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COMPENSATION OF EXPERTS-MODES OF DYING.

He cannot be punished for contempt in refusing to appear or testify as such without he is compensated, but he can be compelled to appear and testify to facts within his knowledge, the same as any other witness, without compensation above the statutory fee to which any witness is entitled: Buchanan v. State, 59 Ind. 1; s. c. 26 Am. Rep. 75; 17 Alb. Law J. 242; Dillis v. State, 59 Ind. 15; Webb v. Page, 1 E. & K. 23; Parkinson v. Atkinson, 31 L. J. (N. S.) C. P. 199; In re Roelker Sprague, 276; People v. Montgomery, 13 Abb. Pr. (N. S.) 207; United States v. Howe, 12 Cent. L. J. 193.

The courts of Alabama and Texas have held that experts are not entitled to extra compensation: Ex parte Dement, 53 Ala. 389; Sumner v. State, 5 Tex. App. 365; but the weight of authority is otherwise. This subject has been exhaustively treated by Lawson in his work on Expert and Opinion Evidence, and by Rogers on Expert Evidence.

The medico-legal authors all treat it, but in a general way. Among them Wharton & Stillé (1882); Dean (1873); Elwell (1881), (1887); McClellan (1872); Ordronaux (1869), (1878); Medico-Legal Papers, series 1, 2 and 3 (N. Y.); Taylor (all English and Phil. editions); Woodman & Tidy (1876), (1884); Naquet's Legal Chemistry (1876); Taylor on Poisons (1875); Field's Medico-Legal Guide (1882); Reese, Med. Jur. & Tox. (1884), (1889), (1891); Bucknill & Tuke (all editions).

The law authors on Evidence (Wharton, Starkie, Greenleaf, Taylor, Best, Wood) all treat the subject in their works on Evidence, to which the student and the expert should refer; vid. also Prof. Washburn's paper in 1 Am. Law Review, 62.

For references to authorities and decisions, the American and English Encyclopædia of Law and Abbott's New Digest are the best sources of information.]

CHAPTER III.

MODES OF DYING.-SYNCOPE, ASPHYXIA, COMA.-SUDDEN DEATH.-SIGNS OF DEATH.—CESSATION OF CIRCULATION AND RESPIRATION.-COOLING OF THE BODY.-CADAVERIC RIGIDITY.-PUTREFACTION.-CHANGES PRODUCED IN THE VISCEEA.-PUTREFACTION MISTAKEN FOR GANGRENE.

MEDICAL jurisprudence takes cognizance of all violent causes of death, and is only indirectly involved in those cases of natural death which simulate the effects of violence. Thus, all causes which operate to produce death suddenly especially demand the attention of a medical jurist. These may be either natural or violent; and the distinction between them is of importance, since the guilt or innocence of a person charged with crime may depend on a correct determination of the cause.

The continuance of life depends upon the proper and regulated action of the heart, the lungs, and the brain; and the interdependence of these organs is such that the arrest of the functions of one of them is speedily followed by the arrest of the functions of the others. Hence, they have been called the tripod of life. When the suspension of the motions of the heart is the primary cause of death the person is said to die by syncope. The term asphyxia is applied to death which begins by the lungs; and coma to that which arises from a primary disturbance of the functions of the brain.

SYNCOPE-ASPHYXIA.

