No. 832.

LONDON, SATURDAY, AUGUST 10, 1839. [1838-39.

CLINICAL OBSERVATIONS

ON

PSEUDO-MORBID APPEARANCES;DELIVERED AT CHARING-CROSS HOSPITAL,

BY W. D. CHOWNE, M.D.,

Physician to the Hospital.

ON a former occasion, when speaking ofecchymosis from blows and sprains, and- other similar hurts, I spoke of the red andthe blue ecchymoses as being those whichwe are in the habit of seeing immediately,or, at least, very soon, after an injury; insome severe instances a few minutes willsuBice. You had opportunities of seeingseveral which exemplified this ; and wefurther saw that the yellow colour in allthese cases was a secondary result. Sincethat time other cases have fallen under our

observation, and we will briefly notice theirprogress.A boy, about two years of age, of light

complexion, with light hair and eyes, wasknocked down by a cab; he received asevere scalp wound, and either a sprain or abruise on the foot.

July 25, six, P.JBT. Immediately after theaccident he was admitted into the hospital;eighteen hours after there was an extensiveindigo blue on the upper part of the foot.

26, twenty hours after. It was still thesame colour.

27, forty hoars after. The blue had begunto change to green at the margins.

Aug. 1, seven days from the accident. Theblue has been gradually becoming moregreen ; there is not, up to the present time;a yellow appearance.

July 30. A woman, aged 40, of dark com-plexion, had received from her husband,who was in liquor, several bruises; amongothers, severe blows on the face. She wasadmitted at ten, P.M., immediately after theoccurrence.

31, three, P.M., seventeen hours after theinjury. The upper and under eyelids ofboth eyes had each a deep ecchymosis ra-

ther of the purple than the indigo blue ;they were quite defined; the lower lidsoedematous.Aug. 1, two, P.M., forty hours after. Ap-

pearances remained the same. She has othermarks from blows, which follow the samecourse.

July 30. A youth, about 16 years of age,was helping to unload a heavily laden cart;the horse had been removed, and the greaterweight being behind, the load tilted (as it iscalled) backward; in endeavouring to pre-vent this he was forced down, but the cartcaught his knees in such a way that his legsremained upright, like two perpendicularprops, and for some time bore the wholeweight, which was- very great; there was nofracture or dislocation.At four o’clock, A.M., immediately after

the accident, he was brought to the hospital,complaining chiefly of pain in the ankles.

Three, P.1I1., eleven hours after. The rightankle was red, and slightly swollen.

31, four, P.M., thirty-six hours after. Theright ankle was still slightly swollen, andhad a very faint livid hue.Aug. 1, four, P.M., forty hours after. The

discolouration had become rather darker,and inclined more to parchment colour.W. Inwood, aged 30, fiir complexion,

was working upon a scaffold, on which therewas a great weight of bricks ; he fell withthe scaffold and the bricks, from a height ofsixty feet, to the ground.

July 30, at nine, A.M., immediately afterthe accident, he was brought to the hos-pital ; had bruises and slight abrasions onthe face; a severe sprain of the ankle, and afractured arm.At three, P.:l1., six hours after the acci.

dent, had swelling of the instep of the footthat had been hurt, with diffused indigo-blue ecchymosis over nearly the whole of itssurface.

31, three, P.M., thirty hours after the hurt.The blue colour remained, mingled withfaint shade of green.

Aug. 1, one, v.rr.,fifty-two hours after. Thegreen had begun to change to yellow.

July 30. John Challen, aged 30, of darkcomplexion, was working with Inwood,and also fell to the ground, with the scaf.

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fold and the bricks, from a height of sixtyfeet.At nine, A.M., immediately after the acci.

dent, he was brought to the hospital. Hehad severe scalp wounds, and a compoundfracture of the leg; complained of severepain in his back, and at the scrobiculuscordis; and had several severe bruises.One of these was on the arm, and three on ithe forearm, all so severe that there wasabrasion and swelling in each. ’

Three, P.M., six hours after the accident,that on the arm presented a faint indigo-blue ; one on the outside of the forearm,near the elbow ; one on the outside of theforearm, near the wrist; and one on theinside of the forearm; all presented a simi-lar appearance.

