DEATH IN ITS MEDICO-LEGAL ASPECTS.

BY

FRANCIS A. HARRIS, M.D.

IN the preparation of an article which shall treat of the subject of death in its relation to forensic inquiry, with the consideration of the phenomena attending and following upon certain forms of violent death, it must be obvious that little that is absolutely novel can be offered to the student of legal medicine who has availed himself of the careful and scientific exploitation of the subject by such eminent writers as Devergie, Tardieu, Casper, Taylor, and Ogston, who from their great opportunities for observation, and from the fact that most of them occupied positions under governments which at a very early period recognized the impor tance of this branch of medical investigation, and which provided a certain fixed and logical method of inquiry, have been enabled to present most accurate data in the matter of medico-legal examinations; and the writer acknowledges at the outset that he has availed himself, in the preparation of this article, of the results of their labors as found in their published works. He will only endeavor to present such facts as have already been found to obtain, and, if possible, to emphasize them by such illustrative cases as have come under his personal observation in the course of the past sixteen years, while acting under the provisions of the so-called medical-examiner law of Massachusetts.

Governmental Regulation.-Other countries, notably France and Germany, have for a long time had statutes which provided for the action of medical experts in criminal cases, or in those which were supposed to be such, and have even laid down with the greatest care and minuteness not only the legal steps to be pursued, but definite instructions as to the method of performing an autopsy and recording the results of the same.

The United States has not thus far advanced. In most States the old-fashioned, illogical, and practically worthless system of investigation, derived from the English custom, the coroner's inquest, still is the primary court of inquiry, and the solutions of questions of great moment to the State and the individual are still left to men who have neither the legal nor the medical training requisite to determine either the cause of the death in a given case or decide the responsibility, if there should be any.

The Massachusetts law still leaves much to be desired both in the matter of accurate phrasing and the complete instruction as to details of a medico-legal examination. It is, however, a great step in advance of anything which has obtained before, and has worked very well in practice. The essential points of the law are that in the first place it follows

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a logical order, and when there is to be an investigation into the manner of any suspicious death it puts the primary part of the inquiry-namely, Was this death one that resulted from violence, or did it result from natural causes?—into the hands of trained medical men, who under certain conditions and under certain proper restrictions make the autopsy; and it puts the second part of the inquiry-if there should be demonstrated the fact that the death was due to violence rather than to natural causes-into the hands of a judge of a court of first instance, who reports his finding to the superior court, and so everything is in train for prosecution. At the outset there was naturally doubt in the minds of the medical men acting under its provisions as to what really was meant by a dead body. They were required to act if they received notice that a dead body was lying within their district; but the courts had never decided what a dead body was. Was it a foetus in the very early stages of development? Was it a child that was at viable term, say at the period from one hundred and eighty to two hundred and ten days, or must it be a child at term to be considered a body within the meaning of the law?

Accepted Period of Life.—Medically, a foetus at the fourth or fifth month, although incapable of independent life, is a human being; but up to 1893 there had been no decision as to its status in law, that is, by the Massachusetts courts. The laws of foreign countries had made the distinction that a child must be wholly born alive before it could be the subject of an assault, and had even gone further, and decided that a child who was born alive and had lived not only for hours, but even days, but who on account of some congenital deformity, such as atresia of the rectum or the oesophagus, was incapable of sustaining independent life, is not a human being within the meaning of the law, whether civil or criminal. On the other hand, a child who had been born alive at a time when it was capable of sustaining a life independent of the mother, even if it was born prematurely, would be a subject of criminal assault like any other human being. During the present year, in the course of a trial for infanticide it was found that there had been no decision on this point in the State of Massachusetts, and for the first time the law was made, following the English law, that it must be proved that the child had been wholly born alive and capable of maintaining a separate existence before a charge of infanticide could be sustained.

Whether this law has been established by the courts of other States or not, the writer has no knowledge; but it is probable that if it is to be established it will be on the same lines. Such legal requirement, of course, increases the difficulty of securing the conviction of persons charged with killing a new-born child; but that is a matter which more nearly concerns the bar and the judiciary than the medical jurist.

