oilcloth for the dissection-room, $2.00 net.

Neither pains nor expense has been spared to make this work the mo9t ex-
haustive yet concise Student's Manual of Anatomy and Dissection ever pub-
lished, either in America or in Europe.

The colored plates are designed to aid the student in dissecting the muscles,
arteries, veins, and nerves. The wood-cuts have all been specially drawn and
engraved, and an Appendix added containing 60 illustrations representing the
structure of the entire human skeleton, the whole being based on the eleventh
edition of Gray's Anatomy.

" The plates are of more than ordinary excellence, and are of especial value to student* in
their work in the dissecting-room."— Journal of American Medical Association.

"Should be in the hands of every medical student." — Cleveland Medical Gazette.

" A concise and judicious work." — Buffalo Medical and Surgical Journal.

A MANUAL OF PRACTICE OF MEDICINE. By A. A. Stevens,
A. M., M. D., Instructor of Physical Diagnosis in the University of Penn-
sylvania, and Demonstrator of Pathology in the Woman's Medical College
of Philadelphia. Specially intended for students preparing for graduation
and hospital examinations, and includes the following sections : General
Diseases, Diseases of the Digestive Organs, Diseases of the Respiratory
System, Diseases of the Circulatory System, Diseases of the Nervous Sys-
tem, Diseases of the Blood, Diseases of the Kidneys, and Diseases of the
Skin. Each section is prefaced by a chapter on General Symptomatology.
Post 8vo, 520 pages. Numerous illustrations and selected formulae.
Price, $2.50, bound in flexible leather.

FIFTH EDITION, REVISED AND ENLARGED.

Contributions to the science of medicine have poured in so rapidly during the
last quarter of a century that it is well-nigh impossible for the student, with the
limited time at his disposal, to master elaborate treatises or to cull from them
that knowledge which is absolutely essential. From an extended experience in
teaching, the author has been enabled, by classification, to group allied symp-
toms, and by the judicious elimination of theories and redundant explanations
to bring within a comparatively small compass a complete outline of the prac-
tice of medicine.

1 8 W. B. SAUNDERS

MANUAL OF MATERIA MEDICA AND THERAPEUTICS.

By A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the
University of Pennsylvania, and Demonstrator of Pathology in the Woman's
Medical College of Philadelphia. 445 pages. Price, Cloth, #2.25.

SECOND EDITION, REVISED.

This wholly new volume, which is based on the last edition of the Pharma-
copceia, comprehends the following sections: Physiological Action of Drugs;
Drugs; Remedial Measures other than Drugs; Applied Therapeutics; Incom-
patibility in Prescriptions; Table of Doses; Index of Drugs; and Index of
Diseases ; the treatment being elucidated by more than two hundred formulae.

" The author is to be congratulated upon having presented the medical student with as
accurate a manual of therapeutics as it is possible to prepare."— Therapeutic Gazette.

" Far superior to most of its class ; in fact, it is very good. Moreover, the book is reliable
and accurate." — New York Medical Journal.

" The author has faithfully presented modern therapeutics in a comprehensive work, . . .
and it will be found a reliable guide."— University Medical Magazine.

NOTES ON THE NEWER REMEDIES: their Therapeutic Ap-
plications and Modes of Administration. By David Cerna, M. D.,
Ph. D., Demonstrator of and Lecturer on Experimental Therapeutics in
the University of Pennsylvania. Post-octavo, 253 pages. Price, $1.25.

SECOND EDITION, RE-WRITTEN AND GREATLY ENLARGED.

The work takes up in alphabetical order all the newer remedies, giving their
physical properties, solubility, therapeutic applications, administration, and
chemical formula.

It thus forms a very valuable addition to the various works on therapeutics
now in existence.

Chemists are so multiplying compounds, that, if each compound is to be thor-
oughly studied, investigations must be carried far enough to determine the prac-
tical importance of the new agents.

" Especially valuable because of its completeness, its accuracy, its systematic consider-
ation of the properties and therapy of many remedies of which doctors generally know but
little, expressed in a brief yet terse manner." — Chicago Clinical Review.

TEMPERATURE CHART. Prepared by D. T. LAINE, M. D. Size
8x 13^ inches. Price, per pad of 25 charts, 50 cents.