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Syncope (ovyzónтw, signifying to strike down).-In order that the action of the heart should be maintained, it is necessary, first, that the blood supplied to it should be in sufficient quantity; and, secondly, that this blood should be of proper quality. In death from hemorrhage we have an instance of deficiency, and in death from certain poisons as well as diseases, an illustration of defect of blood (asthenia). In ordinary syncope (fainting or swooning) there is simply a deficiency in the quantity of blood which passes through the heart, although there is no actual loss of this fluid from the circulation. Certain diseases which affect the muscular structure of the heart, as well as its valves and blood vessels, may also lead to a sudden arrest of its functions. These morbid conditions produce a mechanical impediment to the motions of the organ by which the blood is propelled, and death by syncope is the necessary result. One of the most striking of the phenomena which attend this mode of dying (death from hemorrhage or anæmia) is an extreme palor of the face, hands, and lips, and indeed of the body generally. The patient is very restless, tossing the limbs about in all directions. Giddiness and nausea are often complained of, and actual vomiting may occur. In many cases vision is extinguished, everything appearing black. There is transient delirium, which soon passes into insensibility. The pulse becomes more and more weak and irregular, until at length it is imperceptible. The respiratory movements are repeated at uncertain intervals, and have a sighing or gasping character. Towards the last there are general convulsions (Fagge on the Different Modes of Dying, Guy's Hosp. Rep., 1879, p. 343). In these cases the heart is found empty and contracted at the autopsy. When, however, from any cause, there is sudden stoppage of the heart, the right and left cavities of this organ are found to contain blood in the normal proportion in which that fluid is ordinarily circulated. Blood is found in the large veins (venæ cava) as well as in the arterial trunks. There is no congestion or accumulation of blood in the lungs or brain.

Asphyxia (à priv. and opus pulse, signifying pulselessness).-This state is induced by any cause which arrests the function of respiration. The term apnoea (from à priv. and яvéw, I respire) is less appropriate, and is now applied by physiologists to an exactly opposite condition-that which consists in an excessive supply of oxygen to the blood, rendering respiratory movements for the time unnecessary. The various forms of death by suffocation, as in the obstruction of the air-passages from mechanical causes in drowning, hanging, and strangulation, furnish illustrations of death commencing by the lungs, or asphyxia. The effect of cutting off air from the lungs is that the blood is not aërated, and it is therefore circulated in a state unfitted to support the nutrition of the heart and brain. It is necessarily distributed with the impurities derived from the waste of tissue, and thus acts as a poison to all the organs. It is incapable of sustaining nerve-force or muscular irritability. It stagnates in the capillary vessels of the lungs, produces a languid action of the heart by its circulation through the muscular structure of this organ, and causes insensibility by its distribution through the blood vessels of the brain. The lungs, by purifying the blood, are essential to the circulation. Death from asphyxia may be therefore regarded as death from defect of the blood. The observations of Brodie and others have clearly proved that, in spite of the impurity of the blood, the heart will continue to act and the circulation to be maintained for two or three minutes, or longer, after breathing has entirely ceased. This may be proved by hanging or strangling an animal, and observing the condition of the heart. As the action of this organ continues after the animal has ceased to breathe, life is not actually ex

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DEATH FROM ASPHYXIA.

tinct; and, under favorable circumstances, it may be restored, if no injury be done to the air-cells of the lungs, so long as this action continues. The circulation of the unaërated blood through the brain, appears to annibilate sensibility, so that no consciousness or feeling exists, and the person is to all appearance dead. Supposing that the suspension of respiration is complete, the action of the heart gradually slackens and finally stops. It is at this period of the complete arrest of the motions of the heart that a-phyxia passes into death. There are many diseases which operate fatally by arresting the functions of the lungs; and these may be regarded as furnishing the natural causes of asphyxia. The violent causes, including not only the ordinary modes of suffication, but the effects of certain poisons, are not difficult to appreciate, provided a true history of the case can be obtained. Michael Foster has shown how, in experiments on animals, it is very soon observed that the expiratory efforts become exaggerated out of all proportion to the inspiratory, and how they quickly pass into convulsions. This period lasts about a minute, during which time the pulse is increased in frequency, and the arterial blood-pressure rises. Deep, slow breathing then supervenes, and the inspiratory movements are now more marked than the expiratory, the more yielding parts of the chest wall receding at every inspiration. The cardiac beats decrease in number, but remain forcible, though the arterial pressure falls. The respiratory rhythm becomes irregular, long pauses being followed by quick inspirations with brief intervals. The inspirations next become shallow and gasping, the acceleratory muscles of respiration being brought into active play, and at last the gasps end in a convulsive stretching of the whole body; and, with extended limbs and a straightened trunk, with the head thrown back, the mouth widely open, the face drawn and the nostrils dilated, the last breath is drawn. There are three distinguishable stages of these phenomena of asphyxia, which result from a continued deficiency in air:-1. A stage of dyspnoea, characterized by an increase in the respiratory movements both of inspiration and expiration. 2. A convulsive stage, characterized by the dominance of the expiratory efforts, and culminating in general convulsions. 3. A stage of exhaustion, in which lingering and long-drawn inspirations gradually die out. When brought about by sudden occlusion of the windpipe, these events run through their course in from three to five minutes. The phenomena of slow asphyxia, where the supply of air is gradually diminished, are fundamentally the same, and the same stages are seen, but with their development taking place more slowly than where there is a sudden and total deprivation of air. The heart continues to beat for some seconds after all respiratory movements have ceased, whether the asphyxia be rapidly or slowly developed.

