Criminal Investigation 3rd Edition by

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Contents
Preface xix

Part 1 Fundamentals of Criminal Investigation

CHAPTER 1 Foundations of Criminal Investigation 1
The Book’s Theme 2
The History of Criminal Investigation 3
Criminal Investigation in England 3
Criminal Investigation in the United States 3
The Introduction of Metropolitan Detectives 4
State and Federal Initiatives 5
The Creation of the FBI 5
Other Investigative Initiatives 6
Contributions of August Vollmer 7
Historical Highlights in Forensic Science 7
The Evolution in Research and Science in Forensic Science 8
Criminal Investigation Research 9
The RAND Corporation Study 9
The PERF Study 11
The Objectives of Criminal Investigation 11
Inductive and Deductive Reasoning 12
Critical Thinking and Scientific Methodology 13
The Emergence of the Police Specialist 14
Types of Investigations 14
Crime-Scene Investigators 15
Modes of Investigation 15
The Role of the Criminal Investigator 15
Characteristics of the Investigator 15
The Patrol Officer as an Investigator 16
Solvability Factors 16
The Preliminary Investigation 17
The Crime-Scene Response 18
THE CASE: Anatomy of a Home Invasion 20
Summary and Key Concepts 21

CHAPTER 2 The Crime Scene: Field Notes, Documenting, and Reporting 24

The Role of Field Notes in a Criminal Investigation 26
When to Take Notes 26
What to Write Down 26

vii
 Developing a Note-Taking System 26
Field Interview Cards 26
Writing the Official Investigative Report 26
Factuality 27
Thoroughness 29
Getting to the Point 29
Accuracy and Objectivity 29
Word Choice 29
The Main Components of a Fact Sheet or Initial Complaint 29
Documenting Interviews 29
The Initial Complaint 30
Supplemental Reports 30
Methods for Photographing the Crime Scene 31
Photographs as Evidence 31
Preserving Digital Images 32
What to Photograph 32
Other Hints 32
Legal Considerations for the Admissibility of Photographs 34
Information Included in the Photographic Log 35
Surveillance Photographs 35
The Crime-Scene Sketch 36
Putting It Together 36
Measurement 36
Rough and Finished Sketches 36
Choosing the Best Method 37
THE CASE: Investigative “Tunnel Vision”—The Duke Lacrosse Rape Case 39
Summary and Key Concepts 40

CHAPTER 3 Processing the Crime Scene 43

Understanding the Preliminary Investigation 44
Types of Crime-Scene Evidence 45
Forms of Evidence 46
Responsibilities of the First Officer 46
Broadcasting a Flash Description 48
Securing and Protecting the Scene 49
The “Walk-Through” 51
Establishing “Chain of Custody” 51
Using Legal “Tools” 51
Collecting and Searching for Evidence at the Scene 51
Search Patterns 52
The Crime-Scene Search 53
Collecting Evidence 53
Performing the Follow-Up Investigation 56
Contacting the Medical Examiner 56
Conducting a Neighborhood Canvass 56

viii Contents
 Preparing Crime-Scene Reports 56
Performing the Follow-Up Investigation 57
THE CASE: Pressure, and More Pressure—The Impact of TV on Crime-Scene Processing 58
Summary and Key Concepts 59

Part 2 Follow-Up Investigative Processes

CHAPTER 4 Identifying Criminal Suspects: Field and Laboratory Processes 62
The Role of the Crime Laboratory in Criminal Investigation 63
Trace Evidence 63
Questioned Documents 63
DNA Analysis 63
Ballistics 64
Latent Prints 64
Forensic Photography 64
Types and Patterns of Fingerprints 64
Types of Prints 65
Types of Patterns 65
Searching for Prints 66
Development and Preservation of Latent Fingerprints 67
The “Tools” of the Trade 67
Preserving Fingerprints 67
Prints from Gloves 68
The Integrated Automated Fingerprint Identification System 68
DNA and Criminal Investigations 69
Analyzing DNA 70
Elimination Samples 70
Analyzing Handwriting 71
Collection of Exemplars 71
The Writing Medium 72
Criminal Suspect Composites 72
Investigative Analysis to Solve Crimes 73
Conducting Lineups 74
Identification Procedures 75
The Right to Counsel at Eyewitness Identifications 79
THE CASE: DNA’s First Case: The Narborough Murders 81
Summary and Key Concepts 82

CHAPTER 5 Legal Issues in Criminal Investigation 85

Legal Guidelines for Conducting Searches 86
The Probable Cause Requirement 86
The Exclusionary Rule 87
Search Incident to Lawful Arrest 87

  Contents ix
 Exceptions to the Exclusionary Rule 88
The Good-Faith Exception 88
The Inevitable Discovery Doctrine 88
The Computer Errors Exception 88
Searches with a Warrant 89
When Are Search Warrants Necessary? 89
Advantages of Searching with a Search Warrant 89
Anticipatory Search Warrants 90
Warrantless Searches 91
Search by Consent 92
Emergency Searches 93
Stop-and-Frisk Searches 94
The Consensual Encounter versus Investigative Detention 94
Plain-View Searches 95
Automobile Searches 95
Open-Field Searches 96
Making an Arrest 97
What Is an Arrest? 97
The Lawful Arrest 97
Detention versus Arrest 98
Investigatory Stops 98
When Is a Person under Arrest? 99
Use of Force 100
Understanding Reasonableness 101
Levels of Force 101
Use of Deadly Force 102
The Fleeing-Felon Rule 103
THE CASE: The Search for the Craigslist Ripper 104
Summary and Key Concepts 105

Part 3 Obtaining Information

CHAPTER 6 Interviews and Interrogations 108
Interview versus Interrogation 109
The Interview Process 110
Interviewing Witnesses, Citizens, and Victims 110
The Cognitive Interview 110
“Think-Aloud” Interviewing 112
Verbal-Probing Techniques 112
The Suspect Interrogation Process 112
Goals of the Interrogation 112
Safeguarding against Police Misconduct 112

x Contents
 The Suspect’s Right to Legal Counsel 112
The Interrogation Setting 114
The Interrogation Procedure 115
Detecting Deception 115
Verbal Symptoms of Deception 115
Breaking the Suspect’s Alibi 116
Challenging the Suspect’s Information 116
Lying Techniques 116
Use of the Polygraph 117
The Voice Stress Analyzer 119
Why Suspects Cooperate and Confess 119
Searching for Information 119
Closing the Communication Gap 120
Admission versus Confession 120
False Confessions 120
Written Statements 120
Structuring the Written Statement 121
Recorded Statements 121
Confessions on Video 121
THE CASE: The Stephanie Crowe Murder Investigation 123
Summary and Key Concepts 124

CHAPTER 7 Criminal Intelligence and Surveillance Operations 127

The Usefulness of Intelligence 128
Overt and Covert Intelligence Collection 129
Criminal Intelligence and Criminal Investigation 130
Defining Criminal Intelligence 130
Types of Intelligence 130
Procedures for Intelligence Gathering 131
Analyzing the Information 133
Link Analysis 133
Flowcharting 134
Auditing and Purging Files 135
Surveillance Operations 136
Preparing for the Surveillance 136
Foot Surveillance 136
Vehicle Surveillance 137
Stakeouts, or “Stationary Surveillance” 138
Investigative Procedures 139
Poststakeout Procedures 139
Electronic Surveillance and Wiretaps 139
Satellite-Assisted Surveillance 140
Computer Surveillance 140
Telephones and Mobile Telephones 141

  Contents xi
 Surveillance of Social Networks 142
Biometric Surveillance 142
Thermal Imaging 143
THE CASE: Surveillance and the Killing of Osama Bin Laden 145
Summary and Key Concepts 146

CHAPTER 8 Informant Management and Undercover Operations 149

Who Becomes an Informant? 151
Using Informants 151
Informant Motivations 152
Documenting Your “Source” 153
Maintaining Control 153
Legal Considerations 153
Undercover Operations 155
Types of Undercover Operations 157
The Undercover Working Environment 157
The Cover Story 157
Protecting the Undercover Officer’s “Cover” 158
Infiltration 158
Risks in Undercover Assignments 159
THE CASE: The Antisnitch Movement 161
Summary and Key Concepts 162

