the body temperature may be 112° F., the pulse is full, and a peculiar
pungent odour is given off from the skin. Coma, convulsions with
(rarely) delirium, may precede death. _Treatment_ consists in lowering
the body temperature by application of cold cloths, stimulants,
strychnine or digitalin hypodermically.
XXIII.--PREGNANCY
The signs of the existence of pregnancy are of two kinds, uncertain and
certain, or maternal and foetal. Amongst the former class are
included--Cessation of menstruation (which may occur without pregnancy);
morning vomiting; salivation; enlargement of the breasts and of the
abdomen; quickening. It must be borne in mind that every woman with a
big abdomen is not necessarily pregnant. The tests which afford
conclusive evidence of the existence of a foetus in the uterus
are--Ballottement, the uterine souffle, intermittent uterine
contractions, foetal movements, and, above all, the pulsation of the
foetal heart. The uterine souffle is synchronous with the maternal
pulse; the foetal heart is not, being about 120 beats per minute.
Evidence of pregnancy may also be afforded by the discharge from the
uterus of an early ovum, of moles, hydatids, etc. Disease of the uterus
and ovarian dropsy may be mistaken for pregnancy. Careful examination is
necessary to determine the nature of the condition present. Pregnancy
may be pleaded in bar of immediate capital punishment, in which case the
woman must be shown to be 'quick with child.' A woman may also plead
pregnancy to delay her trial in Scotland, and both in England and
Scotland, in civil cases, to produce a successor to estates, to increase
damages for seduction, in compensation cases where a husband has been
killed, to obtain increased damages, etc. A woman may become pregnant
within a month of her last delivery.
In cases of rape and suspected pregnancy, it must be borne in mind that
a medical man who examines a woman under any circumstances against her
will renders himself liable to heavy damages, and that the law will not
support him in so doing. If, on being requested to permit an
examination, the woman refuse, such refusal may go against her, but of
this she is the best judge. The duty of the medical man ends on making
the suggestion.
XXIV.--DELIVERY
The signs of recent delivery are as follows: The face is pale, with dark
circles round the eyes; the pulse quickened; the skin soft, warm, and
covered with a peculiar sweat; the breasts full, tense, and knotty; the
abdomen distended, its integuments relaxed, with irregular light pink
streaks on the lower part. The labia and vagina show signs of distension
and injury. For the first three or four days there is a discharge from
the uterus more or less sanguineous in character, consisting of blood,
mucus, epithelium, and shreds of membrane. During the next four or five
days it becomes of a dirty green colour, and in a few days more of a
yellowish, milky, mucous character, continuing for two to three weeks.
The change in character of the lochial discharge is due to the quantity
of blood decreasing and its place being taken by fatty granules and
leucocytes. The os uteri is soft, patulous, and its edges are torn. The
uterus may be felt for two or three hours above the pubis as a hard
round ball, regaining its normal size in about eight weeks after
delivery. Most of these signs disappear about the tenth day, after which
it becomes impossible to fix the date of delivery.
In the dead the external parts have the same appearance as given above.
The uterus will vary in appearance according to the time elapsed since
delivery. If death occurred immediately after delivery, the uterus will
be wide open, about 9 or 10 inches long, with clots of blood inside, and
the inner surface lined by decidua.
The signs of a previous delivery consist in silvery streaks in the skin
of the abdomen, which, however, may be due to distension from other
causes; similar marks on the breast; circular and jagged condition of
the os uteri (the virgin os being oval and smooth); marks of rupture of
the perineum or fourchette; absence of the vaginal rugæ; dark-coloured
areola round the nipples, etc. The difference between the virgin _corpus
luteum_ and that of recent pregnancy is not so marked as to justify a
confident use of it for medico-legal purposes.
XXV.--FOETICIDE, OR CRIMINAL ABORTION
This consists in giving to any woman, or causing to be taken by her,
with intent to procure her miscarriage, any poison or other noxious
thing, or using for the same purpose any instruments or other means
whatsoever. It is a felony to procure or attempt to procure the
miscarriage of a woman, whether she be pregnant or not, and it is a
felony for the woman, if pregnant, to attempt to procure her own
miscarriage. It is a misdemeanour for any person or persons to procure
drugs or instruments for a like purpose. It is not necessary that the
woman be _quick_ with child. The offence is the intent to procure the
miscarriage of any woman, _whether she be or be not with child_. When
from any causes it is necessary to procure abortion, a medical man
should do so only after consultation with a brother practitioner. Even
in these cases there is no exemption legally. Any medical man who gives
even the most harmless medicine where he suspects the possibility of
pregnancy may render himself liable to grave suspicion should the woman
abort.
In medicine, an _abortion_ is said to occur when the foetus is expelled
before the sixth month; after that it is _premature birth_. In law,
however, any expulsion of the contents of the uterus before the full
time is an _abortion_ or _miscarriage_.
In deciding whether any substance expelled from the uterus is really a
foetus or a mole, and therefore the result of conception, or the coat of
the uterus, and unconnected with pregnancy, the examination of the
substances expelled must be carefully made. Moles are blighted foetuses.
An examination of the woman will be necessary, though it is not easy
during the early months of pregnancy, and especially in those who have
borne children, to say whether abortion has taken place or not. The
history must be inquired into; the regular or exceptional use of drugs
to promote menstruation is important, for in the former case no criminal
intent may exist, although pregnancy be present. The state of the
breasts, the hymen, and the os uteri, should all be carefully examined.
Putting a few apparently unimportant questions as to the frequent use of
purgatives, the presence or absence of constipation, will often assist
the diagnosis as showing that the woman has acted in an unusual manner.
Abortion may be procured by the introduction of instruments, by falls,
violent exercise, blows on the abdomen, etc. In the hands of ignorant
persons the use of instruments (sounds, bougies, skewers, etc.) is
attended with great danger. Perforation of the vaginal walls, bladder,
cervix, or uterus, may follow their use. Septic pelvic peritonitis may
ensue, and the woman may lose her life. The person who has employed such
means for inducing abortion is liable to be charged with the crime of
murder. There is no evidence to show that ergot, savin, bitter-apple,
pennyroyal, or any other drug administered internally, will cause a
woman to abort, except when taken in such large doses that actual
poisoning results, with inflammation of the contents of the true
pelvis. In such cases reflex uterine contractions may be set up, and
abortion may follow. Diachylon pills are largely employed to induce
abortion, and very often the woman taking them suffers severely from
lead-poisoning.
XXVI.--INFANTICIDE
Infanticide, or the murder of a new-born child, is not treated as a
specific crime, but is tried by the same rules as in cases of felonious
homicide. The term is applied technically to those cases in which the
mother kills her child at, or soon after, its birth. She is often in
such a condition of mental anxiety as not to be responsible for her
actions. It is usually committed with the object of concealing delivery,
and to hide the fact that the girl has, in popular language, 'strayed
from the paths of virtue.' The child must have had a separate existence.
To constitute 'live birth,' the child must have been alive after its
body was entirely born--that is, entirely outside the maternal
passages--and it must have had an independent circulation, though this
does not imply the severance of the umbilical cord. Every child is held
in law to be born dead until it has been shown to have been born alive.
Killing a child in the act of birth and before it is fully born is not
infanticide, but if before birth injuries are inflicted which result in
death after birth, it is murder. Medical evidence will be called to show
that the child was born alive.
The methods of death usually employed are--(1) Suffocation by the hand
or a cloth. (2) Strangulation with the hands, by a tape or ribbon, or by
the umbilical cord itself. (3) Blows on the head, or dashing the child
against the wall. (4) Drowning by putting it in the privy or in a bucket
of water. (5) Omission: by neglecting to do what is absolutely necessary
for the newly-born child--_e.g._, not separating the cord; allowing it
to lie under the bed-clothes and be suffocated.
