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UNIVERSITY

OF CALIFORNIA

LOS ANGELES



SCHOOL OF LAW
LIBRARY



WHARTON AND STILLE'S

MEDICAL JURISPRUDENCE



VOL III

PHYSICAL CONDITIONS AND TREATMENT



MEDICAL ASPECTS

BY

TRUMAN ABBE, A.B. (Harv.), M.D. (Col.)

Assistant to the Professor of Surgery and to the Professor of Physiology at
THE Georgetown University Medicaij School.



LEGAL ASPECTS

BY

FRANK H. BOAVLBY

Of the Publishers' Editorial Staff



FIFTH EDITION



ROCHESTER, N. Y.:

THE LAWYERS' CO-OPERATIVE PUBLISHING COMPANY

1905



T



Entered according: to Act of Congress, in the year eighteen hundred fifty-five, by

KAY & BROTHER.

In the OflBce of the Clerk of the District Court of the United States

In and for the Eastern District of Pennsylvania.

Entered according to Act of Congress, in the year eighteen hundred sixty, by

KAY & BROTHER,

In the Clerk's Office of the District Court of the United States

In and for the Eastern District of Pennsylvania.

Entered according to Act of Congress, in the year eighteen hundred serenty-two, by

KAY & BROTHER,

In the OfiBce of the Librarian of Congress, at Washington.

Entered according to Act of Congress, in the year eighteen hundred eighty-four, by

FRANCIS ■WHARTON,

In the Office of the Librarian of Congress, at "Washington.

Entered according to Act of Congress in the year nineteen hundred five, by

LAWYERS' CO-OPERATIVE PUBLISHING COMPANY,

In the Office of the Librarian of Congress, at Washington, D. C.



i3WU



E. R. Andrews Pbinting Company, Rochester, N. Y,



PEEFAOE TO THE FOCJETH EDITION.



In this volume, the sections between § 1 and § 262 have been
revised by Dr. Samuel Ashhurst, and those between § 265 and § 586
by Dr. Wharton Sinkler. The chapters on Life Insurance and on
Defects of Vision (including Color Blindness), which close the
volume, are new. The portions of the work which bear on juridical
law have been rearranged and in a large measure rewritten so as to
incorporate in them recent English and American decisions.

¥. W.

Philadelphia, Makch, 1884.



PREFACE TO THE FIFTH EDITION.



In the present edition, Volume III., Books I., II., and III. have
been ahnost entirely rewritten, following the same general lines as in
the fourtii edition. This rewriting has been made necessary by the
advances during the past twenty years in so many lines of scientilic
work, especially in physics, chemistry, entomology, bacteriology,
anatomy, pathology, and physiology. A vast quantity of material that
we have had to make use of in this book, however, is still far from
being placed on a scientific basis. It rests upon the assertions of the
men who, in the past, have done the writing. Their ideas, no matter
whether based upon accurate observations and careful reasoning or
not, have been copied from book to book, and when analyzed show
that they are merely the opinion of one man, that has been followed
by others, not because it was proved to be true, but because the others
knew nothing more accurate. And for that same reason in some
instances this present edition, in order to present at least some work-
ing basis on which to build, has quoted the widespread statements
that have generally been accepted, but the editor has endeavored to
show the doubts and the unsatisfactory state of our knowledge by
hedging in these statements with "may be," "perhaps," " in some
cases," etc. Investigation from a scientific standpoint in medical lines
is advancing slowly enough in the lines of disease and treatment
which appeal to all the practising physicians, but the parts that are
important to the medical jurist advance much more slowly, and in
these the Americans, much to our regret, are far behind the French
and the Germans.

Two entirely new chapters have been added, one on the effects of
electricity, and one on the causes of sudden death. The spelling of the
medical terms has been largely in conformity with the choice of the
recent lexicographers, although that standard has not been fully
adopted by the medical profession. In the references to medical
works the abbreviations used are those ado})ted in the Index Cata-
logue of the librar}' of the Surgeon General's office.

The chapters on questions distinctively legal have been entirely
rewritten and rearranged, and extensive additions have been made.



