EXAMINATION AND DESCRIPTION.
The examination of wounds or injuries in a case which is or may become the subject of a medico-legal investigation should be made with particular care and exactness.
As the examination of the wounded person is to give most, and in some cases all, the information to the medical expert on which he is to base his testimony, it should be made with reference to all the possibilities of the case.
The particular variety of wound as described in the foregoing section should be noted, and any peculiarities as to its situation, shape, extent, length, breadth, depth, direction, and the parts involved. Besides these points, the condition of the edges of the wound, whether swollen and ecchymotic, smooth and straight or dentated and irregular, and whether inverted or everted and gaping, are matters of importance. The presence or absence of coagula and clots, the staining of the tissues with blood, the presence of ecchymosis and its comparative age, as shown by its color, should also be noted.
Many of the above points help us in solving another problem, namely, the form of the instrument used. This question will be discussed in a subsequent section, but the basis for our opinion is founded, of course, on an examination of the particulars of the wound. The solution of still another question which often arises and which will be discussed in the next section, namely, whether a wound was produced before or after death, is based upon particular features of the wound such as the fluid or clotted condition of the blood on the surface, or ecchymosed in the tissues, also the amount of the hemorrhage as compared to the vascularity of the part as well as the greater or less staining of the tissues with blood, and the conditions of the edges, whether inverted or everted and whether or not retracted. The question as to whether a wound was directly, secondary or necessarily the cause of death, is determined, in part at least, by examination of the wound. In this connection we take note as to whether a wound has opened or divided a large vein or artery or is situated in such a vascular part as to be fatal from hemorrhage. We also note whether death could have been due to shock from the situation of the wound, or whether an inflammation which was directly responsible for death was necessarily due to the wound, as in case of a penetrating wound of the viscera, etc. Further, we note whether one of the many forms of wound diseases from infection of the wound has complicated the case and caused death in the case of a wound not otherwise necessarily fatal. It may be added that often the necropsy aids us in the solution of the question as to whether the wound was the necessary and direct cause of death, by showing a healthy or diseased condition of the viscera.
The question as to which of a number of injuries was first inflicted, also as to the relative position of the victim and assailant, can be answered, if at all, only by an accurate and close examination of the wounds.
Finally, the most important question of all, from a medico-legal standpoint, namely, the distinction between homicidal, suicidal, and accidental wounds, is decided or inferred from the characteristics of the wound after careful examination.
All the foregoing questions contribute to the solution of this the most important one. The various questions referred to above will be considered at greater length in the subsequent sections. They have been merely referred to in brief above, to show the various lines of thought a medical examiner must have in mind in making an examination.
As to the act of examination itself, the physician should conduct it in such a way as not to harm the wounded person. Often simple inspection is the most that can be done, or the examination may have to be deferred altogether until the physician in charge informs the court that an examination may be safely made. It is often necessary for the expert to get information as to the original lesion from the physician in charge. If the wound has been a fatal one and if we are called in after death, we may examine the wound on the dead body with much more freedom. Here we may examine the depth, direction, etc., of a punctured wound by cutting down on a probe or director. After careful inspection of the wound we may examine it by palpation, and go on to the dissection of the wound and the surrounding parts, tracing and noting the various vessels, muscles, etc., involved in the wound, and looking for the presence of any foreign body in the wound.
Furthermore, if the cause of death be at all obscure, we should examine not only the wound itself and the parts about the wound, but also, by an autopsy, all the cavities and organs of the body. For death may have been due to natural causes in an organ not examined, if the examination has not included all, and the physician has to disprove it.
In examining at an autopsy the depth of a wound in reference to the instrument which caused it, it should be borne in mind that the wound may be deeper than the weapon owing to a depression of the surface by the handle of the weapon. This may appear especially marked in the case of the movable viscera, as at the time of the accident the viscus may have been as near as possible to the surface, and at the examination as far as possible from the surface, as in the case of a given coil of the intestines. Also the thorax when opened at autopsy enlarges or expands a little, so that the measured depth of a wound may be greater than the weapon which caused it. Vibert[612] mentions a case of a penetrating wound of the thorax involving the heart, where the measured depth of the wound was 0ᵐ.035 greater than the length of the instrument. This may also be accounted for by a depression or flattening of the thorax by the blow, as in the case of soft parts. It is often difficult in an examination to measure accurately the depth of a wound, for one may find it hard to determine the precise end of a wound. Also, for exact measurement it is necessary to have the parts in the same position as at the time of the accident, and these parts are more or less displaced by the necessary dissection.