With regard to the question of the maturity of a child, the differences
between a child of six or seven months and one at full term may be
stated as follows:
Between the sixth and seventh month, length of child 10 to 14
inches--that is, the length of the child after the fifth month is about
double the lunar months--weight 1 to 3 pounds; skin, dusky red, covered
with downy hair (lanugo) and sebaceous matter; membrana pupillaris
disappearing; nails not reaching to ends of fingers; meconium at upper
part of large intestine; testes near kidneys; no appearance of
convolutions in brain; points of ossification in four divisions of
sternum.
At nine months, length of child 18 to 22 inches; weight, 7 to 8 pounds;
skin rosy; lanugo only about shoulders; sebaceous matter on the body;
hair on head about an inch long; testes past inguinal ring; clitoris
covered by the labia; membrana pupillaris disappeared; nails reach to
ends of fingers; meconium at termination of large intestine; points of
ossification in centre of cartilage at lower end of femur, about 1-1/2
to 2-1/2 lines in diameter; umbilicus midway between the ensiform
cartilage and pubis.
Owing to the difficulty of proving that the crime of infanticide has
been committed, the woman may in England be tried for _concealment of
birth_, and in Scotland for _concealment of pregnancy_, if she conceal
her pregnancy during the whole time and fail to call for assistance in
the birth. Either of these charges would only be brought against a woman
who had obviously been pregnant, and now the child is missing or its
dead body has been found. It is expected that every pregnant woman
should make provision for the child about to be born, and so should have
talked about it or have made clothes, etc., for it. The punishment for
concealment is imprisonment for any term not exceeding two years. The
charge of concealment is very often alternative to infanticide. To
substantiate the charge, however, it must be proved that there had been
a _secret disposition of the dead body_ of the infant, as well as an
endeavour to conceal its birth.
A woman may be delivered of a child unconsciously, for the contractile
power of the womb is independent of volition. Under an anæsthetic the
uterus acts as energetically as if the patient were in the full
possession of her senses.
Nowadays a woman is rarely hanged for infanticide, and it is a mere
travesty of justice to pass on her the death sentence, well knowing that
it will never be executed.
XXVII.--EVIDENCES OF LIVE BIRTH
The signs of live birth prior to respiration are negative and positive.
A negative opinion may be formed when evidence is found of the child
having undergone intra-uterine maceration. In this case the body will be
flaccid and flattened; the ilia prominent; the head soft and yielding;
the cuticle more or less detached, and raised into large bullæ; the skin
of a red or brownish-red colour; the cavities filled with abundant
bloody serum; the umbilical cord straight and flaccid.
A positive opinion is justified when such injuries are found on the body
as could not have been inflicted during birth, and are attended with
such hæmorrhage as could only have occurred while the blood was
circulating. Fractures of the cranium from accidental falls (precipitate
labour) are as a rule stellate, and are situated on the vertex or in the
parietal protuberance. The fractures from violence are more extensive,
usually depressed, and accompanied by laceration of the scalp.
The evidences of live birth after respiration has taken place are
usually deduced from the condition of the lungs, though indications are
also found in other organs. The diaphragm is more arched before than
after respiration, and rises higher in the thorax in the former case
than in the latter. The lungs before respiration are situated in the
back of the thorax, and do not fill that cavity; they are of a dark,
red-brown colour and of the consistence of liver, without mottling.
After respiration they expand and occupy the whole thorax, and closely
surround the heart and thymus gland. The portions containing air are of
a light brick-red colour, and crepitate under the finger. The lungs are
mottled from the presence of islands of aerated tissue, surrounded by
arteries and veins. The weight of the lungs before respiration is about
550 grains, after an hour's respiration 900 grains; but this test is of
little value. The ratio of the weight of the lungs to that of the body
(Ploucquet's test), which is also unreliable, is, before respiration,
about 1 to 70; after, 1 to 35. Lungs in which respiration has taken
place float in water; those in which it has not, sink. There are
exceptions to this rule, on which, however, is founded the _hydrostatic
test_. As originally performed, this test consisted merely in placing
the lungs, with or without the heart, in water, and noticing whether
they sank or floated. The test is now modified by squeezing, and by
cutting the lungs up into pieces.
The objections to the test as originally performed are--(1) That the
lungs may sink as the result of disease--_e.g._, double pneumonia. (2)
That respiration may have been so limited in extent that the lungs may
sink, owing to large portions of lung tissue remaining unexpanded
(_atelectasis_). (3) Putrefaction may cause the lungs to float when
respiration has not taken place. (4) The lungs may have been inflated
artificially. Few of these objections apply, however, when the
hydrostatic test, modified by pressure, is employed. To take these
objections in detail, it may be stated: (1) If the lungs sink from
disease, the question of live birth is answered. (2) This objection is
too refined for practical use. The lungs sink, there is an absence of
any of the signs of suffocation, and the matter ends. The examiner has
only to describe the conditions which he finds, and is not required to
indulge in conjectures as to the amount of respiration which may or may
not have taken place. (3) Gas due to putrefaction collects under the
pleural membrane, and can be expelled by pressure, and is not found in
the air cells. The lungs decompose late, hence in a fresh body
putrefaction of the lungs is absent; in a putrefied child, if the lungs
sink, it must have been stillborn. The so-called _emphysema pulmonum
neonatorum_ is simply incipient putrefaction.
The lung test simply shows that the child has breathed, but affords no
proof that the child has been born alive. The child may have breathed as
soon as its head protruded, the rest of the body being in the maternal
passages. The child is not born alive until it has been completely
expelled, although it is not necessary that the umbilical cord should
have been cut.
In addition to these tests, live birth may be suspected from the
following conditions: The _stomach_ may contain milk or food, recognized
by the microscope and by Trommer's test for sugar; the _large
intestines_ in stillborn children are filled with meconium, in those
born alive they are usually empty; the _bladder_ is generally emptied
soon after birth; the _skin_ is in a condition of exfoliation soon after
birth. The _organs of circulation_ undergo the following changes after
birth, and the extent to which these changes have advanced will give an
idea of how long the child has lived: The _ductus arteriosus_ begins to
contract within a few seconds of birth; at the end of a week it is about
the size of a crow quill, and about the tenth day is obliterated. The
_umbilical arteries and vein_: the arteries are remarkably diminished in
calibre at the end of twenty-four hours, and obliterated almost up to
the iliacs in three days; the umbilical vein and the ductus venosus are
generally completely contracted by the fifth day. The _foramen ovale_
becomes obliterated at extremely variable periods, and may continue open
even in the adult.
Importance of late has been attached to the _stomach-bowel test_. If the
stomach and duodenum contain air, and consequently float in water, the
chances are that the child did not die immediately after birth; this is
known as Breslau's second life test, and the lower the air in the
intestinal canal, the greater is the probability that the child survived
birth.
The umbilical cord in a new-born child is fresh, firm, round, and bluish
in colour; blood is contained in its vessels. The cord may be ruptured
by the child falling from the maternal parts in a precipitate labour,
and the ruptured parts present ragged ends. It is seldom that a child
bleeds to death from an untied or cut umbilical cord, and the chances in
a torn cord are still more remote. The changes in the cord are as
follows: First it shrinks from the ligature towards the navel; this
change may begin early, and is rarely delayed beyond thirty hours; the
cord becomes flabby, and there is a distinct inflammatory circle round
its insertion. The next change is that of desiccation or mummification;
the cord becomes reddish-brown, then flattened and shrivelled, then
translucent and of the colour of parchment, and falls off about the
fifth day. The third stage, that of cicatrization, then ensues about the
tenth to the twelfth day. The bright red rim round the insertion of the
cord, with inflammatory thickening and slight purulent secretion, may be
considered as evidence of live birth, and the stage at which the
separation of the cord by ulcerative process has arrived will point to
the probable duration of time the child has existed after birth.
