the day following her removal. She was seen at Penge by a medical man a few hours previous to death. At the postmortem examination the following appearances were found the body was greatly emaciated and was covered with vermin; the entire weight was seventy-four pounds, although two and a half years previously she weighed one hundred and nineteen pounds. The skin was dry and parchment-like, and the muscles were generally atrophied. The stomach was contracted and its walls thinned; the intestines were shrivelled, empty and transparent; the rectum was hyperæmic; and the omentum was much contracted and quite destitute of fat. The only appearances of disease were a small patch of tubercular deposit at the apex of the left lung, and a few miliary tubercles on the arachnoid membrane at the upper surface of the left side of the brain. From their examination of the body, the medical witnesses for the prosecution came to the conclusions that there was no disease sufficient to account for the extreme emaciation, or sufficient to cause death; and that the appearances were those indicative of death from starvation. the defence, it was urged that tubercular meningitis was responsible for the emaciation and other symptoms of starvation. The general evidence, however, led the jury to return a verdict of wilful murder against all the prisoners. The evidence given at the trial was subsequently much discussed and criticised. There was a feeling amongst some medical men that proof of death from starvation was not, by any means, complete. It was objected that proper and careful search for other possible causes of death had not been made. For instance, the œsophagus had not been examined for stricture, the urine in the bladder had not been tested for sugar, and the suprarenal bodies had not been examined for disease. consequence of the strong expression of public opinion, and for other reasons, Alice Rhodes was pardoned, and the capital sentences passed on the other three prisoners were commuted. This case serves to indicate the extreme importance of making a thorough and exhaustive examination of a body when a For In post-mortem examination is being made for medico-legal purposes. It will be well to enumerate here the principal organic diseases which may produce wasting and death, closely simulating the appearances produced by starvation; for signs of these diseases careful search should always be made in suspected cases of death from starvation. They are stricture or compression of the oesophagus, malignant disease in any part of the body, tubercular disease, diabetes, dysentery or chronic diarrhoea, and disease of the suprarenal bodies. In addition, certain neuroses, such as hysteria or some form of insanity, which leave no post-mortem signs of their occurrence, may have been responsible for the general wasting. ASPHYXIA CHAPTER XXXI Various forms of death from asphyxia-General symptoms produced by asphyxia-Drowning-Post-mortem appearances of drowning-Accidental, homicidal, and suicidal drowning-Treatment of the apparently drowned-Determination of length of time a body has been under water. THE different forms of death from asphyxia comprise death from drowning, hanging, strangulation, and suffocation, in all of which death is chiefly due to asphyxia. All of these forms of violent death possess many features in common, although they are distinguished by individual peculiarities. They will each be dealt with separately and in detail, but previous to their separate description it is advisable to consider their common features. By asphyxia is meant the non-aeration, or the imperfect aeration, of the blood from want of a proper supply of fresh air, by which means the function of respiration becomes arrested. This condition may be brought about by various means-by water occupying the place of air in the air-passages, as in drowning; by a ligature around the throat, as in hanging and strangling; by mechanical pressure upon the throat, as in throttling; or by blocking of the upper air-passages with some mechanical impediment to the entry of air, as in suffocation. Death from asphyxia is not instantaneous, as the heart may continue to beat for two or three minutes, or even longer, after the cessation of breathing; it is during this period that the opportunity occurs for the resuscitation of the asphyxiated and apparently dead. After cessation of the heart's action recovery is practically impossible. GENERAL SYMPTOMS PRODUCED BY ASPHYXIA For convenience these may be divided into the following four periods: 1. A period of sensibility.-This is brief, and during it severe though ineffectual efforts at breathing are made. The knowledge that this stage of consciousness is very brief is derived from the statements of persons who have been rescued from drowning, or who have been cut down from hanging, or who have experimented upon themselves by partial strangulation. During this period the senses may be unusually active, and the memory abnormally acute, so that many of the events of a lifetime may appear to be crowded into a few moments. 2. A period of insensibility. During this period convulsive spasms occur. They are involuntary, and are caused by the stimulation of the nervous centres in the brain and spinal cord by the imperfectly aerated blood.. 3. Arrest of respiration. This is the period of apparent death; the action of the heart continues, and it is during this period that the asphyxiated person may be resuscitated. 4. Arrest of the heart's action. The advent of this stage means death. From the beginning to the end of these stages ten minutes. may be taken as the outside limit in the great majority of cases; frequently the time is much shorter. GENERAL POST-MORTEM APPEARANCES INDICATIVE OF 1. There is more or less lividity of the lips, face, extremities, and surface generally. 2. The cadaveric lividities or post-mortem stains are usually of a darker colour than those found in other forms of death. 3. The blood is usually dark coloured and fluid. 4. The veins are filled with dark-coloured blood, while the arteries are generally empty. 5. The right side of the heart is usually full of dark fluid blood, the left side being more or less empty, 6. The lungs are mostly gorged with blood. 7. Minute extravasations of blood are frequently found beneath the pleuræ, pericardium, and peritoneum. The small sub-pleural extravasations of blood are very suggestive of death from asphyxia, but, at the same time, it must be borne in mind that their absence does not contra-indicate death from asphyxia, as in several such cases of death they have not been present. They are produced by rupture of capillaries, from the forcible attempts at respiration after the entry of air is shut off, the rupture being aided possibly by increased blood-pressure caused by stimulation of the vaso-motor centre. On the other hand, it should be remembered that such extravasations are sometimes found after other modes of death than asphyxia;-for instance, after death from some poisons, from burns, and from hæmorrhagic diseases such as scurvy, purpura, &c. 8. The vessels of the membranes of the brain and of the brain itself are congested. 9. The abdominal viscera generally are enlarged from engorgement with dark venous blood. This condition is, as a rule, especially apparent in the liver, spleen, and kidneys. DROWNING Drowning is that special form of death from asphyxia in which the breathing is arrested by the prevention of the introduction of air into the lungs by water or some other liquid. In order to cause death by drowning, it is not necessary that the whole body should be submerged. Drowning may result from merely the nose and mouth being beneath the surface of the fluid, as is illustrated by the facts that drunkards and persons in epileptic fits have been drowned by falling with their faces |