In animals, the cardiac chambers at the moment of death are all gorged with blood-the left ones as well as the right. When rigor mortis sets in, the left auricle and ventricle empty themselves; and in ordinary autopsies in the human subject, the pulmonary artery, the right cavities of the heart, and the vena cava are found gorged with blood. The pulmonary veins, the left cavities of the heart, and the aorta, are either empty or contain but little blood. In certain cases of asphyxia, the right cavities of the heart, as well as the left, have been found empty. When the access of air to the lungs is suddenly and completely cut off, the circulation of the blood is very speedily arrested; but supposing the occlusion of the air-passages to be partial or gradual, the circulation of the blood may continue for a time, and thus cause congestion of certain organs. Hence the appearances in asphyxia differ greatly. A mixed condition, under the

name of syncopal asphyxia, has been described by some pathologists. In this the cavities of the heart are found empty. Geo. Johnson (Asphyxia, 1889) states that when the chest is opened immediately after death from apnoea (asphyxia) the right cavities of the heart are distended with blood, while the left contain comparatively little blood; and he holds that the phenomena of asphyxia are characterized by two well-defined stages. In the first stage there is systemic arterial resistance, with resulting distension of the left side of the heart. In the second stage there is pulmonary arterial resistance, with distension of the right cavities and comparative emptiness of the left.

Coma (from zo zupa, a deep sleep).-Besides a due supply of properly aërated blood, the brain requires for the exercise of its functions a proper quantity of blood, so that either by the sudden withdrawal of this fluid, or by a circulation of impure blood, these are arrested. A person thus affected falls into a state of complete insensibility (coma), so that it is impossible to rouse him. The functions of the heart and lungs are not always suddenly arrested under these circumstances. They appear to be less dependent on the brain than the brain is upon them; but this is rather a question of degree. A due supply of nerve-force is required for the action of the muscles, whether of the heart or of the chest; and when this is withdrawn, the heart ceases to beat, and the respiratory muscles cease to act: circulation and respiration are thus arrested by the absence of innervation. This is sometimes described as death by paralysis of the heart and lungs. The blood is neither aërated nor circulated. Sudden death from apoplexy is an illustration of death by the brain. Coma may also be a result of the introduction of certain poisons into the blood, and of fractures of the skull leading to compression of the brain or destruction of its substance. Death beginning at the brain is, indeed, scarcely to be regarded as a mode of dying, since it may usually be resolved into either death from sudden paralysis of the respiratory centre, when death is often absolutely quiet; or the coma ends in asphyxia, when the extinction of respiration is brought about more slowly. In death by the brain, the appearances observed consist chiefly in a congested state of the cerebral membranes and substances of the brain. As before death the breathing is affected, the lungs are congested and blood accumulates in the cavities of the heart, more on the right than on the left side.