There are many fallacies in the application of any of these tests, and
the whole subject bristles with difficulties. The medical witness would
do well to exhibit a cautious reserve, for if the child dies immediately
after birth it is almost impossible to prove that it was born alive.
XXVIII.--CAUSE OF DEATH IN THE FOETUS
The death of the foetus may be due to--(1) Immaturity or intra-uterine
malnutrition, or simply from deficient vitality; (2) complications
occurring during or immediately after birth, which may either be
unavoidable or inherent in the process of parturition, or may be induced
with criminal intent.
In the latter category come such accidents as the pressure of tumours in
the pelvic passages, or disease of the bones in the mother, or pressure
on the cord from malposition of the child during labour, asphyxiation
from the funis being twisted tightly round the neck or limbs, or from
injuries due to falls on the floor in sudden labours. Where the death of
the foetus has been induced with criminal intent, it may be due to
punctured wounds of the fontanelles, orbits, heart, or spinal marrow;
dislocation of the neck; separation of the head from the body; fracture
of the bones of the head and face; strangulation; suffocation; drowning
in the closet pan or privy, or from being thrown into water.
Under the head of infanticide by _commission_, we have injuries of all
kinds; under infanticide by _omission_, neglecting to tie the cord,
allowing it to be suffocated by discharges in the bed, neglect to
provide food, clothes, and warmth, for the new-born child.
XXIX.--DURATION OF PREGNANCY
The natural period of gestation is considered as forty weeks, ten lunar
months, or 280 days. A medical witness would have to admit the
possibility of gestation being prolonged to 300 days, and if this time
were not very materially exceeded it would be well to give the woman
the benefit of the doubt. It may be mentioned that 300 days is the
extreme limit fixed by the French and Scottish law. No fixed period is
assigned in English or American law to the duration of pregnancy, though
it is allowed that utero-gestation may be greatly prolonged. In a recent
case decided, the Lord Chancellor accepted a case where it was alleged
pregnancy had extended to 331 days. A child only five months old may
live, for a short time at all events. There is considerable difficulty
in many cases in fixing the date of conception. The data from which it
is calculated are the following: (1) _Peculiar sensations attending
conception_, which are not sufficiently defined to be recognized by
those conceiving for the first time. (2) _Cessation of the catamenia._
Other causes may, however, cause this; and, on the other hand, a woman
may menstruate during the whole period of her pregnancy. This datum also
gives a variable period, and may involve an error of several days or a
month, for the menses may be arrested by cold, etc., at one monthly
period, and the woman become pregnant before the next. (3) _The period
of quickening._ This, when perceived (which is not always the case),
also occurs at variable periods from the tenth to the twenty-sixth week.
(4) _A single coitus._ This does not, however, correspond to the time of
fertilization. Several days may elapse before the spermatozoa meet with
an ovum and fertilize it.
In Scotland a child born six months after marriage is legitimate, which
is allowing an ample margin.
XXX.--VIABILITY OF CHILDREN
A child may be born alive, but may not be viable, by which is meant that
it is not endowed with a capacity of maintaining its life. Speaking
generally, 180 days represents the lowest limit at which a child is
viable, but prolonged survival under these circumstances is the
exception. Many cases, however, have been recorded in which children
born at six months have been reared. The signs of immaturity and
maturity may be thus tabulated:
IMMATURITY. MATURITY.
Centre of body high; head Strong movements and cries as soon
disproportionate in size; membrana as born; body clear, red colour,
pupillaris present; testicles coated with sebaceous matter; mouth,
undescended; deep red colour of nostrils, eyelids, and ears, open;
parts of generation; intense red skull somewhat firm, and fontanelles
colour, mottled appearance, and not far apart; hair, eyebrows, and
downy covering, of skin; nails not nails, perfectly developed;
formed; feeble movements; testicles descended; free discharge
inability to suck; necessity for of urine and meconium; power of
artificial heat; almost unbroken suction, indicated by seizure on the
sleep; rare and imperfect nipple or a finger placed in the
discharges of urine and meconium; mouth.
closed state of mouth, eyelids,
and nostrils.
XXXI.--LEGITIMACY
A child born in wedlock is presumed to have the mother's husband for its
father. This may, however, be open to question upon the following
grounds: Absence or death of the reputed father; impotence or disease in
the husband preventing matrimonial intercourse; premature delivery in a
newly-married woman; want of access; and the marriage of the woman again
immediately on the death of her husband. In the last case, where either
husband might have been the father, the child at the age of twenty-one
is at liberty to select its father from the possible pair.
A child born of parents before marriage is in Scotland rendered
legitimate by their subsequent marriage, but in England the offspring
remains illegitimate whether the parents marry or not after its birth.
The offspring of voidable or invalid marriages may be made legitimate
by application to the courts.
There is a difference between being legitimate and lawfully begotten. A
child born in wedlock is legitimate, but if the parents were married
only a week previously it could not have been lawfully begotten.
The Acts and rulings relating to Marriage and Legitimacy are extremely
complicated. It is not putting it too strongly to say that a very large
number of people in this country who believe themselves to be legally
married are not married at all, and that thousands of children who have
not the slightest doubt as to their legitimacy are in the eyes of the
law bastards.
XXXII.--SUPERFOETATION
By superfoetation is meant the conception, by a woman already pregnant,
of a second embryo, resulting in the birth of two children at the same
time, differing much in their degree of maturity, or in two separate
births, with a considerable interval between. The possibility of the
occurrence of superfoetation has been doubted, but there are
well-authenticated cases which countenance the theory of a double
conception. It has been shown that the os uteri is not closed, as was
once supposed, immediately _on conception_. Should an ovum escape into
the uterus, it may become impregnated a month or so after a previous
conception. The most probable explanation is that the case has been one
of twins, one being born prematurely; or, on the other hand, the uterus
may have been double, and conception may have taken place in one cornu
at a later period than in the other cornu.
XXXIII.--INHERITANCE
In order to inherit, the child must be born alive, must be born during
the lifetime of the mother, and must be born capable of inheriting--that
is to say, monsters are incapable of inheriting. There is a mode of
inheritance called 'tenancy by courtesy.' When a man marries a woman
possessed of an estate or inheritance, and has, by her, issue born alive
in her lifetime capable of inheriting her estate, in this case he shall,
on the death of his wife, hold the lands for his life as tenant by the
courtesy of England. The meaning of the words 'born alive' in this
instance is not the same as in cases of infanticide. In Civil law any
motion of the child's body, however slight, or the fact of it having
been heard to cry by witnesses, is held to be sufficient proof of the
child having been born alive. It may die immediately afterwards, and it
is not necessary that the child be viable.
XXXIV.--IMPOTENCE AND STERILITY
In the male, impotence may arise from physical or mental causes. The
physical causes may be--too great or too tender an age; malformation of
the genital organs; _crypsorchides_, defect or disease in the testicles;
constitutional disease (diabetes, neurasthenia, etc.); or debility from
acute disease, as mumps. Masturbation, and early and excessive sexual
indulgence, are also causes. The mental causes include--passion,
timidity, apprehension, aversion, and disgust. The case will be
remembered of the man who was impotent unless the lady were attired in a
black silk dress and high-heeled French kid boots.
