Death by duress of imprisonment was in all probability a very frequent occurrence in the earlier periods of our history, we know that it has often been inflicted by the individual tyranny of the nobles on their vassals; and we have every reason to suppose, that even the keepers of our public prisons were not free from the imputation of cruelty to their unfortunate inmates; many have died by violence, more by neglect; it was therefore a wise and humane precaution that the circumstances of every death of a prisoner should be made the subject of minute enquiry; it is also desirable that such enquiry should be carried on by persons of competent skill, and with every possible and proper publicity. Our own times we will hope are entirely free from the crime of premeditated murder on the body of a prisoner; but we must not allow our confidence in the modern improvements of prison discipline to lull us into a false security as to the conduct of gaolers and their underlings many of these may be men of mild and humane disposition, but as their daily occupation must tend to blunt the finer feelings of humanity, it is well that every charge of misconduct should be met by immediate and rigorous enquiry. On this subject see Rex v. Huggins, warden of the Fleet, 2 Lord Raym. 1578; 2 Str. 882; 9 Harg. St. Tri. 107; Bambridge’s case, 9 Harg. St. Tri. 146, 151; Acton’s case, 9 Harg. St. Tri. 182, 210, 218; see also the several Parliamentary Reports on Coldbath-fields, Ilchester, &c.
“A gaoler, knowing a prisoner to be infected with an epidemic[[97]] distemper, confines another prisoner against his will, in the same room with him, by which he catches the infection, of which the gaoler had notice, and the prisoner dies; this is a felonious killing. Stra. 856; 9 St. Tri. 146. So, to confine a prisoner in a low damp unwholesome room, not allowing him the common conveniences which the decencies of nature require, by which the habits of his constitution are so affected as to produce a distemper of which he dies; this also is felonious homicide. Stra. 884; Lord Raym. 1578. For although the law invests gaolers with all necessary powers for the interest of the commonwealth, they are not to behave with the least degree of wanton cruelty to their prisoners. O. B. 1784, p. 1177; and these were deliberate acts of cruelty, and enormous violations of the trust the law reposeth in its ministers of justice. Forster, 322.” See I Hawk. P. C. by Leach, p. 119.
Previous to the researches of the celebrated John Howard, (see his treatise on Prisons and Lazarettos) our prisons appear to have been in a most disgraceful state; they are now greatly improved, but something may yet be done for their amelioration, more particularly as affecting the health of the prisoners; and this principally, by allowing the most unrestrained medical inspection by disinterested practitioners, who should be as much as possible unconnected with local prejudices, or partialities; some of the parliamentary regulations of madhouses might in this respect be usefully extended to all places of confinement; those who are not sui juris are ever entitled to additional protection.[[98]]
The best practical proof of improvement, in the construction of our prisons, and in our prison discipline, is to be found in the disappearance of that fatal pest, which was commonly called the gaol fever, a disorder which, with something of retributive justice, frequently extended its ravages to those, whose proper vigilance might have prevented its generation. At the assizes held at Oxford in 1577,[[99]] called the black assize, we learn from Baker’s Chronicle (p. 353) that all who were present died within forty hours: the Lord Chief Baron, the Sheriff, and about three hundred more. Lord Bacon ascribed the fatality to a disease brought into court by the prisoners, and Dr. Mead entertained the same opinion; nor was similar infection, though to a less extent, an uncommon occurrence[[100]], see vol. 1, p. 125. The ancient practice of strewing the court with aromatic herbs and flowers, and presenting bouquets to the Judges, is said to have derived its origin from the idea of preventing infection: fresh air, still wanting in our courts, would have proved a more powerful, and not less agreeable prophylaitic.
BY WOUNDING, OR BLOWS.
