MORTALITY OF WOUNDS. 311 whereby some blood vessel or organ important to life is directly affected. Age, sex, constitution, and a previous state of health or disease, may accelerate or retard the fatal consequences. In Reg v. Slane and others (Durham Wint. Ass., 1872), it was proved that the deceased had sustained severe injuries to the abdomen by kicks and other violence, but there were no marks of bruises. On a post-mortem examination, all the organs were healthly. Nevertheless, death took place twenty minutes after the maltreatment. Death was attributed to shock, and the prisoners were convicted of murder. A case of manslaughter involving this question was tried (Reg v. McGowan and others, Leicester Ass., Nov. 1877), where three men were charged with the murder of the deceased. It was proved that he had been maltreated by kicking, and by blows inflicted with heavy stones. He died in four days, obviously from the effects of the violence. The medical evidence showed that the nasal bones were much fractured as by a blow from a heavy stone, and that there were fractures of one clavicle and of several ribs. The witness assigned the cause of death to shock to the system, from the number of injuries received and the inflammation set up by them. The whole of the injuries in his opinion combined to cause death. The prisoners were convicted. From these considerations, it is obviously unreasonable to expect that in every case of death from violence or maltreatment there must be some specific and visible mortal injury to account for this event. When the circumstances accompanying death are unknown, a medical opinion should certainly be expressed with caution; but if we are informed that the deceased was in ordinary health and vigor previous to the infliction of the violence, and there is no morbid cause to account for his sudden illness and death, there is no reason why we should hesitate in referring death to the effects of a number of injuries. Among non-professional persons an unfounded prejudice exists that no person can die from violence unless there is some distinctly mortal wound actually inflicted on the body. By this we are to understand a visible mechanical injury to some organ or blood vessel important to life; but this is obviously an erroneous notion, since death may take place from the disturbance of the functions of an organ important to life, without this being necessarily accompanied by a perceptible alteration of structure. The prevalence of this popular error often leads to a severe cross-examination of medical witnesses. Among the questions put, we sometimes find the following: Would you have said, from the wounds or bruises alone, that they were likely to have occasioned death? Now, in answer to this it may be observed that we cannot always judge of the probability of death ensuing, from the appearance of external violence alone. Because the appearances were slight, it would be wrong to infer that they were not sufficient to cause death by shock. Then it may be inquired, Were the wounds or bruises mortal? In the vulgar sense of the word, i.e. by producing great loss of blood, or a destruction of parts, they might not be so; but in a medical view they may have acted mortally by producing a shock to the nervous system. Again, it may be inquired, Which of the several wounds or bruises found on the body of the deceased was mortal? The answer to this question may be, not one individually, but all contributed to occasion death by syncope or exhaustion. It must be remembered that in cases in which a person has sustained a number of injuries, the loss of a much smaller quantity of blood than in other instances will suffice to destroy life. When there are several wounds, it is difficult to decide on their relative degree of mortality, and on the share which each may have had in causing death. By a wound being of itself mortal, we are to understand that it is 312 MORTALITY OF WOUNDS. capable of causing death directly or indirectly, in spite of the best medical assistance. It is presumed that the body is healthy, and that no cause has intervened to bring about, or even accelerate, a fatal result. The circumstance of a person laboring under disease when wounded in a vital part, will not, of course, throw any doubt upon the fact of such a wound being necessarily mortal, and of its having caused death. If there should be more wounds than one, it is easy to say, from the nature of the parts involved, which was likely to have led to a fatal result. In order to determine, on medical grounds, whether a wound was or was not mortal, we may propose to ourselves this question-Would the deceased have been likely to die at the same time, and under the same circumstances, had he not received the wound? There can obviously be no general rule for determining the mortal nature of wounds. Each case must be judged by the circumstances which attend it. In some Continental States, the law requires that a medical witness should draw a distinction between a wound which is absolutely and one which is conditionally mortal. An absolutely mortal wound is defined to be that in which, the best medical assistance being at hand, being sent for, or actually rendered, the fatal event could not be averted. Wounds of the heart, aorta, and internal carotid arteries, are of this nature. A conditionally mortal wound is one in which, had medical assistance been at hand, been sent for, or timely rendered, the patient would, in all probability, have recovered. Wounds of the brachial, radial, and ulnar arteries may be taken as instances. The responsibility of an assailant is made to vary according to the class of injuries to which the wound may be referred by the medical witnesses; and, as it is easy to suppose, there is seldom any agreement on this subject. Our criminal law is entirely free from such subtleties. The effect of the wound, and the intent with which it was inflicted, are looked to; its anatomical relations, which must depend on pure accident, are never interpreted in a prisoner's favor. Some extenuation may, perhaps, be occasionally admitted when a wound proves mortal through an indirect cause, as inflammation or fever, and medical advice was obtainable, but not obtained