If a man is impotent when he marries, the marriage may be set aside on
the ground that it had never been consummated. The law requires that the
impotency should have existed _ab initio_--that is, before
marriage--and should be of a permanent or incurable nature; marriage,
as far as the law goes, being regarded as a contract in which it is
presupposed that both the contracting parties are capable of fulfilling
all the objects of marriage. In the case of the Earl of Essex the
defendant admitted the charge as regards the Countess, but pleaded that
he was not impotent with others, as many of her waiting-maids could
testify. When a man becomes impotent _after_ marriage, his wife must
accept the situation, and has no redress. A man may be _sterile_ without
being impotent, but the law will not take cognizance of that. The wife
may be practically impotent, but the law will not assist the husband. He
must continue to do his best under difficult circumstances. In former
times in case of doubt a husband was permitted to demonstrate his
competency in open court, but this custom is no longer regarded with
favour by the judges.
The removal of the testicles does not of necessity render a man
impotent, although it deprives him of his procreative power. Eunuchs are
capable of affording illicit pleasure, whilst the male sopranos, or
_castrati_, are often utilized for that purpose.
In the female, impotence may be caused by the narrowness of the vagina,
adhesion of the vulva, absence of vagina, imperforate hymen, and tumours
of the vagina.
Sterility in women may occur from the above-named causes of impotence,
together with absence of the uterus and ovaries, or from great debility,
syphilis, constant amenorrhoea, dysmenorrhoea, or menorrhagia.
XXXV.--RAPE
Rape is the carnal knowledge of a woman by force and against her will.
The resistance of the woman _must be_ to the utmost of her power, but if
she yield through fear or duress it is still rape. The woman is a
competent witness, but her statements may be impugned on the ground of
her previous bad character, and evidence may be called to substantiate
the charge. The perpetrator must be above the age of fourteen years.
The definition of rape which we have given is not altogether
satisfactory. Take, for example, the case of a woman who goes to bed
expecting her husband to return at a certain hour. The lodger, let us
say, takes advantage of this fact, and, getting into bed, has connection
with her, she not resisting, assuming all the while that it is her
husband. This is rape, but it is not 'by force,' and it is not 'against
her will,' but it is 'without her consent,' as she has not been fully
informed as to all the circumstances of the case.
In all cases of rape in which there is no actual resistance or
objection, consent may be assumed. It is not essential that the woman
should state in so many words that she does not object. The force used
may be moral and not physical--_e.g._, threats, fear, horror, syncope.
By 48 and 49 Vict., c. 49, the carnal knowledge of a girl under thirteen
is technically rape. The consent of the girl makes no difference, since
she is not of an age to become a consenting party.
An attempt at carnal knowledge of a girl under thirteen is a
misdemeanour. Her consent makes no difference, and even the solicitation
of the act on the part of the child will not exonerate the accused.
Intercourse with a girl between thirteen and sixteen, even with her
consent, is a misdemeanour.
This Act is a favourite with the blackmailer. The child is sent out to
solicit, dressed like a woman, but appears in the witness-box in a much
more juvenile costume.
To constitute rape there must be _penetration_, but this may be of the
slightest. There may be a sufficient degree of penetration to constitute
rape without rupturing the hymen. Proof of actual emission is now
unnecessary.
The subject of carnal knowledge (C.K.) or its attempt may be summed up
as follows:
Under thirteen C.K. Felony.
Under thirteen Attempt Misdemeanour.
Consent no defence.
From thirteen to sixteen C.K. Misdemeanour.
From thirteen to sixteen Attempt Misdemeanour.
Consent and even solicitation no defence.
Reasonable cause to believe the girl over sixteen is a good defence.
Charge must be brought within three months.
Over sixteen C.K. with consent Nil.
Subject to civil action for loss of girl's services by father.
Idiot or imbecile C.K. with violence Rape.
Idiot or imbecile C.K. without violence Misdemeanour.
Personation of husband Rape.
Tacit consent no defence, for obtained by fraud.
Married woman C.K. with consent Adultery.
Mother, sister, daughter, C.K. consent immaterial; Incest.
grand-daughter born in wedlock or not
Females Indecent assaults Misdemeanour.
It is a misdemeanour to give to a woman any drug so as to stupefy her,
and so enable any person to have unlawful connection with her.
False charges of rape are very often made. The motive may be to extort
blackmail, revenge, or mere delusion. On examining such cases bruises
are seldom found, but scratches which the woman has made on the front of
her body may be discovered, and the local injuries to the generative
organs are slight, if present at all.
_Physical Signs._--In the adult the hymen may be ruptured, the
fourchette lacerated, and blood found on the parts, together with
scratches and other marks and signs of a struggle. In the child there
may be no hæmorrhage, but there will be indications of bruising on the
external organs, with probably considerable laceration of the hymen, the
laceration in some cases extending into the rectum. Severe hæmorrhage,
and even death, may follow the rape of a young child. The patient will
have difficulty in walking, and in passing water and fæces. After some
hours the parts are very tender and swollen, and a sticky
greenish-yellow discharge is present. These signs last longer in
children than in adults; but as a rule--in the adult, at least--all
signs of rape disappear in three or four days. Young and delicate
children may suffer from a vaginal discharge, with swelling of the
external genitals, simulating an attempt at rape. Infantile leucorrhoea
is common, and many innocent people have been exposed to danger from
false charges of rape on children, instituted as a means of levying
blackmail. A knowledge of these facts suggests the necessity of giving a
guarded opinion when children are brought for examination in suspected
cases. Pregnancy may follow rape.
_Seminal stains_ render the clothing stiff and greyish-yellow in colour,
with translucent edges. On being moistened they give the characteristic
seminal odour.
Semen may be found on the linen of the woman and man, and will be
recognized under the microscope by the presence in it of spermatozoa,
minute filamentary bodies with a pear-shaped head; but it must not be
forgotten that the non-detection of spermatozoa is no proof of absence
of sexual intercourse, for these bodies are not always present in the
semen of even healthy adult young men. Spermatozoa must not be mistaken
for the _Trichomonas vaginæ_ found in the vaginæ of some women. The
latter have cilia surrounding the head, which is globular.
_Florence's Micro-Chemical Test for Spermatic Fluid._--If a drop of the
fluid obtained by wetting a supposed spermatic stain be mixed with a
drop of the following solution (KI, parts 1.65; pure iodine, 2.54;
distilled water, 30) in a watch-glass, brownish-red pointed crystals
resembling hæmin crystals are obtained.
_Barberio's Test._--Mix a drop of the spermatic stain with a drop of a
saturated solution of picric acid, when needle-shaped yellow rhombic
crystals are formed.
_Gonorrhoeal Stains._--A cover-glass preparation stained with methylene
blue reveals the gonococci lying in pairs within the leucocytes.
XXXVI.--UNNATURAL OFFENCES
Trials for =sodomy= and =bestiality= are common at the assizes, but, as
they are rarely reported, they fail to attract attention. Sodomy is a
crime both in the active and passive agent, unless the latter is a
non-consenting party. The evidence of either associated may be received
as against his colleague. If the crime is committed on a boy under
fourteen, it is a felony in the active agent only. As in cases of rape,
emission is not essential, and penetration, however slight, answers all
practical purposes.
There can be no doubt that in the majority of these cases there exists a
congenitally abnormal condition of the sexual instinct, these
individuals from their childhood manifesting a perverted sexual
instinct. The man is physically a man, but psychically a woman, and
_vice versâ_. The tendency nowadays is not to charge these people with
the more serious offence, but to deal with them under Section 11 of the
Criminal Law Amendment Act, 1885 (48 and 49 Vict., c. 69). This section,
which is sufficiently comprehensive, runs as follows: 'Any male person
who in public or private commits or is a party to the commission, or
attempts to procure the commission by any male person, of any act of
gross indecency with another male person, shall be guilty of a
misdemeanour.' The penalty is imprisonment for two years, with or
without hard labour. It is provided by Section 4 of the same Act that a
boy under sixteen may be whipped.