A conveniently arranged chart for recording Temperature, with columns for
daily amounts of Urinary and Fecal Excretions, Food, Remarks, etc. On the
back of each chart is given in full the method of Brand in the treatment of
Typhoid Fever.

CATALOGUE OF MEDICAL WORKS. 1 9

SAUNDERS' POCKET MEDICAL LEXICON; or, Dictionary of
Terms and Words used in Medicine and Surgery. By John M.
Keating, M. D., editor of " Cyclopaedia of Diseases of Children," etc. ;
author of the " New Pronouncing Dictionary of Medicine;" and Henrv
Hamilton, author of " A New Translation of Virgil's ^Eneid into Eng-
lish Verse;" co-author of a " New Pronouncing Dictionary of Medicine."
A new and revised edition. 32mo, 282 pages. Prices: Cloth, 75 cents.-
Leather Tucks, $1.00.

This new and comprehensive work of reference is the outcome of a demand
for a more modern handbook of its class than those at present on the market,
which, dating as they do from 1855 to 1884, are of but trifling use to the student
by their not containing the hundreds of new words now used in current litera-
ture, especially those relating to Electricity and Bacteriology.

" Remarkably accurate in terminology, accentuation, and definition."— Journal of Amer*
ican Medical Association.

" Brief, yet complete .... it contains the very latest nomenclature in even the newest
departments of medicine." — Mew York Medical Record.

SAUNDERS' POCKET MEDICAL FORMULARY. By William
M. Powell, M. D., Attending Physician to the Mercer House for Invalid
Women at Atlantic City. Containing 1800 Formulae, selected from several
hundred of the best-known authorities. Forming a handsome and con-
venient pocket companion of nearly 300 printed pages, with blank leaves
for Additions; with an Appendix containing Posological Table, Formulas
and Doses for Hypodermatic Medication, Poisons and their Antidotes,
Diameters of the Pemale Pelvis and Fcetal Head, Obstetrical Table, Diet
List for Various Diseases, Materials and Drugs used in Antiseptic Surgery,
Treatment of Asphyxia from Drowning, Surgical Remembrancer, Tables
of Incompatibles, Eruptive Fevers, Weights and Measures, etc. Fourth
edition, revised and greatly enlarged. Handsomely bound in morocco,
with side index, wallet, and flap. Price, $1.75 net.

A concise, clear, and correct record of the many hundreds of famous formulae
which are found scattered through the works of the most eminent physicians
and surgeons of the world. The work is helpful to the student and practitioner
alike, as through it they become acquainted with numerous formulae which are
not found in text-books, but have been collected from among the rising genera-
tion of the profession, college professors, and hospital physicians and surgeons.

" This little book, that can be conveniently carried in the pocket, contains an immense
amount of material. It is very useful, and as the name of the author of each prescription is
given is unusually reliable." — Mew York Medical Record.

" Designed to be of immense help to the general practitioner in the exercise of his daily
calling." — Boston Medical and Surgical Journal.

20 W. B. SAUNDERS'

DISEASES OF WOMEN. By Henry J. Garrigues, A. M., M. D.,
Professor of Gynecology and Obstetrics in the New York School of Clinical
Medicine; Gynecologist to St. Mark's Hospital and to the German Dis-
pensary, New York City. In one handsome octavo volume of 728 pages,
illustrated by 335 engravings and colored plates. Prices : Cloth, #4.00 net ;
Sheep or Half Morocco, #5.00 net.

A practical work on gynecology for the use of students and practitioners,
written in a terse and concise manner. The importance of a thorough know-
ledge of the anatomy of the female pelvic organs has been fully recognized by
the author, and considerable space has been devoted to the subject. The chap-
ters on Operations and on Treatment are thoroughly modern, and are based
upon the large hospital and private practice of the author. The text is eluci-
dated by a large number of illustrations and colored plates, many of them being
original, and forming a complete atlas for studying embryology and the anatomy
of the female genitalia, besides exemplifying, whenever needed, morbid condi-
tions, instruments, apparatus, and operations.