Part 4 Crimes Against Persons

CHAPTER 9 Death Investigations 165

The Extent of Homicide 166
The Homicide Investigator’s Guiding Principle 167
Murder and Wrongful Death 167
Dynamics of the Homicide Unit 167
Selecting the Right Detective 167
Caseload Management 168
Investigative Tools 168
Cold Case Squads 168
The Homicide 911 Call 168
Analyzing the Call 168
Legal Characteristics of Homicide 169
The Preliminary Investigation 170
Protecting the Crime Scene 170
Taking Notes at the Scene 170
Identifying the Victim 170
Estimating the Time of Death 171
Changes in the Body: Decomposition 171

xii Contents
 The Forensics of Decomposition 172
Other Visual Evidence of Decomposition 173
Gunshot Wounds as Evidence 174
Assessing the Severity of Gunshot Wounds 175
Entrance Wounds 175
Exit Wounds 175
Smudging 175
Tattooing 175
The Role of Gunshot Residue 176
THE CASE: The Investigation of the “BTK” Killer 180
Summary and Key Concepts 181

CHAPTER 10 Robbery 183

Understanding Robbery 184
The Extent of Robbery 184
Consequences of Robbery 184
Elements of Robbery 185
Types of Robbery 185
Commercial Robberies: Stores and Banks 186
Street Robberies 186
Residential Robberies 186
School Robberies 186
Vehicle Robberies 186
The First Officer on the Scene 187
The Preliminary Investigation 189
The Neighborhood Canvass 190
The Robber’s Method of Operation 190
Physical Evidence 191
The Role of Witnesses 191
THE CASE: A New Reality in Robberies—Pharmaceuticals 193
Summary and Key Concepts 194

CHAPTER 11 Assault and Related Offenses 197

Legal Classifications of Assault 199
Simple Assault 199
Aggravated Assault 199
Domestic Violence 200
Legal Approaches to Domestic Violence 201
Stalking 202
Who Stalks Whom? 203
Sexual Assault 203
Forcible Rape 203
Legal Aspects of Rape 204

  Contents xiii
 Evidence in Rape Cases 205
Investigative Procedures: The Crime-Scene Investigation 205
Investigative Procedures: The Interview 208
THE CASE: Date Rape in Connection with a University Employee 210
Summary and Key Concepts 211

CHAPTER 12 Missing and Abducted Persons 213

Understanding the “Big Picture” 214
Profiling the Abductor: Stranger versus Nonstranger 214
Children Who Are Killed 215
Abductor Characteristics and Factors 216
Types of Missing Children Cases 216
Abductions via the Internet 217
Code Adam 217
The Investigative Response 218
The Initial Call for Assistance 219
Responding Officer Responsibilities 219
The 16 Steps of Investigation 220
The Importance of the Neighborhood Canvass 222
The Investigator’s Role 222
Moving Forward with the Investigation 222
THE CASE: The Abduction of Elizabeth Smart 225
Summary and Key Concepts 226

CHAPTER 13 Crimes against Children: Child Abuse and Child Fatalities 228
The Abuse of Children 229
Why Does Child Abuse Occur? 229
Child Fatalities: The Nature of the Problem 230
Child Abuse and the Law: The Doctrine of Parens Patriae 231
The Role of Child Protective Services and the Police 232
Evidence from the Autopsy 232
The Child Fatality Review Board 233
Child Physical Abuse 233
Emergency Room Personnel and Medical Examiners 234
Battered Child Syndrome 235
Steps in Investigating Battered Child Syndrome 235
Interviews with Medical Personnel 235
Consultation with Experts 236
Interviews with Caretakers 236
The Crime-Scene Investigation 236
Shaken Baby Syndrome 237
Munchausen Syndrome by Proxy 237
Sudden Infant Death Syndrome 238
Sexual Abuse of Children 239

xiv Contents
 The Forensic Interview 240
Why Are Forensic Interviews Needed? 240
The Initial Interview 240
The Secondary Forensic Interview 241
Techniques of Forensic Interviewing 241
Investigating the Molester 242
Premeditation and Intent 242
Child Exploitation 242
Legal Implications 243
Recent History 243
Victims of Child Pornography 243
Child Prostitution 244
Child Exploitation Offenders 244
THE CASE: Sexual Abuse of Children within the Catholic Church 245
Summary and Key Concepts 246

Part 5 Crimes Against Property

CHAPTER 14 Theft-Related Offenses 249
Burglary 250
The Frequency of Burglary 250
The Preliminary Investigation 251
Indications of Burglary 251
Tracing Stolen Property 252
The Fence 252
Proving the Receipt of Stolen Property 252
Larceny-Theft 253
The Extent of Larceny-Theft 253
Fraud-Forgery 253
Forgery 254
Check Fraud 255
Embezzlement 256
Investigating Embezzlement 256
Shoplifting 256
Investigative Steps 257
Identity Theft 258
The Investigative Response 259
Computer Crime 259
Understanding the Computer Crime Problem 260
Computer Crime Investigations 260
Motor Vehicle Theft 261
The Extent of Motor Vehicle Theft 262
The Preliminary Investigation 263

  Contents xv
 The Vehicle Identification Number 263
Tools of the Trade 263
Motorcycle Theft and Fraud 264
Motor Vehicle Fraud 264
Motor Vehicle Insurance Fraud 265
A Collective Response to Crime 265
THE CASE: Identity Theft and Its Implications . . . 266
Summary and Key Concepts 267

CHAPTER 15 Arson and Bombings 270

Arson Offenses 271
The Extent of Arson 271
The Definition of Arson 272
The Police and Fire Alliance 272
Arson Investigative Techniques 272
The Preliminary Investigation of Arson 272
Motivations of the Arsonist 275
Serial Fire Setters 276
Profiling the Fire Starter 276
The Role of the Insurance Industry 276
Prosecution of Arson Cases 277
Investigation of Bombing Incidents 278
Investigating Bomb Threats 278
When a Bomb Is Found 278
Handling the Media 279
THE CASE: The Case against the Unabomber . . . 280
Summary and Key Concepts 281

Part 6 Terrorism
CHAPTER 16 Terrorism and National Security Crimes 283
Terrorism Defined 284
Identifying the Terrorists 285
Criteria Describing Terrorists 286
Forms of Terrorism 287
Notable Terrorist Incidents 288
Recent Terrorist Threats 289
International Terrorism 289
Threats of Mass Destruction 292
Chemical 292
Biological 292
Radiological 292
Nuclear 293

xvi Contents
Domestic Terrorism 293
Self-Radicalization: The Homegrown Terrorist 294
Who and How 295
The Self-Radicalization Process 295
Role of the Internet 296
Assassination as a Terrorist Tactic 297
Tactics to Destabilize Terrorist Organizations 297
THE CASE: The Reality of Criminal Investigations Dealing with Domestic Terror Threats 299
Summary and Key Concepts 300