Tiie work is entirely new ; but all of the subjects treated la the fourth
edition are here considered, though some of them are under different
names, and substantially everything there found is here reproduced
with the addition of subsequent decisions. Some matters thought to
be medical rather than distinctively legal are to be found in other parts
of this work, and some which seemed to belong to the general field of
law rather than that of medical jurisprudence are omitted. New
chapters on various subjects are here incorporated. Among these
are the following chapters : The Right to Practise Medicine, Surgery,
etc.; Duty to call a Physician ; Relation between Physician and Patient
or Employer; Degree of Care and Skill Required; Compensation;
OflEicial Employment and Duties. Also an extended consideration of
the questions of medical books as evidence, of the privilege of
physicians, of injuries to physicians, and of the effect of their acts
upon the rights, duties, and liabilities of third persons. The design
has been to furnish all the law as to the rights, regulations, duties,
and liabilities of physicians and surgeons in all their personal relations,
and as to situations arising from their acts.
Januaky, 1905.



TABLE OF CONTENTS.



BOOK I.



QUESTIONS RELATIVE TO PREGNANCY AND

INFANTICIDE.



CHAPTER I.

DIAGNOSIS OF EXISTING PREGNANCY.

1. Introduction 3

2. Presumptive signs in general , 4

3. Suppression of the menses 4

4. Enlargement of the abdomen 5

5. Rhythmical contractions 5

6. Pseudocyesis 6

7. Discoloration of linea alba 6

8. Prominence of umbilicus 6

9. Cervix and lower uterine changes, — vaginal flattening; uterus

anteflexion ; cervix softening ; Hegar's sign 6

10. Quickening 7

11. Genital coloring 7

12. Kiestein 7

13. Changes in the breasts 8

14. Sympathetic changes, — morning nausea, mental derangements,

et cetera 8

15. Positive changes in general 9

16. Fetal outline 9

17. Passive fetal movements, — ^ballottement 9

18. Active fetal movements , 9

19. Fetal heart sounds, — umbilical soulSe, et cetera 9

20. Summary of positive signs 10

21. Abnormal pregnancies in general 10

22. Hydatidiform moles, etc 10

23. Extrauterine pregnancy 10

24. Summary 11

25. Post-mortem diagnosis 12

vii



▼iii CONTENTS.

CHAPTER II.

DIAGNOSIS OF PREVIOUS PREGNANCY.

L Afteb early abortions and abnomal cases 13

26. Signs in objects discharged from uterus ....." Hi

27. Signs remaining in woman •>.... 14

II. All'EB SECOND-HALF ABORTION AND LABOR AX TERM 14

28. In general 14

29. Temporary signs in general 14

30. Breasts 14

31 . Parturient canal 15

32. Uterus 15

33. Lochia If)

34. Permanent signs in general 10

35. Parturient canal 10

III. Post-mortem examinations 16

36. Temporary signs in general 16

37. Corpus luteum 17

38. Permanent signs, — size of uterus 18

39. Uterine walls l!>

IV. Menstruation versus pregnancy 19

40. In general 19

V. Number of pregnancies, and date of delivery 20

41. Number of pregnancies 20

42. Date of delivery 20

VI. Feigned delivery 20

43. In general 20

CHAPTER III.
DURATION OF PREGNANCY.

I. Presumption that child eoen in wedlock is legitimate 23

44. General rule 23

n. Normal duration of pregnancy 24

45. Date of conception, in general 24

46. Conclusions as to determination of exact duration 25

47. Mode of reckoning duration of pregnancy, in general 26

48. From sensations of woman at coitus 26

49. From quickening 27

50. From cessation of menses 27

51. From ten monthly periods 28

52. From single coitus 28

III. Variations in* period of pregnancy 30

53. In general 30

54. Variations in other physiological functions 30

55. Variations in period of gestation in lower animals 30

56. Variations in period of gestation in woman, in general 31

57. Signs of protracted gestation 31

58. Cases dating from menses 32



CONTENTS.



iz



69. Cases dating from coition 33

60. Limit of protraction 33

61. Protraction in abnormal cases 34

62. Legal decisions 34

63. Early viability, in general 35

64. Evidences of age of fetus 37

65. Cases of early viability 38

66. Conclusions as to limits of variation 39

CHAPTER IV.

SUPERFETATION.