The medical jurist may be required to examine the body of a fœtus at any term when the question of pregnancy is involved; but in general, he has to consider that only as a dead body which has arrived at least at a period of development where it is capable of sustaining independent life-that is, from the one hundred and eightieth to the two hundred and tenth day, and later.

The Determination of Death.-At the above-named period and later, a dead body, as far as the purposes of forensic inquiry are concerned, is a dead human being, and an investigation into the cause of its death

may be necessary to assist the criminal courts; and, furthermore, an examination of a dead body may be necessary to establish certain civil rights, such as succession, by determining the period at which death has occurred.

This brings us naturally to the consideration of the signs of death, and the changes produced in the economy by the cessation of the vital

functions.

Identity of the Dead Body.-Before proceeding directly to that subject, however, it occurs to me that a few words on the question of establishing the identity of an unknown body may not be out of place, as such an inquiry would naturally precede the autopsy itself. I am indebted to Dr. C. A. Hebbert for very great assistance in the preparation of the portion of this article relating to this question of identity. His experience with Mr. Bond, of London, renders his work of great value, and several cases cited by him in the Westminster Hospital reports are exceedingly interesting.

The determination of the identity of human remains is one of the most important and often most difficult problems submitted to the medical jurist. It is especially interesting to the student of forensic medicine in the United States, as the nation is composed of people from all parts of the world. Not only are met members of all the European races, but also the negroid, Australoid, and Mongoloid races, each presenting different and distinct characteristics. The examination will also include the subordinate or mixed people, such as the mulatto, a mixture of the European with the negro, the mestizos, a mixture of the European and the American indigenes, and the zambos, a mixture of the American indigenes with the negroes, and in these sub-races the physical characters and proportions are necessarily modified. These sub-races are particularized, inasmuch as they are all prolific and not sterile, as is the marriage of the European with the Australoid.

Let us first consider the cases where the whole body or the whole skeleton has been found, and secondly where the body has been mutilated, dismembered, or partially destroyed, so that only a portion or portions have been discovered, and see how far, from such data as we have, we can identify the individual.

Such study will involve observation of the following points:

1. Race.

2. Sex.

3. Age.

4. Stature (including measurement of body and limbs).

5. Features (hair, nails, etc.).

6. Scars, moles, depressions on fingers by rings, or on legs by garters. 7. Deformities.

8. Occupation, as shown by stains on body or fingers, or tanning by exposure to the sun, callosities (bursæ, corns, etc.), the effects of pressure of dress on various parts of the body, the presence of foreign substances on the body (hair, straw, flour, etc.).

In addition to the above there is to be remembered the great value of photography, not alone in the case of the features, but also where several portions of a corpse are found at different intervals, and the question arises whether they belong to the same individual. In such a case, in addition to detailed measurements, photographs of the two arms

or of the two feet would be of material assistance in determining the question of identity.

1. Race. Where the corpse is entire and but partially decomposed, no great difficulty will be met, as the characters of the four great families are distinct; but it will be useful to bear in mind a brief summary of these features.

(a) The Australoid type, such as the coolies in southern India and the native Australians: skin chocolate-colored, hair black and wavy, the skull narrow or dolichocephalic, the brow ridges prominent, with a projecting or prognathous jaw, and thick lips; the nasal index platyrhine.

(b) The negroid type: the skin dark brown to black, the hair black, crisp, or woolly, the skull dolichocephalic, the brow ridges not prominent, the jaw prognathous, with fleshy, protuberant lips, the nose and nasal bones flat, the index being platyrhine.

(c) The Mongolian type, which includes the Chinese, the Japanese, and the American indigenes: skin from yellowish brown to a mahogany tint, the skull broad or brachycephalie, the hair black and straight, the brow ridges not prominent, the jaw not projecting except in the Esquimaux, the nose mesorhine, small and flat in the Japanese and Chinese, with oblique eyes, and the cheek-bones high. In some of the American Indians. the nose is prominent; but as we are dealing with such peoples as are commonly met with, it is not necessary to do more than specify the typical features of the main group.

