was probably a rupture of the ligaments within the canal which caused the pressure symptoms because of a slight flexion in the canal. The prominence of the two vertebræ could be accounted for in that way. Case X. Man, 32 years old, a bricklayer. He had a fall of 30 feet. Examination made in bed. Angular projection of last dorsal and first lumbar, while there was a depression of these vertebræ, one inch in depth. The transverse processes were prominent; the pain was chiefly from the other bruises and not at the seat of spinal lesion. There was no paralysis; the chief discomfort was that he was unable to stand erect. He assumed the following position when on his feet: He stood beside a low table, leaned forward with his chest on the table; walked by grasping the front of both thighs with the knees bent. Six months after the accident he resumed his former occupation; walked some distance to his work, although the back was still flexible at the seat of injury and the kyphos still prominent. Feeling of weakness in the back relieved by lying down. This case is of interest because of the extreme grade of bony deformity without pressure symptoms and the persistence of the fissure at the seat of the spinal injury, which would indicate a failure to unite on the part of the vertebræ if it were a fracture, but the same would be caused by the stretching out of a ligamentous rupture which had healed. It would seem as though a fracture could hardly have failed to have given rise to some signs of callus. Case XI. A man, 29 years old. About a half a ton was sustained by the arms, shoulders and back of this man for half a minute before help came. He felt something give way in the back and he became insensible; recovered his senses, was helped home for a mile, and then became unconscious. He was paralyzed from the dorso-lumbar region downwards. He remained thus for two weeks; gradually sensation returned, and although weak in the back he started on a horseback ride, but on his return he became paraplegic and then entered the hospital. Well-nourished man, paralyzed in the lower half of the body; no displacement of the spine; no control over bladder or rectum. Electricity, tonics, etc., without relief, tried for six weeks. Application of Sayer plaster-of-paris jacket. The symptoms improved and he left the hospital. After eight weeks he was so much better that he removed the jacket and applied an improvised support himself. The symptoms returned. At this time he was given by mistake an overdose of morphine and died, and at autopsy it was found that the third lumbar vertebra was partially dislocated over the fourth. This illustrates the fact that deformity is not necessary for the existence of a dislocation, though it does not prove that dislocation existed at the time of the original injury. Rupture of the ligaments may have allowed the vertebræ to slip past each other at some time subsequent to the first injury. Case XII. A blacksmith, aged 23, was on the top of a pleasure van when the driver attempted to go beneath a low archway. The patient stooped and was drawn through the arch with the spine forcibly flexed. Dyspnea; left leg was paralyzed; hyperasthesia. Opposite the spines of the tenth, eleventh and twelfth dorsal vertebræ, a prominence which terminated below in a slight depression. In five days he was much better, and in one month he was discharged convalescent. This case shows the manner, more or less usual, in which this class of injuries is produced, namely, the force being brought downwards upon the partially flexed spine, the two extremities of the column being crowded together. Case XIII. M. Lasalle reports a case of the rupture of the posterior ligament of the spine in the cervical region and intervertebral muscular fibres from simple muscular action in a case of acute mania. Death which followed was due to hemorrhage into the cord. In this case there was no fracture or dislocation. No outside influences were brought to bear, and yet rupture of ligaments and hemorrhage, sufficient to cause death, ensued. Case XIV. Male, 20 years old, strong, athletic and muscular. Roof of a flatboat fell on patient, forcing his chest down between his legs upon the floor. The immediate symptoms were violent concussion, insensibility, intermitted respiration, bleeding from the eyes and ears. Examination showed the spine apparently entire and uninjured, except at articulation between last dorsal and first lumbar. Integuments were here contused; articulation completely torn asunder and a rupture of the ligaments. The spinous processes were broken off. Articulating surfaces were two inches apart. The patient was turned on the side and there was an angular projection at this point of 100 degrees, but to the surprise of the attending physicians he gradually improved under simple rest treatment and being placed flat on his back on a hard surface. In two weeks he sat up; in four weeks he returned on foot to the flatboat, a distance of half a mile. Thirty-two days after the injury he was apparently well. There was a slight deformity at the seat of the injury. Up to this time he had done no lifting. Several weeks later, after some slight exertions, there was reported considerable backward curvature at the seat of the lesion. Otherwise apparently perfectly well. This is the most remarkable of the series and was observed carefully by two or three competent physicians. It cannot be proven that there was no dislocation, but there certainly was a rupture, and the fracture was confined to the spinous processes, so far as known, and for that reason it seemed fair to report it in this series. Case XV. Male, 73, fell three feet from carriage, striking on head. Head bent forward. On sitting up there was almost a right angle flexion in the neck. Two hard bodies could be felt. Slight lateral movement between the atlas and occiput. Paralysis from third rib down; feeling gone also. Intellect intact; respiration imperfect. Lived eighteen hours. Post-mortem: Vertebral column.