Glossary 303
References 309
Name Index 319
Subject Index 321

  Contents xvii
This page intentionally left blank
Preface
This Book’s Theme
This book is now in its third edition. It is intended to meet the
needs of students and others interested in criminal justice by pre-
senting information in an easy-to-read, logical flow, paralleling
the steps and considerations observed in an actual criminal inves-
tigation. Additionally, it is designed to fulfill an ongoing need for
an abbreviated book that explains clearly and thoughtfully the
fundamentals of criminal investigation as practiced by police
investigators on the job in communities across the nation.
The book is written with several observations in mind. First,
it is designed to blend scientific theories of crime detection with
a practical approach to criminal investigation. Its underlying
assumption is that sound criminal investigations depend on an
understanding of the science of crime-detection procedures and
the art of anticipating human behavior. There is yet another
critical observation made in the book: It recognizes that both
the uniformed officer and the criminal investigator play impor-
tant roles in the field of criminal investigation. The duties of
each are outlined throughout the book, recognizing that there is
a fundamental need for both to work in tandem throughout
many aspects of the criminal investigation process.
Another underlying theme of the book is that, as with all police
endeavors, criminal investigation is a law enforcement responsibil-
ity that must be conducted within the framework of the U.S. Con-
stitution and the practices of a democratic society. Consequently,
court decisions and case studies have been quoted extensively for
clarification of issues and general reader information.
Additional Highlights to the Author’s
Approach
• A 16-chapter format specifically designed to enable the
instructor to cover the entire book in a standard semester
and to enable the student to read without being pressured
to cover numerous chapters in a short period of time
• An enhanced graphical interface affording the student an
additional venue for learning
• Recent and meaningful case studies that begin and end
each chapter
• Boxed features specifically designed to allow the student
to consider how chapter material applies to the real world
of criminal investigation
• A dedicated chapter on terrorism and the investigation of
such crimes
• Coverage of the latest investigative methods for dealing
with eyewitness testimony, missing and abducted persons,
computer/Internet crime, and other “hot-button” issues in
criminal investigation
New to This Edition
• Updated case studies
• Updated statistics
• More detail about crime-scene searches and evidence
• Learning outcomes identified throughout each chapter
• New graphics throughout the book
• Refreshed “Think About It” sections in each chapter
• New and refreshed photos and informational boxes
throughout the book
• Revised “Learning Outcomes” at the end of each chapter
   xix
 ▶ Instructor Supplements
• Instructor’s Manual with Test Bank. Includes content outlines
for classroom discussion, teaching suggestions, and answers
to selected end-of-chapter questions from the text. This also
contains a Word document version of the test bank.
• TestGen. This computerized test generation system gives
you maximum flexibility in creating and administering
tests on paper, electronically, or online. It provides state-
of-the-art features for viewing and editing test bank ques-
tions, dragging a selected question into a test you are
creating, and printing sleek, formatted tests in a variety of
layouts. Select test items from test banks included with
TestGen for quick test creation, or write your own ques-
tions from scratch. TestGen’s random generator provides
the option to display different text or calculated number
values each time questions are used.
• PowerPoint Presentations. Our presentations offer clear,
straightforward outlines and notes to use for class lectures or
study materials. Photos, illustrations, charts, and tables from
the book are included in the presentations when applicable.
To access supplementary materials online, instructors need to
request an instructor access code. Go to www.pearsonhighered.
com/irc, where you can register for an instructor access code.
▶ REVEL for Criminal Investigation, 3e by Lyman
Designed for the way today’s Criminal Justice students
read, think and learn
REVEL offers an immersive learning experience that engages
students deeply, while giving them the flexibility to learn their
way. Media interactives and assessments integrated directly
within the narrative enable students to delve into key concepts
and reflect on their learning without breaking stride.
REVEL seamlessly combines the full content of Pearson’s
bestselling criminal justice titles with multimedia learning tools.
You assign the topics
Author Explanatory Videos
your s­tudents cover.
Author Explanatory
Videos, application
exercises, and short
quizzes engage students
and enhance their
understanding of core
topics as they p­ rogress
through the content.
Instead of simply
Point/CounterPoint Videos reading about criminal
justice topics, REVEL
empowers students to
think critically about
important concepts by
completing application
exercises, watching
Point/C ounterPoint
xx Preface
Within hours after registering, you will receive a confirming
e-mail, including an instructor access code. Once you have
received your code, go to the site and log on for full instructions
on downloading the materials you wish to use.
Alternate Versions
• eBooks. eBooks This text is also available in multiple eBook
formats. These are an exciting new choice for students look-
ing to save money. As an alternative to purchasing the printed
textbook, students can purchase an electronic version of the
same content. With an eTextbook, students can search the
text, make notes online, print out reading assignments that
incorporate lecture notes, and bookmark important passages
for later review. For more information, visit your favorite
online eBook reseller or visit www.mypearsonstore.com.
• REVEL™ is Pearson’s newest way of delivering our
respected content. Fully digital and highly engaging,
REVEL replaces the textbook and gives students everything
they need for the course. Seamlessly blending text narrative,
media, and assessment, REVEL enables students to read,
practice, and study in one continuous experience—for less
than the cost of a traditional textbook. Learn more at
­pearsonhighered.com/revel.
videos, and participating in shared writing (discussion board)
assignments.
Track time-on-task throughout the course
The Performance Dashboard allows you to see how much time
the class or individual students have spent reading a section or
doing an assignment, as well as points earned per assignment.
This data helps correlate study time with performance and pro-
vides a window into where students may be having difficulty
with the material.
NEW! Ever-growing Accessibility
Learning Management System Integration
REVEL offers a full integration to the Blackboard Learning
Management System (LMS). Access assignments, rosters
and resources, and synchronize REVEL grades with the
LMS gradebook. New direct, single sign-on provides access
to all the immersive REVEL content that fosters student
engagement.
The REVEL App
The REVEL App further empowers students to access their
course materials wherever and whenever they want. With the
REVEL App, students can access REVEL directly from their
iPhone or Android device and receive push notifications on
assignments all while not being tethered to an Internet connec-
tion. Work done on the REVEL app syncs up to the browser
version, ensuring that no one misses a beat.
Visit www.pearsonhighered.com/revel/
 ▶ Acknowledgments
written entirely as a solo effort, and this
No book project was no exception. The prepara-
can be tion of the third edition represents hun-
dreds of painstaking hours maintaining
continuous contact with criminal justice
agencies, federal information clearinghouses, police practitio-
ners, and colleagues in the field of criminal justice. In addition,
to offer the reader the most up-to-date and relevant informa-
tion, it was important to consult libraries, police journals, peri-
odicals, newspapers, government publications, and other
sources of literature germane to the field of crime detection on
an ongoing basis.
Many persons were helpful in the preparation of this book,
including practitioners in the field as well as experts in aca-
deme. Among these, the contributions of certain persons
deserve special recognition. Included are the men and women
of the Missouri State Highway Patrol, agents from the Federal
Bureau of Investigation and Drug Enforcement Administration,
contributors from the Department of Homeland Security and
the International Association of Chiefs of Police.
A special debt of gratitude goes to Detective Michael Him-
mel of the Columbia Police Department (ret.) and Brian Hoey
of the Missouri State Highway Patrol Crime Laboratory, who
both provided a number of crime-scene and laboratory photos
for this new edition. Without the cooperation of these persons
and organizations, this book would not have been possible.
I would also like to thank the reviewers of the third edition
for their comments and suggestions: Peter Curcio, Briarcliffe
College; Scott Donaldson, Tarrant County College NW; Russ
Pomrenke, Gwinnett Technical College; and Gregory Roth,
Kirkwood Community College. A special thank you is also well
deserved for Portfolio Manager Gary Bauer, along with the
many other dedicated publishing professionals at Pearson for
their hard work and support of this text. Finally, I would like to
extend special thanks to those criminal justice academics and
practitioners who painstakingly reviewed the manuscript of this
book. Without the support and assistance of all these people and
many more, this book would not have become a reality. Thank
you all.
—Michael D. Lyman
  Preface xxi
 ▶ About the Author
Michael D. Lyman is a Professor of
Criminal Justice at Columbia College,
located in Columbia, Missouri. In addition
to being a teaching faculty member, he
serves as the program coordinator for the
Master of Science of Criminal Justice Pro-
gram and the founder of the college’s
Forensic Science Program. Before enter-
ing the field of college teaching, he was employed as a certified
police trainer and also served as a sworn criminal investigator
for state police organizations in Kansas and Oklahoma. He has
taught literally thousands of law enforcement officers in the
proper police techniques and methods of professional criminal
investigation. Dr. Lyman has authored numerous textbooks in
xxii Preface
criminal justice dealing with the areas of criminal investigation,
policing, organized crime, drug enforcement, and drug traffick-
ing. He received both his bachelor’s and master’s degrees from
Wichita State University and his Ph.D. from the University of
Missouri–Columbia. He has served law enforcement and legal
communities on over 375 occasions to review criminal investi-
gations and render the results of his evaluations and his opin-
ions in federal court proceedings nationwide.
Textbooks such as this are an ongoing work in progress, and
the author welcomes communication and correspondence about
his work. Dr. Lyman can be contacted at Columbia College,
Rogers Street, Columbia, MO or at mlyman@cougars.ccis.edu.
Thank you for using this textbook.
 1
“Our current system of criminal investigation
is a direct result of what we have learned
and what we have inherited from the past.”

Foundations
of Criminal Investigation

1 Explain the history of criminal investigation.

2 Identify how research affects criminal investigation.

3 Explain the current research in criminal investigation.

4 Discuss the objectives of criminal investigation.

5 Distinguish between inductive and deductive

reasoning.

6 Explain the expanding role of the patrol officer

as criminal investigator.

7 Discuss the solvability factors in a criminal

investigation.