31, three, P.M., thirty hours after the acci-dent. The ecchymosis on the arm still blue;that on the forearm, nearest the elbow, adeeper blue than before. It is abun-dantly dotted with a still deeper blue be-neath the cuticle; there is a faint yellowdiffusing itself from this all around, espe.cially towards the ecchymosis near the

wrist; the yellowness is in parts which hadact been blue. The ecchymosis near thewrist as on the previous day ; that on theinside of the arm more blue, and has alsothe dotted appearance.Aug. 1, three, P.M., fifty-four hours after

the aeeident. That on the arm retains the in-

digo shade of blue; that on the arm, nearestthe elbow, is giving place in some parts toa purplish hue; in others to greenish-yel-low ; that on the, forearm, nearest the elbow,is growing fainter; the shade the same ;that near the wrist is growing fainter; thehue the same as at the report thirty hoursafter; that on the inside of the forearm ischanging from blue to purple, the marginbecoming of a greenish-yellow.

There was, also, a severe blow, with abra-sion, on the inner condyle of the other arm.He was bled from this arm, and at the timethere was only a faint discolouration; thissubsequently became intense, but its formwas exactly defined by the ligature, put onin the usual way. The deep, intense mul-berry-purple ceased abruptly at the partsencircled by the ligature ; under the liga-ture, and for some distance beyond, therewas a faint shade of yellow; this was notnoticed until the ligature (not being longernecessary) was removed ; the ecchymosis ’was from the bruise, not from the orifice Imade in bleeding. ’

There is also another somewhat similarcase, of which I will remind you. Theman who fell on the edge of a stair, andfractured the patella, of whom I spoke on aformer occasion, had one bandage appliedabove the knee and another below it; a

tape was passed from one to the other, onthe outside of the knee, to prevent theirreceding from each other. From the vio-

lence of the blow on the knee an intenseblue ecchymosis ensued on the outside ofthe knee ; it was bounded above by the onebandage and below by the other; the bluedid not spread beyond either, and it wasdivided perpendicularly by the pressure ofthe tape, which passed between the two;the skin under the tape retained its naturalcolour. It is desirable that you should re-collect the effect of these bandages, parti-cularly in connection with the subject ofecchymosis in the event of death by hang-ing. We perceive that in all these instancesred and blue, with their intermediateshades, were the primary colours, and thatyellow, with its occasional shades of green,were secondary appearances; and it is wor-thy of recollection, that in Challen’s casefour were so severe that there was bothabrasion and swelling.To return to the subject of ecchymosis by

ligature.In determining whether death by hanging

has been sudden or not, we shall be assistedby taking into consideration the immediatecause of death in persons who die by thatprocess. It has been ascribed by different

physiologists to very different causes; forexample,-To interrupted circulation through the

blood-vessels of the neck, causing apo-plexy ;

To interrupted passage of air to and fromthe lungs, causing asphyxia;

To the combined influence of both apo-plexy and asphyxia;

To pressure on the nerves of the parvanm ’ and

To laceration of the ligaments of the neck,or fracture of the cervical vertebrae.

The circumstances which have been re-garded as proofs of death by apoplexy are,The livid hue of the face ;The actual pressure which is in most

cases inevitable on the vessels going toand from the head; and

The frequent existence of apoplectic con-gestions and extravasations within thecranium.

The livid hue of the face, however, cannotbe properly regarded as a strong indicationof apoplexy ; it may be occasioned bypressure on the external jugular veinsalone, which receive blood from the vesselsexternal to the cranium. The externalveins, indeed, may be greatly distendedwhile there is but little change in thosewithin the cranium. Dr. Rhinelander re-cords the case of a person executed, in whom11 the superficial veins were greatly dis-tended with dark fluid blood, while thecarotids and internal jugulars were empty;"and Dr. Kellie, of Leith, mentions threeexamples of persons executed in whom " theveins external to the cranium were fullydistended, while but little change was seeninternally." The livid hue of tlae face

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occurs in many kinds of death, especiallyin death from asphyxia, independently of

hanging ; the face is sometimes of thenatural colour, and it is occasionally evenwhiter than usual in persons who have cer-

tainly died of apoplexy; and the lividity isnot always present even in persons whohave died by hanging. In the course of a

judicial inquiry relating to a young womanwho had been found dead under suspiciouscircumstances, Dr. Channing stated that hehad seen fourteen cases of people hung, andin most of these the countenance was pale.Dr. Dunn, of Newport, confirmed this fromthe observation of four cases.