Second Edition, Thoroughly Revised,

The first edition of this work met with a most appreciative reception by the
medical press and profession both in this country and abroad, and was adopted
as a text-book or recommended as a book of reference by nearly one hundred
colleges in the United States and Canada. The author has availed himself of
the opportunity afforded by this revision to embody the latest approved advances
in the treatment employed in this important branch of Medicine. He has also
more extensively expressed his own opinion on the comparative value of the
different methods of treatment employed.

"One of the best text-books for students and practitioners which has been published in
the English language; it is condensed, clear, and comprehensive. The profound learning
and great clinical experience of the distinguished author find expression in this book in a
most attractive and instructive form. Young practitioners, to whom experienced consultants
may not be available, will find in this book invaluable counsel and help."

Thad. A. Rbamy, M. D., LL.D.,
ProfesMfr 0/ Clinical Gynecology, Medical College of Ohio ; Gynecologist to the Good
Samaritan and Cincinnati Hospitals.

A SYLLABUS OF GYNECOLOGY, arranged in conformity with
"An American Text-Book of Gynecology." By J. W. Long, M. D.,
Professor of Diseases of Women and Children, Medical College of Vir-
ginia, etc. Price, Cloth (interleaved), $1.00 net.

Based upon the teaching and methods laid down in the larger work, this will
not only be useful as a supplementary volume, but to those who do not already
possess the text-book it will also have an independent value as an aid to the
practitioner in gynecological work, and to the student as a guide in the lecture-
room, as the subject is presented in a manner at once systematic, clear, succinct,
?nd practical.

CATALOGUE OF MEDICAL WORKS. 21

A MANUAL OF PHYSIOLOGY, with Practical Exercises. For

Students and Practitioners. By G. N. Stewart, M. A., M. D., D. Sc,

lately Examiner in Physiology, University of Aberdeen, and of the New

Museums, Cambridge University ; Professor of Physiology in the Western

Reserve University, Cleveland, Ohio. Handsome octavo volume of 800

pages, with 278 illustrations in the text, and 5 colored plates. Price,

Cloth, #3.50 net.

" It will make its way by sheer force of merit, and amply deserves to do so. It is one oj
the very best English text-books on the subject." — London Lancet.

" Of the many text-books of physiology published, we do not know of one that so nearly
comes up to the ideal as does Professor Stewart's volume." — British Medical Journal.

ESSENTIALS OF PHYSICAL DIAGNOSIS OF THE THORAX.

By Arthur M. Corwin, A. M., M. D., Demonstrator of Physical Diagno-
sis in the Rush Medical College, Chicago; Attending Physician to the
Central Free Dispensary, Department of Rhinology, Laryngology, and
Diseases of the Chest. 200 pages. Illustrated. Cloth, flexible covers.
Price, $1.25 net.

SYLLABUS OF OBSTETRICAL LECTURES in the Medical
Department, University of Pennsylvania. By Richard C. Norris,
A. M., M. D., Lecturer on Clinical and Operative Obstetrics, University
of Pennsylvania. Third edition, thoroughly revised and enlarged. Crown
8vo. Price, Cloth, interleaved for notes, $2.00 net.

" This work is so far superior to others on the same subject that we take pleasure in call-
ing attention briefly to its excellent features. It covers the subject thoroughly, and will
prove invaluable both to the student and the practitioner. The author has introduced a
number of valuable hints which would only occur to one who was himself an experienced
teacher of obstetrics. The subject-matter is clear, forcible, and modern. We are especially
pleased with the portion devoted to the practical duties of the accoucheur, care of the child,
etc. The paragraphs on antiseptics are admirable ; there is no doubtful tone in the direc-
tions given. No details are regarded as unimportant; no minor matters omitted. We ven-
ture to say that even the old practitioner will find useful hints in this direction which he can-
not afford to despise." — New York Medical Record.

A SYLLABUS OF LECTURES ON THE PRACTICE OF SUR-
GERY, arranged in conformity with " An American Text-Book
of Surgery." By N. Senn, M. D., Ph. D., Professor of Surgery in Rush
Medical College, Chicago, and in the Chicago Polyclinic. Price, $2.00.