=Incest.=--This crime is dealt with under the Punishment of Incest Act,
1908 (8 Edward VII., c. 45). Carnal knowledge with mother, sister,
daughter, or grand-daughter, is a misdemeanour, provided the
relationship is known. It also applies to the half-brother and
half-sister. It is equally an offence whether the relationship can or
cannot be traced through lawful wedlock. Consent is no defence. A woman
may be charged under the Act if she, being above the age of sixteen,
with consent permits her grandfather, father, brother, or son, to have
carnal knowledge of her.
XXXVII.--BLACKMAILING
There are in London and every large city scores of men and women who
live by blackmailing or chantage. There are many different forms of this
industry. There is the man who knows something about your past life,
which he threatens to reveal to your friends or colleagues unless you
buy him off. There is the breach-of-promise blackmailer, and there is
the female patient, who threatens to charge you with improper conduct or
indecent assault. Medical men from their position are often selected as
victims. The introduction of corridor carriages on many of our railways
has done much to stamp out one particular form of blackmailing, but
public urinals are still a source of danger.
It is the worst possible policy to temporize with a blackmailer. If you
give him a single penny, you are his for life. It is as well to remember
that it is just as criminal to attempt to extract money from a guilty as
from an innocent person. It is of no use attempting to deal with these
cases single-handed. You must not only deny the allegation, but 'spurn
the allegator.' Put the matter into the hands of a good sharp criminal
solicitor, and instruct him to rid you of the nuisance by taking
criminal proceedings.
XXXVIII.--MARRIAGE AND DIVORCE
Marriage may be accomplished in many ways: (1) By the publication of
banns; (2) by an ordinary licence; (3) by a special licence; (4) by the
Superintendent-Registrar's licence; (5) by a special licence granted by
the Archbishop of Canterbury in consideration of the payment of the sum
of £25. Then, for persons having a domicile in Scotland, there is the
marriage by repute. The consent of the parties, which is the essence of
the contract, may be expressed before witnesses, and it is not requisite
that a clergyman should assist, but it is essential that the expressions
of consent must be for a matrimonial intent. 'Habit and repute'
constitute good evidence, but the repute must be the general, constant,
and unvarying belief of friends and neighbours. The cohabitation must be
in Scotland.
Any irregularity in the marriage ceremony or the non-observance of any
formality will not invalidate the marriage, unless it were known to both
the contracting parties. If a man were married in a wrong name the
contract would still be valid if the wife were unacquainted with the
deception at the time. If the person who officiated were a bogus
clergyman, the marriage would hold good if the contracting parties
supposed him to be a properly ordained priest. In a case in which a
marriage was solemnized in a building near the church at a time when the
church was undergoing repairs, and where during such alterations Divine
service had been performed, it was held that the ceremony was good. To
all intents and purposes marriage comes under the 'Law of Contract' (see
Anson, W.R., Bart.), and the law looks to the _intention_ rather than to
the actual details. All marriages between persons within the prohibited
degrees of consanguinity or affinity are null and void. This prohibition
extends both to the illegitimate as well as the legitimate children of
the late wife's or husband's parents. A marriage with a deceased wife's
sister is now legal in Great Britain and the Colonies, and is recognized
in most foreign countries. A common device with people within the
prohibited degrees is to get married abroad, but such marriage is
strictly speaking inoperative, and the children of such union are
illegitimate. Practically, however, it is a matter of no importance, for
when people live together and say they are married, they are accepted at
their own estimate.
A man can obtain a divorce from his wife if he can prove that she has
been guilty of adultery since her marriage. This may be established by
inference. Obviously, it is difficult in the majority of cases to
establish by ocular demonstration that adultery has been committed. But
given evidence of familiarity and affection with opportunity and
suspicious conduct, a jury will commonly infer it.
A woman cannot obtain a divorce from her husband for adultery alone. She
must prove adultery plus cruelty, or adultery plus desertion without
reasonable cause. Failing this, she may be able to prove either bigamy
or incestuous adultery. Legal cruelty is a very comprehensive term, and
does not of necessity mean physical violence. If the husband as the
result of his infidelity were to give his wife a contagious disease,
that would constitute cruelty. Taking a more extreme case, if a husband
were to have connection in her house with his wife's maid, that would
probably be held to constitute cruelty, as it would tend to lower her in
the eyes of her servants.
A wife can obtain a judicial separation if she can prove (1) adultery,
(2) cruelty, or (3) desertion without reasonable cause for two years. If
a husband is away on his business, as, for example, the case of an
officer ordered abroad, that is not desertion. For a woman to get a
judicial separation, it is sufficient if she can prove one variety of
matrimonial offence, but for a divorce she requires more than one.
The jury may find that Mrs. A. has committed adultery with Mr. B., but
that Mr. B. has not committed adultery with Mrs. A. The explanation is,
that a wife's confession is evidence against herself, but not against
another person. You can confess your own sins, but not another's.
The Divorce Law of Scotland differs materially from that of England. In
Scotland there is no decree nisi, no decree absolute, and no
intervention by the King's Proctor. Instead there is a single and final
judgment, and when a decree of divorce is pronounced the successful
litigant at once succeeds to all rights, legal and conventional, that
would have come to him or her on the death of the losing party. If the
husband is the offender, the wife in such circumstances may claim her
right to one-third of his real estate; and if there are children, to
one-third of his personal property, and to one-half if there are none.
=Voidable Marriages.=--If a man and woman go through the marriage
ceremony, such a contract is null and void under the following
circumstances: (1) Where bigamy has been committed; (2) if one of the
parties were insane at the time of marriage; (3) where the plaintiff is
under sixteen years of age; (4) when the marriage has not been
consummated or followed by cohabitation; (5) when one of the parties was
incapable of performing the marital act (impotent, and such not known by
the other at the time); (6) when drunkenness had been induced so as to
obtain consent; (7) concealment of pregnancy at the time of marriage.
XXXIX.--FEIGNED DISEASES
Malingering in its various forms is by no means uncommon, and by many is
regarded as a disease in itself. It is necessary, however, to
distinguish between those cases in which it is feigned for some definite
purpose--for example, to escape punishment or avoid public service--and
those in which there is adequate motive, and the patient shams simply
with the view of exciting sympathy, or from the mere delight of giving
trouble. It is not uncommon for individuals summoned on a jury, or to
give evidence in the law courts, to apply to their doctor for a
certificate, assigning as a cause of exemption neuralgia, or some
similar complaint unattended with objective symptoms. In such cases it
is well to remind the patient that in most courts such certificates are
received with suspicion, and are often rejected, and that the personal
attendance of the medical man is required to endorse his certificate on
oath.
Malingering has become much more common since the National Health
Insurance Act has been passed. The possibility of obtaining a fair sum
each week without the necessity of working for it induces many persons
either to feign disease or to make recovery from actual disease or
accident much more tedious than it ought really to be.
The feasibility of successfully malingering is greatly enhanced by the
possession of some chronic organic disease. An old mitral regurgitant
murmur is useful for this purpose.
It is not flattering to one's vanity to overlook a case of malingering,
but should this occur little harm is done. It is a much more serious
matter to accuse a person of malingering when in reality he may be
suffering from an organic disease.
Here are some of the diseases which are most frequently feigned:
=Nervous Diseases=, as headache, vertigo, paralysis of limbs, vomiting,
sciatica, or incontinence or suppression of urine, spitting of blood;
others, again, simulate hysteria, epilepsy, or insanity.
On the other hand, the malingerer may actually produce injuries on his
person either to excite commiseration or to escape from work. Thus, the
beggar produces ulcers on his legs by binding a penny-piece tightly on
for some days; the hospital patient, in order to escape discharge,
produces factitious skin diseases by the application of irritants or
caustics.
