This specimen was normal in every respect. I left instructions that the catheter be employed in the same manner during the next twentyfour hours; at the same time ordered the patient to be closely watched, and the entire quantity of liquid drank to be measured without his suspecting what was being done. Again the quantity of urine passed and drawn off by the catheter was only three and a half ounces. No one had seen him go to the water-closet or any other place in which he might urinate. It was certain that he had not gone to the toilet-room during the day. He was undressed and apparently in bed all the time. The quantity of liquid that he had drank during the twenty-four hours that he had been under such close observation was 48 ounces. It was reported that he had not perspired much. His temperature, pulse, and respiration were normal. During the time that this man was under observation in St. Luke's Hospital I had been conducting a series of observations on afebrile patients in the Arapahoe County Hospital to determine the relative quantity of urine passed to the quantity of liquid ingested. In no case, while the patients were in bed, had the quantity passed been less than two-thirds of the quantity ingested, and in most of the cases the former quantity was about three-fourths as much as the latter. Thus fortified, I boldly charged the man with lying, telling him that I had measured every drop of fluid that he had drank, and that there could be no such discrepancy. He confessed. During the day he had kept a vessel secreted back of the wardrobe, into which he had urinated, and between midnight and day, when everything was still, he had quietly gone to the water-closet and emptied the vessel.

Diarrhea and constipation are sometimes feigned, but the fraud may easily be detected by having the malingerer closely watched.

Blood-spitting or hemoptysis, if assumed, can usually be detected by a careful inspection of the mucous membrane of the nose, mouth, and fauces.

Feigned asthma, according to DaCosta, is not worse at night nor much increased by exercise.

Feigned Poisoning.-An evilly disposed person might assume some of the symptoms produced by a poison and accuse an innocent person, against whom the simulator had a grudge, of administering the poison. The symptoms would be ill feigned by an ignorant person. One well versed in the action of poisons might take a cathartic and an emetic and then place a poison in the discharge from the bladder and bowels or in the vomited matter. The finding of a poison in these would be no proof that it had come from the body of the person alleged to have been poisoned, unless they had been passed into clean vessels in the presence of a physician or some other reliable witness. If the urine. drawn with a catheter showed the presence of the poison, this would be conclusive evidence of its having been within the patient's body, and nothing more.

Feigned Pregnancy.-Pregnancy may be feigned to extort charity, to secure an unjust settlement of property, or to escape infliction of condign punishment. The deception may be detected by skilled

physicians versed in the symptoms of pregnancy. In no case should an opinion be given without a careful internal and external examination of the alleged mother. If the period of gestation has not advanced sufficiently to permit of a definite opinion in regard to the woman's real condition, the physician should not hesitate to ask for an extension of time, during which repeated careful observations should be made.

Feigned Menstruation.-A woman may be pregnant, yet, desiring to conceal her condition, feign menstruation by soiling her linen with blood. The chemical tests are uncertain for distinguishing ordinary blood from that found in the menstrual flow. An examination of the woman to determine the presence of the results of conception will usually suffice to settle the question. It must be borne in mind that a few persons menstruate throughout the period of gestation. I have met with one woman who menstruated only during gestation and lactation. Throughout these periods her menstrual epochs occurred regularly every twenty-eight days. Suppressed menstruation could be determined only by keeping the suspected person under close observation.

Feigned Delivery.-Taylor says: "Delivery has often been feigned by women for the purpose of extorting charity, compelling marriage, or disinheriting parties who have claims to an estate, and in other cases without any assignable motive." In most of these cases it is recent delivery that is assumed, and an examination of the alleged mother by a competent medical man would soon determine the matter.

Feigned Abortion.-If a woman charges another person with having perpetrated the crime of abortion on her, the truth or falsity of the statement may be easily demonstrated by a physical examination, if this is made soon after the crime has been committed. If the charge is made several months after the alleged commission of the crime, it should raise a suspicion of deception on the part of the woman making the charge. At so late a date it may be impossible to decide positively whether an abortion has been performed.