This, the latest work of its eminent author, himself one of the contributors
to " An American Text-Book of Surgery," will prove of exceptional value to
the advanced student who has adopted that work as his text-book. It is not
only the syllabus of an unrivalled course of surgical practice, but it is also an
epitome of or supplement to the larger work.

_ " The author has evidently spared no pains in making his Syllabus thoroughly comprehen-
sive, and has added new matter and alluded to the most recent authors and operations. Full
references are also given to all requisite details of surgical anatomy and pathology."— British
Medical Journal, London.

22 IV. B. SAUNDERS'

AN OPERATION BLANK, with Lists of Instruments, etc. re-
quired in Various Operations. Prepared by W. W. Keen, M. D.,
LL.D., Professor of Principles of Surgery in the Jefferson Medical Col-
lege, Philadelphia. Price per Pad, containing Blanks for fifty operations,
50 cents net.

SECOND EDITION, REVISED FORM.

A convenient blank, suitable for all operations, giving complete instructions
regarding necessary preparation of patient, etc., with a full list of dressings and
medicines to be employed.

On the back of each blank is a list of instruments used— viz. general instru
ments, etc., required for all operations ; and special instruments for surgery of
the brain and spine, mouth and throat, abdomen, rectum, male and female
genito-urinary organs, the bones, etc.

The whole forming a neat pad, arranged for hanging on the wall of a sur-
geon's office or in the hospital operating-room.

" Will serve a useful purpose for the surgeon in reminding him of the details of prepa-
ration for the patient and the room as well as for the instruments, dressings, and antiseptics
needed " — New York Medical Record

" Covers about all that can be needed in any operation." — American Lancet.

" The plan is a capital one."— Boston Medical and Surgical Journal.

LABORATORY EXERCISES IN BOTANY. By Edson S. Bastin,
M. A., Professor of Materia Medica and Botany in the Philadelphia Col-
lege of Pharmacy. Octavo volume of 536 pages, 87 full-page plates. Price,
Cloth, #2.50.

This work is intended for the beginner and the advanced student, and it fully
covers the structure of flowering plants, roots, ordinary stems, rhizomes, tubers,
bulbs, leaves, flowers, fruits, and seeds. Particular attention is given to the gross
and microscopical structure of plants, and to those used in medicine. Illustra-
tions have freely been used to elucidate the text, and a complete index to facil-
itate reference has been added.

" There is no work like it in the pharmaceutical or botanical literature of this country, and
we predict for it a wide circulation." — American Journal of Pharmacy.

DIET IN SICKNESS AND IN HEALTH. By Mrs. Ernest Hart,
formerly Student of the Faculty of Medicine of Paris and of the London
School of Medicine for Women; with an Introduction by Sir Henry
Thompson, F. R. C. S., M. D., London. 220 pages; illustrated. Price,
Cloth, #1.50.

Useful to those who have to nurse, feed, and prescribe for the sick. In
each case the accepted causation of the disease and the reasons for the special
diet prescribed are briefly described. Medical men will find the dietaries and
recipes practically useful, and likely to save them trouble in directing the dietetic
treatment of patients.

CATALOGUE OF MEDICAL WORKS. 23

HOW TO EXAMINE FOR LIFE INSURANCE. By John M.
Keating, M. D., Fellow of the College of Physicians and Surgeons of
Philadelphia; Vice-President of the American Pediatric Society; Ex-
President of the Association of Life Insurance Medical Directors. Royal
8vo, 211 pages, with two large half-tone illustrations, and a plate prepared
by Dr. McClellan from special dissections ; also, numerous cuts to elucidate
the text. Second edition. Price, Cloth, $2.00 net.

"This is by far the most useful book which has yet appeared on insurance examination, a
subject of growing interest and importance. Not the least valuable portion of the volume is
Part II., which consists of instructions issued to their examining physicians by twenty-four
representative companies of this country. As the proofs of these instructions were corrected
by the directors of the companies, they form the latest instructions obtainable. If for these
alone, the book should be at the right hand of every physician interested in this special branch
of medical science." — The Medical News, Philadelphia.

