EVIDENCE FROM EXAMINATION OF THE DEAD BODY.
Fractures.—Considerable evidence of great interest with respect to the effect of a bullet-wound upon the skull and the possibility of fractures being produced at the base by contre coup will be found in the statement of the case of The People v. Elisha B. Fero, published by Dr. Charles T. Porter, of Albany, in the Journal of Psychological Medicine, April, 1870. Mrs. Fero was murdered while in her bed and was found to have been bruised about the head and body, her husband claiming that the deed was that of a robber who had attacked them both. He was found with slight bruises or scratches about the face and black marks as if from burnt powder between the middle fingers of his right hand. The first autopsy appears to have been carelessly made, but a flattened conical ball weighing twenty-six and one-half grains was found lodged in the middle of the right cerebral hemisphere. It had not gone completely through the brain. Its base fitted the shells of the metallic cartridges used in Fero’s revolver. Eight days after death a second examination was made, after which the head was removed and preserved in 95% alcohol. A theory of the prosecution was that Mrs. Fero was murdered by her husband; that he shot her, as well as struck her numerous blows upon both sides of the head and its front and back with some broad, heavy, and elastic body, making fractures found on autopsy. Not the least interesting part of the testimony is that referring to the condition of tissues alleged to have been bruised after long preservation in alcohol. The expert testimony in this case appeared to show that such fractures as were found, without reference to the fact of external bruises, were due to the unskilful manner in which the skull-cap was removed. In this connection it is well right here to emphasize the fact that fresh fractures can be produced in the skull by too forcible or injudicious efforts to remove the calvarium when making autopsies, or that fractures previously existing can be extended or complicated in the same way. Shaw in his “Manual of Anatomy” says: “The question whether there has been a fracture of the cranium previous to death is sometimes more difficult to decide than a person not accustomed to make dissections might imagine. If the fracture has occurred immediately before the patient’s death, there will be found coagulated blood upon the bones and in the fissures. If the patient has survived for some time, there will be marks of inflammation and, perhaps, pus in contact with the skull, but if a fracture has been made in making the examination, which sometimes happens in even very careful dissectors’ hands, the blood in the fracture will not be coagulated, nor will there be any effusions around the portions. In Beck’s Medical Journal, Vol. XXII., p. 28, Mr. Alcock some time since stated in a public lecture in London that he had known a fracture of the base of the skull produced by the awkward and violent tearing of the upper portion by the saw in penetrating enough to divide the bones, and this to be mistaken by the inexperienced operator for fracture of the skull producing death. Being a medico-legal case, it might have led to melancholy consequences had not the error been detected by an observer.” That an extensive and often complicated fracture by contre coup can occur as the result of gunshot injuries of the skull is a fact well known to all surgeons of experience and laid down in all text-books and illustrated in all large museums.
In view of these well-known facts, it would always be well to insist in cases of this kind that the saw alone should be used and not the hammer nor the chisel. When a cranial bone is fractured blood is poured out from the ruptured vessels, as is always the case with any bone. Its amount varies indefinitely with the number and size of the ruptured vessels, the activity of circulation, the length of time a person lives, etc. The blood may collect in circumscribed masses or become infiltrated in the surrounding tissues, although usually both phenomena are observed. The extent to which infiltration takes place depends upon the quantity of blood and the nature of the surrounding tissues. In loose tissues like those about the orbit infiltration is much more rapid and extensive.
Examination of the Weapon.—French medical jurists have tried to indicate how we may determine the time elapsed between the death of a person and the discharge of a weapon found near the body, but exact statements in this matter are utterly out of the question. Certain facts bearing on the subject are these: When recently discharged there will be found adhering to the barrel of the piece and consisting of the fouling of which sportsmen complain, a quantity of potassium sulfid mixed with charcoal. This is shown by its forming a strong alkaline solution with water, evolving an odor of hydrogen sulfid, and a dark precipitate with a solution of acetate of lead. Depending upon the degree of exposure to air and moisture, after some hours or days this sulfid becomes converted into potassium sulfate, which forms a neutral solution with water and gives a white precipitate with acetate of lead; but if a considerable time has elapsed since the discharge of the piece oxid of iron (iron rust) with traces of sulfate may be found (Ann. d’Hygiene, 1834, p. 458; 1837, p. 197; 1842, p. 368).