67. Definition 40

68. Ovulation during pregnancy 40

69. Possibility of conception 41

70. Evidence from alleged superfetation in normal cases, in

general 41

71. Twins with different fathers 41

72. Simultaneous birth of two fetuses of different ages 42

73. Two viable fetuses born within nine months 43

74. Interpretation of this evidence ; twin compression 44

75. Evidence from superfetation in abnormal cases; double uterus 40

76. Coincident extra- and intra-uterine pregnancy 46

77. Conclusions 47

CHAPTER V.

ABORTION AND FETICIDE.

i 8. Definition 48

79. Causes of spontaneous abortion 49

80. Signs of spontaneous abortion 4<j

81. Causes of induced abortion, in general 49

82. Use of drugs in general 49

83. Irritants 49

84. Purges 49

85. Emmenagogues .50

86. Ergot 50

87. General m^echanical means o 1

87a. Baths, bleeding 51

87b. Traumatisms and operations ^ 52

88. Local mechanical means 53

89. Signs of induced abortion in fetus 53

90. Signs of induced abortion in mother 54

90a. Eiipture of the uterus 54

91. Age of fetus 56

92. Medical abortion 59

93. Summary of evidence of criminal abortion 60



CONTENTS.

CHAPTER VI.

INFANTICIDE.

L In general 62

94. Definition 62

II. Evidence of death in ■ uteko 63

95. Jjong before delivery .' 03

96. Just before delivery 63

III. Evidence of live birth 63

97. General 63

98. Respiratory tests 64

99. Static tests 64

100. Docimasia pulmonum hydrostatica 05

101. Objections to docimasia pulmonum hydrostatica on the positive

side 66

101a. Vagitus uterinus 60

101b. Freezing and alcohol hardening 66

101c. Emphysema 67

lOld. Artificial inflation of the lungs 67

lOle. Putrefaction 67

102. Objections to docimasia pulmonum hydrostatica on the nega-

tive side ; disease 69

102a. Atelectasis 69

102b. Boiled and water-soaked lungs 70

103. Docimasia intestinalis hydrostatica 70

104. Circulatory tests, in general 70

105. Caput succedaneum 70

106. Fetal channels 71

107. Blood coagulation 71

108. Live birth before respiration 71

IV. Duration of the child's life 71

109. Evidence from the lungs, stomach, umbilical clots 71

110. Condition of the umbilical cord 72

111. Skin desquamation ... 73

112. Obliteration of the fetal channels 73

1 13. Centers of ossification 73

V. Causes of death during labor 74

114. Placental separation 74

1 15. Prolapse of cord 74

116. Cord around neck « 74

117. Head compression 75

118. Rupture of cord 75

119. Fracture of skull 76

119a. From contracted pelvis 70

119b. From forceps application 7G

119c. Precipitate labor 7G

120. Hemorrhage from rupture of the cord 78

121. Breech presentation 78

71. Death after labor 79

122. Caused by malformations 79



CONTENTS. xi

123. Caused by prematurity 79

124. Death from avoidable causes in general 71>

125. Suffocation 80

120, Manner of producing suffocation 80

126a. PharjTigeal tampon 82"

12Cb. Burial alive 82

127. General evidence of suffocation 83

128. Taclies de Tardieu 84

129. Strangulation 85

130. General signs of strangulation 86

131. Submersion in water 86

132. Submersion in privy 86

133. Fracture of skull 87

134. Wounds and mutilation 88

135. Combustion 89

136. Poisoning 89

137. Lack of care ; caul 90

137a. Cord ligature 90

137b. Exposure 90

137c. Inanition 91

VII. Time since death of child 91

138. Evidence from putrefaction 91

139. Evidence from mummification 92

140. Date of delivery from evidence of mother 92

VIII. Responsibility of mother fob caee of infant 92

141. Ignorance of pregnancy 92

142. Unconscious delivery 93

143. Physical inability 93

144. Mental irresponsibility 94

IX. General cojiments 95

145. In general 95



BOOK II.

QUESTIONS AEISING OUT OF THE DIFFERENCE

OF SEX.



CHAPTER I.

DOUBTFUL SEX.



146. Definition of hermaphroditism 99

147. Pseudo-hermaphrodites, in general 100

148. Male pseudo-hermaphrodites 100

149. Female pseudo-hermaphrodites 101

150. True hermaphrodites, in general 104

151. Mixed external and internal 104



CONTExNTS.