NURSING: ITS PRINCIPLES AND PRACTICE. By Isabel
Adams Hampton, Graduate of the New York Training School for
Nurses attached to Bellevue Hospital; Superintendent of Nurses and
Principal of the Training School for Nurses, Johns Hopkins Hospital,
Baltimore, Md. ; late Superintendent of Nurses, Illinois Training School
for Nurses, Chicago, 111. In one very handsome i2mo volume of 484
pages, profusely illustrated. Price, Cloth, $2.00 net.

This original work on the important subject of nursing is at once comprehensive
and systematic. It is written in a clear, accurate, and readable style, suitable
alike to the student and the lay reader. Such a work has long been a desidera-
tum with those entrusted with the management of hospitals and the instruction of
nurses in training-schools. It is also of especial value to the graduated nurse
who desires to acquire a practical working knowledge of the care of the sick
and the hygiene of the sick-room.

OBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA-
TIONS. By L. Ch. Boisliniere, M. D., late Emeritus Professor of
Obstetrics in the St. Louis Medical College. 381 pages, handsomely illus-
trated. Price, $2.00 net.

" For the use of the practitioner who, when away from home, has not the
opportunity of consulting a library or of calling a friend in consultation. He
then, being thrown upon his own resources, will find this book of benefit in
guiding and assisting him in emergencies."

INFANT'S WEIGHT CHART. Designed by J. P. Crozer Griffith,
M. D., Clinical Professor of Diseases of Children in the University of Penn-
sylvania. 25 charts in each pad. Price per pad, 50 cents net.

A convenient blank for keeping a record of the child's weight during the first
two years of life. Printed on each chart is a curve representing the average weight
of a healthy infant, so that any deviation from the normal can readily be detected.

24 W. B. SAUNDERS'

THE CARE OF THE BABY. By J. P. Crozer Griffith, M. D.,
Clinical Professor of Diseases of Children, University of Pennsylvania;
Physician to the Children's Hospital, Philadelphia, etc. 404 pages, with
67 illustrations in the text, and 5 plates. l2mo. Price, $1.50.

SECOND EDITION, REVISED.

A reliable guide not only for mothers, but also for medical students and
practitioners whose opportunities for observing children have been limited.

" The whole book is characterized by rare good sense, and is evidently written by a mas-
ter hand. It can be read with benefit not only by mothers, but by medical students and by
;iny practitioners who have not had large opportunities for observing children." — American
Journal of Obstetrics.

THE NURSE'S DICTIONARY of Medical Terms and Nursing
Treatment, containing Definitions of the Principal Medical and Nursing
Terms, Abbreviations, and Physiological Names, and Descriptions of the
Instruments, Drugs, Diseases, Accidents, Treatments, Operations, Foods,
Appliances, etc. encountered in the ward or the sick-room. By Honnor
Morten, author of " How to Become a Nurse," " Sketches of Hospital
Life," etc. i6mo, 140 pages. Price, Cloth, $1.00.

This little volume is intended for use merely as a small reference-book which
can be consulted at the bedside or in the ward. It gives sufficient explanation
to the nurse to enable her to comprehend a case until she has leisure to look up
larger and fuller works on the subject.

DIET LISTS AND SICK-ROOM DIETARY. By Jerome B. Thomas,
M. D., Visiting Physician to the Home for Friendless Women and Children
and to the Newsboys' Home ; Assistant Visiting Physician to the Kings
County Hospital ; Assistant Bacteriologist, Brooklyn Health Department.
Price, Cloth, #1.50 (Send for specimen List.)

One hundred and sixty detachable (perforated) diet lists for Albuminuria,
Anaemia and Debility, Constipation, Diabetes, Diarrhoea, Dyspepsia, Fevers,
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sheets of Sick-Room Dietary, containing full instructions for preparation of
easily-digested foods necessary for invalids. Each list is numbered only, the
disease for which it is to be used in no case being mentioned, an index key
being reserved for the physician's private use.

DIETS FOR INFANTS AND CHILDREN IN HEALTH AND
IN DISEASE. By Louis Starr, M. D., Editor of "An American
Text-Book of the Diseases of Children." 230 blanks (pocket-book size).
perforated and neatly bound in flexible morocco. Price, $1.25 net.