8 Describe the preliminary investigation process.

Arthur Turner/Alamy Stock Photo
 INTRO When Murder Targets the Police
On July 17, 2016, Gavin Eugene Long shot and killed
three Baton Rouge, Louisiana police officers and
wounded three additional officers. This occurred 10 days
after five police officers were shot and killed in Dallas.
On that day, shortly before 8:40 a.m. Long arrived at
Hammond Aire Plaza in Baton Rouge, Louisiana, which
was a shopping complex on Airline Highway. He immedi-
ately began scouting the area in search of police officers.
He first spotted a police patrol vehicle parked at a ­B-Quik
convenience store that belonged to a sheriff’s deputy
who was working security in the area. Long parked his
­vehicle behind an adjacent building, got out, and pre-
pared to shoot, but discovered that the vehicle was
empty. He then drove north and noticed a police officer
washing his vehicle a short distance away, but the officer
left before Long could get close. By 8:40, a call came in
to the police about a suspicious person carrying a rifle
near the plaza.
When officers arrived at the scene, they found Long
behind the Hair Crown Beauty Supply store dressed.
­ At the scene of the shooting, police recovered numerous
He was dressed black and wearing a face mask. Shots
were fired two minutes later. In two more minutes, there
were reports that officers were down.
According to investigators, Long fired upon the first re-
sponding officers, fatally wounding three. One of the
officers was killed trying to help another. Long shot an-
other police officer and then moved to another part of the
complex, where he shot two sheriff’s deputies. The entire
shooting lasted for less than 10 minutes. At 8:46, Long
was reported to be near Benny’s Car Wash. Officers fired
on Long from behind the cover of patrol cars. Eventually,
a SWAT team arrived on the scene. One SWAT officer took
aim at Long from about 100 yards away and killed him
and at 8:48, Long was dead. Responding officers used a
robot to check Long’s body for explosives.
The ensuing investigation of the active shooter was con-
ducted by the Louisiana State Police. Their preliminary
investigation determined that Long was actively target-
ing officers and ignoring civilians. It was also determined
that Long was the only person involved in the shooting.
A preliminary autopsy indicated that in addition to being
The study of criminal investigation involves probing several
different fields at once, and is therefore a difficult task about
which to write. For example, it is important for an investigator to
understand the basic techniques of collection and preservation of
evidence, but to do so, a fundamental understanding of criminal-
istics or forensic science is often required. In addition to technical
▶ The Book’s Theme
Criminal investigation is one of the most charismatic, engaging,
and rewarding endeavors in the field of criminal justice. The
theme of this book is its underlying “true north.” That is, the
premise of the book is that the function of criminal investigation
2 Chapter 1 Foundations of Criminal Investigation
Pool/Getty Images
A Police Officer Bows His Head during Funeral
Services for Baton Rouge Police Officer Matthew
Gerald. Multiple Police Officers Were Killed and
Wounded Five Days Earlier in a Shooting Near a Gas
Station in Baton Rouge.
shot by the SWAT officer, Long suffered multiple other
gunshot wounds.
firearms. These included an IWI Tavor SAR 5.56-caliber
rifle and a Springfield XD 9mm pistol. A third weapon—a
Stag Arms M4-type 5.56-caliber semi-automatic rifle—
was recovered from Long’s rental Malibu. Officials be-
lieved that Long had intentions of attacking the Baton
Rouge police headquarters and continuing to kill officers.
It was also learned that Long was associated with orga-
nizations linked to black separatism and the sovereign
citizen movement.
Whether motivated by anger or hate,
Discuss
the presence of an active shooter in
a public location is one of the greatest
public concerns. Is it possible for police
investigators to proactively predict if and
where an active shooter might be next?
What are some methods or techniques that
could make this a reality?
competence, modern-day investigators must be well versed in the
law. Legal skills include a working knowledge of criminal law,
constitutional law, and rules of evidence, all of which are essen-
tial for successful prosecution of a criminal case. This chapter is
designed to give the reader the underlying essentials of this field
of policing, which is both rewarding and challenging.
is both an art and a science. It calls on the abilities of the most
competent, professional, and hard-working personnel in the
criminal justice field. In order for this to take place, investiga-
tions must be conducted with the understanding that the end
Another random document with
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subject, how to diagnose, not alone hyperæmia and anæmia of the
brain and spinal cord, but also of special lobes of the former and
particular columns of the latter. These directions are in most
instances based on assumptions which are not supported by direct
or tangible evidence, and the consequence is that they have failed to
stand the tests of experience, where this gauge is applicable, and
necessarily failed to advance in any way either our theoretical or
practical knowledge of those states of the brain mechanism which
are due to alterations in its nutrition.

Much of the unsatisfactory state of our knowledge on this head is

due to the grouping together of the physiological anæmia of sleep
and the pathological anæmia with which the physician has to deal.
The anæmia of the brain in a sleeping person is probably a
secondary factor; it ensues after the person falls asleep, the first step
in the latter process being probably an altered dynamic state of the
brain which lessens the requirements of that organ for blood. This
can be readily demonstrated in the case of infants whose anterior
fontanelle has not yet closed. In deep sleep the fontanelle is deeply
sunken in, but this sinking in does not occur simultaneously with the
child's falling asleep, but shortly thereafter. On the other hand, the
fontanelle does not rise simultaneously with the child's awakening,
unless it cry, which adds a disturbing factor. There are a number of
other facts which show that while a comparison between the
sleeping state and cerebral anæmia may be made for the purposes
of theoretical discussion, yet there are many important points in
which they are at variance. To illustrate this I need but refer to the
fact that in deep sleep the pupils are in a state of immobility and
pinhole contraction,14 while in chronic cerebral anæmia of young
persons a dilated and mobile pupil is the commoner condition. In
acutely-produced cerebral anæmia an initial contraction has been
noted, but it is not then persistent.
14 Inability to counterfeit this feature is one of the most reliable tests of simulation,
and served to convince me that in the well-known case of a colored cadet, who was
tried by a court-martial on charges involving simulation, the latter was proven. There
are persons who can voluntarily contract the pupils, but as they are compelled to
 innervate all the muscles supplied by the third pair, in so doing they are compelled to
converge the optic axes—an act which does not take place in sleep.

One of the main reasons of our imperfect knowledge of the nutritive

disorders of the brain is the unsatisfactory state of their post-mortem
evidence. Little has been learned in this field, except in those
extreme cases where the suddenness and intensity of the circulatory
catastrophe were sufficient to prove fatal. Even where all
observations made during life justify us in supposing that the amount
of blood sent to the brain is small, that the velocity of its current is
reduced, and its quantity poor, the autopsy may reveal conditions
apparently conflicting with the supposition based on ante-mortem
observations. This is amply illustrated by the experience of alienists
who have studied the relation between nutritive states of the brain
and certain forms of insanity. It is generally held that in so far as the
antithetical forms of mental disorder known as anæmia and
melancholia can be connected with nutritive disorders, the former is
indicative of hyperæmia and the latter of anæmia. A number of facts
can be adduced in support of this view, particularly as regards the
latter condition. It is found, however, in some examinations made of
the brains of patients dying melancholic that the brain is apparently
hyperæmic; the length of time elapsing before an autopsy is made,
the form of somatic disease with which the patient dies, the position
of the body after death,—all these may play a part in the production
of cerebral injections which do not correctly indicate the condition of
the brain as it existed prior to the moribund period, and when the
symptoms of supposed anæmia or hyperæmia could be satisfactorily
differentiated.

ETIOLOGY.—The best studied form of cerebral anæmia is that

ensuing after extensive hemorrhages or from compression and
ligature of either of the common carotid arteries.15 In the latter case
symptoms are produced which are in harmony with the doctrine of
localization, and permit us to form a conception of the mode in which
a diminution of the cerebral blood-supply influences the functions of
the brain. The chief symptoms are noted on the side of the body
opposite to that on which the common carotid artery is tied. Thus if
the left artery be tied, there is at first felt a tingling or pricking feeling
on the right half of the body; this is followed by a warm, sometimes a
cold, and ultimately by a numb, feeling. This sensory disturbance
may become of what might be called the capsular type—that is, a
complete hemianæsthesia; but at first it is distinctly like that which is
found with cortical and subcortical disease, being limited to the
muscular sense and the intelligent contact-perceptions of objects,
the æsthesiometer showing but little or no impairment of the
cutaneous space-sense. With the loss of muscular sense the
movements become heavy, and later true paresis may appear with
perhaps total anæsthesia. Aphasia is sometimes noted in such
cases, and, in obedience to the predominant location of the speech-
faculty in the left side of the brain, is rarely if ever found16 when the
right common carotid artery is the one ligated.
15 As the conditions of the cerebral circulation resulting from surgical and other rare
causes are not apt to be brought to the physician's attention separately from
conditions of more immediate importance, their symptoms are discussed in the
etiological portion of this section in order to avoid complicating the semeiological
picture of cerebral anæmia of every-day experience. For similar reasons the
anomalies of the cerebral circulation of an embolic and thrombotic nature, and those
associated with eclampsia and epilepsy, are not mentioned in this connection, as their
full discussion properly belongs to other portions of this work.

