to the nervousness and indecision of the deceased. A homicidal can usually be distinguished from a suicidal wound by its direction. Thus, for example, if a man were found dead with a wound in the neck of such a character that it could be positively stated that the weapon had been partially turned and withdrawn, and again plunged into the neck in a different direction, as is sometimes done by German butchers,' the proof would be strong of the wound being homicidal. Or, if the nature of the wound in the neck indicated that it had been made by cutting from within outward, as is often done by English butchers in the killing of sheep, it would be strong presumptive evidence that murder had been committed.

Accidental wounds are the body as are exposed.

usually found in such parts of If wounds, the nature of which might otherwise lead to the supposition that they had been made accidentally, are found upon both sides of the body, the presumption would then be that they were homicidal.

Gunshot wounds are essentially contusions. Owing, however, to the vitality of the parts struck being destroyed by the projectile, there ensues a process of sloughing. In this respect gunshot wounds differ from ordinary wounds. They differ very much in appearance, according to the nature of the projectile, to the distance from which the piece was discharged, etc. As a general rule the hemorrhage following a gunshot wound is not very great, unless some of the large vessels are wounded. It should be mentioned, however, that though the external hemorrhage may not be very great, owing to the form and size of the wound, the internal hemorrhage may be so severe as to prove fatal. If the weapon be in close proximity to the

1
1 Kopp's Jahrbucher, Erster Jahrgang, 1808, S. 143.

body at the moment that it was discharged, the wound made is large, the skin is denuded, blackened, and partly burned. The hair or the clothes are also usually scorched. The orifice of entrance of the missile, if it be a ball, is depressed and larger than that of the exit orifice.1 The character of the entrance orifice of the wound will depend upon the shape of the missile, the velocity with which it was travelling, and the distance from which it was fired. Thus, a wound made by a conoidal ball, like that of a minie rifle, is linear in form. Such a wound produces but little external, though considerable internal, injury. On the other hand, the wound made by a rifle ball is ragged and large. A ball after entering the body may, as is well known, be so deflected from its course by striking a bone or a tendon, etc., as to pass entirely around the body and so reach finally the point of entrance. If a gunshot wound be caused by a load of shot, the appearance presented will depend upon the distance from which the shot was fired. If the weapon discharged be within twelve inches of the body, the wound will usually be a single one. Beyond that distance each shot will make a single individual wound. It should be mentioned that a single shot might cause death, as in the case of the wounding of the aorta. Serious, if not fatal, wounds may be caused by wadding and gunpowder alone if the weapon be within three or four inches of the body.

Causes of Death from Wounds.-With reference to the committing of suicide by means of fire-arms, it may be mentioned that in fully four-fifths of the cases reported

1

1 According to some authorities, the exit is larger than the entrance orifice (compare Casper, vol. i. p. 266; Woodman and Tidy, p. 1115; Wharton and Stillé, vol. iii. p. 234).

2 Lachese: Annales de Hygiene publique, Paris, 1836, p. 359; Casper : op. cit., vol. i. p. 266.

the part of the body selected for the infliction of the wounds was the head, the mouth being the part more particularly chosen.1 Under certain circumstances it may become important for the medical examiner to be able to state, in the case of death from wounds, the real cause of

FIG. 12.

Imaginary lines drawn upon the surface of the abdomen, dividing it into regions. These were, no doubt, devised by reason of the absence of any characteristic eminences or depressions upon this extensive surface, principally attributable to the absence of any skeleton, osseous or cartilaginous. 1. Right hypochondriac region. 2. Epigastric. 3. Left hypochondriac. 4. Right lumbar. 5. Umbilical. 6. Left lumbar. 7. Right iliac. 8. Hypogastric. 9. Left iliac.

death, whether immediate or remote. The immediate cause of death from a wound is either hemorrhage or shock, the latter being the result of a powerful impression made upon the nervous centres. Of the remote causes of death from wounds the most common are tetanus or 1 De Boismont: Du Suicide, deuxième edition, Paris, 1865, p. 681.

lock-jaw, erysipelas, hospital gangrene, surgical operations, including the use of ether or chloroform. The danger of wounds depends, to a great extent, upon the parts of the body affected. Thus scalp wounds are not usually dangerous unless followed by erysipelas. It should be remembered, however, in cases of wounds of the head, that a fracture or effusion of blood upon the brain, or concussion, may be produced by a blow, even though the scalp be uninjured. It is most important that the effects of concussion should not be mistaken for those of intoxication. Unfortunately in too many instances persons arrested upon the charge of intoxication have died in station-houses from concussion of the brain, when their lives might have been saved had medical attendance been summoned.

Wounds of the face are not usually dangerous unless the orbit be involved, as in penetration of the orbital plate by the point of an umbrella thrust into the face. The danger of wounds of the neck is due to the presence of the great vessels, the division of which, in case of the throat, gives rise to severe hemorrhage. The trachea and larynx may be divided, however, without necessarily proving fatal, unless the blood flows into the trachea in such quantity as to cause death. Death from wounds of the chest is usually due to hemorrhage from the heart, lungs, or great vessels. In cases of wounds of the abdomen, involving the liver, stomach, or intestines (Fig. 12, 1, 2, 3), the cause of death is frequently peritonitis. With regard to wounds of the bladder (Fig. 12, 8) it must be borne in mind that, if distended, it may readily be ruptured by a blow upon the abdomen, the cause of death being usually peritonitis. Frequently, however, under such circumstances, there may be no signs of external injury. In wounds of the spine the danger is proportional to the extent to which the spinal cord is in

volved, death taking place instantaneously if the medulla or upper portion of the spinal cord be wounded. The danger in wounds of the generative organs is due to the severe hemorrhage which usually ensues. In the male sex, in the case of the insane, castration and amputation of the penis are frequently self-inflicted.