With respect to interrupted circulation,admitting that the cord does arrest thetransit of blood through the arteries andveins of the neck, such interruption is notfollowed by immediate death in analogouscases, as experiments show. We may,moreover, take this view of the question ofpressure on the vessels of the neck, that thepressure to be injurious must have one or

more of three effects :-It must either renderboth the artery and the vein impervious, orit must close the artery and leave the vein

pervious, or close the vein and leave theartery pervious. Should the artery and thevein both be rendered impervious, then thesevessels obviously can neither increase nordecrease the quantity of blood within thecranium ; and although the vertebral ar-

teries, from their protected situation, shouldstill carry blood to the brain the vertebralveins, being equally protected (for they alsopass through the foramina of the transverseprocesses of the cervical vertebrae), wouldcontinue to return it, and so preserve theequilibrium in that particular. Should thecarotid artery be closed and the internal

: jugular vein remain pervious, then anaemiarather than hyperaemia would be the result ;but should the artery remain pervious andthe vein impervious then, certainly,an accu-mulation of blood within the cranium mighttake place, and apoplexy be a probableresult.

Dr. Fleichman remarks that " when thecord is so placed round the neck as to com-press, in preference, the large vessels, andparticularly the venous ones, and at thesame time prevent the passage of the bloodbelow the constriction,apoplexy may follow."When we recollect, however, the situationof the carotid artery and its correspondingvein,-when we remember that they are injuxta-position and inclosed in the samesheath until they have reached the deep andprotected situation in the neck where (withina finger’s breadth of the cranium) they divideto pass through their canals, it certainlyappears to be far from obvious that a cordround the neck should compress, in prefer-ence, the large vessels, and particularly thevenous ones yet, in the event, of such occur-

rence, it would be a good presumptive ex.planation of the occurrence of apoplexy.With respect to these vessels it is more

probable that they should both escapepressure, especially if the knot should beover them, for, as we shall see, that part isgenerally less affected by the ligature thanothers, owing to the drawing upward of thecord and the falling away of the head fromthat particular point. It is possible that thebalance of circulation may be destroyed bythe obliteration of two vessels on one sideof the neck and one only on the other, butthis is a complication which we need notfollow out.We find numerotis instances of persons

who have been suspended so long that bothrespiration and circulation had either ceasedor become so faint as to be imperceptible,until, indeed, the cause or causes producingdeath had come into full action, yet suchpersons, upon resuscitation, have not pre-sented the usual phenomena attendant uponapoplexy,as paralysis, nor the less formidableconsequences. It is true that in describingtheir sensations they stated that they felt as ifgoing into a profound sleep, and Foderestates"that there were individuals living at Mar-seilles who, during the French revolution,were hung, and their lives saved in the

night-time, and who for a long time wereaffected with a ringing in the ears and deaf-ness ;" these, however, appear to have beenthe nearest approaches to apoplexy whichtheir conditions indicated.

The cases of a man and a woman whosurvived hanging are recorded by Wepper;the woman did not recollect anything,-theman stated that on the application of thecord he felt no pain, but seemed to sink intoa profound sleep. A case is recorded byMorgagni of a person who had survivedhanging, and who said that the first sensa-tion was flashes of fire before his eyes, andthat then he sunk into a profound sleep. Acase is recorded, and upon good authority,however incredible it may appear, of a gen-tleman who, to ascertain whether personswho were hung experienced any pain,actually performed the experiment on him-self, and was saved from a tragical end onlyby the accidental arrival of a friend, whocut him down. This is, perhaps, the mostwhimsical waste of scientific zeal that wasever put on record; it was seeking to knowthe result of an experiment the very natureof which experiment made it impossiblethat the result could be known.