It is much more difficult to decide whether certain symptoms are due to
a real disease which is present, or whether they are merely
exaggerations of slight symptoms or simulations of past ones. The miner,
after an injury to his back, recovers very slowly, if at all. He is
suffering from 'traumatic neurasthenia'--a condition only too often
simulated, and a disease very difficult to diagnose accurately. The
miner takes advantage of our ignorance, and continues to draw his
compensation. A workman during his work receives a fracture; instead of
being able to resume work in six weeks, he asserts that the pain and
stiffness prevent him, and this disability may persist for months. Such
cases as these frequently come before the courts when the employer has
discontinued to pay the weekly compensation for the injury. Medical men
are called to give evidence for or against the injured workman.
=Epilepsy= is often simulated. The foaming at the mouth is produced by a
piece of soap between the gums and the cheek. The true epileptic,
especially if he suspects that a fit is imminent, takes his walks abroad
in some secluded spot, whilst the impostor selects a crowded locality
for his exertions. The epileptic often injures himself in falling, his
imitator never; one bites his tongue, but the other carefully refrains
from doing so. The skin of an epileptic during an attack is cold and
pallid, but that of the exhibitor is covered with sweat as the result of
his exertions. In epilepsy the urine and fæces are passed involuntarily,
but his colleague rarely considers it necessary to carry his deception
to this extent. In true epilepsy the eyes are partly open, with the
eyeballs rolling and distorted, whilst the pupils are dilated and do not
contract to light; the impostor keeps his eyes closed, and he cannot
prevent the iris from contracting when a bicycle-lamp is flashed across
his face. A useful test is to give the impostor a pinch of snuff, which
promptly brings the entertainment to an end.
=Lumbago= is often feigned, and the imposture should be suspected when
there is a motive, and when physical signs, such as nodes and tender
spots, are absent. A simple test is to inadvertently drop a shilling in
front of him, when he will promptly stoop and pick it up. The same
principles apply to spurious sciatica.
=Hæmorrhages= purporting to come from the lungs, stomach, or bowels,
rarely present much difficulty. The microscope is of use in all cases of
bleeding. Possibly the gums or the inside of the cheeks may have been
scratched or abraded with a pin.
=Skin Diseases= are excited artificially, especially those which may be
produced by mechanical and chemical irritants. The most commonly
employed are vinegar, acetic acid, carbolic acid, nitric acid, and
carbonate of sodium; but tramps frequently use sorrel and various
species of ranunculus. The lesions simulated are usually inflammatory in
character, such as erythema, vesicular and bullous eruptions, and
ulceration of the skin. They may be complicated by the presence of
pediculi and other animal and vegetable parasites. Chromidrosis of the
lower eyelids in young women often owes its origin to a box of paints.
Factitious skin diseases are seen most commonly on the face and
extremities, especially on the left side--in other words, on the most
accessible parts of the body.
Feigned menstruation, pregnancy, abortion, and recent delivery are
common, and should give rise to no difficulty. The same may be said of
feigned insanity, aphonia, deaf-mutism, and loss of memory.
The following hints may be useful to a medical man when called to a
supposed case of malingering: Do not be satisfied with one visit, but go
again and unexpectedly; see that the patient is watched between the
visits; make an objective examination, compare the indications with the
statements of the patient, noting especially any discrepancies between
his account of his symptoms and the real symptoms of disease; ask
questions the reverse of the patient's statements, or take them for
granted, and he will often be found to contradict himself; have all
dressings and bandages removed; suggest, in the hearing of the patient,
some heroic methods of treatment--the actual cautery, or severe surgical
operation, for example; finally, chloroform will be found of great use
in the detection of many sham diseases.
XL.--MENTAL UNSOUNDNESS
The presumption in law is in favour of a person's sanity, even though he
may be deaf, dumb, or blind.
The terms 'insanity,' 'lunacy,' 'unsoundness of mind,' 'mental
derangement,' 'madness,' and 'mental alienation or aberration,' are
indifferently applied to those states of disordered mind in which the
person loses the power of regulating his actions and conduct according
to the ordinary rules of society. The reasoning power is lost or
perverted, and he is no longer fitted to discharge those duties which
his social position demands. In some cases of insanity, as in confirmed
idiocy, there is no evidence of the exercise of the intellectual
faculties. It is probable that no standard of sanity as fixed by nature
can be said to exist. The medical witness should decline to commit
himself to any definition of insanity. There is no practical advantage
in attempting to classify the different forms of insanity.
According to English law, madness absolves from all guilt, but in order
to excuse from punishment on this ground it must be proved that the
individual was not capable of distinguishing right from wrong in
relation to the particular act of which he is accused, and that he did
not know at the time of committing the crime that the offence was
against the laws of _God_ and _nature_.
Lunatics are competent witnesses in relation to testimony, as in
relation to crime, if they understand the nature of an oath and the
character of the proceedings in which they are engaged. The judge, as in
the case of children, examines the lunatic tendered as a witness as to
his knowledge of the nature and obligation of an oath, and, if
satisfied, he allows him to be sworn.
A person, if suffering from such a state of mental unsoundness as to be
unable to take care of his property, may be placed under the care of the
Court of Chancery. The Court then administers his property, and
otherwise allows him entire freedom of action.
With regard to the care of lunatics, no person is allowed to receive
more than one lunatic into his house unless such house is licensed and
the proper certificates have been signed. One patient may be taken
without the house being licensed, but the usual certificates must in all
cases be signed, and the Lunacy Commissioners communicated with. If a
person receives another not of unsound mind into his house, and such
person becomes subsequently insane, the person so keeping him renders
himself liable to heavy penalties, unless the legal certificates are at
once procured and the Commissioners of Lunacy communicated with.
At common law it appears that a lunatic cannot be placed in an asylum
unless dangerous to himself or to others, but under the Lunacy Acts the
placing of a madman in an asylum is considered as a part of the
treatment with a view to the cure of the patient.
XLI.--IDIOCY, IMBECILITY, CRETINISM
=Idiocy= is not a disease, but a congenital condition in which the
intellectual faculties are either never manifested or have not been
sufficiently developed to enable the idiot to acquire an amount of
knowledge equal to that acquired by other persons of his own age and in
similar circumstances with himself. Idiots, as a rule, are deformed in
body as well as deficient in mind. Their heads are generally small and
badly-shaped, and their features ill-formed and distorted. The teeth are
few in number and very irregular. The hard palate has a very deep arch,
or may even be cleft. The complexion is sallow and unhealthy, the limbs
imperfectly developed, and the gait is awkward, shambling, and unsteady.
In his legal relations an absolute idiot is civilly disabled and
irresponsible, but in regard to crime, or as a witness, see remarks made
above.
=Imbecility= is a form of mental defect not usually congenital, but
commencing in infancy or in early life. The line of demarcation between
the imbecile and the idiot may be found in the possession by the former
of the faculty of speech, in distinction from the mere parrot-like
utterance of a few words which can be taught the idiot. Imbecility may
be intellectual, moral, or general. Questions frequently arise as to
their responsibility for actions done by them, or as to their ability to
manage their own affairs.
=Cretinism= is a form of amentia, which is endemic in certain districts,
especially in some of the valleys of Switzerland, Savoy, and France. The
malady is not congenital, but its symptoms usually appear within a few
months of birth. The characteristics of this form of idiocy are an
enlarged thyroid gland constituting a goitre or bronchocele, a
high-arched palate, dwarfed stature, squinting eyes, sallow complexion,
small legs, conical head, large mouth, and indistinct speech.
=Feeble-Minded.=--These are persons who are capable of earning a living
under favourable circumstances, but are incapable, from mental defect
which has existed from birth or from an early age, of (a) competing on
equal terms with their normal fellows, or (b) of managing themselves
and their affairs with ordinary prudence. Feeble-mindedness may affect
the moral nature only, rendering the person selfish, untruthful,
obscene, or unemployable. The Act of 1899 controls feeble-minded
children; many such become paupers, criminals, prostitutes, etc.