Was the Weapon Fired from a Distance or Near By?—A gunshot injury from a bullet implies at least one wound, namely, that of entrance, and perhaps another, that of exit. It does not always happen that the bullet passes through the body. The appearance of the wound of entrance is usually one of irregular circular puncture, its edges perhaps slightly torn or lacerated, with a purplish or dark areola, varying in width from a line or two to one-half inch. When the weapon is fired close to the body there are likely to be more or less powder-marks, and possibly actual burning from the heat and flame of the gunpowder. If the part of the body injured had been covered by clothing at the time, the marks of powder and of burning would probably be confined to the same. Bleeding is usually slight and occurs more commonly from the wound of entrance than from that of exit. Regularity of either of these wounds depends in large measure upon the angle at which the bullet has struck the surface. When striking very obliquely the wound may be more oval or the bullet may have ploughed a furrow or a channel, by a study of which the relative position of the assailant and the assailed at the moment of injury may, perhaps, be determined. It is of importance to determine if possible the approximate distance at which the bullet was fired, since the question of self-defence, for instance, may hinge upon evidence of this character. The charge of powder and the weight of the bullet being known, one may sometimes estimate this distance by the depth of penetration or the appearance of the bullet. Still, the nature of the tissues must figure largely in such consideration. Many suicides who shoot themselves in the head show only one wound of entrance and none of exit.
Experiments Testing Powder-Marks.—Powder-marks and burns from weapons ordinarily used will scarcely appear when the distance has exceeded ten or twelve feet. LaChese, of Antwerp, found that in firing a gun even from a distance of only four feet the skin was only partially blackened.
As the result of experiments made with a Ballard rifle, old style, .44 calibre, with bullets of 220 grains and 28 grains of powder, Dr. Balch, of Albany, found that powder-marks were made at distances as follows:
At two feet, particles too numerous to count, with some of the lubricant blown upon the board;
At four feet the same;
At six feet the same;
At eight feet, nine grains of powder;
At ten feet, five grains of powder in one case and six in another.
That these were powder-grains were shown in court by picking some of them out, placing them on a glass, and igniting them with a galvano-caustic point. From those at ten feet no distinct flash could be elicited; from those obtained at eight feet distinct flashes were seen (Trans. New York State Med. Soc., 1881).
In the celebrated case of Peytle, brought in 1839 for the murder of his wife, who had been killed by two bullets entering near the nose, the eyebrows, lashes, and lids were completely burned, and a large number of powder grains were imbedded in the cheeks. Experiments being made in order to ascertain the distance necessary to produce these effects, it was found that the weapon must have been held within a distance of twelve inches.
Wounds of Entrance and of Exit.—A great deal has been written in time past about the peculiarities of the wounds of entrance and of exit, much of which cannot be maintained under expert criticism. It is true that the wound of entrance will usually be well defined, the skin slightly depressed and appearing as above noted. It is true also that powder-marks will appear about this wound rather than that of exit. Usually, too, the orifice of exit is larger, less regular, its edges everted slightly, with more or less laceration of the skin, and quite free from any powder-marks or evidence of burning. The depression at the border of the wound of entrance differs after some days, by which time the contused margins slough away, and its appearance is daily changed by a process of granulation providing the individual recover or live long enough. According to Dupuytren, the hole in the clothing is smaller than that made by the same bullet in the skin. These are all points worth remembering when fitting bullets into wounds which they are supposed to have made; but the conditions under which gunshot punctures occur are constantly varying, and the significance of local markings is mainly the product of experience, care, observation, and reasoning. Thus the shape of either of these wounds will depend naturally upon the integrity of the bullet and its original shape and dimensions. Matthysen’s experiments give the following: A pistol fired at twelve paces distance, with a ball 15 mm. in diameter, made a wound in chest of 8¼ mm. diameter, and at its point of exit at the back one of 10 mm. In two experiments at the same distance as above, the entrance wound was 4 mm. larger in diameter than that of exit, and when a larger ball with a diameter of 17 mm. was used the same results were preserved, both wounds being less in size than the ball which made them. A spherical ball will usually cause more loss of substance than a conical, while the latter will cause usually more irregularity of outline and may even give the wound of entrance a slit-like appearance. Complications may also occur from other sources; a single wound of entrance may give rise to two or more wounds of exit due to splitting of the bullet, or if the bullet have been divided and the larger part lodged in the bone, only the smaller portion passing out, the wound of exit may in reality be much smaller than that of entrance. Again, a bullet may split into fragments before striking the body, and of these one may enter the body, or one or more of them lodge. Multiple wounds are possible even from one bullet, as when it passes through two different parts of the body. Again, when two wounds, for instance, are discovered, one of them may be regarded as that of exit, when in reality they may be two wounds of entrance, neither bullet having left the body. So while it is possible in some cases to decide which is which, too much dependence should not be placed upon appearances of this kind, least of all until after a careful autopsy has been made.