-No fracture; blood extravasation. Posterior ligaments so lacerated as to allow finger to enter the canal. In front the transverse ligaments were torn at the level of fourth and fifth cervical vertebræ. The body of the fourth was entirely bare. Spinal dura intact. Interlaminal ligaments torn. The muscles were all that held the fourth and fifth cervical vertebræ together. Ligamentum flavum completely torn off. Dura colored with blood; no exudate. Cord re moved. Hyperemic; medulla not torn, and in center blood extravasation three inches long on posterior surface, extending through cortex and destroying nerves. No microscopical examination. Intervertebral cartiiages torn in shreds. This shows conclusively, we think, the possibility of an uncomplicated rupture of the ligaments, and offers a possible explanation of the pressure symptoms in many of these cases. The hemorrhage here was sufficient to cause death very soon, but had it been of less extent or in some other portion of the cord, it is reasonable to suppose it might not have terminated so disastrously. It is furthermore not irrational to assume that serious effusions following a forcible flexion of the column might cause temporary pressure, and this become absorbed and symptoms disappear. Case XVI. An elderly shoemaker was sitting at his table using a drawshave on a piece of wood, one end of which rested against his chest. This slipped, causing him to fall suddenly forward. As a result, there was a slight deformity in the mid-dorsal region; no paralysis; great pain and weakness in the back. He was treated by being placed on his back with a pillow so placed as to arch his back up directly beneath the deformity. By By keeping in this position for seven weeks he was able to get up and get about at his work again. Case XVII. Wagner and Stolper report rupture of ligaments of odontoid, and lateral ligaments between the atlas and axis; luxation with compression of cord, but no fracture or crushing of the cord. Recovery. Lived a year and died of cerebral tumor. This case illustrates again the possibility of compression of the cord after rupture with luxation, and is cited simply because an autopsy was performed which showed the rupture of the ligaments, the luxation having been reduced at the time of the accident. This is not an uncommon result, of course, and plenty of cases of the sort could be cited from the literature of spinal luxations, but not many with autopsy so long after the injury where the rupture of the ligaments were carefully noted. Case XVIII. Male, aged 32, telephone lineman. In January, 1901, fell from telephone pole as a result of contact with "live wire," striking on frozen ground upon the back of his neck; was stunned, and taken to the hospital, where he was suspected to have a fracture of the upper dorsal spine, and was so treated. In three weeks he was put in a plaster jacket and discharged. He wore the jacket for some months and then had a back brace made. He complained of pain referred to the seat of the injury; numbness and tingling in the legs and inability to stand erect. He was a tall, well-built man. There was no deformity in the back. The line of the spinous processes was regular, no sign of luxation. Long rounded kyphos in upper dorsal region. This could be partially corrected by extension. A jacket was applied standing, correcting as much as he would bear. This entirely relieved the pain and numbness, but as it did not wholly correct the kyphos a second attempt was made two weeks later, this time with the patient on his back upon the frame. This caused so much pain that it had to be cut off within a few hours, and we went back to the erect position. Six weeks later we were able to fit him with a leather jacket which is holding him entirely erect and relieves his symptoms, though when it is removed he does not seem to be able to hold himself wholly erect as yet. This will probably come, however, if the jackets are worn long enough. An analysis of these cases, from the pathological point of view where this has been possible, and from the clinical and anatomical point of view in other cases, woul! seem to justify the following conclusions: (1) Spinal ligaments, during life, may be ruptured without fracture or dislocation. (2) Nerve pressure symptoms may occur from a simple flexion of the vertebral column. (3) Recovery in these cases requires prolonged rest in a position which favors the repair of ligaments, and that the effects of treatment speak more for the ligamentous rupture than for luxation or fracture. (4) The force which commonly produced the injuries (when stated) was one which, a priori, would be most likely to produce ligamentous rupture. The cases which may prove the first point are: Cases I, II, IV, VI, VIII, IX, XII, XIII, XIV, XV and XVII in all, eleven cases. In one of these we have the