Punctures, or such as are made by the thrust of pointed weapons, as by swords, daggers, lances, and bayonets, or by the accidental and forcible introduction of considerable thorns, large nails, skewers, &c. into the flesh,[[106]] comprise a class of wounds of great importance and danger, as they generally penetrate to a great depth, so as to injure large blood-vessels, nerves, viscera, and other organs of importance; and being inflicted with considerable violence the parts always suffer more injury than what would be produced by their simple division. It must also be considered, that a great number of the weapons by which such wounds are occasioned, increase materially in diameter from the point towards their other extremity; and hence, when they penetrate far, they must force the fibres asunder like a wedge, and cause a serious degree of stretching and contusion. It is this circumstance which gives so dangerous a character to bayonet wounds in the soft parts. The opening which the point of such a weapon produces is quite insufficient for the passage of the thicker part of it, which can therefore only enter by forcibly dilating, stretching, and otherwise injuring the fibres of the wounded flesh. But mortal injury may be inflicted by an extremely slender instrument, so as to occasion an apparently trivial puncture; and in some cases, the external injury is healed before the death, which it occasions, takes place. Such cases can only receive satisfactory elucidation from the lights of an anatomical dissection, under which head we have furnished several instructive examples.
Bruises, or Contusions, strictly comprehend those injuries which are occasioned by the violent application of blunt or obtuse instruments to the soft parts. They are not unfrequently complicated with severe internal injury resulting from the violence which the parts have sustained, such as inflammation, suppuration, or even the rupture of some of the viscera, of which we shall hereafter present several illustrative cases.
A blow on the region of the stomach sometimes occasions instant death; an effect which would appear to arise from an injury inflicted upon the eighth pair, and great sympathetic nerves, by which the heart is instantly paralysed. In these cases the heart has been found empty, and the stomach has appeared red and inflamed; this latter appearance is the obvious effect of the sudden cessation of the heart, producing the settling of the blood in the extreme arterial branches.
Wounds of this description are, of course, more or less important, according to their locality; unless complicated with laceration, they are never attended with any considerable hemorrhage, although the minute vessels are necessarily ruptured, and the effusion of their contents produces the discoloration so characteristic of this kind of injury.
As in the case of wounds, so also in respect of blows, injuries apparently inadequate have produced death; it then becomes difficult to fix the degree of guilt which should be attached to the aggressor; for though according to the strict letter of the law, every man is responsible for the ultimate effect of an illegal act committed by him; yet in moral justice there is much difference between the atrocity of him who strikes a grievous wound with a deadly weapon, from which by chance his victim may recover; and the fault of him who transported by sudden passion gives an ordinary blow, which by accident, by reason of some inward and unknown disease of his adversary, or by injudicious treatment, becomes fatal. Numerous cases might be cited in support of this position: that of Brain for the murder of Watts, Cro. Eliz. 778: H. P. C. 455. is one of the most remarkable, not only from the circumstances attending the trial, where the jury were fined and imprisoned for a corrupt verdict, but also for the physiological circumstance, that the deceased died instantly from a blow on the calf of his leg. The parties had previously quarrelled and fought; and Brain, the prisoner, was hurt; the next day Watts passing his shop made mouths at him, on which new provocation Brain hit him the blow which instantly proved fatal. The Court held that the new provocation was insufficient, and that the death must be referred to precedent malice—might they not also have considered that a blow on the calf of the leg was more insufficient to produce death under ordinary circumstances, than a wry face to induce or inflame a quarrel? The prisoner was found guilty, but not without considerable and as it appears to us proper resistance on the part of the jury; the case being on Appeal, the Crown could not pardon, though the appellant might compromise his suit:—we are not informed whether the prisoner was executed.
A case, nearly parallel to the above, is that of Lydia Alder, who was tried in 1744 for the murder of her husband, whom she kicked on the groin; in consequence of which, having at the time an inguinal rupture, mortification came on, and he died. Verdict, Manslaughter. The circumstances attending the case of Bartholomew Quain were, in some respects, different; he was tried and convicted for the murder of his wife, at the Assizes for the Isle of Ely, in 1790. It appeared in evidence, that a rupture of the spleen was produced by the violent kicks, of which the indictment stated that she had died. The jury, under the direction of the Chief Judge of Ely, found a special verdict, in order to take the opinion of the Court of King’s Bench upon the following question, whether the facts found by the jury amounted to murder, or only to manslaughter, when the Court was clearly of opinion that it was murder, because there did not appear to have been any provocation on the part of the deceased; and no man had a right, even to inflict chastisement, without a just provocation.