=Mental Deficiency and Lunacy Act, 1913.=--Those included under this Act
are idiots, imbeciles, feeble-minded persons, and moral imbeciles. The
parents or guardians of such children between the ages of five and
sixteen years must provide for them education and proper care. If they
are unable to do so, the School Boards or Parish Councils must do so.
XLII.--DEMENTIA: ACUTE, CHRONIC, SENILE, AND PARALYTIC
In dementia the mental aberration does not occur until the mind has
become fully developed, thus differing from amentia, which is congenital
or comes on very early in life.
=Acute Dementia.=--This is a condition of profound melancholy or stupor,
which arises from sudden mental shock, the mind being, as it were,
arrested and fixed in abstraction on the event.
=Chronic Dementia= is generally caused by the gradual action on the mind
of grief or anxiety, by severe pain, mania, apoplexy, paralysis, or
repeated attacks of epilepsy.
=Senile Dementia= is a form which is incidental to aged persons, and
commences gradually with such symptoms as loss of memory for recent
events, dulness of perception, and inability to fix the attention. Later
on the reasoning powers begin to fail, and finally, memory, reason, and
power of attention, are quite lost, the muscular power and force
remaining intact. In the last stage there is simply bare physical
existence.
=General Paralysis of the Insane, Paralytic Dementia.=--This is a most
interesting form of dementia. It is closely allied to, if not identical
with, locomotor ataxy. Its most prominent and characteristic symptom
consists in delusions of great power, exalted position, and unlimited
wealth--megalomania. The exaltation is universal, and the patient may
maintain at one and the same time that he is running a theatrical
company, that he is the Prince of Wales, and that he is the Almighty.
Moral perversion is a common symptom, and the patient is often guilty of
criminal assaults, indecent exposures, bigamous marriages, and the like.
It is accompanied with progressive bodily and mental decay. Women are
comparatively rarely affected by it, and it generally commences in men
about middle age, and its duration is from a few months to three years.
It is commonly parasyphilitic in origin. Paralytic symptoms first appear
in the tongue, lips, and face; the speech becomes thick and hesitating.
The paralytic symptoms gradually go on increasing, the sphincters refuse
to act, and death may occur from suffocation and choking. Sometimes,
during the earlier stages especially, there may be maniacal paroxysms or
epileptic fits. The delusions remain the same throughout, the patient
always expresses himself as being happy, and his last words will
probably have reference to money and other absurd delusions.
When a person of hitherto blameless life is charged with an act of
indecency, he should be examined for G.P.I. The condition of his
prostate should also be investigated. He may be suffering from either
mental or physical disease, or both (see p. 59).
XLIII.--MANIA
Under the term 'mania' are included all those forms of mental
unsoundness in which there is undue excitement. It is divided into
general, intellectual, and moral, and each of the two latter classes
again into general and partial.
=General Mania= affects the intellect as well as the passions and
emotions. Mania is usually preceded by an incubative period in which the
patient's general health is affected. The duration of this period may
vary from a few days to fifteen or twenty years. When the disease is
established, the patient has paroxysms of violence directed against
himself as well as others. He tears his clothes to pieces, either
abstains from food and drink or eats voraciously, and sustains immense
muscular exertion without apparent fatigue. The face becomes flushed,
the eye wild and sparkling; there is pain, weight, and giddiness in the
head, with restlessness.
=General Intellectual Mania=, attacking the intellect alone, is rare;
but some one emotion or passion, as pride, vanity, or love of gain, may
obtain ascendancy, and fill the mind with intellectual delusions.
A _delusion_ may be defined as a perversion of the judgment, a
chimerical thought; an _illusion_, an incorrect impression of the
senses, counterfeit appearances; hence we speak of a delusion of the
mind, an illusion of the senses. Lawyers lay great stress on the
presence of delusions as indicative of insanity. An _hallucination_ is a
sensation which is supposed by the patient to be produced by external
impressions, although no material object acts upon his senses at the
time.
=Partial Intellectual Mania=, or =Monomania=, also called =Melancholia=,
is a form of the disease in which the patient becomes possessed of some
single notion, contradictory alike to common-sense and his own
experience.
=General Moral Mania.=--This is a morbid perversion of the natural
feelings, affections, inclinations, temper, habits, moral dispositions,
and natural impulses, without any remarkable disorder or defect of the
intellect, or knowing and reasoning faculties, and particularly without
any insane illusion or hallucination. It is often difficult to
distinguish this form of mania from the moral depravity which we
associate with the criminal classes.
=Partial Moral Mania--Paranoia--Delusional Insanity.=--In this form one
or two only of the moral powers are perverted. Delusions are always
present, and very frequently are those of persecution. The patient's
conduct is dominated by his delusion; thus murder and suicide may be
committed. There are several forms:
_Kleptomania_, a propensity to theft; common in women in easy
circumstances. _Dipsomania_, or _Oinomania_, an insatiable desire for
drink. _Morphinomania_, a craving for morphine or its preparations.
_Erotomania_, or amorous madness. When occurring in women this is also
called _Nymphomania_, and in men _Satyriasis_. It consists in an
uncontrollable desire for sexual intercourse. _Pyromania_, an insane
impulse to set fire to everything. _Homicidal mania_, a propensity to
murder. _Suicidal mania_, a propensity to self-destruction. Some
consider suicide as always a manifestation of insanity.
=Insanity of Pregnancy.=--This may show itself after the third month of
pregnancy in the form of melancholia. It is not recovered from until
after delivery.
=Puerperal Mania.=--This form of mania attacks women soon after
childbirth. There is in many cases a strong homicidal tendency against
the child.
=Insanity of Lactation= comes on four to eight months after parturition,
either as mania or melancholia. The mother may repeatedly attempt
suicide.
=Mania with Lucid Intervals.=--In many cases mania is intermittent or
recurrent in its nature, the patient in the interval being in his right
mind. The question of the presence or absence of a lucid interval
frequently occurs where attempts are made to set aside wills made by
persons having property. In these cases the law, from the reasonableness
of the provisions of the will, may assume the existence of the lucid
interval. A will made during a lucid interval is valid. When an attempt
is made to set aside the provisions of a will on the ground of insanity
in a person not previously judged insane, the plaintiff must show that
the testator was mad; when the provisions of the will of a lunatic are
attempted to be upheld, the plaintiff must show that the will was made
during a lucid interval.
A testator is capable of making a valid will when he has (1) a knowledge
of his property and of his kindred; (2) memory sufficient to recognize
his proper relations to those about him; (3) freedom from delusions
affecting his property and his friends; and (4) sufficient physical and
mental power to resist undue influence. The fact of a man being subject
to delusions may not affect his testamentary capacity. He may believe
himself to be a tea-kettle, and yet be sufficiently sound mentally to
make a valid will.
=Undue Influence.=--Persons of weak mind or those suffering from senile
dementia are often said to have been unduly influenced in making their
wills, and subsequently their dispositions are disputed in court. Before
witnessing the will made by such a person, the medical man should
satisfy himself that the testator is of a 'sound disposing mind.' This
he will do by questioning, and his knowledge of the home-life of the
patient will either confirm or set aside the idea of influence.
A person who is aphasic may be competent to make a will. He may not be
able to speak, but may understand what is said to him, and may be able
to indicate his wishes by nods and shakes of the head. Ask him if he
wishes to make a will, then inquire if he has £10,000 to leave, then if
he has £100, and in this way arrive approximately at the sum. Then ask
him if he wishes to leave it all to one person. If he nods assent, ask
if it be to his wife or some other likely person. If he wishes to divide
it, ascertain his intention by definite questions, and, having
ascertained his views, commit them to writing, read the document over to
him, and ask if it expresses his intentions. That being settled, a mark
which he acknowledges in the presence of two witnesses, preferably men
of standing, will constitute a valid document.