16 I am unaware of the record of any case where aphasia occurred with ligature of the
right common carotid artery. There is a singular observation by Hagen-Torn of
permanent paralysis of the right hypoglossal nerve after such an operation, but the
report to which I have access does not state whether this may not have been due to
some peripheral involvement of that nerve.

In this series of symptomatic sequelæ it is seen that the functional

manifestations of the highest centres are the first to be involved, and
this establishes that of all parts of the cerebrum the cortex and
subcortical tracts are the more vulnerable to the influence of a
deficient blood-supply.17 As we shall see, it is precisely to the
insufficient nutrition of these parts that the more important symptoms
of the cerebral anæmia of ordinary practice are attributable.
 17 To this there is an apparent exception: when blindness occurs in consequence of
ligature of one carotid artery, it is monocular and limited to the side of the ligation. The
visual disturbance of cortical and subcortical disease is bilateral, being of the
character known as hemianopsic. The blindness due to tying of the carotid is,
however, not due to cerebral, but to retinal, anæmia, and its monocular character
does not therefore invalidate the observation in the text. Litten and Hirschberg
(Berliner klinische Wochenshrift, 1885, No. 20) found complete bilateral amaurosis in
a chlorotic girl of fifteen, and on ophthalmoscopic examination the peripheral origin of
the blindness was conclusively proven by the existence of an exquisite choked disc.
Both the morbid ophthalmoscopic appearance and the amaurosis disappeared under
tonic regimen. It is well to recollect that choked disc may occur in chlorosis, and thus
be perhaps erroneously attributed to a coexisting hysteria, as was done in some
cases at least by Rosenthal in his textbook.

With bilateral ligature18 of the primary carotids—and this applies in

the main to cerebral anæmia from profuse hemorrhages or sudden
changes in the blood-pressure, such as occur in enteric affections,
ruptures of aneurisms, in obstetric practice, and after brusque
tapping for ascites—the same phenomena noted with unilateral
compression are observed on both sides of the body, and usually in
slighter intensity. In addition, there is a profound and characteristic
disturbance of respiration; a cold sweat breaks out; the senses of
sight and hearing become greatly impaired or perverted; the mind
becomes clouded, consciousness blurred; complete syncope may
ensue, and pass to a fatal termination. In other cases vertigo
preponderates or vomiting, and finally convulsions appear. It would
seem that the respiratory centre exceeds even the cortex in
susceptibility to the evil influence of anæmia. It differs from them in
two features: firstly, it appears to require bilateral involvement of the
brain for its production; secondly, although the respiratory
disturbance precedes that of the higher cerebral functions, it does
not become as intense, for at a time when the intellectual functions
are abolished, as in anæmic coma and syncope, the respiratory
function, however disturbed, is in most cases sufficiently well carried
on to bear the organism safely through the crisis. The disturbance is
marked by the following characters: The respiration is at first deep
and sighing, perhaps frequent; it later becomes slow, and is
associated with a subjective sense of oppression; the patient feels
as if he could not fill his lungs properly; there is an unsatisfied
sensation, as if a deeper breath should be taken, and when, in
obedience to this subjective need, a full deep breath is taken, the
patient feels as if he had stopped short of completing the act, and
remains as unsatisfied as before.19 Yawning and moaning are often
accompaniments of this symptom.20 As we shall see, these signs are
often among the chief sources of complaint in the less grave forms of
anæmia of every-day experience. In the serious condition before us
the Cheyne-Stokes phenomena may follow.
18 I exclude the observations of Flemming, Hammond, and Corning on carotid
compression by external pressure, owing to the difficulty of determining whether or
no, and what, other important structures are compressed at the same time.

19 The occurrence of this functional respiratory trouble is a feature of toxic as well as

of anæmic irritation of the respiratory centre; it is accordingly found in cases of
profound alcoholic poisoning.

20 It is somewhat difficult to understand why in cases of anæmia induced in both

carotid districts the symptoms of anæmia should be marked in the functions of that
part of the brain-axis which through the basilar trunk derives its blood from the
vertebral arteries. Here the blood-current must necessarily be increased. That the
disturbance of breathing, the yawning, and the sighing belong to the group of irritative
symptoms due to anæmia is in harmony with the general physiological law which is
illustrated in the initial contraction of the pupil, which is found in experimental cerebral
anæmia. Observations on anæmia of the brain-axis are too few, and, so far as noted,
have been so rapidly fatal that it is not possible to derive from them any facts bearing
on the physiological reactions of the respiratory centre to high-graded anæmia. One
of the curiosities of medicine appertaining to this subject is the observation recorded
in Virchow's Archiv, lxix. p. 93, of the case of a man who had fractured the base of the
skull in its posterior fossa, and, the basilar artery becoming caught and pinched in the
crack, death occurred rapidly with all the signs of cerebral anæmia, verified by the
post-mortem appearances.

Anæmia of the brain may develop at any period of life, not excluding
the intra-uterine period. Kundrat and Binswanger regard the
deformity of the brain known as porencephaly as the result of an
anæmic (non-embolic) necrosis of brain-substance, developed either
in the fœtal or the infantile period. The occasional symmetry of the
deformity is in favor of this view. That there are other conditions of
cerebral malnutrition,21 masking themselves in defective
development and imperfect isolation of the conducting tracts, and
that the consequent differing rate of maturation of these tracts has
some relation to the absence or presence of a predisposition to
chorea and other disturbances of nervous equilibrium so common at
this period of life, I regard as at least probable. But it is at the period
of puberty that we encounter the most important discrepancies
between the requirements of brain-nutrition and the furnished blood-
supply. The disposition to uncomplicated cerebral anæmia is
greatest at this period of life and in the female sex. Beneke22 has
shown that as the human being grows the arteries, which in children
are very large in proportion to the length of the body, get to be
relatively smaller and smaller toward the period of puberty—that
after this period they widen to again attain a large circumference at
old age. There is thus added to the other and more obscure factors
which may determine general anæmia at puberty a diminished
calibre of the arteries in both sexes. To some extent the
disadvantageous influence of (relatively) narrow vascular channels
may be overcome by increased cardiac action, and the almost
sudden increase in size of the heart about this period is probably the
result of the demand made upon its compensatory power. But, as we
learn from the same observer that the female heart remains
relatively as well as absolutely smaller than that of the male, we can
understand why the female should be less able to overcome the
pubescent disposition to cerebral (and general) anæmia than the
male. Menstruation, which in a certain proportion of girls scarcely
maintains the semblance of a physiological process, acting rather as
a drain than a functional discharge, is added to the anæmia-
producing factors. It is among those who marry in the ensuing
condition, who bring forth child after child in rapid succession,
perhaps, in addition, flooding considerably at each confinement, that
we find the classical symptoms of chronic cerebral anæmia
developed.
 21 I have found in three children under fourteen months of age, who died with
symptoms not unlike those of slowly-developed tubercular meningitis, including
convulsions, strabismus, temperature disturbance (slight), and terminal coma, without
nuchal contracture or pupillary anomalies, a remarkably anæmic brain. The sulci
gaped; there were few or no puncta vasculosa; the cortex extremely pale, and the
white substance almost bluish-white. On attempting to harden the brain of the
youngest of these children, using every precaution and a sufficient number of sets of
hardening fluids, including the chromic salts and alcohol, I found that small cavities
formed in the cortex, varying from the scarcely visible to two-thirds of a millimeter in
diameter. Their existence were demonstrable the day after the death and almost
immediate autopsy performed in this case. There had been no antecedent disease in
any one of these cases; the children had been lethargic, inactive, and the oldest had
made no attempt to walk or talk. There was no morphological or quantitative defect in
cerebral or cranial development, and microscopic examination showed that the
cavities were not perivascular. In all these cases the patients belonged to the
tenement-house population.

22 An excellent abstract of Beneke's original monograph, by N. A. P. Bowditch, will be

found in volume i. Transactions of the Massachusetts Medico-Legal Society.

