evidence drawn from them is that they were made with suicidal intent, for when homicide is by an incised wound of the throat, it is more apt to be not only lower, but much deeper; the larger vessels are severed; the cutting is for the purpose of misleading, and if it has been done after death, it was caused by other means; not only the position, but all characteristics of the wound aid in showing this fact. The regularity of the wound is considered an evidence of suicide, but this, while it may be indicative, is not positive, for a murderer may make just as regular a wound on a person incapable of resistance, if drunk, asleep, or unconscious from any cause, and yet the wound have the appearance of one self-inflicted. The case of Lord William Russel, killed by his valet Courvoisier in 1840, is quoted as bearing upon this subject.' Suicidal stab-wounds present little if any peculiarity by which it can be said they are made by the deceased. The position and direction tell more than the wound, for if it is in such a place as could hardly be reached by the hand of the person, the presumption that it is homicide is increased. Generally suicides select the chest and abdomen for punctured wounds, but if mental derangement is present, other places are also chosen. Suicide by drowning is quite a frequent method. The autopsy, described in another place, shows the cause of death, but it does not always show that death was self-sought. Some other circumstances may give this conclusion, such as a note left by the deceased or some action taken by him just before he committed the deed. While serving as house-surgeon in the Brooklyn City Hospital, Brooklyn, N. Y., in 1871, the writer saw a man who had had an operation performed on his jaw and suffered greatly thereafter, on being informed that a second operation was necessary, asked and obtained permission to go out and see some friends. He did not return, and shortly afterward his dead body was found in Gowanus Bay, when the tide went out. It was clearly a case of suicide and death by drowning, for he had taken care that his body should not float after the plunge by filling his pockets with stones. A When insanity exists, the self-inflicted wounds are often extraordinary. Taylor reports some peculiar cases.2 "In 1850 a case occurred in Guy's Hospital, in which a person in a fit of delirium tremens tore away the whole of the abdominal muscles from the lower and fore part of the abdomen. Had the body of this person been found dead with such an unusual and serious personal injury it is not improbable that it would have been pronounced homicidal and not suicidal. pregnant woman under delusion so ripped up the abdomen that a large wound was made, and the omentum and gravid uterus protruded. A gentleman was found lying in a state of insensibility in the kitchen of his house, with a cleaver by his side. On examining the head, upward of 30 wounds were found over the back part of the skull." The man before dying stated that he had inflicted the wounds. 1 Principles and Practice of Medical Jurisprudence, Taylor, 485. Accidental Wounding.-It may be difficult to determine whether a given wound was caused by accident or the action of another, if the wound alone is relied on for the evidence. Wounds by accidental falls are usually on exposed parts of the body, and therefore if a bruise or laceration is the external wound, if it is found in a place where, by fall, it could not be made, the natural and logical inference is that some. human agency was instrumental in inflicting the injury. This has, however, been already referred to, and while we may and do have wounds which are the result of accident where persons have been engaged in a struggle, the chief class of these accidental wounds is of those which are due to a bona fide accident, such as a railroad smash-up, and which become the basis of civil suits for damages. There is no question is such cases of the wounding being intentionally done by another, and therefore, if the injuries are seen shortly after the reception, the wounds are examined with a view to whether they could be made in the manner claimed by the plaintiff. The questions the medical experts are expected to solve are in the main two: Is the wound, say a fracture of the leg, permanent in its disabling, and could it be caused by a fall or whatever the accident was? There is not much difficulty in deciding the last question, for generally there are witnesses to the accident, and the result is apparent to them without the aid of a doctor; but the first is different. An ordinary fracture of the leg recovers, under ordinary skill and care, in about eight weeks. The patient may be on crutches for two months longer or possibly three, and then a cane is used for varying lengths of time, according to the character and determination of the patient. There may be shortening; even if there is, if the fracture has united well and with no deformity that interferes with nerve or muscular action, there is no permanent disability, for shortness of one-half an inch will not be noticed and will not require any addition to the thickness of the shoe-sole to prevent limping. The pelvis accommodates itself to this amount of shortening, and the strength and usefulness of the leg are not impaired. The medical witness, therefore, can only state these facts, for he has nothing to do with the bearing they may have upon the case. Where, however, the injury done is more serious-say a dislocation followed by some paralysis of muscular power in the limb-his prognosis must be more cautious. The length of time that has elapsed from the receipt of the injury, the efforts made to restore the limb to its normal activity, are to be taken into account; for if a trunk-nerve has been injured by the dislocation or fracture and has not recovered, or but partially so, and months have passed since any improvement has taken place, the chances are the injury is permanent. It must be remembered that claimants for damages on account of injury often make marvelous recoveries when a favorable verdict is rendered in their case, and while they may not intentionally deceive the examiner, they often do so. The utmost care is then necessary in examining one of these cases (see chapter on Accident and Injury). Regional Wounds.-Head.-Incised wounds of the scalp are not generally dangerous. They heal readily, and unless the cause of the wound gave some deeper injury, no further trouble need be apprehended. If, however, the wound is a contused and lacerated one, made either by a blow or a fall, it becomes of more moment. If the laceration is extensive, the wound is serious, for septic substances have probably been carried into the wound at the time of its infliction, and inflammation may result, giving pus and the attendant train of evils. A blow may cause a deeper injury than the external wound accounts for. First to consider is the concussion of the brain from the blow, and this depends upon its degree for its danger. The blow may be so strong that the concussion is at once fatal, and the external bruise not of sufficient severity to cause it to be considered dangerous of itself. And the individuality of the person struck enters into the subject, for what would be almost fatal to one man may be borne with impunity by another. The blow of a prize-fighter hardly raises a mark on the head of his opponent, equally trained and hardened. If it was delivered to one in ordinary condition, the result would probably be unconsciousness and severe bruising. A man with concussion is confused. He staggers as if drunk, and he cannot talk coherently; he may be considered intoxicated, for some one may have given him stimulants and the smell of liquor be present. But there is no intoxication, and it is sometimes difficult to differentiate. If he dies, the autopsy is not conclusive, for no determinate appearance is found which decides for concussion, and the general congestion present is equally so when alcohol is the cause of death. If the subject is living, the doctor can but await developments before giving a statement as to the injury, and whether one exists or not; if dead, he must ascertain all possible concerning the case, and render his opinion accordingly. The contusion may go further than the mere bruising or concussionwhether from a fall or blow makes no difference. The force may have been sufficient to cause a rupture of a blood-vessel, the pouring-out of blood, and the formation of a clot, which, by its pressure upon the brain, causes death. As a general rule, when an effusion of blood is caused within the skull by a fall or blow, the vessel found ruptured is one of the meningeal arteries which run between the bone and the dura mater. A clot in this position and from one of these vessels is more apt to be from violence than from disease, and the doctor examining will, knowing this fact, hesitate before giving a certificate that death was due to apoplexy. The brain is tolerant of considerable pressure, especially if the pressure comes on slowly. A man may receive an injury to the head which will cause effusion of blood. If this is not rapid, he may apparently be recovering from the effects of the blow, when suddenly he becomes worse, develops coma, and dies. The autopsy shows effusion. It cannot, therefore, always be told how serious an injury to the head may be, and even if the first effects pass off, years after symptoms of derangement of the mental faculties may present themselves, their origin traceable to this initial contusion. VOL. I.-19 |