In certain forms of neurasthenia, the 'phobias' are common, but must not
be regarded as evidence of insanity. 'Agoraphobia' is the fear of
crossing an open space, 'batophobia' is the fear that high things will
fall, 'siderophobia' is the fear of thunder and lightning, 'pathophobia'
is the fear of disease, whilst 'pantophobia' is the fear of everything
and everybody.
=Epilepsy in Relation to Insanity.=--The subjects of this disease are
often subject to sudden fits of uncontrollable passion; their conduct is
sometimes brutal, ferocious, and often very immoral. As the fits
increase in number, the intellect deteriorates and chronic dementia or
delusional insanity may supervene. (1) Before a fit the patient may
develop paroxysms of rage with brutal impulses (_preparoxysmal
insanity_), and may commit crimes such as rape or murder. (2) Instead of
the usual epileptic fit, the patient may have a violent maniacal attack
(_masked epilepsy_, _epileptic equivalent_, _psychic form of epilepsy_).
(3) After the fit the patient may perform various automatic actions
(_post-epileptic automatism_) of which he has no subsequent
recollection. Thus the patient may urinate or undress in a public place,
and may be arrested for indecent exposure. Epileptics who suffer from
both petit and grand mal attacks are specially liable to maniacal
attacks. Such insanity differs from ordinary insanity in its sudden
onset, intensity of symptoms, short duration and abrupt ending. To
establish a plea of epilepsy in cases of crime, one must show that the
individual really did suffer from true epilepsy, and that the crime was
committed at a period having a definite relation to the epileptic
seizure.
=Alcoholic Insanity.=--This may occur in three forms:
1. _Acute Alcoholic Delirium_ (_mania a potu_), due to excessive amount
of alcohol consumed.
2. _Delirium Tremens_, due to long-continued over-drinking. The patient
suffers from horrible dreams, illusions, and suspicions, which may lead
him to attack people or commit suicide.
3. _Chronic Alcoholic Insanity._ Loss of memory is the chief symptom,
with paralysis of motion, hallucinations and delusions of persecution.
=Responsibility for Criminal Acts.=--To establish a defence on the
ground of insanity, it must be proved that the prisoner at the time when
the crime was committed did not know the nature and quality of the act
he was committing, and did not know that it was wrong. At the present
time, however, the _power of controlling his actions_ is usually made
the test.
The plea of insanity is brought forward, as a rule, only in capital
charges, so that the prisoner, if found guilty, will escape hanging. If
proved 'guilty, but insane,' the person is sentenced to be kept in a
criminal lunatic asylum 'during His Majesty's pleasure.'
XLIV.--EXAMINATION OF PERSONS OF UNSOUND MIND
The following hints with regard to the examination of patients supposed
to be insane will be useful: The general appearance and shape of head,
complexion, and expression of countenance, gait, movements, and speech,
should be noted; the state of the general health, appetite, bowels,
tongue, skin, and pulse, should be inquired into; and in women the state
of the menstrual function should be ascertained. The family history must
be traced out, and the personal history taken with care, especially as
to whether the unsoundness came on late in life or followed any physical
cause. Ascertain whether it is a first attack, whether the patient has
suffered from epilepsy, has squandered his money, grown restless, has
absurd delusions, etc. In order to ascertain the capacity of the mind,
questions should be asked with regard to age, birthplace, profession,
number of family, and common events, such as the day of week, month, and
year. The power of performing simple arithmetical operations may be
tested. It may be necessary to pay more than one visit. The examiner
should be careful to ask questions adapted to the station of life of the
supposed lunatic; a man is not necessarily mad because he cannot perform
simple arithmetical operations, or does not know about things with which
his questioner is well acquainted. The opinion of a supposed lunatic
that his examiner's feet _were large_ was not considered by the
Commissioners among the facts indicating insanity, yet statements quite
as absurd are made by medical men as 'facts of insanity' observed by
themselves. 'Reads his Bible and is anxious about the salvation of his
soul' is another example of a bad certificate. Some well-marked delusion
should be recorded.
For a lunacy certificate (_Reception Order on Petition_ or _Judicial
Reception Order_), except in the case of a pauper patient, there are
required the signatures of two independent medical men and of a relation
or friend. The medical men must not be in partnership or in any way
interested in the patient; they must make separate visits at different
times, and write on the proper forms the facts observed by themselves
and those observed by others, giving the name of the informer. A
certificate is valid only for seven days. In very urgent non-pauper
cases the signature of one medical man is sufficient, but such
certificate (_Emergency Certificate_ or _Urgency Order_) is only valid
for two days, and, as the patient can only be detained in the asylum
under this order for seven days in England or three in Scotland, it must
be supplemented by another signed as above directed. The medical
certificate must contain a statement that it is expedient for the
alleged lunatic to be placed forthwith under care, with reasons for
making such statement. The certifying medical practitioner must have
personally examined the patient not more than two clear days before his
reception. In London and other large towns, where an expert opinion is
readily obtainable, it is not expedient to resort to such urgency
orders. Medical men should be careful how they sign certificates of
insanity. No medical man is bound to certify, but if he does so he must
be prepared to take the responsibility of his acts. There must be no
reasonable ground for alleging want of 'good faith' or 'reasonable
care.' The practitioner must exercise that amount of care and skill
which he may reasonably be expected to possess.
XLV.--THE INEBRIATES ACTS
It is somewhat difficult to define an inebriate, but for the moment the
following will suffice, and will ultimately, in all probability, be
officially adopted:
An inebriate is a person who habitually takes or uses any intoxicating
thing or things, and while under the influence of such thing or things,
or in consequence of the effects thereof, is--(a) dangerous to himself
or others; or (b) a cause of harm or serious annoyance to his family or
others; or (c) incapable of managing himself or his affairs, or of
ordinary proper conduct.
Under the provisions of the Habitual Drunkards Acts (42 and 43 Vict., c.
19, and 51 and 52 Vict., c. 19), any habitual drunkard may voluntarily
place himself under restraint. He must make an application to the owner
of a licensed retreat, stating the time during which he undertakes to
remain. His application must be accompanied by a statutory declaration
of two persons stating that they knew the applicant to be a confirmed
drunkard. Without this testimony as to moral character his application
cannot be entertained. His signature must also be attested by two
justices, who must state that he understands the effect of his
application, and that it has been explained to him. The limit to the
term of restraint is twelve months, after which he must resume his
former habits if he wishes to qualify for another period. The Act works
automatically, and, when it has been set for a certain time, the patient
cannot release himself until the period has expired. The Inebriates'
Retreat must be duly licensed, and the licensee incurs distinct
obligation in return for the powers entrusted to him. It is an offence
against the Act to assist any habitual drunkard to escape from his
retreat, and should he succeed in effecting his escape he may be
arrested on a warrant. A drunkard who does not obey orders and conform
to the rules of the establishment may be sent to prison for seven days.
It may be as well to mention that it is an offence to supply any
drunkard under the Act with any intoxicating drink or sedative or
stimulant drug without authority, and that the penalty is a fine of £20
or three months' imprisonment. The Act is a good one, but might be
carried farther with advantage. It has been ruled that a crime committed
during drunkenness is as much a crime as if committed during sobriety. A
person is supposed to know the effect of drink, and if he takes away his
senses by drink it is no excuse. He is held answerable both for being
under the influence of alcohol or of any other drug, and for the acts
such influence induces.
=Inebriates Act= (1898-1900).--If an habitual drunkard be sentenced to
imprisonment or penal servitude for an offence committed during
drunkenness, or if he has been convicted four times in one year, the
court may order him to be detained for a term not exceeding three years
in an inebriate reformatory.