The appearances described as characteristic of the different modes of death by the heart, lungs, and brain, are liable to variation by reason of the intimate relations of these organs. Thus, there may be a mixed condition of syncope and asphyxia, or of asphyxia with cerebral congestion. With regard to the interruption of the functions of the brain as a result of pressure by the effusion of blood or serum, it is to be observed that a very small effusion at the base or in the substance of the medulla oblongata is sufficient to cause death; while, generally speaking, a larger effusion is required into the membranes, ventricles, or substance of the brain, in order to produce a fatal result. In cases of chronic hydrocephalus, in which the brain has resisted the pressure of a large accumulation of serum for many years, a slight and sudden increase in the quantity at any period of life may lead to coma and death. This condition may be mistaken for narcotic poisoning.

All causes of death, whether from disease or violence, are referable to an effect produced primarily on the heart, the lungs, or the brain; but, as it has been elsewhere stated, death does not take place until the action of the heart has entirely ceased, the arrest of the circulation producing an immediate impression upon the functions of the brain and lungs.

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SIGNS OR INDICATIONS OF DEATH.

The natural causes of sudden death may be generally traced to some injury or impediment to the action of the heart, lungs, or brain It would be foreign to the objects of this manual to give a description of them. The violent causes are those which demand the especial attention of a medical jurist; they will be considered hereafter. In its relation to medicine and medical jurisprudence the subject of sudden death has been fully treated by Herrich and Kopp, Der Plötzliche Tod aus inneren Ursachen, 1848; by Devergie, Ann. d'Hyg., 1838, 2, 145; and by Fagge, Guy's Hosp. Rep., 1879, p. 343. [By far the most important and valuable work upon this subject is La Morte et la Morte Subite, by Prof. Brouardel of Paris (J. B. Ballière et fils, Paris, 1895). Vide also article by Charles Templeton, M.D., Med.-Legal Jour., vol. xiii. No. 1, p. 1.]

The violent causes of death, whether sudden or protracted, which chiefly require the skill of a medical jurist for their elucidation, are poisoning, wounds, and personal injuries, such as burns and scalds, as well as those forms of death which commence by the lungs, including drowning, hanging, strangulation, and suffocation. In nearly all cases, the body of the deceased is produced, and a medical opinion can be based upon a careful examination.

Signs or Indications of Death. The verification of death is occasionally a duty thrown on the medical jurist. Certain signs or indications have been pointed out as proving that death is real, and not apparent. These are taken in the order of their importance.

1. Cessation of Circulation and Respiration.—-The heart is considered to be the organ in which life begins and ends the primum vivens and ultimum moriens—the first to live and the last to die. The proof of death is the proof of the cessation of the heart's action for a certain period. The more visible indication of death is the cessation of breathing, and, in the opinion of Brodie, the entire cessation of breathing alone may be regarded as a decisive test of the extinction of life. The movements of respiration cannot be overlooked by any one who does not choose to overlook them; and the heart never continues to act for more than four or five minutes after respiration has ceased. The proofs of the continued action of this organ are, however, less obvious to the unskilled observer than the movements of the chest. The cessation of breathing for a period of five minutes furnishes a certain proof that the person is really dead. But the skilled observer would apply the test of auscultation, and before giving an opinion should satisfy himself of the permanent cessation of the heart's action. It is impossible to admit that the heart can remain for even half an hour in a state of inaction in a human being, and then spontaneously recover its activity.

2. Cooling of the Body.-The normal temperature of the interior of the living body in health is about 98.4° F. It is liable to be increased in some diseases, and to be diminished in others In a case of typhoid fever the blood was found to have a temperature of 113° F.; and in strychnine poisoning it is very high. The time usually assigned for the cooling of the dead human body is from fifteen to twenty hours, but it varies according to the condition of the body at the time of death, the mode of death, and the circumstances under which it had been placed. Thus, if exposed naked to a cold atmosphere, the cooling of the body is very rapid. If it is well covered, the cooling takes place slowly. When death has taken place suddenly from accident, apoplexy, or acute disease, the body has been observed to maintain its temperature for a long period. Obviously, a dead body cools less rapidly as its temperature approaches that of the surrounding medium. Goodhart found the average rate of cooling during