The first series of blanks are prepared for the first seven months of infant
life ; each blank indicates the ingredients, but not the quantities, of the food,
the latter directions being left for the physician. After the seventh month,
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SYPHILIS AND THE VENEREAL DISEASES. By James
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DISEASES OF WOMEN. By J. Bland Sutton, F. R. C. S., Assistant
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VOLUMES IN PREPARATION.
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illustrations. By Charles B. Nancrede, M. D.

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INORGANIC. 4th edition, revised, with an Appendix. By Law-
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larged. 75 illustrations. By W. Easterly Ashton, M. D.

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7th thousand. 46 illustrations. By C. E. Armand Semple, M. D.

7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS,

AND PRESCRIPTION- WRITING. 4th edition. By Henry
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8. 9. ESSENTIALS OF PRACTICE OF MEDICINE. By Henry

Morris, M. D. An Appendix on Urine Examination. Illustrated.
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sential Formulae, selected from eminent authorities, by Wm. M. Powell,
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HYGIENE. 130 illustrations. By C. E. Armand Semple, M. D.

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THROAT. 124 illustrations. 2d edition, revised. By Edward
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tion. By William H. Powell, M. D.
.6. ESSENTIALS OF EXAMINATION OF URINE. Colored
" Vogel Scale," and numerous illustrations. By Lawrence Wolff,
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A. A. Eshner, M. D. 55 illustrations, some in colors. (Price, $1.50 net.)

18. ESSENTIALS OF PRACTICE OF PHARMACY. By L. E.

Sayre. 2d edition, revised.

20. ESSENTIALS OF BACTERIOLOGY. 3d edition. 82 illustra-

tions. By M. V. Ball, M. D.

21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY

48 illustrations. 3d edition, revised. By John C. Shaw, M. D.

22. ESSENTIALS OF MEDICAL PHYSICS. 155 illustrations. 2d

edition, revised. By Fred J. Brockway, M. D. (Price, #1.00 net.)

23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illustrations.

By David D. Stewart, M. D., and Edward S. Lawrance, M. D.

24. ESSENTIALS OF DISEASES OF THE EAR. By E. B. Glea

son, M. D. 114 illustrations. Second edition, revised and enlarged.

RECENT PUBLICATIONS

PENROSE'S DISEASES OF WOMEN

A Text-Book of Diseases of Women. By Charles B. Penrose, M.D., Ph.D.,
Professor of Gynecology in the University of Pennsylvania ; Surgeon to the Gynecean
Hospital, Philadelphia. Octavo volume of 529 pages, handsomely illustrated. Cloth,
$3.50 net.

" I shall value very highly the copy of Penrose's " Diseases of Women " received.
I have already recommended it to my class as the best book." — Howard A. Kelly,
Professor of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Md.

SENN'S QENITO-URINARY TUBERCULOSIS

Tuberculosis of the Genito-Urinary Organs, Male and Female. By Nicholas
Senn, M.D., Ph.D., LL.D., Professor of the Practice of Surgery and of Clinical
Surgery, Rush Medical College, Chicago. Handsome octavo volume of 320 pages,
illustrated. Cloth, $3.00 net.

SUTTON AND GILES' DISEASES OF WOMEN

Diseases of Women. By J. Bland Sutton, F.R.C.S., Assistant Surgeon to Middle-
sex Hospital, and Surgeon to Chelsea Hospital, London; and Arthur E. Giles,
M.D., B.Sc. Lond., F R.C.S. Edin., Assistant Surgeon to Chelsea Hospital, London.
436 pages, handsomely illustrated. Cloth, J2.50 net.

BUTLER'S MATERIA MEDICA, THERAPEUTICS, AND PHAR-
MACOLOGY. Second Edition, Revised

A Text-Book of Materia Medica, Therapeutics, and Pharmacology. By George
F. Butler, Ph.G., M.D., Professor of Materia Medica and of Clinical Medicine in
the College of Physicians and Surgeons, Chicago; Professor of Materia Medica and
Therapeutics, Northwestern University, Woman's Medical School, etc. Octavo, 858
pages, illustrated. Cloth, $4.00 net ; Sheep, $5.00 net.