In relation to the question of apoplexy,as the cause of death, Beck say:-" Infatal cases, as we shall presently show, thebrain exhibits all the ordinary appearancesof apoplexy." It is indubitable that many,perhaps the majority of cases do so, but it isequally certain that many do not; and it

appears to me that the passage requires acorresponding qualification. We need not

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travel out of the author’s admirable work,however, for examples of the frequency ofdeath by hanging, without apoplexy; and Iwould direct your attention especially tothe statements that, " In those dead from

apoplexy the brain will be gorged withblood, its vessels distended, and sometimesthere will be suffocation." * * * 11 Whenan individual expires from suffocation cere-bral congestions will be wanting, but thelungs will be engorged and filled with air."4 * * 11 Of the cases examined by Remernine appeared to have died from apoplexyand six from suffocation." On the subjectof asphyxia we have greater uniformity ofproof. That interruption to breathing is themostfrequent, and indeed the general, cause,appears from experiments of the most con- Iclusive character, which, indeed, while they iconfirm the doctrine that death is inevitable iunder interruption of the respiration, demon-strate with equal certainty that it is notinevitable under interruption to the circula-tion in the large vessels of the neck.

In numerous instances, and under a va-riety of circumstances (but all tending tothe same result), experiments have beenperformed. Animals suspended by the

neck, for example, with an orifice in thetrachea, between the ligature and the lungs;and they have been cut down, after anhour’s suspension, not dead, the respirationand circulation having proceeded during theexperiment. The relative position of theligature and the orifice have been reversed,and death immediately ensued. Such ex-periments you will find detailed in nume-rous works on physiology, forensic medi-cine, and others, each instance affording thedouble proof that interruption to the respira-tion does kill, and that interruption to thecirculation of the blood does not.A dog was made the subject of this expe-

riment ; after the trachea had been opened aslip.knot was passed round the neck, abovethe wound. The animal, though hanged,continued to live and respire ; the air wasadmitted and expelled through the openingin the trachea; the constriction was madebelow the orifice, and the animal died. Inanother instance a dog was hanged ; as soonas he became insensible the trachea wasopened below the ligature, and sensibilitywas restored.

According to Dr. Fleichman death ensuesfrom suffocation, more especially when " thecord is placed between the larynx and oshyoides," as the" pressure operates power-fully on the respiratory passages withoutso strikingly affecting the blood-vessels;"the distinction, however, appears to be toonice for practical purposes and safe physio-logical deductions ; that the air-passagewould be closed, and death ensue, there ap-pears to be no doubt, but it does appear tohe doubtful how far we may venture to rea-son upon the particular degree of pressure

to which the blood-vessels would be sub-jected under such circumstances. Suddendeath may also be produced by rupture ofthe ligaments of the neck and by luxation orfracture of the cervical vertebrae.

It has been stated that several execu.tioners in France performed their office insuch a manner as to save the lives of some,while others were irrecoverably killed, and,upon inquiry, they professed to have thepower of causing laceration of the trachea,and a luxation of the first cervical vertebrafrom the second, " by placing the knot ofthe cord under the neck, and then giving arotatory motion to the body at the momentwhen the ladder was taken away from underits feet." I must confess that I am ex-

tremely sceptical on this point, and shouldbe disposed to consider that in those caseswhere they " saved the lives of the crimi-nals," it was rather by an awkwardnessthan by an adroitness in the mode of execu-tion.On a previous occasion I have stated that

in this country our executions are not al-ways so complete as humanity demandsthat they should be, and attributed thedefect to some movement of the unhappysufferer while still on the’ platform, whichaltered the adjustment of the cord ; a causestill more likely to have this effect is the re-moval of a ladder from under the feet, andgiving a " rotatory motion" to the body atthe moment when it is cast ofl’. Luxationsand fractures of the vertebrae, and lacera-tion of the spinal chord, are necessarilymore likely to occur in proportion as thebody is heavy and the fall considerable;especially in those countries where the ex-cutioner, at the moment he casts off the suf-ferer from the ladder, springs upon his

shoulders, and throws upon his neck the ad-ditional weight of his own body.

l’

That we may occasionally meet with in-jury to the cervical vertebrae there is no

doubt; and in such event, in determiningthe influence that any given lesion may havehad on the suddenness with which life hasbeen extinguished, we must regard especiallytwo considerations, first, the exact situationof the lesion, and next the effect of suchlesion in accidents and injuries under ordi-nary circumstances. It would be irrelevantto our present subject to digress into a dis-cussion of these, but there is a broad gene-ral distinction which it may be desirable to

recal to your recollection, in order that youmay perceive the immediate bearing it mayhave on an investigation such as we are

contemplating., The distinction (suggested by Sir Astley

Cooper, in his work on dislocations) is, thatfractures and displacement of the cervicalvertebrae should be divided into two classes,

i -First, those which occur, above the thirdcervical vertebrae; seconoly, those whichoccur below it. In the first, if the accident

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is accompanied by the usual displacement,death is the almost immediate result, thephrenic nerves, having their origin in thethird and,fourth cervical pairs; in the secondit may be at a more or less distant period.It is scarcely necessary to say that this in-jury forms a rare exception to the generalrule.