Besides the examination of the wound there are other points the examination of which may aid us in solving the problems presented by a case. Among these, the examination of the clothing or dress is perhaps the most important. This may indicate the weapon used in an incised or punctured wound. Contused and lacerated wounds or fractures, etc., may be produced without injuring the clothing. Blood, dirt, or grease on the clothing may throw light on the case. In self-inflicted wounds the wound in the clothing and that on the body may not and often do not correspond, as an intending suicide often (a murderer rarely) opens the clothing to select the spot for the wound. The wound in the dress is then added by a second blow not corresponding to the first. In this way we may sometimes distinguish between a homicidal and suicidal wound, and thus remove a false suspicion of murder or show that a wound was self-inflicted to conceal other crimes or to falsely impute it to another. The suspicion of homicide in accidental wounds may be cleared up by an examination of the dress, as in the following instance related by Taylor:[613]
A woman was found dead in bed with two indentations about the middle of the right parietal bone, a large superficial clot here and three ounces of clotted blood between the dura mater and skull, which latter was fractured over an area of four inches. No other cause of death was found. The evidence brought out the facts that she had been knocked down the evening before, about 7:30 o’clock, by a man accidentally running into her. She fell on the back of the head, was stunned, raised up, and stimulated; she then walked home, ate her supper, and was last seen at 9 o’clock by a fellow-lodger who let her in and noticed nothing unusual. The next morning she had evidently been dead some time. Suspicion fell upon the lodger, who had often quarrelled with her, and the two claws of a hammer found in his room corresponded more or less closely with the two indentations found in the skull. At the adjourned inquest, however, the bonnet worn by the deceased at the time of the accident was found to have two indentations on the back of it corresponding to those on the woman’s skull and containing dust and dirt, and rendering probable what from the history seemed unlikely, that the fall in the road caused the fatal injury. The examination of the dress thus avoided an unjust accusation of murder.
Contused and lacerated wounds and fractures or dislocations may be produced without injury to the dress, especially if the latter be elastic or yielding. The comparison of the wound in the clothes with that on the body may indicate the position of the body at the time of the blow. The examination of the clothes of the injured person may indicate a struggle which would support the idea of homicide. A blunt instrument may indirectly cause an injury by striking something in or on a person’s clothes. Instances have been reported where a wound has been caused by an article in the pocket, or worn outside the clothing, without any trace of an injury to the clothes or pocket lining.[614]
The examination of the dress may further show which of several cuts or stabs was first inflicted. This is shown by the staining of the edges of the cuts in the clothing, the edges of the first cut or stab showing no blood-stain or only on the inner surface, as the knife is clean of blood on entering and all that is removed by the clothing on its withdrawal is found on the inner edges. If the edges of the cuts in the outer layers of clothing are bloody, it is evident that the knife was already bloody when used, and the corresponding wound was not the first inflicted.
The imprint of the bloody hand of the assailant may sometimes be found on the clothing of the one injured, and is especially important as evidence, when the hands of the assaulted are not bloody. In the case of a severe wound, especially if it is likely to become the object of a criminal investigation, the physician should always require to see the dress of the wounded. The examination of the clothing which the accused wore at the time the assault took place may give important evidence by showing evidences of a struggle or blood-stains. Absence of the latter would not prove the innocence of the accused, as the clothes actually worn may be destroyed and others substituted, or the marks and stains may be removed. In the latter case, the eye of a medical man may detect traces of blood which otherwise would go unnoticed, and a microscopical and chemical examination would reveal the real character of the stain.
Besides the examination of the clothing of the accused, the examination of his person may furnish evidence of his being engaged in a more or less desperate struggle by the scratches, marks of nails, contusions, bites, etc., on the face, neck, front of chest, forearms, and hands. If the accused should attempt to explain these wounds and spots, the latter may or may not verify the explanation, and thus additional evidence may be obtained as to the guilt or innocence of the accused.
It is well for the medical expert, as well as for others, to collect the statements of the wounded person relative to the circumstances of the injury. Also, if the accused will vouchsafe any such statements we may compare these with one another and with the facts indicated by the wound, etc.
Other points to examine, especially in cases of suspected suicide, may be briefly mentioned. The presence of the weapon in the hand of the victim and firmly grasped in general indicates suicide, if it corresponds to the weapon causing the wounds, for otherwise it may have been used for defence. If not in the hand, note the spot where the weapon was found. In the case of a suicide, the hand as well as the weapon held by it is likely to be bloody, also in case of murder the generally empty hand is apt to be bloody, as the hand is naturally carried to the wound.
We cannot further describe the many points which the medical examiner should bear in mind in making an examination in a medico-legal case, without repeating too fully what will be given at greater length in subsequent sections, reference to which should be made for further particulars. Tardieu proposed as a basis for examining and studying wounds, (1) to visit the wounded person and see what state he is in, and to determine (2) the nature, (3) the cause, (4) the consequences of the wound. Also if the wounded person is dead (5) to examine the body for the cause of death in order to see if the latter is due to the wound. Also (6) to determine the circumstances of the affray.
The description of a wound should be given in plain language, avoiding the use of scientific terms or expressions, so as to be readily understood by judge and jurors. Otherwise the usefulness of the medical expert is very much decreased. The description should also be precise and sufficient to justify the conclusions arrived at as to the cause of a wound, its gravity and results, and the weapon used. With a view to exact statement in description, it is well to take notes as to the result of the examination and not depend merely on memory. The object of the witness should be to be understood and not to be thought thoroughly scientific.