photograph of a very careful dissection made post-mortem. In another, a rupture of the ligament was shown postmortem, and this occurred from muscular exertion wholly. Further discussion is not necessary in regard to this point, as such facts conclusively show that it is possible to have such an injury. In support of the second point we can only say that in the four cases of our own here reported, the production of deformity (flexion of the column) would bring on pressure symptoms which could be immediately relieved by hyperextension, and there was no apparent lateral deviation of the spinous processes and nothing to suggest that there was any forward displacement of the individual vertebræ at the seat of the kyphos. There was no suggestion of thickening from callus in any of these cases. Of course it must be admitted that every luxation must be accompanied by a rupture of the ligaments, and that it is possible for forward flexion in these cases to have caused a slipping out of the vertebræ which would then exert the necessary pressure for the production of numbness and weakness. One would hardly expect this, however, without some other external evidence. In regard to the third point, it is to be noted that in the case where a period of some months has been devoted to fixation of the spine, fresh ruptures are likely to occur bringing back the old symptoms. Were these cases of ununited fracture of the vertebræ they would naturally be fractures of the spinous processes or the laminæ, and usually some evidences of bony consolidation ought to be found. That did not occur, or at least was not noted, in any of these cases. Furthermore, in the four cases which we report from our own observation, the patients had been in more favorable conditions. for union of a bony rupture before the spinal lesion was noted than they were allowed to be in afterward. And lastly, in regard to the manner of production of the injuries, there seems to be a rather striking uniformity in the way these patients sustained their ruptures: Cases III, IV, V, VII, VIII, IX, XI, XII, XIV, XV and XVI are the only ones, except Case XIII, in which the nature of the injury is given. In Case XIII muscular action alone was responsible for the rupture. In all of the others the force applied was invariably either from above downward upon a flexed vertebral column, or from below upwards. And this is precisely the sort of injury one would expect to tear ligaments. If it is possible, as is shown by Case XIII, to produce within the body, through its own exertions, sufficient force to rupture the spinal ligaments without fracture or luxation, it would certainly seem that the proper combination of external and internal conditions would be forthcoming a sufficient number of times to make this lesion one which is not so very uncommon. Particularly would this seem to be true when one recalls the not infrequent occurrence of ruptures of large tendons, for example, the quadriceps extensor, the patellar, etc., without any fracture of the neighboring bones or even luxation of them.-Boston M. and S. Jour. TREATMENT OF PARALYSIS AND MUSCULAR BY F. C. WALLIS, F. R. C. S., ASSISTANT SURGEON CHARING CROSS HOSPITAL. Considerable attention has been given of late to a very troublesome complication of fractures, viz., that condition which has been variously termed schemic paralysis, pressure atrophy of muscles, etc. It is fortunately not very common, but since it is very difficult to treat, and was formerly looked on as being almost incurable, anything which holds out prospects of alleviation is worth recording. I have had such a case under my care during the last thirteen months, and although it was not the outcome of a fracture or of its treatment, yet it is identical in nature and essence with those which are caused in this way, and hence its many points of interest have a definite bearing on this subject. It will perhaps be best to give the clinical history of the case first, and afterwards the results and deductions derived from the treatment. E. M., a girl about 20, came under my care at Charing Cross Hospital in July last, with the rare deformity of congenital absence of the superior radio-ulnar articulation in both forearms. The right forearm was capable of some degree of supination, but the fusion of the left superior radio-ulnar joint had occurred with the forearm so much pronated that the arm could not be brought even to a midway position. In consequence of this the girl was unable to earn her living, and wished to know whether anything could be done to help her. After consultation with my colleagues, and at the earnestly expressed wish of the patient and her friends, I determined to make an attempt to either form a joint or to get the forearm in a better position for working purposes. The operation was performed on July 6, 1900, an Esmarch's band being previously placed round the upper arm, as it was thought impossible to do the operation without this. It was a long and difficult business, and took one and a quarter hours before the Esmarch was removed. After dividing the radius close up to the head, the arm was somewhat forcibly supinated; in doing this the ulna was fractured at its lower third. The skin incision was closed with interrupted sutures, and the arm fixed in splints. On seeing the patient twenty-four hours later, the arm was seen to be much swollen and red, and covered in places with large bullæ. Paralysis