In the male sex the period of adolescence has not the same
profound influence in producing cerebral anæmia that it has in
females. To some extent, however, habitual self-abuse and early
sexual excess of the former produce results similar to those
occurring in consequence of perverted physiological processes in
the latter. Many of the symptoms presented by the inveterate
masturbator are probably due to cerebral anæmia; there are,
however, in his case and in that of the early libertine certain vaso-
motor complications frequently present which render the clinical
picture a mixed one.23 In addition, abuse of the sexual apparatus has
a direct—probably dynamic and impalpable—exhausting effect on
the central nervous apparatus.
23 Kiernan of Chicago has described peculiar trophic disturbances—dermato-
neuroses, color-changes of the hair, etc.—in a case of masturbatory mental trouble
associated with marked anæmia. The patient whenever he flushed up heard a noise
as of a pistol snapped near the mastoid region. In the case of a young man of
 eighteen who—the pampered son of wealthy parents—became his own master at
fifteen, and had at that age indulged in sexual orgies which were continued to an
almost incredible extent, it was found that he gradually lost his memory, and on one
occasion had a violent epileptiform attack. During his convalescence from the
stuporous state which followed it was noted that the patient was quite bright in the
morning, but that after he had been up a while he relapsed into a state of apathy, with
amnesia, which, decreasing in intensity from week to week, was eventually only noted
toward evening, and finally disappeared, the case terminating in complete recovery.

In the vast majority of cases anæmia of the brain is but a part of

general anæmia, and all conditions which tend to impoverish the
character of the blood and to reduce the rapidity of movement and
fulness of the cerebral blood-column are apt to be associated with
signs of cerebral malnutrition. As early an observer as Addison
noticed the wandering of the mind in pernicious anæmia, in which
disorder anæmia and wasting of the brain have been found post-
mortem. In two cases of extreme chlorosis I heard the sound known
as the cephalic soufflé with great distinctness;24 this sound, when the
other morbid conditions that may lead to it can be excluded,
indicates a high degree of anæmia. Both patients were somnolent
and subject to fainting-spells. In leucocythæmia a rambling delirium
is not infrequently noted toward the close of the patient's life, and the
habitual sadness and depression of many leukæmic patients is due,
as are also certain phases of melancholia, to cerebral malnutrition. In
some stages of most, and in all stages of some, forms of renal
disease the conditions of cerebral anæmia are present; and it is
reasonable to attribute to it some share in the production of the head
symptoms of Bright's disease; but here, as in cases of cardiac
disease, symptoms due to other influences—uræmia in the former,
and insufficient oxygenation of the blood in the latter instance—
obscure or conceal those due to the anæmia strictly speaking.
24 When an anæmic murmur at the base of the heart coexists with the cephalic
soufflé, the latter may be regarded as an evidence of anæmia; but where the former is
absent—that is, when the cephalic soufflé is an isolated, independent symptom—
there is reason to suspect the existence of a tumor or some other cause of
compression of the carotid artery at or after its entry into the cranium. In one of the
 cases referred to in the text, pressing on one or the other carotid produced numbness
and tingling in the opposite arm, leg, and cheek. Similar observations were made by
Tripier (Revue de Médecine, March, 1881), who strenuously maintains the existence
of the cephalic soufflé in the adult, against Henry Roger, and in consonance with the
observations of Fisher and Whitney. In the last-mentioned case of mine the sound
could be heard a distance from the head.

All exhausting diseases, many febrile affections, notably typhoid,

starvation from any cause, and exhausting discharges, may produce
cerebral anæmia. Under the latter head belong the diarrhœal
affections of childhood, which not infrequently lead to an aggravated
form of anæmia of the brain known as hydrocephaloid. In addition to
the provoking causes of cerebral anæmia there are certain
accessory ones: prominent among these is the upright position and
sudden rising. The reason of this influence is self-evident, as is also
the fact that it is most apt to manifest itself in cases of cardiac
enfeeblement. Many a convalescent from an exhausting fever or
other disease has on rising from bed fainted; some have fallen dead
from cerebral anæmia already existing, but fatally intensified by this
sudden change of position. A number of cases are on record by
Abercrombie, Forbes Winslow, J. G. Kiernan, and others where
persons manifested the symptoms of cerebral anæmia only when in
the upright position and even in lying on one side or the other; these
are, however, far rarer than is claimed by some later writers.

The purest form of acute cerebral anæmia, aside from that produced
by surgical interference with the cerebral circulation or extensive
hemorrhages, is that induced by mental influences, such as fright, a
disagreeable odor, or a disgusting or harrowing spectacle. Some
persons, not suffering from general anæmia or any diseased
condition thus far mentioned, on experiencing the emotional
influences named will be observed to turn pale, to breathe heavily,
and either sink into a chair or fall on the floor partly or entirely
unconscious. They are then suffering from a spasm of the cerebral
arteries resulting in acute and high-graded cerebral anæmia or
syncope. This condition is marked by some of the symptoms
previously mentioned as occurring with bilateral ligature of the
carotids: thus, the feeling of oppression on the chest, vertigo,
heaviness of the limbs, nausea, and vomiting are characteristic; a
cold sweat breaks out on the forehead; the visual field becomes
darkened; and hearing is rendered difficult by the tinnitus.25 The
pulse is small and of low tension, but regular.
25 Most authors claim that the sense of hearing is blunted, as that of vision is. This is
so in some, but certainly not in a large number of other cases. I have now under
observation a girl whose physical conformation—her neck is very long and her
shoulders tapering—and extreme susceptibility combine to favor the occurrence of
syncope. She faints in my office whenever an examination is made, even though it be
entirely verbal; and after recovering frequently lies down to answer by deputy, as
experience has shown her that she is less likely to faint in this position. I have
repeatedly satisfied myself from her subsequent statements that she heard what was
said, while she appeared to be quite unconscious and “saw everything black or
through a cloud.” It is not improbable that the impressions which most writers on the
subject convey were derived from the experience of novices in fainting; these, in the
alarm and anxiety of their condition, and confused by the tinnitus, might well fail to
hear what the bystanders said, particularly as on many such occasions the fainting
person is apt to be surrounded by a confused Babel of tongues. While the auditory
nerve is as sensitive to the irritative influence of anæmia as any, and there is a case
of a boy on record (Abercrombie) who could only hear well when lying down, and was
deaf when he stood up, yet the conclusions of other authorities who have studied the
subject would lead one to think that there are individual differences in this respect.
How often does not the dying person, after feeling for the hands of a relative whom he
cannot see, converse with him responsively! And how much need is there not of the
humane physician to remember that the sense of hearing is the last intellectual sense
to die, lest he speak unguardedly at the bedside!

As a rule, the subjects of simple syncope recover, the horizontal

position, which is assumed perforce in most cases, carrying with it
the chief remedial influence—namely, the facilitating of the access of
a fuller blood-supply to the brain. While, as stated, the tendency to
syncope may exist in healthy non-anæmic individuals, it is far more
common with those who suffer either from chronic cerebral anæmia
or from many of its predisposing conditions. The arterial spasm
which causes syncope is an exaggeration of what occurs within
physiological limits26 in all persons when subjected to emotional or
violent external impressions of any kind.
26 It has been experimentally determined by Istomanow (St. Petersburg Dissertation,
1885) in persons whose brain-surface had become partially accessible to observation
through traumatic causes that pain, warmth, pleasant smells, and sweet tastes cause
a contraction of the cerebral vessels and a sinking in of the brain-surface, while
tickling, unpleasant odors, bitter and sour tastes, produce the reverse condition; that
is, bulging of the brain-surface and increased injection of the vessels. Istomanow's
results are verified by other observations, particularly by the fact that with the latter
class of impressions there is an increase in the general blood-pressure, with sinking
of the surface-temperature, and, as measured by Mosso's method, decrease in the
volume of the extremities. While there is a general correspondence between these
observations and clinical experience, there are a few unexplained discrepancies.

MORBID ANATOMY.—In those severe cases of cerebral anæmia which

terminate fatally the entire brain appears bloodless. Since the color
of this organ under ordinary circumstances is in great part due to the
vascular injection, it appears very different when this admixture is
lessened or removed. Then the gray substance, instead of
presenting a reddish-gray tint, is of a pale buff color in infants, and a
pale gray in adults who have died of acute or intense cerebral
anæmia. The white substance exhibits few or no puncta vasculosa,
and there is no indication of the faint rosy tinge which even the white
substance has in the normal brain. All these appearances can be
imitated in the brain of an animal that is bled to death; they are also
met with in those who have died of inanition, particularly in cases of
melancholia attonita, the subjects of which had long refused food.
Most writers state that the ventricular and subarachnoid fluids are
increased in amount,27 and that the sulci appear wider in anæmic
than in normal brains. That these fluids must be increased to
compensate for the diminished blood-amount is evident. But it is not
unlikely that exaggerated estimates of the increase have been made;
and for this reason: Since the meninges and choroid plexuses are
comparatively bloodless, the cerebro-spinal fluids are more likely to
present themselves free from that admixture of blood which renders
the obtaining and measuring of their quantity so difficult under
ordinary circumstances. The gaping of the sulci has not been verified
by me either in animals that had been bled to death or in cases of
cerebral anæmia in rapidly-fatal atonic and phthisical melancholia. In
protracted cases of this nature I frequently found gaping of the sulci:
here, from the nature of the cases, the patients dying either from
self-starvation, imperfect assimilation, or wasting diseases, the
occurrence of a certain amount of atrophy of the brain-substance
proper could not be excluded.28
27 Hammond, on the other hand (Diseases of the Nervous System, p. 77), has the
ventricles generally empty.