until every hope of recovery had disappeared. It appears, however, from the case of Reg. v. Thomas and others (Gloucester Aut. Ass., 1841), that the mere neglect to call in medical assistance is not allowed in law to be a mitigatory circumstance in the event of death ensuing. The deceased died from the effects of a severe injury to the head, inflicted by the prisoners, but had had no medical assistance. The judge said it was possible that "if he had had medical advice, he might not have died; but whoever did a wrongful act must take the whole consequences of it. It never could make any difference whether the party injured had or had not the means or the mind to apply for medical advice." The prisoners were convicted. According to Lord Hale, if a man be wounded, and the wound, though not in itself mortal, turn to a gangrene or fever for want of proper applications, or from neglect, and the man die of gangrene or fever, this is homicide in the aggressor; for though the fever or gangrene be the immediate cause of death, yet the wound, being the cause of the gangrene or fever, is held the cause of death. These nice questions relative to the shades of responsibility for personal injuries, occasionally arise in cases in which persons have been wounded at sea on board a ship in which there was no surgeon. DEATH FROM LATENT DISEASE. 313 CHAPTER XXIX. DEATH OF WOUNDED PERSONS FROM NATURAL CAUSES.-DISTINCTION BETWEEN REAL AND APPARENT CAUSE.-DEATH FROM WOUNDS OR LATENT DISEASE.-ACCELERATING CAUse. DEATH FROM WOUNDS AFTER LONG PERIODS.-AVOIDABLE CAUSES OF DEATH.-NEGLECT. -IMPRUDENCE.-UNSKILFUL TREATMENT.-UNHEALTHY STATE OF BODY. Death of Wounded Persons from Natural Causes. It is by no means unusual for individuals who have received a wound, or sustained some personal injury, to die from latent natural causes; and as, in the minds of non-professional persons, death may appear to be a direct result of the injury, the case can only be cleared up by the assistance of a medical practitioner. Such a coincidence has been witnessed in many instances of attempted suicide. A man has inflicted a severe wound on himself while laboring under disease; or some morbid change tending to destroy life has occurred subsequently to the infliction of a wound, and death has followed. Without a careful examination of the body, it is impossible to refer death to the real cause. The importance of an accurate discrimination in a case in which wounds or personal injuries have been caused by another, must be obvious on the least reflection. A hasty opinion may involve the accused in a charge of manslaughter; and although counsel might be able to show on the trial that death was probably attributable, not to the wound, but to the co-existing disease, yet it must be remembered that the evidence of a surgeon before a coroner or magistrate, in remote parts of this country, may be the means of causing the person charged to be imprisoned for some months previously to the trial. This is in itself a punishment, independently of the loss of character to which he must be in the mean time exposed. Death from Wounds or Latent Disease.-A natural cause of death may be lurking within the body at the time that a wound is criminally inflicted, and a close attention to the symptoms preceding and the appearances after death, can alone enable a surgeon to distinguish the real cause. A man may be severely wounded, and yet death may take place from rupture of the heart, the bursting of an aneurism, from apoplexy, phthisis, or other morbid causes which it is here unnecessary to specify. (Cormack's Ed. Jour., 1846, p. 343.) If death can be clearly traced by an experienced surgeon to any of these diseases, the assailant cannot be charged with manslaughter; for the medical witness may give his opinion that death would have taken place about the same time and under the same circumstances whether the wound had been inflicted or not. On these occasions one of the following questions may arise: Was the death of the person accelerated by the wound; or was the disease under which he was laboring so aggravated by the wound as to produce a more speedily fatal termination? The answer to either of these questions must depend on the circumstances of each case, and the witness's ability to draw a proper conclusion from these circumstances. The maliciously accelerating of the death of another, already laboring under disease, is criminal; for in a legal sense that which accelerates, causes. In Reg. v. Timms (Oxford Lent Ass., 1870), it was proved that the prisoner had struck the deceased some blows on the head with a hatchet. In twelve 314 DEATH FROM LATENT DISEASE. days, under treatment, he had partly recovered from the effects; but in six weeks afterwards he was seized with inflammation of the brain, with convulsious, and died. On inspection, disease of the kidneys was found, of which there had been no symptoms. Death was referred to this disease and to inflammation of the brain as the result of the blows. The judge directed the jury that if they believed the blows conduced in part to the death of the deceased it was manslaughter, notwithstanding that other causes had combined with the blows to account for death. The prisoner was convicted. But there may be no connection between the violence and the disease causing death. In this case a charge of murder falls to the ground. A man struck his father a blow upon the back of the head with a hammer, inflicting a scalp-wound, with no signs of injury to the brain itself. The avowed object was to kill the father. As the injury was apparently not serious, the assailant was summarily sentenced by a magistrate to two months' imprisonment, a punishment which the fathera drunkard-thought inadequate. Hereupon the father became greatly excited-hemiplegic six days after the infliction of the wound—and died three days later. On post-mortem examination the occipital bone was found indented at the seat of the blow, and there was a depressed fracture of the inner table of the skull at the point corresponding to the external injury. There was no effusion of blood on the surface of the brain in the neighborhood of the injury, but a large clot was found in the lateral ventricle. Under