and loss of sensation seemed complete. The general temperature was raised. The splints were immediately removed, and some stitches which were under tension were taken out, the arm was dressed afresh, and rested on a pillow. There was no suppuration, and gradually the swelling of the arm and all the untoward symptoms cleared off, except that the paralysis continued, and the fingers gradually assumed the "main en grippe" position. On testing the hand and arm for sensation some ten days after the operation, the ulnar and median nerves were obviously the main ones affected; the external and internal cutaneous and the radial nerves all responded to stimulation, whilst the palmar-cutaneous branch of the median had also escaped. This was a curious circumstance, if, as was then imagined, the condition of the arm was due to the direct pressure of the elastic cord. The unfortunate fracture of the ulna hampered the treatment at this stage to a great extent. Passive movements were daily performed, and galvanism applied, but the movements prevented any union taking place in the fractured ulna. Eventually, some three months after the operation, I wired the fracture with good result. The condition of the hand and forearm after the wired ulna had united was typical of the condition. On extending the wrist, the first and second phalanges of the fingers became acutely flexed onto the palm. When the wrist was flexed, the fingers could be proportionately extended. The wrist itself was flexed, and the movements limited. The thumb was practically useless, and the muscles of the hand were much wasted. The loss of sensation remained as before. For the next seven months the hand and forearm were daily galvanized and faradized, and a hot air bath used. Massage by a most expert masseuse was also daily performed, and on three separate occasions during this period the wrist and fingers were thoroughly manipulated under gas. The result of this continued treatment was at first marked. The muscles at the upper part of the forearm improved, the fingers could be passively extended, and a certain amount of active movement was restored to the fingers and thumb. The wrist was not so stiff nor so fixed, sensation had much improved, and the condition of the skin was normal, and in no way resembled that glossy, smooth condition which is seen in all cases of complete nerve division. This was the condition of affairs nearly twelve months after the original operation, and as no further improvement seemed probable until the tendons were lengthened this was accordingly done. A long incision from the wrist up the middle of the forearm was made through the skin, which was reflected on either side. The tendon sheaths on being opened were found to be much thickened, and rather more vascular than usual. All the tendons of the flexor sublimis and profundus digitorum were divided in the usual manner, as also was that of the flexor carpi radialis. Every tendon, infact, on the flexor aspect of the forearm was divided, except the flexor carpi ulnaris and the flexor longus pollicis. After division of the tendons the fingers were extended, and the tendons united by one or two sutures in the altered position. The sutures were cut quite long, and the ends knotted in the manner described by Littlewood and Barnard. The median nerve was freely exposed during the operation, and was surrounded by a lot of fibrous tissue, which was adherent to the nerve sheath. The muscles exposed were pale in color, and the ordinary muscle fibre was to a great extent replaced by fibrous tissue. The skin was united by interrupted sutures, and the hand placed in a well padded back splint with the fingers extended. Weak boric lotion only was used during the operation, as it was evident from the original operation that the patient's tissues resented the application of strong chemical solutions. The immediate result of the operation was most satisfactory, and passive movements were gradually carried out after the first fortnight; active movements were commenced in the middle of the third week. The galvanism and massage were recommenced. The present condition of the hand which is still an improving one, is as follows: The congenital condition remains as before; the fingers when the hand is at rest are semi-flexed, being the ordinary position when the hand is at rest. Flexion and extension of fingers and thumb can be carried out to a limited extent. The thumb can be apposed to the first phalanx of the index finger with some slight power. Sensation has completely returned over the distribution of the radial nerve, and partially over that of the median, but little improvement has been made as far as the ulnar is concerned. After massage the fingers are quite supple and the range of movement is much increased. The main difficulty now is in the metacarpophalangeal joints, which remain obstinate but are gradually improving. As to utility, the patient herself says that the hand now is almost as useful as it was before, but this I should doubt. However, she is able to do a great deal with it, especially in the way of needlework, and as the patient is most persevering, I anticipate considerable further improvement in the next six or seven months. A case which looked so utterly hopeless as this did ten months ago was only capable of improvement by such unremitting care as has been given to this patient. The main points of interest in this case are: I. The cause of the injury (a) to the nerves, (b) to the muscles. At what length of time afterwards should tendon-lengthening be resorted to? 3. How long after the original lesions may improvement be expected? 