I have enumerated amongst the immedi-ate causes to which the death is assigned,pressure on the nerves, but I need not domore than remind you of the experimentperformed on a rabbit, of which I spoke ona previous occasion.Upon considering, then, the degree of cor-

roborative evidence of death having beensudden, afforded by signs of either of thephenomena to which the fatal result is attri-buted by physiologists, it appears that wemay regard the pressure on the nerves asfaintly corroborative only; the presence ofapoplectic efl’usion, or of injury of the ver-tebral column, above the fourth cervical ver-tebra, as strongly corroborative ; and signsof complete and sudden interruption to re-spiration as proof amounting to absolutecertainty.

·

I have on a former occasion observed, thatin judging between morbid appearances onthe neck, from fatal suspension, and pseudo-morbid appearances produced by ligatureafter death, the distinction will be some-what embarrassing, and I have spoken ofthe peculiarities which tend to make it so.

In observing the progress of ecchymosis,produced even under circumstances the mostfavourable to its production, for example,by a blow ]n!11cted on a person who is nei-ther suffering from general nor from localdeficiency of vital action, either at the time

when the injury is inflicted, or subsequently,we have seen that the ecchymosis is not theresult of a few seconds; that it is the con-sequence of a succession of events; that thefirst is the pouring out of blood from vesselsstill under the influence of the heart’s actionand of the capillaries ; and the second, dif-fusion of that blood into the surroundingtissues.

In death by hanging, where the fatalevent occurs with the accustomed degree ofsuddenness, the action of the heart and thecapillaries ceasing, the blood is no longerforced out of the vessels, and, consequently,ceases to be propelled into the adjacent parts ;hence we perceive how widely dissimilarthe circumstances are, under which full andcomplete ecchymosis from a blow is formed,from those under which the incompleteecchymosis, from the ligature in hanging, isformed ; and we further see how similar thecircumstances are under which the morbidappearances from hanging, and those fromligature after death, occur.There is certainly a period of time, namely,

that between the tension of the ligature andthe cessation of vital action, during which

the condition of the body suspended beforedeath, and of that suspended immediatelyafter, are different; but the period of timeis so extremely brief, that, although theoccurrence of vital phenomena may not bewholly prevented, they are so suddenlyarrested (within a period of time, indeed,obviously less than is sufficient for the for-mation of ecchymosis), and the living bodyso soon becomes a dead body, that the re-spective visible results, although not exactlysimilar, cannot fail to bear an extremelyclose resemblance to each other.There are certain appearances, apart from

those connected with the situation of thecord, which we must not disregard ; someof these are of but little weight individu-ally, while others are important. I willfirst mention briefly those to which muchweight does not attach. The tongue, in

persons who have been hung, is occasionallythrust out and bitten, and has, therefore,been considered as a proof of death by sus.pension; but we must recollect that this isnot truly a sign of such death; that in thoseinstances where it does happen it is the re-sult of accident, and is determined chieflyby the situation of the ligature ; that it mayoccur in strangling by hand, without sus-pension ; that it occurs in epilepsy, andunder many other circumstances; and, finally,that it may be artfully done by a designingperson after death, in order to produce afalse impression.

Projection and suffusion of the eyes areenumerated as signs of death by hanging,but so are they also enumerated as signs ofdeath by asphyxia, and certainly are seenunder circumstances so various ’as not towarrant any confidence in their testimony.The same remark applies to lividity of thechest. The condition of some other partshave been considered to afford evidence ofhanging, but as they, too, are found underother circumstances of violent death, I willnot detain you by dwelling upon them;they, nevertheless, will require your atten-tion ; and in the pursuit of your studies inrelation to the effects of certain poisons,more especially arsenic, and of certain in-juries, more especially of some parts of thevertebral column, and of the nerves impli-cated in such injuries, you have acquired aknowledge of the facts which apply to thesubject.We will now enter into a comparison of

some of the appearances which may presentthemselves in the course of an investiga-tion ; and I scarcely need remind you thatin many instances the comparison will neces-sarily fail to present strong contrasts ; nei-ther should we be justified in imaginingthose contrasts to be greater than they reallyare; by so doing we may delude ourselvesinto a belief that we possess the certainmeans of discriminating between true mor-bid appearances and pseudo-morbid appear.

