Page:Encyclopædia Britannica, Ninth Edition, v. 15.djvu/812

Rh 780 skill and acuteness in order to detect the imposture. Where there is reason to suppose that a disease is simu lated, much caution as to procedure is also required. 13. Insanity or Mental Alienation. This subject pre sents an enormous field to the medical jurist. A medical man may be required to give evidence in any of the law courts, civil, criminal, or ecclesiastical, before commissions de lunatico inquirendo, or before a magistrate, as to the sanity or insanity of an individual ; and he may have to sign certificates of unsoundness of mind with the view of providing for the safe custody and proper treatment of a lunatic. Hence he must be familiar with the chief forms of insanity (see INSANITY), and be able to distinguish and treat each of these. He will also be required to detect feigned insanity, and to examine persons charged with crime with the view of preventing real lunatics from being treated as criminals. The terms &quot; unsoundness of mind/ applied to the con dition of the mind itself, and &quot; non compos mentis &quot; to the person whose mind is affected, are legal terms applied to insanity. Lawyers have disputed as to whether imbecility should or should not be included under the head of insanity ; but medical men include under this category all disorders or defects of the mind which disqualify a person for managing his affairs, and entering into a binding contract, or which render the individual morally irrespon sible for his or her otherwise criminal actions. There is good legal authority for recognizing four forms of unsound- ness of mind idiocy, dementia, mania, and monomania. The chief questions respecting unsoundness of mind which present themselves to the medical jurist are is the person of sound or unsound mind ; if unsound, are there real lucid intervals ; is he fit to manage his affairs, to contract a marriage, or to execute a will; is he dangerous to others ? As grounds for restraint, the law recognizes only these conditions danger to himself, inability to manage his own affairs and property, and danger to the person of others. Before an individual can be placed under restraint in an asylum the certificates of two medical men must be obtained, and the formal order of a relation or friend. The certificates to be valid must be signed by legally qualified medical practitioners having no interest, direct or indirect, in the patient, or in the asylum to which he is to be sent. The medical examiners must pay separate visits, each medical man examining the patient separately. The certificates, which remain valid for seven days only, must bear the exact address of the lunatic, his occupation, and the date of the examination; they must also set forth distinctly the grounds of the opinion they express, under the separate heads of facts observed by the examiner, and facts (to be specified) communicated by others. In the case of pauper lunatics one medical certificate only is required, which is supple mented by an order from a justice of the peace. In urgent cases also one medical certificate suffices for incarceration in an asylum, provided that within three days of the patient s reception two other such certificates are signed by two other medical practitioners, not being connected with the asylum, upon a like examination. The superintendent or proprietor of the asylum must in all cases forward to the commissioners of lunacy a notice of admission within one clear day from the patient s admission. Any infringe ment of the statutory regulations subjects the person who commits it to a heavy penalty. II. INJURIES TO THE PERSON. 1. Defloration. The signs of defloration are obscure and uncer tain ; and it is rather by the coexistence of several of the usual marks than the existence of any one sign, that any just conclusion can be arrived at. 2. Rape. This cri-ne consists in the carnal knowledge of a woman forcibly and against her will. The resistance must be to the utmost, else the crime of rape has not been committed in the legal sense of the word. The proofs of rape, accordingly, apart from the consistency of the woman s story, mainly depend ou the presence of the signs of defloration, and on marks of injury on the man. 3. Mutilation. This may consist in the cutting or maiming of any member ; castration is the most important, and perhaps but rarely effected as a crime. Self-mutilation, giving rise to false accusations, is occasionally resorted to. 4. Criminal Abortion. The crime of abortion consists in unlaw fully administering to a woman, or causing to be taken by her (whether she be with child or not), with intent to procure her mis carriage, any poison or noxious thing, or using for the same purpose any instrument or other means whatsoever ; also in the use of the same means, with the same intent, by any woman being with child. 5. Homicide. The legal sense of the term homicide excludes such injuries as are the result of either accident or of suicide. It embraces murder or wilful homicide, manslaughter or culpable homicide, casual homicide, and justifiable homicide. As a preliminary in all cases of homicide, it is the duty of the medical jurist in the first place to ascertain the fact of death, and to distinguish between real and apparent death ; and then to deter mine, if possible, the period at which death took place. Infanticide or child murder is by the British law treated with the same severity as the murder of an adult. Indeed infanticide as a crime distinct from murder has no legal recognition. Practi cally this severity defeats itself, and offences which are really cases of child murder are often treated simply as cases of concealment of birth. The iniquity of the old law which threw the onus of proof of still-birth on the mother now no longer exists, and the law demands strict proof of live-birth at the hands of the prosecution. Hence the subject involves very nice points of forensic medicine. The child must be proved to have arrived at the period when there was a probability of its living (proof of viability) ; and as the estab lishment of respiration is necessary to prove live-birth the evidences, of this act must be carefully investigated. The size and position of the lungs, and the state of the vessels concerned in foetal circulation, must be carefully noted. The fretal lungs are dark, dense, and liver-like in appearance and consistence, and sink when immersed in water ; whilst the fully respired lungs are rosy, marbled, and soTt and crepitant when handled. Minor degrees of respiration are recognized by the appearance of little groups of dilated air-vesicles, and by the fact that, although the lungs as a whole may sink in water, certain portions of them, into which respired air has pene trated, float in water even after subjection to firm pressure in the hand. Care must be taken, nevertheless, to exclude buovaucy of the lung due to putrefaction ; in this case the air may be expelled by gentle pressure, and the previously buoyant portion of lung now sinks in water. It is impossible, however, to distinguish certainly between a lung naturally inflated and one artificially insufflated. It mu -i be borne in mind that, although live-birth cannot be affirmed in the absence of signs of respiration, the presence of these signs is nut proof of live-birth in the legal sense of the term. The law demands for live-birth a separate existence of the child after delivery ; and breathing may take place whilst the child is still either wholly or partially within the maternal passages, and in some special cases whilst still within the womb itself. When proofs of respiration it may be to such an extent as to- leave no doubt as to live-birth have been found, the cause of death is then to be investigated. Wounds, and other forms of injury, must be sought for. There may be signs of strangulation, suffoca tion, puncture of the fontanelles, and consequent injury to the brain, the administration of a poison, or other means of procuring death. It must be borne in mind that some of these causes rnay be brought about by omission, or even by accident. Thus strangulation may arise from natural and unrelieved pressure of the navel string oa the neck of the child ; suffocation from immersion of the face of the child in the maternal discharges, or by pressure of clothes on the mouth. Death may result from haemorrhage through neglect to tie the navel string, or the infant may perish from exposure to cold. In the case of exposed infants it is very important to ascertain the real mother. As such exposure usually takes place soon after birth, comparison of the age of the infant with the signs of recent delivery in the suspected mother is the best method of proving the relation. Ordinary homicide may be accomplished by several modes that may sometimes be ascertained by examination of the body. Of one of the most important of these consideration is deferred to the article POISONS. Death by asphyxia is a common mode of accomplishing homi cide, as by suffocation, drowning, hanging, strangulation, or by exposure to mephitic air. Suicide and accidental death from these causes are still more common. (1) Droivning is thought to produce death occasionally by the suddenness of the shock causing suspen sion of the functions of circulation and respiration by shock without a struggle. The usual mode of death appears, however,