2. The complete paralysis which existed twenty-four hours after the original operation suggested at first that probably the elastic tube had damaged the nerves where it was put round the limb. It seemed, however, curious that no damage to either artery or vein should have occurred at the same time. Later on, when the swelling of the arm began to subside, the fact that certain nerves such as the internal and external cutaneous and the radial were either not at all or only partially affected made one think that probably the lesion was not due to damage to the nerves at the place where the arm was constricted entirely. The was also Dr. Hunter's view later, when the electrical treatment was begun. which occurred within twenty-four hours of the removal of the band, and which lasted for some days, had a great deal to do with the condition of the median and ulnar nerves, and also with that of the muscles. The excessive capillary hemorrhage which occurs after the removal of the Esmarch is a matter of common knowledge, and what is apparent in the cut surfaces takes place also in the tissues, but more especially in the soft muscular tissue. I do not mean that actual blood is extravasated, but owing to obvious physiological temporary changes in the bloodvessels and capillaries, a large quantity of serum, and with it of fibrous-tissue-forming elements, escapes into and around the tissues. Thus the muscular fibres all become infiltrated with these fibroblastic elements and eventually the healthy contractile muscle tissue becomes largely mixed with fibrous tissue, and in proportion to the amount of fibrous tissue contraction takes place, pulling in the tendons, and so producing the familiar deformity of the fingers in these cases. This condition of the muscles was well seen when the tendons were lengthened ten months after the inquiry, when it may be supposed that the contraction due to the fibrous tissue was finished. In this case, which is quite typical of the class, the clinical facts go to show that hyperemia rather than anemia is the cause of the eventual contraction. The temporary or permanent paralysis which ensues is due to the same cause, and the nerve ends and end plates in the muscle suffer considerably from the sudden and intense interfibrillar infiltration. As to the time that should elapse before tendon-lengthening should be resorted to, it would seem desirable to wait some three or four months to see how much the muscles may recover as far as movement is concerned, and also, what is of more importance, to see the maximum of contraction which occurs. If the tendon lengthening is car ried out before the contraction of the fibrous tissue is finished, the condition is certain to recur to a greater or less extent. I allowed the long interval of ten months to pass because, firstly, the ununited fracture of the ulna had to be dealt with, and secondly, I wished to be quite sure that there was some return of sensation before I proceeded with the tendon-lengthening. The ultimate results are usually so good that the operation should always be undertaken. As I have already stated, a more hopeless-looking condition than that which existed in this patient's hand and arm it would be difficult to imagine, and yet now the hand is of considerable use to her, and I confidently expect will be much more useful still. The degree of disability in the hand depends upon the amount of fibrous tissue, and conversely the extent of movement is proportional to the amount of muscle tissue which is left. The improvement may continue for nearly twelve months after the tendon-legthening if galvanism, electric baths, and massage are persisted in. When the tendons are firmly united the more movements and exercises that are undertaken with the hand the better. Since this case, when in operating it has been necessary to have a good view of the tissues without being hampered by the bleeding, I have accepted a plan, largely used in America, of having a small stream of sterilized warm water continuously playing over the wound (a small amount of hazeline may be added to the water). This It seems reasonable to suppose that the intense swelling does away with any necessity for sponging, any vessels which may require forceps or a ligature are at once seen, and the constant stream washes the tissues clear of blood, so that an excellent view of the operation area is obtained. -The Practitioner. TRAUMATIC APNEA OR ASPHYXIA. BY H. L. BURRELL, M. D., AND L. R. G. CRANDON, M. D., BOSTON. This extraordinary case is recorded because so termed traumatic apnea or asphyxia is rarely seen in the living, and because of the importance of the subject from the point of view of the surgeon and of the medical jurist. E. F., 22 years old, single, was brought to the Boston City Hospital on December 7, 1900, having sustained a crushing injury to the chest. The detailed history is as follows: One hour before admission the patient, in a standing position, had been caught between an electric. car and the door post at the entrance to the car house. His chest had been compressed anteroposteriorly; the head and pelvis were not caught. He was held as in a vise fully three minutes before the car was moved. He then