SAUNDBY'S RENAL AND URINARY DISEASES

Lectures on Renal and Urinary Diseases. By Robert Saundby, M.D. Edin.,
Fellow of the Royal College of Physicians, London, and of the Royal Medico-Chirur-
gical Society ; Physician to the General Hospital ; Consulting Physician to the Eye
Hospital and to the Hospital for Diseases of Women ; Professor of Medicine in Mason
College, Birmingham, etc. Octavo volume of 434 pages, with numerous illustrations
and 4 colored plates. Cloth, $2.50 net.

PYE'S BANDAGING

Elementary Bandaging and Surgical Dressing, with Directions Concerning
the Immediate Treatment of Cases of Emergency. For the Use of Dressers
and Nurses. By Walter Pye, F.R.C.S., Late Surgeon to St. Mary's Hospital,
London. Small 1 21110, with over 80 illustrations. Cloth, flexible covers. Price, 75
cents net.

MALLORY AND WRIGHT'S PATHOLOGICAL TECHNIQUE

Pathological Technique. By Frank B. Mallory, A.M., M.D., Assistant Professor
of Pathology, Harvard University Medical School ; and James H. Wright, A.M.,
M.D., Instructor in Pathology, Harvard University Medical School. Octavo volume
of 396 pages, handsomely illustrated. Cloth, {2.50 net.

" I have been looking forward to the publication of this book, and I am glad to say
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Hopkins University, Baltimore, Md. ■

ANDERS' PRACTICE OF MEDICINE. Second Edition

A Text-Book of the Practice of Medicine. By James M. Anders, M.D., Ph.D.,
LL.D., Professor of the Practice of Medicine and of Clinical Medicine, Medico-
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fully illustrated. Cloth, J5.50 net ; Sheep or Half Morocco, {6.50 net.

ANOMALIES

AND

CURIOSITIES OF MEDICINE.

BY

GEORGE M. GOULD, M. D., and WALTER L. PYLE, M. D.

Several years of exhaustive research have been spent by the authors in the
great medical libraries of the United States and Europe in collecting the material
for this work, Hedical literature of all ages and all languages has
been carefully searched, as a glance at the Bibliographic Index will show. The
facts, which will be of extreme value to the author and lecturer, have
been arranged and annotated, and full reference footnotes given, indicating
whence they have been obtained.

In view of the persistent and dominant interest in the anomalous and curious,
a thorough and systematic collection of this kind (the first of which the
authors have knowledge) must have its own peculiar sphere of Usefulness.

As a complete and authoritative Book of Reference it will be of value
not only to members of the medical profession, but to all persons interested in
general scientific, sociologic, and medico-legal topics ; in fact, the general inter-
est of the subject and the dearth of any complete work upon it make this
volume one of the most important literary innovations of the day.

An especially valuable feature of the book consists of the Indexing.
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cross-references to the subjects discussed, and the names of the authors of the
more important reports, there is a convenient Bibliographic Index and a
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face type, the reader being thereby enabled to tell at a glance the subject-
matter of any particular paragraph or page.

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page plates — a total of over 320 separate figures.

The careful rendering of the text and references, the wealth of illustrations,
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ing, combine to make this book one of the most attractive medical publications
ever issued.

Handsome Imperial Octavo Volume of 968 Pages.

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JUST ISSUED

AN AMERICAN TEXT-BOOK OF GENITO-URINARY AND SKIN
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Edited by L. Bolton Bangs, M.D., Late Professor of Genito-Urinary and Venereal
Diseases, New York Post-Graduate Medical School and Hospital; and William
A. Hardawav, M.D., Professor of Diseases of the Skin, Missouri Medical College.
Octavo volume of over 1200 pages, with 300 illustrations in the text, and 20 full-page
colored plates. Prices: Cloth, $7.00 net ; Sheep or Half Morocco, f8.oo net.

MOORE'S ORTHOPEDIC SURGERY

A Manual of Orthopedic Surgery. By James E. Moore, M.D., Professor of Ortho-
pedics and Adjunct Professor of Clinical Surgery, University of Minnesota, College
of Medicine and Surgery. 8vo, 356 pages, handsomely illustrated. Cloth, $2.50 net.