28 Up to within a very short time ago it would have appeared heretical to claim that
any considerable amount of brain-wasting could ensue from starvation alone, as the
oft-cited experiments of Chossat seemed to show that mammals, birds, reptiles, and
amphibians lose in body-weight while being starved, but that the brain-weight is not
disturbed to any appreciable extent. Six years ago I examined the brain of a tortoise
(Cestudo Virginica) which had starved fully a year through ignorance of the keeper of
an aquarium. The atrophy of the brain was so marked that it had undergone
demonstrable changes of contour. Since then Rosenbach (Archiv für Psychiatrie, xvi.
p. 276) has demonstrated that brain-wasting and other changes do occur in starved
rabbits.

With protracted fevers accompanied by inanition—and this applies

particularly to the later period of typhoid fever—a condition of
cerebral anæmia is found which is of the greatest interest to the
clinician. The brain as a whole is bloodless; there may or may not be
apparently hyperæmic districts, but the injection is altogether on the
surface; the consistency of the brain is considerably diminished, and
this organ is often distinctly œdematous. In exceptional cases the
œdema is so great that softening results, the white substance
becoming fluidified at the cortical limit near the base of the sulci and
at the ventricular walls. This is due perhaps as much to post-mortem
maceration as to pre-mortem œdema, but that the latter condition
exists is shown by the condition of the brain as a whole. The loss of
memory, the difficulty of correlating the past and present, the
rambling, incoherent conversation, and anenergic stupor observed in
the decline of typhoid and other exhausting fevers, especially in
older subjects, may be properly attributed to the injurious effects of
post-febrile anæmia and anæmic œdema of the brain. Aside from
fevers, œdema is apt to be associated with anæmia where venous
stagnation is a complicating feature; consequently, it is not
uncommon with certain uncompensated valvular lesions,
emphysema, and other chronic pulmonic troubles.

Positive observations of tissue-changes from simple cerebral

anæmia have not been recorded. Even in extreme cases the
essential nervous structures, the ganglionic bodies, the nerve-fibres,
their sheaths, and the neuroglia, appear healthy. The adventitial and
pericellular spaces are sometimes enlarged, and variations in the
number and distribution of the free nuclei of the neuroglia and the
border bodies of the periadventitial districts have been observed by
me, but not with such constancy as to justify more than this mere
mention. In his researches on starvation Rosenbach found the brain
œdematous and the ventricles dilated; there were also microscopical
changes which indicated a profound disturbance of nutrition; the
large cells of the anterior spinal horn and cerebellum had lost their
transparency, being in a condition resembling cloudy swelling. The
neuroglia appeared to be in a similar condition as that of nerve-cells.
Singular as it may appear on first sight, the capillaries were found
crowded with blood-corpuscles, and there were many evidences of
diapedesis of such. This may indicate a passive accumulation due to
deficient cardiac and vascular contractility. The changes, as a whole,
were not unlike those found in myelitis,29 except in so far as no
actual inflammatory signs were present.
29 Several distinguished neurologists, notably Westphal, who were present when
Rosenbach presented his conclusions, were unable to recognize so profound a
deviation from the normal structural conditions as he claimed (Archiv für Psychiatrie,
xvi. p. 279).

SYMPTOMS.—The clinical phenomena of acute cerebral anæmia have

been in the main related in connection with the etiology of this
disorder. We shall now proceed to detail those which occur with
cases more likely to engage the attention of the practitioner either on
account of their gravity or protracted duration.

Uncomplicated Chronic Cerebral Anæmia of Adolescents and

Adults.—This condition is one of the common manifestations of
general anæmia. Most anæmic persons are languid, drowsy, suffer
from insomnia, tinnitus aurium, and other signs of imperfect cerebral
irrigation. In some these troubles become alarmingly prominent and
may approach the confines of mental derangement. This is
particularly apt to occur with women who have borne and nursed a
large number of children. In addition to the typical signs of cerebral
anæmia, they exhibit depression, may suffer from hallucinations, and
even become afflicted with lachrymose or suicidal melancholia
(insanity of lactation of the somato-etiological school). Depression of
the mental functions is the most constant symptom of cerebral
anæmia, and the one which most frequently directs the physician's
attention to its existence; its subjects appear mentally blunted, the
apperceptive powers are diminished, and it is difficult for the patient
to interest himself in anything, or when interested to keep up a
mental effort—that is, his attention—any length of time. In more
severe grades of the trouble the patients become somnolent in the
daytime. Contrary to what those who regard sleep as essentially due
to cerebral anæmia might expect, sleep is disturbed, and the patient
is wakeful or suffers from vivid and frightful dreams, or even deliria.
Others pass a quiet night, but are rather in a trance-like condition
than a healthy sleep. Lethargic as the cerebral anæmic person is on
the whole, and unable as he feels himself to exert his will-power
(aboulia), yet he is often irritable, perverse, and petulant in
consequence of that morbid excitability which is a universal attribute
of the overworked or imperfectly nourished nerve-element. The
younger the patient the more likely is the condition apt to impress
one as a stupor, while with older patients irritability is more
prominent. In the former the obtuseness is often rapidly overcome
when the patient assumes the horizontal position.

It was supposed by Abercrombie that an acute exacerbation of

cerebral anæmia of this form in weakly and aged individuals might
terminate in death. This condition corresponded to the so-called
serous apoplexy of the old writers. With increasing accuracy in our
autopsies this condition is more and more rarely recorded, although
the possibility of its occurrence as a pathological rarity cannot be
denied. As a rule, the chronic form of cerebral anæmia when it
terminates fatally, which is exceptional, is marked by a deepening
coma and gradual extinction of the vital processes, the Cheyne-
Stokes phenomenon preceding this.

Patients suffering from chronic cerebral anæmia are afflicted with

morbid irritability of the optic and auditory nerves. Loud sounds and
bright lights are very annoying to them. Roaring, buzzing, and
beating sounds in the ear are common, and scintillations, muscæ
volitantes, and temporary darkening of the visual field—particularly
noticed when the head is suddenly raised—are complained of in all
cases. It is often found that the tinnitus disappears and the hearing
power improves on assuming the horizontal position.

Headache of greater or less severity is found in the majority of

cases: it is more severe in the rapidly-developed forms, and I have
found it to be complained of in agonizing intensity by women who
had risen from childbed and who had flooded considerably. As a
rule, the headache, whether severe or mild, is symmetrical and
verticalar, in some cases associated with an ache subjectively
appearing as if it extended to the back of the orbit. It is remarkable
for its constancy, and its exacerbations are often complicated with
vertigo and nausea, so that it is not infrequently interpreted as a
reflex evidence of gastric disorder. A stitch-like feeling, located in
both temples, is often associated with it.

Occasionally sufferers from chronic cerebral anæmia experience

seizures, or rather exacerbations, of their disorder which approach in
character, while not equalling in degree, an attack of syncope.
Whether in bed or in a chair, they then feel as if their limbs were of
lead; they deem that they cannot stir hand or foot; the other
symptoms related are aggravated; they yawn and breathe deeply,
but hear all that is said by those near them, and do not lose
consciousness. They express themselves as feeling as if everything
around them were about to pass away. One of my patients would
frequently find that if this condition overtook her while lying on one
side, that side would remain numb for some time and be the seat of
a tingling sensation which disappeared on the parts being rubbed.
The same was noticed when she awoke in the morning in a similar
position. To what extent these features were due to the general
anæmia is doubtful. As previously stated, true syncope occurs in
chronic cerebral anæmia, but much less frequently in those subjects
of this disorder who have reached middle life than in adolescents.

The radial pulse in cerebral anæmia does not necessarily show the
anæmic character; not infrequently the general blood-pressure is
increased at the onset of the acute form, and if long continued this
may be followed by a decrease of the same. The pulse-character
may therefore vary greatly in frequency, resistance, and fulness. In
protracted cases it is soft, easily compressible, and rapid.