these circumstances two medical men very properly gave it as their opinion that the immediate cause of death was apoplexy, the clot being in the usual position in such cases, and that there was nothing in the history of the case, or in the appearances after death, that would justify them in stating that the effusion of blood, or, in other words, the man's death, was caused by the injury; and, in spite of the remarks of the judge, the prisoner was acquitted. (Reg. v. Saxon, Lancashire Sum. Ass, 1884. Med. Chron., vol. i. p. 118.) In Reg. v. Thompson (Liverpool Sum. Ass., 1876), involving a charge of murder, it was proved that the prisoner had stabbed his wife in the cheek, producing a severe but not a mortal wound. This was on April 1st. The deceased was taken to an infirmary, and was there delivered of a child on the 3d. She was attacked with puerperal fever and died on the 12th It was properly stated by the medical witness that there was no necessary connection between the wound and the fever. The prisoner was acquitted of the charge of murder, and his life was saved. He was found guilty of wounding with intent to murder In another case, Reg v. Hodgson (Leeds Sum Ass., 1876), the prisoner was charged with the manslaughter of his wife by striking her with a belt A short time after the blow she fell back and died suddenly. The proximate cause of death was proved to be heartdisease, the violence not being sufficient to account for it. The prisoner was acquitted In 1873 an inquest was held at Haslar Hospital on the body of one Rollings The deceased was struck by a seaman and fell with his right arm under him, breaking the two bones of his forearm just above the wrist. He died rather suddenly soon after the violence, and as this did not seem adequate to account for death, a careful inspection was made and it was then found that death had resulted from disease of the heart. Lord Hale, in remarking upon the necessity of proving that the act of a prisoner caused the death of a person, says, 'It is necessary that the death should have been occasioned by some corporeal injury done to the party by force, or by poison, or by some mechanical means which occasioned death; for although a person may, in foro conscientiæ, be as guilty of murder by working on the passions or fears of another, and as certainly WHICH OF TWO WOUNDS CAUSED DEATH? 315 occasion death by such means, as if he had used a sword or pistol for the purpose, he is not the object of temporal punishment." Several acquittals have taken place of late years in cases in which the deaths of persons have been occasioned by terror, or dread of impending danger produced by acts of violence on the part of the prisoners, not, however, giving rise to bodily injury in the deceased. Under 14 and 15 Vict., c. 100, the necessity for tracing death to some corporeal injury appears to be practically abolished. According to sec. 4, in any future indictment for murder or manslaughter it shall not be necessary to set forth the manner or the means by which the death of the deceased was caused. This question arose in Reg. v. Heany (Gloucester Lent Ass., 1875). The prisoner was charged with the manslaughter of his wife. She was suffering from cancerous disease. In the course of an altercation the prisoner held up a knife in a threatening manner, but without touching her. This produced a shock, and she died two days after from fright. The prisoner was acquitted, as there was no distinct proof of the acceleration of death by this act. He was convicted of an assault. Which of Two Wounds caused Death?-A man may receive two wounds on provocation, at different times and from different persons, and die after receiving the second in such a case, the course of justice may require that a medical witness should state which wound was the cause of death. A man receives during a quarrel a gunshot-wound in the shoulder. He is going on well, with a prospect of recovery, when in another quarrel he receives a severe penetrating wound in the chest or abdomen from another person, and, after lingering under the effects of these wounds, he dies. If the gunshot-wound was clearly shown to have been the cause of death, the second prisoner could not be convicted of manslaughter; or if the stab was evidently the cause of death, the first prisoner would be acquitted on a similar charge. It might be possible for a surgeon to decide the question summarily, when, for instance, death speedily followed the second wound; and, on inspection of the body, the heart or a large vessel is discovered to have been penetrated; or, on the other hand, extensive sloughing, sufficient to account for death, might take place from the gunshot-wound, and, on inspection, the stab might be found to be of a slight nature, not involving any vital parts. In either of these cases, all would depend upon the knowledge, skill, and judgment of the medical practitioner; his evidence would be so important that no correct decision could be arrived at without it; he would be, in fact, called upon substantially to distinguish the guilty from the innocent. In Reg. v. Foreman (C. C. C., Feb. 1873), this question arose. The prisoner, it was proved, had struck the deceased some severe blows on the head. A fortnight afterwards the deceased, who had partially recovered, had a fight with another man, during which he again received severe blows on his head. In another fortnight he had paralysis of the left side, and died in a hospital a few days afterward. On inspection a large abscess in the brain was found, which was the cause of the symptoms and death. The question was whether this abscess had arisen from the blows given by the prisoner, or from the violence sustained a fortnight afterward. On this point there was no satisfactory medical evidence, and as the deceased had had no serious symptoms for a fortnight after the assault by the prisonerin fact not until after the second fight-the jury acquitted him. On some occasions death may appear to be equally a consequence of either or both of the wounds; in which case probably both parties would be liable to a charge of manslaughter. (See Ann. d'Hyg., 1835, t. 2, p 432.) The second wound, which is here supposed to have been the act of |