Not to weary your patience, I will simply say that of seven other cases treated with cannabis and bromide, one woman in a state of great agitation, constant distress of mind, and extreme suicidal impulse, took from three fourths grain to one grain cannabis and fifteen to twenty grains bromide three times a day for three months with marked benefit. It was then thought best, from her appearance, to omit it for a while, and opium in moderate doses was substituted. This did not succeed. There was loss of appetite, in fact pretty constant nausea, with, of course, loss of flesh, and a change for the worse in mental condition. Cannabis and bromide were afterward resumed with the former good effect, and are still taken.

Another case, still an inmate of the asylum, thought she had committed the unpardonable sin; was fearful of future punishment, greatly agitated, and made foolish attempts at suicide. For four months she took one and one half grains cannabis and thirty grains bromide three times a day, and later one and one fourth grains cannabis and twenty-five grains bromide three times a day for two months, apparently with great benefit. Of two other women, one was discharged recovered, but not while taking the cannabis and bromide, nor because of it; and the other is not improved after having taken for two months one to one and one fourth grains cannabis and twenty to twenty-five grains bromide. One man left the asylum at the end of a month not improved, but this was not a fair trial either in time or dose. In the case of another man it was omitted after four months' trial, and opium substituted, with good results. A third man took it with doubtful benefit for four months.

Not considering the case still under treatment, of the above eight cases one recovered; the cannabis and bromide was of marked benefit in two cases; of doubtful benefit in two; and of no advantage in three (one not having been a fair trial).

The action of this combination seemed to have been mainly sedative, and the effect was to quiet restlessness and give general treatment a fair chance; indeed, if the patient merely becomes calm it is in itself a long step towards recovery. It is perhaps worthy of remark that though the cannabis and bromide were continued in many cases for long periods of time no depressing effects were observable. Au increased appetite was noticed in some of the cases, while in others it would be difficult to say the appetite failed, for it could not well be less.

simple aqueous solution and tincture are given in one dose.

From a comparison of results in the two series of cases the balance is much in favor of opium, still the cannabis and bromide will do good in some cases, and may sometimes be used when opium cannot. It should therefore not be discarded as a form of medical treatment in melancholia.

Dr. Clouston's conclusion was that "fewer cases of simple melancholia were benefited by the bromide alone or along with Indian hemp than any other form of insanity. Some were made worse by them, but in one case of this disease, when there was great excitement and hallucination of hearing and suspected organic disease of the brain, the combination gave immediate and complete relief of all the symptoms for four months." This conclusion appears to have been based on the observation of five cases.

Opium may have some other action, but its main effect appeared to be sedative.

If there were no diminution in the restlessness and

agitation of the patient I should doubt any great advantage from its use, and this leads me to say that while it is not possible to predict that a given case will be benefited, in a general way it may be said that the most favorable results are obtained in cases of restless melancholia. In some there is apparent intolerance of the drug; the appetite fails, the patient loses ground, and the treatment must be abandoned. It should, however, be borne in mind that a loss in appetite is not always an indication for stopping its use. The modern idea of the opium treatment of melancholia is somewhat like that in regard to its use in peritonitis as compared with the older method. In treating a given case the dose should be increased till the patient becomes calm, or dangerous symptoms appear. The agitation of a case of melancholia is an entirely different affair from the excitement of mania, in which the use of opium is not advised, and there is, so far as I can see, no danger, with careful watching, in gradually increasing the dose to almost any limit.

Many of the cases reported were severe, and the chances of recovery small; in such more vigorous treatment is warranted than in the ordinary cases of simple melancholia that do well with attention to the general conditions of health and little or no medication. I have seen a modification of the "rest treatment" used with success in several cases of this character. In conclusion, I would remark that it is often extremely difficult to say whether or not a given remedy has been beneficial, and much more so to ascribe to it a cure.

An objection to the tincture is that it is a bad looking and bad tasting dose, and I prefer a pill of the extract, which has been used to some extent. A solution of bromide containing considerable glycerine has been used, as this will for a day or two prevent a precipitation of the cannabis, which will occur if the

BY F. W. DRAPER, M. D.

CREMATION AND CRIME.

BROUARDEL, professor of legal medicine in the Medical Faculty of Paris, in a report made to the Council of Public Health, and adopted by that body in August last, makes the following among other observations concerning the relation of crime to the practice of cremation in times of epidemic invasion. He declares his belief that societies and individuals who seek to promote this method of disposing of dead bodies 1 Annales d'Hygiène publique et de Médecine légale, October, 1883, page 315.

have not appreciated fully the medico-legal difficulties in their way. Cases of acute poisoning, he says, are of two kinds. One class includes the accidental cases in which it matters little whether the body is buried or burned. Illustrations of the other class present themselves under totally different conditions. One must be living in intimacy with a person to be able without ready detection to mix poison with his food. After the poison has been swallowed the one who has given it is often the nurse of his victim, sometimes the only witness of his sufferings. Frequently many days elapse after the death before rumor calls attention to the case as one of suspicion, and days, weeks, sometimes months and years intervene before the inquest is held. If cremation has effected the destruction of the body of the victim no trace remains permitting the authorities to confirm the guilt of one suspected, or, what is of equal consequence, to demonstrate the innocence of one falsely accused.