fell unconscious. Physical examination on the accident table showed a large, muscular man, with especially well-developed thorax. He was entirely unconscious, pulse 100, weak but regular; respirations 30, shallow, with a groan at the beginning of each expiration. The hands and nose were cold. There was slight bleeding from both ears and both nostrils, and blood in the mouth; no wounds on the head; pupils small, equal, and did not react; excessive chemosis. Knee jerks were absent, other reflexes present but diminished. In the region of the left lower ribs anteriorly, about the seventh, eighth and ninth, near the nipple line, was an undetermined fracture of one or more ribs-undetermined with exactness because of a considerable area of subcutaneous emphysema. This air under the skin extended over the whole left front chest, and made palpation and auscultation of this area of little value. There was slight general abdominal spasm, but no unusual dulness, nor was there any vomiting. The most striking feature of the case, however, was the condition of the man's skin. From the level of the third ribs, upward over the neck and face and into the scalp, the skin presented a dusky, bluish, mottled appearance. This color became only slightly paler, if pressed with the finger, and when the pressure was removed, it slowly regained its former tint. At first it was thought that the patient was cyanotic, but, as the color was not universal over the body, as it did not disappear on pressing the skin, and as it persisted even after the patient's general condition improved, it was evident that cyanosis was not the cause. Examined more closely, it could be seen that uniformly distributed all over the dusky skin were minute (.5 to 1 mm.) area of natural skin-tint, each surrounded by a poorly defined bluish border-these borders uniting in a mesh work. This condition extended over the red edge of the lips and on the mucous membrane of the mouth to a slight degree. In the eyes there was a considerable subconjunctival hemorrhage, homogeneously distributed over as much of the scleræ as is exposed by the open lids, and not extending to the parts covered by lids. There were minute retinal hemorrhages. The patient was in a condition of extreme shock, and stimulation to the extent of nitroglycerine 1-25 gr., atropine 1-60 gr., and strychnine 1-15 gr. was given subcutaneously, with ice-cap to head and heaters to body. At the end of four hours consciousness returned and there was considerable improvement in the character of the respiration and pulse. About the chest was applied a broken-rib corset, so laced as to limit respiratory movements near the injured part of the chest. The urine on the day of the injury was dark red, acid, specific gravity 1.028, with a large trace of albumin. The sediment was abundant, consisting of normal and abnormal blood. It cleared rapidly, however, for the next day it was smoky, 1.025, trace of albumin and less blood, and in a few days was normal. After three days the patient was relatively comfortable; respirations were 30, pulse 80, good volume and tension, sensorium clear, vision slightly blurred. The dusky, livid appearance of the skin of face and neck was unchanged. Five days later, eight after the accident, the blue color began to fade, the tint, however, remaining as at first, and not going through the usual modifications of a cutaneous hemorrhage. The subconjunctival clot persisted and had not gravitated, as is usual, to the inferior angle of the conjunctiva. Eleven days after the injury the unnatural color of the skin was practically gone and the eyes had begun to clear. After three weeks the patient got up and in a few days was discharged practically well. Accidents of this nature are not uncommon, the most frequent kind being pressure in a struggling crowd. Classic and horrible examples of this are to be found in: (1) The rush of the mob at the Champ de Mars, June 14, 1837, where 23 persons were crushed; (2) the Pont de la Concorde panic in Paris, August 15, 1866, where a mob crowded nine of its number to death; (3) the Vienna Ring Theater fire, December 8, 1881, with nearly 1,000 fatalities; (4) the panic at Victoria Hall, Sunderland, June 16, 1883, where nearly 200 children rushed into a closed corridor and were asphyxiated by crushing; and most recently, at (5) the Charity Bazaar fire, in Paris, May 4, 1897. Numerous post-mortem examinations by most careful observers have given us a picture of what must have been, to a diminished degree, our patient's pathological state. Of these reports, that of Ollivier, quoted by Beck, is the most detailed and complete. Speaking of the Champ de Mars catastrophe in 1837, where 23 people lost their lives from pressure in a crowd, Beck says: "All of them, II men and 12 women, died standing, so that more than one corpse was borne along in this attitude by the crowd. Dr. Ollivier of Angers, who examined the bodies, states that in all, without exception, the skin of the face and neck was of a uniform violet tint spotted with blackish ecchymosis. In nine there was infiltration of blood under the conjunctiva of the eye; in four there was serosanguineous froth running from the mouth and nose; in four, blood flowing from the nostrils; in three, blood flowing from the ears; in seven, fracture of the ribs. In two females the sternum was fractured. There was no mark of either strangulation or wounds, although several |