when the rupture is from external violence, it occurs in the posterior superior wall, running downward, in which case the peritoneum would be involved. A rupture may take place when the bladder is not covered by the peritoneum, and while it is a serious and dangerous wound, it is not so in the same degree as when escaping urine can pass into the peritoneal cavity. The wound is not an immediately disabling one, as many cases are on record where, either with a rupture from violence or from a gunshot wound, the recipient walked greater or less distances before he took to his bed. The condition gives pain, inability to void water, a little blood in that drawn by a catheter, and, if water is injected into the bladder, it is found that a less amount comes out than is put in. The bladder cannot be distended. Prompt surgical work may save life, for these wounds are generally fatal, especially if the rupture be intraperitoneal, as the peritonitis resulting from extravasated urine seems to be very severe. When the extravasation is into the cellular tissue about the bladder, the rupture being outside of the peritoneum, there is a better chance for the patient's recovery, but death often takes place from septicemia.

In rupture from disease, the walls of the bladder, being thinned by a stone or diseased from tuberculosis, syphilis, carcinoma, or other kindred condition, the rupture may be without external cause. The bladder being distended under these circumstances, it may give way from distention; or any movement, such as sudden turning or stooping, might give the necessary additional pressure, and the tear takes place. This might have a good deal of bearing if a man were held for causing the death of another by rupture of the bladder; the accused might not have touched the deceased, merely made a threatening gesture which the other dodged, and this quick movement of escape was the real cause of bringing on a rupture of a diseased and distended bladder. No marks show externally any more than where the intestines or liver are ruptured from blows upon the abdominal walls. The autopsy would show the abnormal condition of the bladder-walls, and distinguish a rupture from a blow and one from disease, except where the diseased viscus was struck, in which case the examination might not be conclusive. Generally the bladder gives way when diseased at the point most weakened by the lesion present.

The bladder may rupture spontaneously from overdistention without being diseased. But in such cases there is always some obstruction, such as stricture or enlarged prostate, which prevents free micturition. and causes the distention.

A stab wound which involves the bladder may give such a small opening into the viscus that but little if any urine will escape, and recovery may take place, the wound closing of itself. If, however, the wound be large, the same danger exists as in a rupture.

Wounds of the rectum are mostly from surgical operations, and rarely become the subject of medicolegal inquiry. Fissures caused by pederasty, while technically they are wounds, hardly come within the province of this article. If insanity exists, there may be rectal wounds,

but in such cases the circumstances and history will determine as to how the injuries were inflicted.

Genital Organs.-Wounds to the male organs are mostly from kicks or blows with a stick, and are more apt to be accidental than intentional-that is to say, the kick or blow is intended to reach the person assaulted, but the part struck is not the part aimed at. While such an injury is a severe one, it is not a dangerous wound, unless the urethra be torn and infiltration of urine ensue. Lunatics may mutilate themselves, and the mutilation may be fatal from hemorrhage, but such cases will be determined as to the manner in which the mutilation was done, by examining into the circumstances and general evidence. These wounds are rarely matters of legal investigation.

Wounds of the female genitals are, however, more frequently in the hands of the prosecuting officer, for criminal assaults in which injury is done to these parts are not infrequent. A wound in this region is dangerous according to its severity. A kick or blow will lacerate the soft parts, the cut being made by the bone, as was described in speaking of blows on the head, and the hemorrhage may prove fatal. And these contused lacerated wounds of the vulva present a clean-cut appearance, looking as if they were incised. Careful examination will show the difference. If incised wounds are found, especially if they extend within the vagina, they are positive evidence of malicious assault.

an

"A

Accidental wounds by a penetrating instrument may cause erroneous statement to be made, as they are similar in appearance to those produced by wilful violence. Taylor1 gives the following: girl, aged six, fell from a tree with her legs apart upon one of the sharppointed shoots below. This entered the vagina, and passing through the posterior wall, broke off. A woman removed the wood with some difficulty. The child died in twenty-four hours from per tonitis. Had the child been found dead with the wood in her body, there might have been some difficulty in assigning an accidental origin to such an injury."

Wounds of the Extremities.-These are of all kinds, the ones leaving more lasting injuries being fractures and dislocations. Incised and lacerated wounds are to be considered dangerous according to their situation, for if a large vessel be cut, death may follow from hemorrhage, or if a nerve be severed and fail to unite, paralysis of the part may ensue, or gangrene for want of proper nerve-supply. An incised wound on the anterior aspect of the forearm, near the wrist, if cut deeply, is serious, not especially to life, but to the use of the hand after recovery, for here the tendons of the flexor muscles of the fingers and hand are close to the surface. If they are severed, the retraction of the muscle parts the cut cords, and there is some difficulty experienced in getting proper union. Should this not take place, the use of the hand is impaired and may be destroyed. Even if there is union sufficiently close to secure fair working of the muscle, the various tendons that belong to the deep and superficial flexors may be more or less matted together by inflammatory process during healing, and in this way impair1 Principles and Practice of Medical Jurisprudence, 659. VOL. I.-20

ment of the action of the flexors, and consequently of the hand and fingers, ensues.