152. True tubular 106

153. True glandular 107

153a. In animals 100

154. Embryological objections lOlt

155. Absence of sexual organs 1 10

156. General comments 1 10



CHAPTEE II.

SEXUAL DISABILITY.

157. Definition 113

158. Normal fertile period in woman 113

159. Precocious menstruation 114

160. Precocious pregnancy 114

161. Late pregnancy ; postponed menopause IIT)

162. Causes of sterility in woman lir>

162a. Ovaries atrophic or diseased IKi

I62b. Artificial menopause 117

162c. Fallopian tubes 117

162d. Uterus 117

162e. Vagina : 118

162f. Psychical causes 11!>

162g. Physical inaccessibility 11!>

162h. Constitutional disturbances 120

163. Sexual disability in man, in general 120

164. Normal virile period, in general 12(1

165. Precocious virility 12(1

166. Precocious paternity 121

167. Late virility 121

168. Causes of sterility in man; testes atrophic or diseased 12.'i

168a. Castration 124

168b. Obliteration of vas deferens 124

169. Impotence ]2.'v

CHAPTER III.

RAPE.

I. In general 127

170. Definition 127

n. Medical evidence of rape 12'^

171. In general 128

172. Evidence of violence 128

173. Possibility of rape on adult female 129

174. Evidence of sexual intercourse, in general 130

175. Anatomical changes 131

176. Hymen may not be destroyed 132

177. Intact hymen as evidence of virginity 133

178. Hymen ruptured otherwise tlian by coitus 133

179. Variations in form of hvnien 133



CONTENTS. xiii

180. Seminal stains 134

181. Venereal disease 135

182. Conclusions 136

III. Clinical aspect of rape 136

183. Rape upon children, in general 136

184. Evidence of rape upon children ; dilatation 136

185. Injuries 137

186. Marks of violence 137

187. Venereal disease 138

187a. Simple vulvo-vaginitis 140

187b. Gonorrheal vulvovaginitis 141

187c. Hereditary syphilis 143

187d. Herpes of the vulva 143

187e. Gangrenous vulvitis 143

188. Rape on adult women 145

189. Rape on old women 146

190. Rape on the weak-minded 146

191. Rape during unconsciousness; under the influence of drugs. . . . 147

192. Under the influence of anesthetics .... 147

193. Possibility of anesthetizing during sleep 147

194. Testimony of person under anesthetic 147

195. During hj-pnotic sleep 161

196. During normal sleep 161

197. Unjust charges of rape 162

198. Rape by women 164

CHAPTEK IV.

UNNATURAL CRIMES.

199. Sexual abuse 166

200. Pederasty 166

201. Sodomy 167

202. Pederasty with animals 167



BOOK III.
PHYSICAL INJURIES BY FORCE.



CHAPTER I.

WOUNDS.



I. Genebal V 173

203. Definition 173

204. Examination, in general 174

205. Expert examination 174



xiT CONTENTS.