(d) The whites, divided by Huxley into the Xanthochroi, or fair whites, with pale skin, fair, wavy, or curly hair, light-colored eyes, mesocephalic skull, jaw orthognathous, and nose leptorhine; and the Melanochroi, or dark whites, the complexion darkening to a sallow or swarthy hue, the hair dark, and the eyes brown or black, the skull mesocephalic, with orthognathous jaw and leptorhine nose.

The comparison of the foregoing characteristics will at once decide the question of the membership of a definite race; but as in the subraces the skull and facial points are modified by the mingling of types so that other and probably external circumstances will be required for a proper decision, these will be considered hereafter, chiefly under the discussion of features. (Vide Identity of the Living.)

No mention is made of the stature or size of races, as it is well known that the height of individual members of each race varies, the Melanochroi, for instance, though being smaller than the Xanthochroi as a rule, having among them large and powerful individuals, and in the negroid group the Bosjesman is much smaller than the average negro. The value of the various indices, cephalic, facial, and nasal, is as follows. The cephalic index is the comparison of the length of the skull to its breadth, the length being taken as 100. The length of the skull is taken from the ophryon to the occipital point, the breadth the greatest interparietal measurement. If the index is above 80 the skull is brachycephalic, as in the Mongoloid races; if from 75 to 80, mesocephalic, as in the whites; if below 75, dolichocephalic, as in the negroid and the Australoid races. For example, if the length is seven inches and the breadth five inches, the index is 71.4, or dolichocephalic. If the length is seven inches and the breadth six inches, the index is 85.7, or brachycephalic.

The gnathic index is reckoned by comparing the basi-alveolar length with the basi-nasal length, the basi-alveolar length being taken from the

basion to the alveolar point, the basi-nasal from the basion to the nasion, the basi-nasal being taken at 100. Below 98 the jaw is orthognathous; from 98 to 103, mesognathous; above 103, prognathous, as in the negroid or Australoid groups.

The nasal index is the comparison of the height of the aperture with the width, the height being from the nasion to the sub-nasal point, the width being the greatest transverse diameter of the anterior aperture, the height being taken as 100. If below 48, leptorhine; from 48 to 53, mesorhine; above 53, platyrhine, as in the negroid.

These indices are here exploited to furnish aid to such as may be obliged to examine a case where the head or skull alone is presented for investigation, and where the first step toward determining identity is the fixing the race, though such minute descriptions and measurements are rarely necessary. Still, the medical jurist should observe everything when he is examining a dead body, and this applies to the part as well as the whole, and in any medico-legal inquiry it is not always possible at the outset to say what may be of the most vital importance in the case before its conclusion.

The method of arriving at the above-mentioned indices may be made more plain, possibly, by the example of an equation such as the following:

Figs. 4 and 5 are intended to illustrate the above-mentioned measure

ments.

2. Sex. The distinction of sex where a whole unmutilated corpse is presented for inspection is too obvious to require comment. On the other hand, if the body is mutilated and decomposed, great care is required on the part of the expert, and still further difficulties are presented when it is the skeleton alone with which he has to deal. Indeed, there may be cases where the whole body has been so mutilated that it is by the preparation of the skeleton alone that an idea of the sex may be formed. Just such a case might have occurred in one of the so-called Whitechapel murders in London, in the years 1887-89. Here nine women were murdered and mutilated by an unknown assassin.

In the particular illustrative instance, the woman was murdered in a bedroom. The body was naked when found. The eyebrows, eyelids, ears, nose, lips, and chin had been cut off, and the face gashed by numerous knife-cuts. The breasts had been cut off, and the whole abdominal parietes, together with the external organs of generation, had been removed. The skin and much of the muscular tissue, not, however, exposing the bone, had been slashed away from the anterior aspect of the thighs as far as the knees. The abdominal viscera and pelvic viscera, including bladder, vagina, and uterus with appendages, had been torn from their cavities, and in fact there was no sign of sex except the long hair upon the head, and, as is well known, that alone is not a posi