Some years ago I examined a man who wished to make a claim for pension. He had been wounded by a bayonet in a fight before Petersburg, Va. The bayonet had struck him on the outer side and a little behind and above the right elbow, making a small punctured wound. It gave him no particular pain, bled but little, and appeared so trivial that he did not report to the surgeon, but dressed the wound himself. In a few days he noticed that his fingers would stay closed on the palm, and that it required an effort on his part to open them. He was discharged from service, and when I saw him there was complete paralysis of the extensors and supinators of the right hand, the result being that the fingers were tightly closed on the palm and the hand pronated by the action of the unapposed flexors and pronators. A little supination could be made by the action of the biceps. The bayonet had torn the musculospiral nerve, which had not again united.

Aneurysms may follow blows or wrenches. When the writer was serving in the Brooklyn Hospital in 1871 a man came in with an injury to the left knee. He had been employed on one of the large river boats, and with others was helping to get the boat ready for her trips. He was carrying a roll of carpet upstairs, the roll being on his shoulder, when a fellow workman, to give him a fright, caught hold of the carpet and pulled it back. To keep himself from falling he made a sudden effort, and said he felt something snap in his knee. The pain made him sit down, but he went to work again until forced, by pain and inability to use his leg, to give up. He kept on his feet for some days. Examination showed an aneurysm of the popliteal artery. Ligation of the femoral was performed and the patient recovered.

A case came under my notice of old dislocation of the shoulderjoint. All efforts at reduction were futile. A system of extending and counterextending forces was devised by means of rubber bands, and the adhesions having been thoroughly broken up, the patient was placed in the position required, the attachments were made, with the result that in a little under twenty-four hours reduction was accomplished. The arm was useless before reduction, and although treatment was pursued for a long time, only partial improvement took place, the nerves in the axilla having received too much injury fully to recover.

Fractures of the long bones, especially if the break is near or involves a joint, are liable to be followed by deformity. This may be from the deposit of callus in or about the joint, or by faulty position of the fragments when union takes place. When, from violence which not only breaks the bone, but injures the soft parts, the case may be dangerous to life from septic poisoning, extensive sloughing, erysipelas attacking the wound, or exhaustion of the vital power of the patient.

A medical witness may be asked to say whether a given fracture is the result of a fall or of a blow, or if a blow, whether a weapon was used. The condition of the injury and the limb will be the guide to the answer. Again, in a civil suit, the question may be put, will deformity or inability

arise from this fracture in the future, and the answer is not always easy to give. If the case has recovered from the fracture so as to allow the patient to walk about without requiring him to use artificial aid, the break being of the leg, examination of the limb should enable the medical witness to answer with considerable certainty, for if no adhesions of muscles or tendons are found about the fracture, if the soft parts can perform their functions without hindrance, and no nerve or large vessel is pressed upon by a callus or badly placed fragment, there is no reason to expect further trouble, for, as time goes on, not only does the seat of fracture become more homogeneous, but if a large callus is present, it lessens, ends of bone become rounded and smooth, and in every way nature endeavors to restore the parts to as nearly normal condition as is possible. Should all these points be found contrary, the answer would be that perfect recovery had not taken place, and unless certain changes were produced, the injury would be enhanced by additional and secondary complications.

GUNSHOT WOUNDS; BURNS AND SCALDS.

GUNSHOT WOUNDS.

WITHIN the limits of this article it will not be possible to consider at length the characteristics of each of the various weapons and explosives commonly used. All that can be accomplished is the pointing out of the characteristic features of the wounds caused under the varying conditions. It should be noted at the outset that hollow castings, gas-pipe, large padlock-keys with hollow point, and many other implements may be used as firearms, with most various ammunition, accidental and suicidal injuries being common from such cause.

Although the nitro-powders are largely used in shotguns and rifles, in pistols and revolvers, with which the great majority of the wounds coming into the hands of the medical examiner are inflicted, black powder is still almost exclusively used, except in the smallest calibers, in which, as in the BB cap, a mixture of fulminate of mercury and chlorate of potassium is used.

Black powder is an explosive mixture, not a chemical compound, as are some of the new powders, and burns with great rapidity, but does not literally explode, as do the latter. It develops about 280 times its volume of gas, chiefly CO and CO2, and leaves a carbonaceous residue, which stains the tissues if brought in contact with them much more than do the residues, less in amount and commonly lighter in color, from the nitro-powders. The latter have as a foundation generally gun-cotton or some form of nitrocellulose, as in the different varieties of Schultze powder; picric acid or some picrate, as in the explosive used in the French Lebel rifle, or ammonium nitrate, as in the powder used in the German army. Because of their rapid action, these latter powders are much more severe upon the weapon than black powder, and more efficient in short barrels.

Inasmuch as the effects produced upon the body depend largely upon the velocity of the ball, the factors which influence its speed will be briefly studied. This, as well as the striking force of the bullet, decreases from the instant of clearing the muzzle, although a contrary statement has been made often, the resistance of the air being practically the only cause of this decrease. The velocity and penetration of the missile are increased by the use of a powder, in proper amount, grain, and quality. It should burn thoroughly before the ball leaves the barrel, too fine powder burning too quickly and endangering the weapon, while too coarse a grain permits much of the explosive to be blown out unburned, thus wasting much of the potential energy of the powder.