WOUNDS.

THE consideration of the injuries called, in ordinary parlance, "wounds" is a matter of moment for the medical jurist. While in surgery the term is used to designate those conditions where a solution of continuity of the skin or mucous membranes of the body takes place, by violence either from within or without, in law the word is given a wider meaning, for it is here held not as a technical word, but one of common speech, and consequently includes other conditions than those accorded it by writers on surgery. "Any lesion of the body, whether cut, bruise, contusion, fracture, dislocation, or burn" is considered in law a wound.2 The words "blow" and "wound" have been held to be synonymous in meaning, but the injury must be one causing an injury in order to be considered a wound. Scratches, even if they do cause a certain solution of continuity, are not considered wounds, for here the danger done is slight, however much discomfort may be caused, and wounding has not taken place, for no ill effects are liable to occur.

A wound, to be one in law, must be an injury which does damage to the part affected. The cut, stab, bruise, or break is followed by more or less loss of power or of substance, and may be, according to circumstances, slight, severe, dangerous, or mortal. All are wounds, and while the slight wound may at first appear trivial, still it may easily be converted into any one of the other types by causes over which the person suffering it has no control. The character of the wound, therefore, becomes of importance, the amount of importance to be decided by the district attorney, upon the statement of the surgeon; for the physician decides from his knowledge of such matters whether no further danger will in all probability arise from the injury or whether the general state of the patient is one which will tend to make healing difficult or even to prevent it altogether.

Care must be exercised, therefore, on the part of the surgeon in stating a prognosis when the wound before him is the subject of judicial inquiry. An assault may be committed and the victim rendered insensible, say, by a blow upon the head. If, shortly after the patient is seen by the physician, he rallies and appears to be in fairly good condition and the surgeon should give a certificate that the injury is slight and no danger need be apprehended, trouble may arise, for in a few days or

1 State rs. Owens, 1 Murph. (N. Car.), 465-4 Am. D. C., 571. * Wharton Law Lex.

3 State rs. Noblett, 2 Jones (N. Car.), 433. Reg. es. McLaughlin, 8 C. & P., 635–34 E. C. L., 561; Reg. vs. Wood, 4 C. & P., 381-19, E. C. L., 430; Com. vs. Gallagher, 6 Met. (Mass.), 568; State vs. Leonard, 22 Mo., 450.

even later the patient may become worse, pass into the condition of coma, and die from an abscess of the brain caused by the blow received. The action of the medical man in giving a certificate that danger from the assault was over would be wrong. Good judgment must be exercised in this matter of giving certificates regarding injuries. The accused has rights which must be observed. If, in such a case as is here supposed, the patient is given a superficial examination, the physician's certificate would be procured on insufficient knowledge. But if care is taken and, from his knowledge of such things and the symptoms before him, the doctor refuses the certificate, he is able to give his reasons before the magistrate and will be upheld, if such reasons are founded upon and supported by the authorities on such injuries.

The evidence presented by wounds is to be studied carefully. The character of the wound, its probable method of infliction, the weapon that could cause such a lesion, its direction as to reception, whether self-inflicted or by another, whether recent or old, on the living or on the dead body, must all be taken into account. Wounds tell their story in most cases with no uncertain tongue, and the evidence they give may be of the utmost importance. Too much care cannot be used in noting carefully every characteristic of any wound, its position as shown by relations to marked and fixed points of the body, the appearances of its edges, or, if a bruise, its color, the size in all directions, length, breadth, and depth, and in short, every appearance presented, that a thorough and absolute knowledge may be had from which deductions can be drawn as to the manner and method of infliction. ence will be made further on concerning this part of the subject.

Refer

Kinds of Wounds.-It is best to follow the usual division given in surgical text-books for the nomenclature of wounds, adding those other injuries which the law places in the same category. Two main classes are given-open wounds, or wounds open to the air, and subcutaneous wounds, or those which include all injuries unaccompanied by breach of the skin. "Open wounds are subdivided, according to the manner in which they are produced, into incised, punctured, contused, lacerated, gunshot, or poisoned wounds, according as the wounding agent has a sharp cutting-edge, a penetrating point, a dull and bruising body, a tearing force, a projectile impelled by the force of an explosive, or one which carries with it into the wound a poison.” 1 To this we may add fractures and dislocations of the bones and burns by different agents. The wounds by missiles and by fire are treated elsewhere in this volume.