MACDONALD'S SURGICAL DIAGNOSIS AND TREATMENT

Surgical Diagnosis and Treatment. By J. W. Macdonald, M.D. Edin., L.R.C.S
Edin., Professor of the Practice of Surgery and of Clinicai Surgery in Hamline Uni-
versity; Visiting Surgeon to St. Barnabas' Hospital, Minneapolis, etc. Octavo
volumeof 800 pages, handsomely illustrated. Cloth, $5.00 net ; Half Morocco, J6.00 net.

CHAPIN ON INSANITY

A Compendium of Insanity. By John B. Chapin, M.D., LL.D., Physician-in-Chiet.
Pennsylvania Hospital for the Insane; late Physician-Superintendent of the Willara
State Hospital, New York, etc. 121110., 234 pages, illustrated. Cloth, $1.25 net.

KEEN ON THE SURGERY OF TYPHOID FEVER

The Surgical Complications and Sequels of Typhoid Fever. By Wm. W. Keen,
M.D., LL.D., Professor of the Principles of Surgery and of Clinical Surgery, Jeffer-
son Medical College, Philada. Octavo volume of 400 pages. Cloth, $3.00 net.

VAN VALZAH AND NISBET'S DISEASES OF THE STOMACH

Diseases of the Stomach. By William W. van Valzah, M.D., Professor of General
Medicine and Diseases of the Digestive System and the Blood, New York Polyclinic ;
and J. Douglas Nisbet, M.D., Adjunct Professor of General Medicine and Diseases
of the Digestive System and the Blood, New York Polyclinic. Octavo volume of 674
pages, illustrated. Cloth, $3.50 net.

IN PREPARATION

AN AMERICAN TEXT-BOOK OF DISEASES OF THE EYE, EAR,
NOSE, AND THROAT

Edited by G. E. de Schweinitz, M.D., Professor of Ophthalmology in the Jefferson
Medical College; and B. Alexander Randall, M.D., Professor of Diseases of the
Ear in the University of Pennsylvania and in the Philadelphia Polyclinic.

CHURCH AND PETERSON'S NERVOUS AND MENTAL DISEASES

Nervous and Mental Diseases. By Archibald Church, M.D., Professor of Mental
Diseases and Medical Jurisprudence, Northwestern University Medical School,
Chicago; and Frederick Peterson, M.D. , Clinical Professor of Mental Diseases,
Woman's Medical College, New York, etc.

KYLE ON THE NOSE AND THROAT

Diseases of the Nose and Throat. By D. Braden Kyle, M.D., Clinical Professor
of Laryngology and Rhinology, Jefferson Medical College, Philadelphia; Consulting
Laryngologist, Rhinologist, and Otologist, St. Agnes' Hospital, etc.

STENGEL'S PATHOLOGY

A Manual of Pathology. By Alfred Stengel, M.D., Physician to the Philadel-
phia Hospital; Professor of Clinical Medicine in the Woman's Medical College;
Physician to the Children's Hospital, etc.

HIRST'S OBSTETRICS

A Text-Book of Obstetrics. By Barton Cooke Hirst, M.D., Professor of Ob

stetrics, University of Pennsylvania.

HEISLER'S EMBRYOLOGY

A Text-Book of Embryology. By John C. Heisler, M.D., Professor of Anatomy,
Medico-Chirurgical College, Philadelphia.

NOW HEADY, VOLUMES FOB 1896,1897,1898.

s.A-~cr:r>r:D:E]:R,s'

AMERICAN YEAR-BOOK OF MEDICINE and SURGERY.

Edited by GEORGE M. GOULD, A.M., M. D.
Assisted by Eminent American Specialists and Teachers.

Notwithstanding the rapid multiplication of medical and surgical works,
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Atlas of Internal Medicine

Dr. Chr. Jakob, of Erlang A 000 509 954 4

Eshner, M.D., Professor of Clinical Medicine in the .Phila-
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Hospital. 68 colored plates. Cloth, $3.00 net.
Atlas of Legal Medicine. By Dr. E. von Hofmann, of
Vienna. Edited by Frederick Peterson, M.D., Clinical
Professor of Mental Diseases, Woman's Medical College, New

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MEDICAL SCIENCES LIBRARY

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