206. Classification of wounds, in general 175

207. Subcutaneous wounds 175

207a. Ecchymoses 176

207b. Dislocation and fractures 177

208. Open wounds, in general • 178

209. Punctured 17S

209a. Size 179

209b. Shape 179

210. Incised 179

210a. Direction of incision 180

210b. Bleeding -. 180

210c. Irregular ■ 180

211. Lacerated 180

211a. Types 181

212. Gunshot wounds, in general 181

213. Cannon balls 181

214. Small shot 181

215. Rifle and revolver bullets; smaller caliber jacketed bullets. . . . 182

215a. Larger caliber leaded bullets ISo

216. Wadding wounds 185

217. Powder wounds 187

218. Multiple wounds 187

n. Degree of injury 188

219. Mortal versus nonmortal wounds, in general 188

220. Sources of danger 189

221. Direct sources, in general 189

222. Exliaustion 189

223. Hemorrhage 190

223a. Bleeders 191

223b. Internal 192

224. Post-mortem indications as to hemorrhage 192

225. Shock 192

226. Abnormal conditions 193

227. Indirect sources of danger; infection 194

228. Fat embolism 195

229. Surgical interference 195

229a. Method 19U

229b. Anesthesia 197

229c. Complications 198

230. Remote sources of danger, in general 198

231. Spinal paralysis 198

232. Epilepsy 198

233. Diabetes 199

234. Sarcoma and epithelioma 199

235. Traumatic neuroses 190

235a. Railway spine 200

III. Homicidal, suicidal, and accidental wounds 201

236. In general 201

237. Situation of wound 201

238. Direction of wound 202

239. Circumstantial evidence 203



CONTENTS. XV

240. Position of body 204

241. Mode of death ; throat cutting 206

241a. Gunshot 207

IV. Akte-mobtem versus post-mortem wounds 20S

242. In general 208

243. Ante-mortem open wounds ; hemorrhage 20S

243a. Clotting 208

243b. Healing 20!>

243c. Scar 200

244. Ante-mortem subcutaneous wounds; ecchymoses 210

244a. Ecchymoses from natural causes ' 211

245. Physiological actions before death 211

246. Acts after receiving a mortal wound 212

247. Post-mortem wounds, in general 213

248. Appearances 214

249. Hemorrhage . 215

249a. Coagulation 215

250. Ecchymoses 210

251. Cadaveric spots 218

252. Post-mortem blisters 219

V. Wounds of various parts of the body 219

253. Head, in general 219

254. Face 219

255. Eye . , 219

256. Ear 220

257. Scalp 221

258. Skull fractures, in general 221

259. Vault of skull 221

260. Base of skull 221

261. Mechanism of fractures 222

262. Gunshot fractures 223

263. Brain, in general 224

264. Concussion of brain * . 224

265. Compression of brain 224

266. Destruction of portion of brain 225

267. Derangements of mind resulting from injuries 228

268. Spine, in general 228

269. Concussion of spinal cord 228

270. Compression of spinal cord 229

27 1. Dislocation of vertebrae 2Z9

272. Fracture of vertebras 22!)

273. Destruction of spinal cord 23 1

274. Stab wounds 231

275. Direct traumatism 231

276. Subcutaneous wounds 232

277. Open wounds of neck 233

278. Larynx and tracliea 233

279. (Esophagus 233

280. Thorax ; concussion 234

281. Nonpenetrating wounds -of tliorax 234

282. Penetrating wounds of thorax 234



xvi CONTENTS,

283. Heart; nonpenetrating wounds 235

284. Heart ; penetrating wounds 235

285. Abdomen ; nonpenetrating wounds 237

2SG. Abdomen ; penetrating wounds 238

287. Pelvis 23!J

288. Genitals; female 2H)

289. Genitals : male 242

290. Extremities 243

VI. Blood stains 244

291. In general 244

292. General appearance 245

293. Arterial distinguished from venous blood 245

294. Chemical tests ; sodium tungstate test 248

294a, Guaiacum test 24S

294b. Hemin test 249

295. Spectroscopic tests 250

296. Microscopic test 253

297. Biologic test 256

CHAPTEK II.

BURNS AND SCALDS.

298. Agents causing burns 262

299. Classification according to severity 263

300. Danger from burns > extent 263

300a. Complications 264

300b. Burn scars 264

301. Causes of death 204

302. Post-mortem examination ; local lesions 265

302a. Internal lesions 205

302b. Other causes of death 265

303. Duration of life after fatal burns 266

304. Post-mortem burns ; first degree ; reddening 266

304a. Second degree ; vesication 266

304b. Third degree ; eschar 269

304c. Fourth degree and more severe ; carbonization 270

305. Time for combustion of body 270

306. Identity of charred body 270

307. Spontaneous combustion 270

308. Spontaneous ignitability 271

309. Increased combustibility 272

CHAPTEE III.

HEAT AND SUNSTROKE.

310. Degree of heat consistent with life 274

- 311. Heat exhaustion 275

312. Sunstroke 275

313. Post-mortem appearances 275



CONTENTS. xvii
CHAPTEE IV.
COLD.

814. Degree of cold consistent with life 277

315. Symptoms 277

3 16. Post-mortem appearances 278

317. Frostbite : 278

318. Causes of death from cold 278

CHAPTER V.

ELECTRICITY AND LIGHTNING.

I, Electbicity 280

319. In general 280

320. Conditions determining effect 28 1

321. Accidents 282

322. Suicide 283

323. Electrocution 283

324. Post-mortem lesions 281

II. Lightning 284

325. In general 284

326. Effects 285

327. External lesions 286

328. Post-mortem findings 286

329. Cases 287

CHAPTER VI.