In investigating the subject of Wounds, it will be convenient to adopt, on the present occasion, the usual classification of local injuries, viz. 1. Incised wounds, or cuts; 2. Punctures, or such as are inflicted by pointed instruments; 3. Bruises, injuries occasioned by blunt instruments; 4. Lacerations, where the integuments are torn, and 5. Gun-shot wounds; upon each of which we shall offer a few observations, and, in the first place, it may be remarked generally, that no graduated scale of wounds, expressive of the degree in which they are curable or dangerous, can ever be constructed; in appreciating the probable degree of danger that attends a wound other data will be required for the solution of the problem than those deduced from situation and extent, such as the constitution and temperament, age, habits of life, especially as they regard temperance and sobriety, previous state of health, unnatural structure and disposition of parts, and existing diseases of the wounded individual; together with the temperature of the season, and other extrinsic circumstances. As a general rule for our guidance a division of wounds into four classes has been suggested, viz. 1. Absolutely mortal. 2. Dangerous. 3. Accidentally mortal. 4. Not mortal. Every practitioner, however, must be aware that death will occasionally supervene on the slightest injury, and at other times that the patient recovers in spite of the most serious and extensive mischief; in proof of the former assertion, the author may state that he has seen a case in which the extraction of a tooth was followed by death in less than forty-eight hours; and every experienced surgeon must in the course of his practice have observed the slightest wound[[101]] productive of alarming and even fatal consequences; in illustration of the occasional occurrence of a contrary result we may recal to the recollection of the reader the extraordinary case[[102]] of Mr. Thomas Tipple, who recovered after an accident, by which the shaft of a chaise had been forced through the thorax! There have also been instances of the recovery of persons whose brain has been wounded to a considerable depth, of others shot through the head; Dr. Male states that a pauper in Paris, some years ago, used to receive charity in a piece of his skull. In the second volume of the Medico-chirurgical Transactions, we have a well attested case of a bayonet wound in the heart not causing immediate death. Littre has given us a report of a man who inflicted upon himself no less than eighteen stabs in the abdomen with a knife; and although some of them did not penetrate beyond the parieties, yet others wounded the contents; the symptoms which followed are stated to have been very severe, but by judicious treatment the patient recovered; seventeen months afterwards, however, he threw himself into the street from a three pair of stairs window, and was instantly killed. On examining the body all the wounds were found healed, and, with the exception of one, all the cicatrices were firm and level; they were traced into the intestines, where corresponding adhesions were observed.[[103]]
The surgical practitioner will, after such cases, be cautious in his prognosis, and profit by the experience of Hoffman, who says, “In judicio de vulnerum lethalitate ferendo multorum Medicorum fama et fortuna periclitantur.”[[104]] Fortunately for the administration of justice, that act of the Legislature, called “the Ellenborough act,” relieves us from many of those embarrassments under which the professional witness[[105]] must otherwise have laboured, and the surgeon will appreciate the high importance and utility of the law, by which wounding with an intent to kill is deemed equally criminal, whether death be the result or not. Still, however, the testimony of the medical practitioner will always be important; indeed the evil intent is often to be inferred, or disproved, by the nature of the injury inflicted; as is so well illustrated in the case of a man, who fractured the skull of a boy with a stick, upon finding him in the act of plundering his orchard; when it was clearly made out in evidence, that a mere chastisement was only intended, for the size of the stick was not such as to have occasioned any fatal effect, had not the skull of the unfortunate boy been unusually thin.
If the surgeon is called upon to inspect a wound, with a view to ascertain whether it produced death, he should in the first instance, endeavour to examine its nature and direction, so as to disturb as little as possible the position in which the body was found; the knife of the anatomist must afterwards explore its more particular condition and relations, by a dissection, for the performance of which we shall give ample directions in a future chapter.
The importance of examining the wound, so as not to alter the position of the parts must be obvious when we consider how necessary it may afterwards become to compare as strictly as possible the internal appearances with the external lesions. The direction of a wound is frequently a circumstance of much greater importance than may at first appear, we ought not therefore to probe it without extreme caution, lest we should give to it a direction which it did not originally possess. This precaution becomes the more necessary as the putrefactive process advances.
Of incised wounds, or cuts. The prognosis of wounds made with a cutting instrument varies, cæteris paribus, according to the extent and depth of the division, the nature of the injured parts, and the circumstances which attend the operation; where the instrument has been so sharp as not to occasion any contusion or laceration, the fibres and texture of the wounded part will have suffered no other injury but their mere division; and there is consequently less tendency to inflammation, suppuration, gangrene, and other bad consequences; if the wound be large and deep it will be more dangerous, as well as more difficult to heal, than one which only affects the skin. Wounds, accompanied with injury of considerable vessels or nerves, are more or less hazardous, according to the magnitude or number of those vessels or nerves; generally speaking, the most dangerous examples of incised wounds are those which are made about the throat; here there are so many large blood-vessels, nerves and other parts of great importance, that deep incised wounds often prove fatal, either immediately, or in a few days; in some cases of suicide the carotid artery is opened, and the person perishes from hemorrhage on the spot, before any assistance can be afforded; in other instances he divides some of the principal branches of the external carotid, and after losing a great deal of blood, he faints, and the hemorrhage being thus checked, the life of the patient is preserved, until surgical assistance can be procured. Cut wounds of the extremities, when such arteries as the femoral and brachial are injured, may also suddenly destroy the patient, by hemorrhage.