Course of the Projectile.—When a bullet traverses a body the two apertures may be nearly opposite to each other, although the bullet may not have taken a direct course between them, having been deflected by tissues of varying density in its course. This leads to the mention of the effect of animal tissues upon the course of bullets, with which works on military surgery deal extensively.
The following is a remarkable illustration, yet authentic, of a devious path of a ball. In a duel with pistols between two students at Strasburg one fell, apparently mortally wounded in the neck, but recovered without feeling any inconvenience from his wound. It was found that the bullet had struck the larynx and had gone completely around the neck. It was taken out by simply making an incision over it. Other instances may be cited where bullets have made a circuit around the head, thorax, or abdomen. The ball may make a half circuit of the body and lodge or emerge at a point opposite that at which it entered, thus leading one to suppose that it must have passed directly through (Wharton and Stille).
As the writer of a chapter on the effect of projectiles of small-arms, in the Third Surgical Volume of the “Medical and Surgical History of the War of the Rebellion,” p. 709, says: “Such bullets attain great range and effectiveness as oppose least frontage of resistance to air; their velocity consequently is greater. Rotation upon their long axes tends to give them steadier flight and more direct course. By their pointed apices they pierce more easily the structures opposed to them. Such bullets, owing to the elasticity of the skin, make a wound of entrance perhaps a trifle smaller in diameter than themselves, while spherical balls are more likely to carry a portion of the integument in with them.”
The differences of structure and density of the muscle tissues and their aponeuroses encountered by a bullet in its passage materially influence the directness of its course unless its velocity be very great, while round bullets are the more easily deflected from their course. The track of a small conical bullet passing swiftly through a muscle is more cleanly cut than that made by a round bullet, but in all gunshot wounds there is usually found a regular canal, with lacerated walls, with more or less destruction along the area of injury, shading off concentrically until lost in healthy tissue. There is always loss of substance dependent on muscle tension or direction of the bullet, whether transverse or obliquely to the direction of the muscle fibres; the more fibrous structures are torn and lacerated or simply perforated, mainly owing to their different tension at the instant; their openings seldom correspond to those of the muscle tissues or those upon the surface of the body, because of the constant change in the relation of the parts due to muscle action. This makes it often difficult to follow the course of a bullet with accuracy. The irregularity of a bullet-track due to these causes constitutes one of the great sources of danger, since cavities and pouches thus formed give lodgment to foreign matter driven in with the bullet, by retention of which a fertile source of sepsis is maintained. Gunshot injuries of bone may be classified as contusions, simple fractures, partial fractures, penetrations, perforations, and complete fractures with more or less comminution or loss of substance, all of these, of course, in the surgical sense compound. These are all manifestations of mechanical force acting in accordance with established laws. On autopsy these will be ascertained, while one or more portions or all of a bullet may be found imbedded in or attached to some bone. The best illustration of such accidents will be found in the “Medical and Surgical History of the War of the Rebellion.”
Such questions as pertain to the position of the wounded person when shot or that of his antagonist, and other similar inquiries, can only be settled by reference to particular circumstances of individual cases. Position of the wound may help a little. A bullet-wound directly in the centre of the top of the head could scarcely be received by a person standing unless his assailant occupied an elevated position. If accompanied by evidence of severe blows by which the deceased might have been knocked down, it might show that he had been shot after falling.
Wounds by Small Shot.—Small shot rarely traverse the entire body unless discharged from such proximity as to make a clean, round opening. Paley relates the following instance: A boy was shot in the neck by the accidental explosion of his own gun, No. 8 shot. He died instantly. He was lying forward of the muzzle so that it was nearly in contact with the skin of the neck. A large round hole was produced, in diameter one and one-half inches, whose edges were slightly darkened by powder. The wound of exit at the back of the neck, at the third vertebra, was a mere slit in the skin scarcely an inch in length with the diameter placed vertically. The smallness of this aperture may have been owing to the greater part of the charge being lodged in the body. Dr. Lowe states that in some experiments it was found that a round aperture might be produced by a discharge of small shot at a much greater distance than that assigned by Dr. LaChese, namely, ten to twelve inches. Even admitting such exceptional instances, it will scarcely ever occur that a wound from a small shot can be mistaken for one produced by a leaden bullet.