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ances; but our especial object is to guardagainst that delusion ; and our especial dutyis not to act upon the presumption that wepossess means of discrimination more precisethan we really do, and not to place more re-liance in any individual sign of distinction

than it is fully, fairly, and strictly entitledto. Orfila has stated, on the faith of severalexperiments, that he doubts whether in an-swering the question of suspension before orafter death we can go beyond probability.

In making a comparison between discolourations produced by the ligature in hanging,and one caused by a lig tture applied after death, we finu that-

In Morbid Discolourations produced by theLigature in Death by Hanging.

The discolouration may be blue or pur-plish, although it is generally either of adull lead colour, or a dirty yellow-brown.The discolouration, if death has been

slow, may extend beyond the mark of theligature, but generally it does not.The degree of discolouration will not de.

pend so much upon the weight of the body,the depth of the fall, or the time duringwhich it may have been suspended, as uponsuddenness of death.There may be no discolouration.

In Pseudo-morbid Discolourations produced byLigature from Hanging after Death.

The blue hue of ecchymosis is scarcelypossible, the general colour is a dirty yel.low-brown.The discolouration does not extend be.

yond the mark of the ligature.

The degree of discolouration will chieflydepend on the greater weight of the body,and the depth of fall, and the time duringwhich the body has remained suspended.

There may be no discolouration.

In making a comparison between the peculiarities of different depressions by the liga-ture in hanging, and that caused by a ligature applied after death, we find that-

In the event of Death by Hanging. In the erent of the Ligature being applied qfterDeath.

Suspension for a period sufficiently longto cause death, is most generally productiveof depression.

A body cut down immediately may bewithout depression.

Depression is most likely to occur in fatpersons, more especially if the suspensionhas been continued until the adipose sub-stance of the neck has become cold, andhas taken the form of the ligature.The depression does not become sponta-

neously obliterated within any moderatespace of time.

The depression generally is not removed,and is sometimes scarcely diminished, byrubbing with the hand.

Suspension may be continued to a periodof time much longer than would be suffi.cient to cause death, without producing de-pression.A body cut down immediately or soon

after suspension, would very probably bewithout depression.The depression would be less deep or less

permanent in proportion as the period ofapplying the ligature, even in fat persons,was more distant from the time of death.

The depression is very apt to becomespontaneously obliterated within a moderatetime.The depression frequently may be remov-

ed, and is generally diminished, by rubbingwith the hand.

Some assistance will be gained by com-paring the situation and the direction of themark. If death has taken place from hang-ing the mark will be near the upper part ofthe neck ; it will be in an inclined or obliquedirection, and the mark of the knot will beat the highest part.

If the ligature has been put on the body,either during life to strangle, or after death,to produce the appearance of its havingbeen suspended, there is a great probabilitythat the mark would not be at the upperpart of the neck; that it would not be in-clined or oblique in its direction, and thatthe mark of the knot would be either on alevel with the mark encircling the neck, or

that it would be even below it.Dr. Fleichman, in explaining, according

to his views, the particular situation of the

cord, which at one time may produce deathby asphyxia, in another by apoplexy, and inanother by a combination of these, statesthat " the mixed state, or death from a com-bination of suffocation and apoplexy, pro-bably ensues when the cord is placed belowthe larynx," and says its direction must ne-cessarily be horizontal, and it will interruptthe passage of air, as well as compress theblood-vessels. The particular part of thispassage to which I wish to direct your at-tention, is that which relates to the horizon-tal direction of the cord.

I have, in reference to the subject of dis-crimination between the mark of a cord on a

person who has been suspended, and onewho has not, stated that the direction of thecord in the one case will be indirect or ob-

lique, that in the other it may be direct;

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and I do not consider that we may safely Iadopt the opinion that the cord, in a personwho has died by hanging, can be horizontal,without further observation and confirmationthan it has yet received.