If, as those who favor cremation propose, an autopsy is invariably made before the destruction of the body is permitted, a great difficulty will still be encountered. The chemical detection of poisons often requires a month or two months of analysis. How shall we harmonize these complicated and laborious researches with frequent cremation? Then, too, if the expert finds in the dead body an alkaloid or a mineral poison, such as arsenic or mercury, inquiry must be made of the family to ascertain if the deceased person in the last months of his life had not taken as medicine one or another of these poisons.

It does not appear that hygiene finds any advantages from the cremation of dead bodies in times of epidemic invasion. The speedy equipment of proper apparatus for the combustion of several hundred bodies daily is almost an insurmountable difficulty when it is recalled that the best appliances now known cannot reduce an adult body to ashes in less than four hours. On the other hand it is not demonstrated that a cadaver dead from cholera, for example, can become an agent for the spread of the disease. Whether such a body be destroyed by fire or slowly by decomposition in the earth the result appears to be the same. It is impossible to invoke any danger that comes from the burial of cholera victims as a reason for the necessity of adopting the cremation of their bodies.

All writers on toxicology point out the similarity in the symptoms of cholera and of certain forms of poisoning. For example we may recall two of the agents most frequently employed with criminal intent, arsenic and corrosive sublimate, not to mention any of the alkaloids occasionally used in like manner. Dr. Laveran says: "In certain forms of poisoning and at the beginning of epidemics one cannot exercise too much caution in diagnosis." In the East Indies, according to Morehead, criminal poisoning is frequent during epidemics of cholera.

Brouardel sums up his objections to cremation as follows:

The handling of the bodies subjected to cremation is such as to expose those engaged in the work to greater danger of infection than would be the case in burial. The interests of justice and those, equally great, of persons unjustly accused of having committed crime, would be seriously compromised by the adoption of

cremation.

If cremation is permitted only after an autopsy and an analysis of the viscera it would be necessary before

adopting such a scheme to establish a great number of autopsy rooms, and to educate a numerous corps of experts. It is only when these various questions have been seriously considered and properly solved that cremation could be permitted without detriment.

1

ON DEATH BY COLD.

Dieberg has formulated some valuable conclusions on this subject as the result of his observations on the bodies of thirty-one persons who died by exposure to cold. He found in all these cases that the heart in all its cavities was distended with blood of a fluid consistency and deep color, with an occasional soft clot. He determined the relative fullness of the heart by weight, and shows that although many of the victims of frost may be supposed to have been intoxicated when they became chilled alcohol was not the cause of the death, because in cases of fatal alcoholism alone, without the intervention of cold, he found the weight of the blood contained in the heart to be nearly four times less than in the others.

In explanation of the cause or manner of death in these instances the author states that under the effect of cold the tissues and the vessels undergo a contraction which is in proportion to the temperature depression; that the more superficial and thus the more exposed the vessels are the greater also will be their contraction; that according as the exposure to the cold is prolonged the contraction will progress from the periphery to the centre; that the heart will be able to send only a limited amount of blood forward into the vessels, the latter being unable to receive the normal supply; that the lungs continuing their functions still further supplies of blood are forced in upon the heart, and finally the arrest of that organ is effected, and death by syncope results.

This theory is in accord with facts observed by persons who have survived exposure to a very low temperature. In the report of his voyage to the North Pole Wrangel relates that when the thermometer on one day registered -53° C. every one suffered from headache, tinnitus aurium, subjective optic symptoms, and especially an extremely violent sense of weight and discomfort, indications apparently of circulatory disturbances.

Dieberg believes that death by cold is really due to syncope rather than, as Lesser and Hofmann have held, to asphyxia. In asphyxia one finds at the autopsy dark fluid blood, engorgement of the large veins and the right side of the heart, hyperemia of the lungs and other organs, punctate hæmorrhages in the serous and mucous membranes. But in death by cold the blood is not always or wholly fluid; it contains clots, especially in the heart. Moreover, its color, instead of being very dark as in asphyxia, is of a brighter hue. Distention of the large veins is not observed, and in the heart the blood is equally distributed in the cavities, and is not found in relatively increased amount in the right side.

The author summarizes his conclusions thus: If, he writes, on making an autopsy upon a frozen cadaver one finds no appreciable lesions to account for the death, but discovers the heart engorged with blood in all its parts, he may declare that the individual was exposed to cold while still living, and that the cold was the cause of the death. If, on the other hand, the 1 Vierteljahrsch. f. gerichtl. Med. u. offentl. San., xxxviii., page 1.

heart is empty of blood the examiner may conclude that the person was already dead when exposed to the cold, and that another cause of death must be sought for.

PUNCTURED WOUNDS.