Feigned Strangulation.-In the few cases of simulated strangulation the marks of violence around the neck have been slight or entirely absent, the impostors have retained sufficient consciousness to take cognizance of everything that has occurred, the cord around the neck has not been sufficiently tight seriously to endanger life, produce cyanosis of the face, protrusion of the tongue, or congestion of the eyes, and the other circumstances surrounding the alleged attempts at murder have been such as to prove the innocence of the accused parties.

If a serious, but unsuccessful, attempt is made to commit murder by strangulation, either by means of the hands or a cord tied around the neck, the parts would not be so delicately handled as to leave no marks of violence. If a cord were tied around the neck, it would be with a firm knot, and the constriction would be so great as to endanger life unless the cord were removed within a few minutes from the time it was applied. There would, in all probability, be evidence of a desperate struggle, and the general circumstances would be in keeping with the acts of the attempted murder.

THE LEGAL ASPECTS OF PREGNANCY.

IT is exceedingly important that the medicolegal expert be well versed in the clinical signs and manifestations of the various stages of pregnancy, since it is not at all infrequent for the question of gestation or the effects of child-bearing to arise in a certain class of cases. Thus, in civil law a physician may be called upon to testify as to the virginity of a woman or the purity of a divorced wife libelously accused of gestation, as proved, negatively, by the absence of the signs of pregnancy or of parturition; he may be required to show the absence of pregnancy in cases of feigned gestation, or when a woman claims to be with child by a man recently dead, for the purpose of advancing an additional heir to a disputed title or estate, or for the purpose of substituting a child in place of the legitimate heir. The claim of pregnancy may be made in order to institute blackmail; it may be advanced as a plea to prevent attendance upon the witness-stand in an important trial by jury; it not infrequently is employed as a means of enforcing marriage to satisfy feelings of unrequited love or to establish a claim for financial support. It has been used as a means of holding the affections of an estranged husband desirous of offspring.

In the criminal court instances are recorded of women pleading pregnancy to bar execution. From the time of the old Roman law to the present such a claim, if verified, has been ample to postpone the carrying out of the sentence of capital punishment until the birth of the child is accomplished. In all such cases, under writ of de ventre inspiciendo, proof of the supposed condition is required, and is secured by careful investigation by medical experts or by the physician appointed by the court. These have rightfully supplanted the old English jury of twelve matrons who were summoned to ascertain the unfortunate woman's condition, and whose main duty was to determine whether or not the woman was quick with child. If the woman is acting bona fide, the examination will not be refused; indeed, it will probably be insisted upon by her. Refusal to permit the examination will expose her to the strong suspicion of unfair dealing. The practitioner must remember, however, that he becomes liable to legal action on her part if he force an examination against her will. It should be his duty, likewise, to warn the patient in all cases that any suspicious appearance may be used as valuable evidence against her. Again, the existence of pregnancy may be denied strenuously by a woman in order to avoid the stigma of illegitimacy, or to gain time for the induction of an abortion.

Here the effort of the physician should be to demonstrate the presence of the gestational signs.

It is important to note that a positive diagnosis of pregnancy is impossible before the sixth week, and often not until the second menstrual epoch, especially in multiparous women. After the date of the positive signs no difficulty should be experienced in proving or disproving the existence of pregnancy. Hence the examination should be postponed, if possible, until such a time as will elicit positive results. An error in diagnosis, whereby an innocent woman is erroneously declared by the examining physician to be pregnant, will react disastrously upon the so-called expert, and may prove ample ground for the institution of legal proceedings.

It is patent, therefore, that a knowledge of the signs of pregnancy is essential for a positive affirmation or denial in a given case.

THE SIGNS OF PREGNANCY.