In public executions the rope is so adjust-ed that the knot is on one side, near themastoid process, behind the ear ; at this

part the cord is necessarily drawn up, andgives an inclined or oblique direction to themark, so far as the mark continues ; but atthis point there is frequently no mark, as thehead, by falling forward or to one side, I,draws the integument of the neck awayfrom that close contact with the rope whichexists at other parts. In homicidal and siii-cidal hanging there would be, at some part,although probably not at the same, a similardrawing up of the knot; the head wouldincline forward, or to one side, and a spacewould be left not embraced by the cord soclosely as the other parts. Dr. Monro, whospeaks from frequent personal examinationof the necks of persons killed by hangingsays, " that the mark upon the skin ends oneach side in a narrow point below the ear,and does not extend across the back part of Ithe neck." This absence of mark is parti-cularly likely to occur where the wholeweight has not been on the cord, and thebody has leaned forward,-some curious ex-amples of which have occurred. In anycase there may be abrasions of the cuticle,and, as a general rule, in case of abrasionsby ligature, whether produced before or

after death, they are more likely to be dis-coloured, and to retain the discolouration,than parts in which the cuticle remains en-tire.We perceive in these comparisons many

points of resemblance, and but few in whichthe differences are strongly characterised ;there are certain general appearances, how-ever, from which inferences of considerableimportance may be drawn : discolourations,for example, from hyperaemia, the effect ofgravitation.

Should the body have hung sufficientlylong for the results of gravitation to havebecome visible, and should it be examined ’,immediately, or at least within a short pe.riod from its being cut down, the hyperaemiawill be found in parts indicating that thegeneral position of the body was eMct whenthe discolourations took place.

Should the lividity above the ligature notbe uniform, then it will be found to be great-est at the lowest parts of the face, and onthat side to which the head had inclined,and which may be called the under side.Dr. Beck states that sometimes one side ofthe face is more livid than the other, andDr. Kellie ascribes this to the position of thecord. He considers that as the executionergenerally adjusts it on one side of the neckby the weight of the body, it slips upwardson that side towards the mastoid process,

and that there is consequently a space cor-responding to the rising of the noose, whichis not embraced by the cord, and where theveins are subjected to little pressure. Youhave had an opportunity of seeing, withinthe last few days, an instance of extremehyperaemia in one side of the face, the con-sequence of my having placed the head forsome time in such a position that it was ra-ther lower than the other; the ear and otherparts on the upper side were quite white,the parts corresponding on the lower sidequite livid ; although something may, per-haps, in the cases alluded to by Dr. Kellie,dtpend upon the position of the cord overthe vein, I am rather disposed to considerthat gravitation alone would fully accountfor the greater lividity of the one aide.Above the ligature the part nearest to it

will be the darkest; below the ligature, theparts nearest to it will be the palest. In thesuperior and inferior extremities the hyperae.mia will be more conspicuous than in thebody, and of these, in the most dependingparts ; it will also be diffused equally allaround them, and will not be accumulatedin the back part of the thigh, and in thecalves of the legs, nor in those parts of thearms which, had the body been recumbent,would have been the lowest.Should a body which has not been bereft

of life by hanging, have lain some time (andwhich time need not be long), and then besuspended, in order to produce a wrong im-pression, early examination would afford anopportunity of discovering certain anoma-lies, and of detecting the fraud. It is neces-sary, however, that the examination shouldbe made before the body has been suspendedsufficiently long for new results to have takenplace. A body which has lain long beforeit is suspended will have, for some timeafter suspension, hyperasmia in parts whichwere lowest while the position was recum-bent ; and hence a strong indication wouldbe afforded that the suspension had takenplace after death. Should the body then beallowed to remain in the erect position, andshould the hypersemia leave the back andthe loins, and descend into the extremities,and diffuse itself around these, instead ofbeing confined to those parts which were thelowest, then the evidence would be stillmore convincing; and, finally, should restor-ing the body to the refumbent position bringback the hyperaemia to the parts it originallyoccupied, the circumstances would affordcorroboration extremely strong, if not con-clusive, of the suspension having takenplace after death.We must, on the other hand, not forget

that a body actually deprived of life byhanging, would, even after it has remainedsuspended sufficiently long for hyperaemiatohave taken place in the depending parts, besubject to transposition of the discoloura-

712

tion, upon its being placed in a position tofavour such change.