It is not uncommon to find indications of a slight unilateral

preponderance of the signs of cerebral anæmia. In one case which
terminated in recovery, and was otherwise pure, vertigo was not
produced on turning from the left to the right, but it was produced to
a distressing degree on turning in the opposite direction; in a second,
equally typical, there was for a long time a subjective sensation of
falling over toward the right side.

There appears to be much less constancy in the relationship of the

deficient blood-supply to the severity of the symptoms than is usually
supposed. Much depends upon the time of life at which the disorder
develops: a brain that has acquired stability through education and
exercise is less vulnerable to the influence of general anæmia than
one that has not. The nerve-centres appear, to some extent at least,
to regulate their own blood-supply; and whether it be through a
change in the blood-current rapidity or some other factor neutralizing
the evil effects of the intrinsically inferior quality of the blood, we
must attribute to the self-regulating nutrition power of the brain the
not uncommon phenomena of an active mind in an anæmic body.
And where the general anæmia reaches so high a degree as to
involve the brain, under such circumstances we find that irritability to
sensory impressions and fretfulness are more prominent than the
lethargy and indifference which characterize the juvenile chlorotic
form. Although this distinction is less marked between these two
classes in regard to acutely-produced anæmia, yet it is observable
even there. If in a youth or girl while undergoing phlebotomy cerebral
anæmia were to reach such a degree as to cause subjective sounds,
they would either approach or fall into a faint; but Leuret, the
distinguished cerebral anatomist, while being subjected to the same
procedure, hearing a hissing sound, did not lose consciousness, but
complained that some one must have upset a bottle of acid on a
marble table in the same room, as he supposed he was hearing the
sound of effervescence thus produced.

Much, too, appears to depend on dynamic and other thus far

undiscovered intrinsic conditions of the brain-tissue itself,
irrespective of the mere amount and rapidity of the blood-current. If
the subject be exposed to wasting diseases, to blood-poisons, or to
vicissitudes of temperature and to physical exhaustion in addition to
the causes producing cerebral malnutrition, deliria of a cortical
nature are more apt to characterize the case than in simple anæmia.
These are known as the deliria of inanition, and present themselves
under two forms. The first has been frequently observed in sailors,
travellers, and others who have undergone starvation in exposed
situations, and is tinctured by the psychical influences incident to
such a condition. Just as the Greeley survivors at Cape Sabine,
when reduced to their miserable rations of seal-skin boot-leather and
shrimps, entertained each other with the enumeration of imaginary
culinary luxuries, so others who have suffered in the same way
declaim about gorgeous banquets in the midst of a howling
wilderness, or, as occurred to a miner who lost his way in Idaho a
few winters ago, experienced hallucinatory visions of houses, kitchen
utensils, and persons with baskets of provisions. In others the terror
of the situation leads to the development of rambling and incoherent
delusions of persecution.
The second form, regarded as a variety of starvation delirium, is
found in the post-febrile periods of typhoid and other exhausting
fevers. In aged persons it may even develop shortly after the onset
of the disease. It is usually unsystematized, of a depressive cast,
and may be associated with a condition resembling melancholia
agitata. In a small proportion of cases insanity of the ordinary types,
but more commonly of the special kinds comprised in the group of
post-febrile insanity, develops from the anæmic fever delirium as its
starting-point.

The spurious hydrocephalus (hydrocephaloid, hydrencephaloid) of

Marshall Hall and Abercrombie, referred to in the section on Etiology,
is an important condition for the diagnostician to recognize. A child
suffering from this disorder presents many symptoms which are
customarily regarded as characteristic of tubercular meningitis or of
chronic hydrocephalus; thus the pupils are narrow—sometimes
unequal;30 there is strabismus, and there may be even nuchal
opisthotonos, while the somnolent state in which the little patient
usually lies may deepen into a true coma, in which the pupils are
dilated, do not react to light, nor do the eyelids close when the
cornea is touched. Ominous as this state appears, it may be
completely recovered from under stimulating and restorative
treatment. On inquiry it is found that the symptoms above mentioned
were preceded by cholera infantum or some other exhausting
complaint, such as a dysentery or diarrhœa, and that the somnolent
condition in which infants are often found toward the close of such
complaints passed gradually into the more serious condition
described.31 The infants thus affected do not, however, sleep as
healthy children do, but moan and cry, while apparently unconscious
of their surroundings. The surface of the body is cool and pale; the
pulse and respiration are normal, except in the comatose period, but
the former is easily compressible. The chief points distinguishing
hydrocephaloid from true hydrocephalus and other diseases
associated with similar symptoms are the following: 1st, There is no
rise of temperature; 2d, the pupils are equal; 3d, the fontanelle is
sunken in; 4th, the pulse and respiration, with the exception stated,
are natural; 5th, there is an antecedent history of an exhausting
abdominal disorder; 6th, also a facial appearance characteristic of
the latter.
30 This is not admitted by most writers, but does occur exceptionally.

31 It should not be forgotten, however, that very similar symptoms occur after cholera
infantum, with a much graver pathological condition—namely, marantic thrombosis of
the sinuses.

One of the gravest and rarest forms of cerebral anæmia is one which
occurs as a result of extreme general anæmia in very young infants.
In a remarkable case which I have had an opportunity of studying,
the abolition of certain cerebral functions reached such a degree that
the opinion of a number of physicians was in favor of tubercular
meningitis.32 There was at the time of my examination complete
extremity hemiplegia, and there had been conjugated deviation,
restlessness in sleep, and dulness in the waking hours: all these
symptoms except the hemiplegia disappeared whenever a more
assimilable and nutritious food was used than the one previously
employed. On one occasion there were evidences of disturbed vaso-
motor innervation; on several, convulsive movements. This history,
associated with ordinary evidences of general anæmia, covered a
period of eighteen months, without the slightest abnormality of
temperature being noted or discoverable during that period. The
mucous surfaces of this child were almost colorless, certainly without
any indication of the normal tinge; the mother had nursed it, and her
milk had been found to possess scarcely any nutritive value. The
case terminated fatally at the age of twenty months.
32 It was stated by an experienced practitioner that death occurred with unmistakable
symptoms of tubercular meningitis. Certainly, the absence of temperature disturbance
at the time of the hemiplegic and other exacerbations, as well as other important
features for a period exceeding a year, shows that whatever favorable soil the earlier
condition may have furnished for the secondary development of such or other gross
structural disease, tubercular meningitis did not exist at the time; while the absence of
pupillary and optic-nerve symptoms, as well as the rapid changes from day to day or
week to week under dietetic treatment, militate against the assumption of any other
organic affection incident to childhood.
Partial Cerebral Anæmia.—Most writers on cerebral anæmia discuss
a number of varieties of partial cerebral anæmia as distinguished
from the acute and chronic general forms. Some of the conditions
thus described properly appertain to the angio-spastic form of
hemicrania, others to epilepsy, and the majority to circulatory
disturbances dependent on arterial disease. Aside from the partial
cerebral anæmia resulting from surgical causes, I am acquainted
with but one evidence of limited cerebral anæmia which can be
regarded as independent of the neuroses or of organic disease, and
that is the scintillating scotoma. This symptom, in the only case in
which I observed it, occurred in a medical student, accompanied by
pallor and nausea in consequence of the disgust produced in him by
the combined odors of a dissecting-room and of a neighboring
varnish-factory. The totally blind area of the visual field was strictly
hemianopsic in distribution and bounded by a colored zone
scintillating, to use the sufferer's words, like an aurora borealis. The
attack, probably protracted by his great alarm at being blind in one-
half of the visual field, lasted three hours. As the cause in this case
was a psychical impression and accompanied by the ordinary signs
of that fainting which is not an uncommon occurrence in the
dissecting-room; as, furthermore, the individual in question never
had a headache except in connection with febrile affections, and
then in the lightest form, and is neither neurotic himself nor has a
neurotic ancestry or relatives,—I regard it as the result of a simple
arterial spasm intensified in the visual field of one hemisphere,
analogous to the more general spasm of ordinary syncope.33
33 It may be remembered that Wollaston had scintillating scotomata, and that after his
death a small focus of softening was found in the one visual field. Ordinarily, this
disturbance is associated with hemicrania.

DIAGNOSIS.—There is so little difficulty in recognizing the nature of

those cases of acute cerebral anæmia which depend on
recognizable anæmia-producing causes that it is unnecessary to
point out their special diagnostic features. With regard to chronic
cerebral anæmia, and its differentiation from other circulatory brain
disorders, I refer to the last article. In this place it will be necessary