It is customary to group the signs of pregnancy broadly under the two headings of subjective and objective, of which the latter only-those detected by the senses of the examining physician-are to be trusted implicitly, since they alone are capable of demonstration. While the subjective signs, when present, are exceedingly valuable as suggestive of pregnancy, it must be remembered that a woman may be voluntarily deceiving her physician, or that she may be herself deceived, as has been frequently noted in remarkable instances in the history of obstetries. Thus, a woman nearing her menopause and married late in life, or sterile since an early marriage, may readily coax herself into believing that the menstrual suppression characteristic of the so-called "dodgingperiod" of the climacteric is due to an incipient gestation. Once firmly fixed in her mind, this belief can grow pari passu with the supposed advancing pregnancy. Intestinal movements will be interpreted as fetal motions; gaseous distention of the bowels and fat-accumulations in the abdominal walls are the progressively enlarging uterine body; the irritable bladder of elderly women is construed to mean the irritable bladder of uterine pressure; the breasts may be found to secrete a small amount of serous fluid, and the woman and her husband, and even the family doctor himself, may be deceived into believing that pregnancy exists. In other words, a typical pseudocyesis or phantom pregnancy is developing.

Let it be noted here that pseudocyesis, with the one exception of abdominal enlargement, is a subjective consciousness entirely. The woman feels the sensation of quickening, the fetal movements, the pressure upon the bladder, the sympathetic breasts. The diagnosis of her true condition can be made by the skilled obstetrician only by giving attention to the following points: The woman's age-she is approaching the menopausal period when menstrual suppression or irregularity is the rule, and nervous manifestations are frequently exaggerated; abdominal palpation and percussion will reveal a heavy accumulation

of fat in, together with a lax and pendulous condition of, the walls, and a highly resonant or tympanitic note over the entire surface; no fetal outlines can be detected by palpation of the abdominal surface; examination of the vulvar orifice and vagina reveals the senile atrophy and probably the beginning yellow discoloration of the mucous membrane that are characteristic of advancing years; the vagina may be more or less contracted, the cervix senile and atrophic, and the uterine body small and undergoing retrograde changes; the appendages are also small and detected with difficulty. In order to avoid any error in diagnosis it is better in these cases to administer chloroform or ether, when the abdominal enlargement will collapse and the true condition be made patent. These cases of genuine pseudocyesis may be much more difficult to diagnosticate than feigned pregnancy in hysteric women (see Feigned Pregnancy, p. 44).

It is well, then, to note that a pregnancy may be presumptive, it may be probable, or it may be certain. It is presumptive when, without any expert investigation, the woman, having been exposed, legitimately or illegitimately, to the possibility of conception, presents some or all of the subjective signs of pregnancy, together with a minor degree of abdominal enlargement. It is probable if these signs steadily increase in intensity and other signs develop at proper periods, which in a typical case of gestation should be superadded to the initial symptoms. Finally, a pregnancy is certain only when there are present the so-called positive or diagnostic signs of pregnancy, variously estimated as from three to five in number. They include the fetal heart-sounds, the fetal movements, ballottement, vaginal and vulvar discoloration, and intermittent uterine contractions.

For convenience of reference the signs of pregnancy may be grouped under four headings: namely, the uterine, the vaginal, the abdominal, and the general.

THE UTERINE SIGNS.

Cessation of Menstruation. This is probably the most valuable of the subjective signs of pregnancy. If the previous history has been one of regularity, greater value is to be attributed to the irregularity or suppression of the function, especially if this be associated with other suspicious circumstances, as the history of sexual intercourse. It is the usual result of gestation, although it may follow other pathologic causes, or it may be absent altogether, and the woman menstruate regularly throughout the first trimester or even the full period of pregnancy. Other remarkable cases are those in which the normal (?) condition of the woman is that of amenorrhea, save during the progress of gestation, when regular menstrual discharges prevail. Again, it is possible for pregnancy to occur in young girls prior to the establishment of the menstrual flow, and for rapid successive pregnancies to prevent the appearance of the menses until late in the woman's life, or even altogether. Again, cases are on record of conception having occurred some time after the woman had passed through her climacteric. These