De Vergie has shown that when the ball enters a portion of the body well covered with fat, this often protrudes between the edges of the wound and may alter its character. If clothing have been carried in some shreds of it may show upon the wound, and such fragments of texture will nearly always characterize the wound at once as that of entrance.
Wounds by Blank Charges.—Experience has shown that no matter with what the piece is charged, it is capable, when fired close by, of producing a wound which may prove fatal. Thus a gun loaded with wadding or gunpowder only may cause death. A portion of clothing may be carried into the wound and lead to death from hemorrhage, or death may occur from many secondary causes, such as tetanus or sepsis. Accidents so frequently occur from weapons discharged in sport, not loaded with ball or shot, that it is worth while to bear this in mind. It has been observed, for instance, that persons attempting to commit suicide have forgotten to put a bullet in the pistol, nevertheless the discharge of the weapon into the mouth has sufficed, from the wadding alone, to produce a considerable laceration and hemorrhage (Taylor). Many fatal accidents have taken place by the discharge of wadding from cannon. LaChese has ascertained by experiment that a piece charged with gunpowder alone is capable of producing a penetrating wound somewhat resembling that produced by gunshot, when the piece is large and fired within six feet of the body (Ann. d’Hygiene, 1836, p. 368). This arises from unexploded grains of powder acting as pellets of small shot. Sweet has experimented with pistols loaded with gunpowder and wadding in order to determine the effect of their discharge at different distances. At twelve inches he found that the clothing was lacerated and the skin abraded, but the wadding did not penetrate; at six inches the clothes were lacerated and the wadding penetrated to the depth of one-half inch; at one and one-half inches from the chest the wadding passed into the thoracic cavity between the ribs, and at a second experiment carried away a portion of the ribs.
It is probable that an ordinary wadding such as loosely wrapped paper, rag, or similar material, especially as prepared by one not accustomed to military use of a weapon, would not produce a wound which would resemble that made by a bullet, and it is doubtful whether such a wound could be produced at a greater distance than six inches from the body.
It is on record that in Paris, in 1858, a circus cannon of four inches bore, loaded with three ounces of grain powder retained by a wad of old theatre bills loosely folded together and rammed home with only moderate force, was discharged in the direction of the boxes at a distance of about one hundred and fifty feet. A man seated in one of these boxes opposite the muzzle of the gun, leaning forward, his arms crossed upon the handle of his umbrella, had his arm broken above the elbow immediately upon its discharge. Several portions of wadding were found beneath the place where the man sat, but no marks existed upon his clothing nor upon the anterior part of the arm, which must have been inaccessible to any projectile that did not first strike the forearm. It was concluded that the fracture had been caused by the violent and sudden starting of the man backward, which must have brought his arm against the hard part of the partition. An experiment tried with the cannon proved that any wadding that could be made with paper was dispersed in passing, or lost all power of mischief, at much less distance than one hundred and twenty feet (Annales d’Hygiene, 1859, p. 420, Wharton and Stille).
The Mannlicher Rifle.—It may be of interest here to note the effects of the rifle-bullets used in the most recently invented improved arms. The last new projectile used in the German army, 1892, with the Mannlicher rifle, has an inner core of lead inclosed in a casing of steel or firm metal, which prevents the lead, even when softened by heat, from becoming deformed and enlarged by contact. The weight of the bullet is much less than any of the old, but to its higher rate of velocity and its pointed shape, which is preserved, must be ascribed its greater perforating power. Owing to this immense velocity and the small surface of contact, it meets with little resistance on striking a person, has no time to stretch the various tissues it encounters, causes little or no commotion of the neighboring parts, and merely punches a hole, carrying the contused elements before it clear out of the wound without seriously damaging the surrounding wall of the bullet-track. This absence of contusion must lead to more frequent deaths from hemorrhage, while when this arm is used we shall hear very little of deflection or deviation of the bullet from its path, since it has sufficient power to pass directly through any part of the body which it may meet on its way. The result in battle will be a reduction of the list of wounded, but a terrible augmentation of that of the dead.