It is well to remember that while wounds are divided into the classes stated above, to the lay mind a wound is a wound, and but little stress is given as to whether it is incised, lacerated, or what. The medical witness, bearing this in mind, will be understood more readily if he is willing to use the word wound as usually accepted, and not be too technical in insisting upon the descriptive adjective being tacked on whenever the injury is described. Once having stated clearly the character

1 American Text-Book of Surgery.

of the wound and why it is so called, all reference to the injury may afterward be easily and understandingly made by speaking of the wound.

Wounds Dangerous to Life.-It has already been outlined that a medical man must be cautious in certifying as to the nature of a wound which is the result of a homicidal or criminal assault. The questions arise, What is a wound that is dangerous to life? and, For what length of time is it necessary to wait before giving a certificate that such and such a wound is not one involving doubt as to recovery therefrom? It is perfectly evident that unless the danger from a given wound is imminent, while the wound may be a dangerous one, still life may not be immediately threatened, and the surgeon must give a qualified opinion. It may be that he has been required by the district attorney or some other judicial officer to furnish this opinion, as the question of holding the prisoner in restraint depends upon his statement. If the wound is one penetrating a cavity, such as the chest or abdomen, or is of such violence to the head as either to cause fracture or to render death probable from the concussion, it is perfectly proper to state that the wound is one dangerous to life. The reasons, if chance for crossexamination is given the accused's counsel, are easily given by the medical witness and are conclusive. But should the wound be a serious one, such as Dr. A. S. Taylor calls a "wound doing grievous bodily harm," but not dangerous to life unless secondary complications arise, then the physician could not state that it was of such magnitude as those just described. Again, the wounding may be so severe as to raise a doubt of its degree in the minds of those seeing it; still, when carefully examined, although dangerous, the danger may not be imminent, and the doctor so states. It is apparent, then, that caution must be exercised in giving a certificate concerning the danger to be apprehended from severe wounds, and the surgeon making the certificate had best set forth fully all the facts about the wound before him, and just why and when dangers from it arise, and how much, in his opinion, life is threatened, leaving the court and prosecuting officer to decide what action should be taken in such conditions. One caution to medical men is here inserted, and it holds good in all they may have to do, when either writing for or giving testimony before the courts, and that is, to put what is written and said in plain, simple English. While lawyers are of the learned professions, they do not pretend, any more than laymen, to understand all the technical terms of medicine or surgery; and to dilate learnedly upon a case while a witness, using freely terms familiar to the witness alone, and, after having given so brilliant an exhibition of great erudition to the crowded court-room, to be asked quietly by either judge or counsel to "please put that in English, Doctor, so that ordinary mortals may understand you," does not conduce to either comfort or reputation.

Wounds on the Dead Body.-All characteristics of a wound on a dead body must be carefully noted. The size, character, extent, depth, direction, and condition should have attention; for the question

must be decided whether this is a wound made before or after death.

The further decision, was death due to the wound, is to be made, but this is settled by the autopsy, the making of which is described elsewhere.