It is obvious, however, that in any casethe examination, in order to be substantiallyuseful, should be made early, and this maybe cited as one striking example in whichevidence the most important to the ends ofjustice may be lost, either from neglecting toconsult persons able to investigate the sub-ject with all the advantages which medicalscience can supply, or from deferring to con-sult them until the appearances from whichconclusions may have been drawn, have be-come either blended with others, or totallyobliterated in the process of decomposition.

THE CIRCULATING SYSTEM.

[WE have been favoured by a friend withthe following analysis of a valuable work,translated from the manuscript of its author,Professor Charles Henry Schultz, M.D., ofBerlin.-ED. L.]

I. I have proved that in the living bloodare found living constituent particles, orrather organic elements, quite distinct fromthe chemical elements into which the bloodhas hitherto been separated, and which wereconsidered as the only constituent parts. Ihave likewise demonstrated the true rela-tions of the organic elements with the che-mical elements of the blood.H. 1 have proved that the organic ele-

ments, that is to say, the vesicles of theblood, which had been called the globules,are not, as has hitherto been supposed, per-manent and motionless, but are in a conti-nual state of evolution and regeneration,whether in the embryo or in digestion, andthat afterwards they are dissolved and re-jected from the body by the secretions, inproportion as new vesicles arise. Thus thevesicles of any one animal are not equalamongst themselves, but they assume asmany forms and conditions as there are de- igrees of development. I believe I have

I

been the first to give a history of the evolu- Ition of the blood. III. By this means we are enabled to un- ’

derstand the true organisation of the so-called globules of blood, and of what I callthe plasma, as well as their destination anduse, and their pathological alterations.The following is a brief account of the

results contained in my work upon the cir-culation :-

I. Exposition of the Organic Elements of theBlood.

1. There are but two organic elements inthe living blood, viz., the plasma and thevesicles of blood. The serum is not foundin the living blood, but forms, as a chemical

product, by coagulation after death. Thesame in regard to the fibrine, which like-wise does not exist in living blood, but is aplastic product of the living plasma, whichdies by coagulation. Nevertheless, all phy-siologists, from Leeuwenhoeck and Hallerto the present day, have supposed that the.living blood contained serum, in which the

globules of blood floated. There was onlythis difference of opinion, that Berzelius hadadmitted that the serum contained, in che-mical solution, a portion of fibrine; andProfessor Mutter had given this chemicalsolution the name of liquor sanguinis; butthere exists neither pure serum nor this che-mical solution in the blood of the livingbody ; for if we separate, as stated above,.the vesicles of blood from the fluid in whichthey swim, we shall find that this colour-less liquid will coagulate, or rather congeal,by itself, which congelation does not takeplace in the true serum ; the serum is form-ed much later after the death of this liquid.By the coagulation of this liquid the colour-less fibrine is formed, which has an organictexture, a texture never found in a solidseparated from a chemical solution. More-over, this formation of fibrine does not takeplace at all times, and under all circum-

stances, hut only whilst the blood is still

living. The fibrine will never separate fromthe blood which was already dead, in thebody itself, as in the case of persons whohave died by apoplexy, by narcotic poisons,or struck by lightning. It is also possibleto prevent the formation of fibrine by addingto the living blood salts, which do not affectthe fibrine when once formed. Thus thecolourless liquid of the blood is neither pureserum, nor serum with any kind of chemicalsolution whatsoever, but an organic liquid,.which forms, by its plastic force, fibrine, andof which the serum is a chemical productafter death. It is on this account that Ihave called the living liquid the plasma;this latter is the true nutritive and plasticportion of the blood, from which all the

organs of th8 body are formed and nou-rished.

2. The plasma may be separated from thevesicles of living blood by different modes.1. If we add culinary salt, or some otherneutral salt, to fresh blood, the plasma re-mains liquid for some time, so that in thestate of repose the vesicles collapse, andthe plasma becomes clear. This method is,however, imperfect, because the salt altersthe plasma and the vesicles. 2. If a cylin-drical glass be filled with blood flowing froma vein or an artery, after having corked theglass, to prevent the contact of the atmo--spheric air with the blood, we shall see,after it has been at rest a few moments inthe glass, a perfect subsidence of the redparticles, whilst the plasma floats colour-less. The same takes place in blood re-ceived into portions of intestine, or blood-