STARVATION.

330. Starvation by accident or intent 289

331. Modes of starvation 289

332. Period 290

333. Symptoms 291

334. Post-mortem findings 292

335. Diagnosis of starvation 294

CHAPTER VII.

SUFFOCATION.

336. Definition 296

337. Modes 296

338. Symptoms 297

339. Post-mortem signs 297

340. Diagnosis 298

341. Cases ; accidental suffoeation 299

341a. Suicide 300

341b. Homicide 302



CONTENTS.

CHAPTER VIII.

STRANGULATION.

342. Definition 311

343. Strangulation by bands 311

344. Throttling 312

345. Symptoms 312

346. Post-mortem signs, in general 313

347. General external appearances 31.)

348. Marks on the neck 31:!

349. General internal appearances 314

350. Deep tissues of the neck 314

351. Diagnosis 31.^

352. Ante-mortem versus post-mortem strangulation 3 If

353. Cases ; accidental strangulation f 317

353a. Suicidal strangulation 31H

353b. Homicidal strangulation . . 32."^

353e. Simulated strangulation 327

CHAPTER IX.

HANGING.

354. Definition 331

355. Cause of death 33 1

356. Symptoms 332

357. Post-mortem signs ; external examination 3S^

358. Examination of neck 334

359. Internal appearances . . . . * 33(J

360. Deep tissues of the neck 330

361. Associated lesions 338

362. Ante-mortem versus post-mortem suspension 338

363. Suicidal versus homicidal hanging 340

364. Cases ; accidental hanging 343

364a. Homicidal hanging 343

364b. Suicidal banging 344

CHAPTER X.

DROWNING.

865. Conditions necessary for drowning 347

366. Types of death 347

367. Time of submersion without drowning 348

368. Symptoms 34!)

369. Post-mortem appearances ; external 34!i

370. Froth at nostrils 350

371. Abrasions of the'hands , 350

372. Internal appearances, in general 351

373. Condition of the lungs 351



CONTENTS. xix

374. Water in the stomach 351

375. Marks of violence 352

376. Ante-mortem versus post-mortem violence 363

377. Submersion, ante-mortem versus post-mortem 353

378. Accident, homicide, and suicide 354

379. Decomposition; time of floating 355

380. Putrefaction in water-soaked bodies 359

381. Course of maceration in the water 360

382. Time in the water 362

CHAPTER XI.

SUDDEN DEATHS FROM NATURAL CAUSES.

383. Definition 364

384. Lesions of the circulatory system 365

385. Lesions of the central nervous system 366

386. Lesions of the respiratory system 368

387. Lesions of the digestive system 360

388. Constitutional diseases 370

389. Lesions of the female generative system 370

390. Lesions of the urinary system 370

CHAPTER XII.

DEATH AND SIGNS OF DEATH.

I. Apparent death versus real death 373

391. Premature burial 373

392. Conditions simulating death 373

n. Time of death 374

393. Instant of death 374

394. Order of deaths 375

IIL Signs of death 376

395. In general 376

396. Cessation of response to stimulation 376

397. Cessation of respiration 376

398. Cessation of circulation 377

399. Cessation of movements of the chest 377

400. Examination of the eye 378

401. External suggillation 37S

402. Internal suggillation 379

402a. Limgs 370

402b. Brain .379

402c. Kidneys and intestine 379

402d. Heart .380

403. Extinction of animal heat 380

404. Condition of muscles; primary relaxation 381

405. Cadaveric rigidity 381

406. Cadaveric spasm 382

407. Secondary relaxation 383



c CONTENTS.

408. Destruction of the body, in general 383

409. Rate of putrefaction 383

409a. Air, water, temperature 384

409b. Environment 384

409c. Manner of deatii 385

410. External signs of putrefaction 385

411. Putrefaction of internal organs 388

412. Windpipe and lai-jTix 38S

413. Brain of infants 388

414. Stomach 383

415. Intestinal canal 389

416. Spleen 389

417. Omentum and mesentery 389

418. Liver 389

419. Brain of adult 389

420. Heart 390

421. Lungs 390

422. Kidneys 390

423. Urinary bladder 390

424. CEsophagus 390

425. Pancreas 390

426. Diaphragm 391

427. Arteries and aorta 391

428. Uterus .- 391

429. Saponification 391



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