Professor Hofmann, of Vienna, states in a recent article that many errors have grown out of the notion which is widely entertained, by physicians as well as by the laity, that one can readily recognize, from the shape of a punctured wound, the kind of weapon which produced it. There is only one class of pointed instruments, those namely with a double edge, which makes wounds whose outlines exactly reproduce those of the weapon. The shape of such wounds is like that of a cross section of the blade, two arcs of a circle meeting at an acute angle. But double-edged blades are not the only ones which produce wounds of this shape; they could be made also by thrusts with a knife having a single cutting edge, or with an instrument conical in shape or many sided. Dupuytren and Malgaigne long ago established the fact that conical weapons make punctured wounds which are not round but linear, and they added the observation that the direction of these wounds was different according to the various parts of the body. In 1861, Langer elaborated these views and showed that the skin has a special "cleavage" for each region. In making deep punctures in various parts of the cadaver, he was able to mark out zones or areas more or less extensive wherein identity of appearances, due to the anatomical structure of the skin, was manifested.

With regard to ordinary knives, it is generally thought that they make wounds whose shape is that of a cone with the base larger or smaller according to the thickness of the blade. Observation shows that this is not true, but that oftener the wound terminates in two tapering ends just as if it had been made by a doubleedged weapon.

Wounds made with blades with several faces usually have a stellate form, and the number of rays corresponds with the angles upon the weapon. When the little triangular flaps of skin outlined by the faces of the weapon have been forcibly driven inwards by the thrust, we may have a wound whose shape reproduces

that of the blade.

With weapons which have a great number of sides and angles, the angles necessarily becoming more obtuse according to their number, we may have linear wounds like those made with conical blades; but there may often be seen little secondary rents, corresponding to the angles of the weapon, branching from the primary opening.

The foregoing rules are subject to some exceptions. Thus, when a conical weapon wounds a part where different systems of cleavage in the skin converge, the resulting lesion may be triangular. Wounds made with a knife may likewise show secondary cuts when the weapon is turned in withdrawing it. When the knife has penetrated a fold in the skin, the part, if put upon the stretch, will show an opening of zigzag shape.

The dimensions of punctured wounds may supply some indications for identifying the weapon used. But here again experience often contradicts theory. Thus with a conical weapon the wound generally has a 1 Annales d'Hygiène publique et de Médecine légale, June, 1883,

page 491.

length greater than the diameter of the weapon at the point where it was arrested. This is explained by the elasticity of the skin; but as this quality is limited, it may show itself, under the action of a thick conical instrument, in secondary rents, and then the principal wound is shorter than the diameter of the weapon. When one thrusts a very sharp knife into a cadaver, if care be used in entering and withdrawing the blade, a wound results whose length is equal to the width of the instrument at the point where it was arrested in the skin. But almost always the length of the wound exceeds the width of the blade because the cut is enlarged by the lateral movements made involuntarily in the thrust or the withdrawal, so that a very narrow blade may make large wounds and when these are superficial one might readily classify them as incised. It is plain from this that the manuer of holding the knife with reference to the cutting edge has great influence on the resulting lesion.

Sometimes, on the other hand, the wound is smaller than the weapon which produced it. This is due to the retraction of the skin, which spreads the edges of the cut and thus approximates its extremities a little. This retraction is more or less marked according to the looseness of the skin's attachment to the subjacent tissues; and it is further modified by the direction in which the thrust was received, whether in a perpendicular or a parallel direction with reference to the line of cleavage in the dermal layers; it is thus that on the extremities wounds perpendicular to the long axis of the limb always gape more than others and hence appear shorter. This affords a practical hiut; in taking the dimensions of such wounds it is well to bring the edges of the cut together into a rectilinear shape and then to measure the length only.

Knives whose cutting edge is dull may make punc tured wounds much smaller than their own diameter. The same thing results with a cutting instrument sharp at the point and blunt in the rest of its length; in such a case, once the point has penetrated, the thicker part of the instrument simply stretches the skin, which by virtue of its elasticity returns to its previous condition, as far as may be, as soon as the weapon is withdrawn. When a blade of this kind is slowly pushed through the skin, a funnel-shaped depression is seen around the instrument at the point where it penetrates; upon reversing the direction in process of withdrawal, the skin forms a cone around the blade. bayonet in this way makes a wound which may centimetre shorter than the blade's diameter.

A

be a

If the weapon is very dull, it acts like a wedge and makes a wound whose direction is wholly subordinate to the anatomical structure of the skin; if, for example, one thrusts a dull bayonet into a limb perpendicularly to its axis, the resulting wound has a direction parallel with that axis. In these cases the wound is generally smaller than the weapon, always depending in this regard on the elasticity of the skin. But the aspect of the wound, if it shows secondary rents at its edges, proves that the skin has been stretched, and it thus furnishes important evidence of the nature of the weapon. In making on the same region of the body several punctures with a blunt bayonet, each time in a different direction, one sees that all these wounds are parallel, one with the others, and with the predominant direction of the fibres in the skin; but the direction of indicates that in which the weapon entered. the little secondary rents at the edges of the puncture