Was the Wound Made after Death ?-Certain wounds made upon the living body have different characteristics when made on the cadaver, but the time of infliction as regards the time of death has a marked influence upon these diagnostic signs. Supposing a wound-say a cut of some kind-on a dead body showed evidence of purulent matter, the statement would be positive that that wound was made before death; there could be no doubt about it, for all know that pus does not form in a dead body. But if the wound should present similar characters on the living, the question could not so readily be answered. The wound may have been instantly mortal, the body living when the knife was driven in and dead when the knife was withdrawn. Here no one could say, except from the probability that death followed the wounding, whether the cut was made before or after death. Caspar mentions a case of this kind in which a woman was stabbed, the knife cutting the aorta, making death instantaneous. If the wound is a cut and made after the body has been dead long enough for most of the animal heat to have passed off, or if postmortem rigidity has set in at the time the cutting is done, the characteristics of the wound as being one made after death are fairly clear. The skin, having lost its contractility, is not everted, and the tissues do not gape; if blood is effused it is venous and coagulates slowly if at all; clots are not found in the wound. But where the wounding is done immediately after death, or within, say, half an hour, then the signs are not so positive. Muscular contractility and that of the skin have not been lost at this period, rigor mortis is still absent, and consequently the wound will have much the appearance of one inflicted during life. In fact it is difficult to distinguish positively, and a guarded opinion has to be given. In such a wound blood-clots in the cut are found, and the clots are more or less attached to the sides. The main point of distinction between such a wound and one made during life is, whether in the cutting an artery is divided. If a vessel of fair size be severed, the spurting that follows while the heart is still acting gives the peculiar bleeding that tells of arterial hemorrhage, and on the surrounding parts or clothing may be found the spots of blood thrown from the vessel. In a like wound in the dead, however, there is no such bleeding. Here all the blood flows by gravity and is from the fulness of the veins; its color, when seen, may be that of arterial flow, it having absorbed oxygen from the air, but the spurting is wanting. While this holds good where the wound is such that the divided vessel has a chance to bleed in its natural manner, the wound may be so made that no spurting takes place, the cut artery being interfered with by the sides of the wound. The difficulty of deciding whether the wound was made before death or after is in such a case increased.

In torn, or what are called lacerated wounds, the same difficulty exists. Here there is rarely as much arterial spurting as in an incised

or cut wound, for the torn tissues tend to clot the blood and prevent its being driven out in jets. But another element may come into consideration in deciding the time of reception of this kind of wound, and that is the element of bruising, for frequently such wounds, when homicidal, have been made by a dull weapon, and contusion exists, with the solution of continuity.

Wounds that divide the skin and deeper tissues, if made on the dead, do not bleed so much as those on the living body. The bleeding, as said before, is venous, and the blood flows by gravity. It is, therefore, more from a depending point of the wound than from its entirety. It does not well up and flow over as in the living. Again, in the dead body, capillary bleeding does not take place, and this may be an aid in determining the question as to the time when the wounding was done.

When the wound consists of a contusion or bruise without the breaking of the skin, it is found that unless it is inflicted upon the body immediately after, or within a short time after death, the same characteristics as are observed in a contusion on the living do not obtain. Christison gives two hours as the time when blows upon the dead body cease to resemble those upon the living. But experiments show that to produce an appearance liable to be mistaken for a contusion before death the violence used must be much increased, for the capillaries do not contain as much blood after death as in life, and the ecchymosis or discoloration following a blow is mainly due to the rupture of these vessels and the effusion of blood into the tissue of the true skin or into the subcutaneous tissue. A bruise, therefore, made after death, while its appearance to the will be so similar as readily to be considered one that was received during life, will usually, by the aid of the knife, be shown in its true character, for the blood will not be so generally or so completely diffused in the true skin. Should the violence be done after the body is well advanced in cooling, or with rigor mortis marked, the determination of such a contusion as postmortem is a much easier task for the same reasons as were given when wounds involving the solution of continuity were considered.

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In fractures the tearing of dead muscles surrounding the broken bones does not show the same amount of blood as in fractures before death, and for the same reason the bullet-track differs from one in live tissue. The blood is not effused in the same way from dead vessels as from live ones, and the bleeding around the fracture is not only reduced, but more circumscribed, coming as it does from some vein torn by one or the other of the fragments. As in the condition just recited, care must be exercised in the giving of an opinion, and unless the appearances are such as to warrant an unqualified statement that the wound under consideration was inflicted after death, the most that can be said is that the wounds were received either just before or just after death took place.

Wounds on the Living.-Contusions.-These, known in ordinary parlance as bruises, are such injuries as are inflicted with a dull

1 Taylor's Medical Jurisprudence.