Lacerations, where the integuments are torn.—These differ from incised wounds not only in the circumstance of their being less disposed to heal by the first intention, but in the singular fact of their not bleeding to any extent; there are perhaps no facts, in the history of surgery, more extraordinary than those which have been recorded on the subject of whole limbs being torn away, without hemorrhage. The most remarkable of these is related by Cheselden, in his work on Anatomy, being the case of a miller, “whose arm, with the scapula, was torn off from his body, by a rope winding round it, the other end being fastened to the coggs of a mill; there was no hemorrhage, nor did any severe symptoms supervene, so that the wound was cured by superficial dressings only, the natural skin being left almost sufficient to cover it.” Analogous cases are recorded by La Motte, in his Traité des Accouchemens; by Mr. Carmichael, in the fifth volume of the Edinburgh Medical Commentaries; and by others, in the second volume of the Mem. de l’Acad. de Chirurgie. In appreciating the degree of danger attendant upon wounds of this description, the practitioner must not overlook the possible occurence of Tetanus.
Gun-shot wounds. Long after the invention of gunpowder, Surgeons continued to entertain very vague opinions respecting the nature of wounds produced by it; some considered that the injured parts were either dreadfully burnt by the heat of the projected body, or were irritated by the presence of poison, communicated to them by the powder. Thomas Gale, who served as a Surgeon in the army of Henry 8th, at Montreuil in 1554, was the first to refute the absurd opinions of “the poisoning, burning, and conquassation of gun-shot wounds.” A gun-shot wound is now defined “a violent contusion, with, or without a solution of continuity, suddenly and rapidly effected by a solid body projected from fire-arms.” If a musket or pistol ball has struck a fleshy part, without injuring any material blood-vessel, we see a hole about the size of, or smaller than the bullet itself; with a more or less discoloured lip forced inwards, and if it has passed through the parts, we find an everted edge, and a more ragged, and larger orifice at the point of its exit; the pain in this case is so inconsiderable that the wounded person is frequently not aware of his having received any injury. The course of balls is frequently most extraordinary, and it behoves the judicial surgeon to keep in mind a fact which may often throw considerable light upon the subject of his investigation. A ball will often strike the thorax or abdomen, and, to an inexperienced eye, appear to have passed directly across, or to be lodged in one of the cavities. If great difficulty of breathing or hemorrhage from the mouth, with sudden paleness and laborious pulse, in the one case, or deadly faintness, coldness of the extremities, and the discharge of stercoraceous matter from the wound, in the second, are not present, we shall perhaps find that the ball has coursed along under the integuments, and is marked in its progress either by a redness, which Mr. Hunter compared to a blush, or by a wheal, or dusky line, terminated by a tumour, on the opening which it will be easily extracted. In some of these long and circuitous routes of balls, where we have not this mark, a certain emphysematous crackling discovers their course, and leads to their detection. The ball is in many instances found very close to its point of entrance, having nearly completed the circuit of the body. In a case related by Dr. Hennen, as one that occurred to a friend of his in the Mediterranean, the ball, which struck about the Pomum Adami, was found lying in the very orifice at which it had entered, having gone completely round the neck, and being prevented from passing out by the elasticity and toughness of the skin which had confined it to this circular course. This circuitous route is a very frequent occurrence, particularly when balls strike the ribs, or abdominal muscles, for they are turned from the direct line by a very slight resistance indeed, although they will at times run along a continued surface, as the length of a bone, along a muscle, or a fascia, to a very extraordinary distance. If there is nothing to check its course, and if its momentum be very great, it is surprising what a variety of parts may be injured by a musket ball. Dr. Hennen states that in one instance, which occurred in a soldier, who having his arm extended in the act of endeavouring to climb up a scaling ladder, had the centre of his humerus pierced by a ball, which immediately passed along the limb, and over the posterior part of the thorax, coursed among the abdominal muscles, dipped deep through the glutæi, and presented on the fore part of the opposite thigh, about midway down. In another case, a ball which struck the breast of a man standing erect in the ranks lodged in the scrotum. The propensity of balls to take a curved direction is often seen in their course on a concave surface; in short, they take very unusual and deep-seated routes, not at all to be accounted for by any preconceived theories drawn from the doctrine of projectiles, nor to be explained by diagrams founded upon mathematical rules. These considerations ought to render the Surgeon very cautious how he delivers his opinion, as to the direction in which the shot was fired, and yet instances frequently occur where no difficulty can arise upon this point, such was the case of Richard Annesley, tried for the murder of Thomas Eglestone (9 Harg. Sta. Tri. 327). The deceased was a poacher. Annesley who was in company with the game-keeper, stated in his defence, that his gun had accidentally gone off in his attempt to secure the deceased. The instructions given by the Court on this occasion was that if the jury were of opinion that the gun had so gone off accidentally, they should bring in a verdict of Chance-medley, which was returned accordingly, in consequence of the evidence of the Surgeon who had examined the wound, and stated that its direction being upwards, very satisfactorily proved that the fowling-piece had not been levelled from the shoulder, which would have implied design; but must have been discharged at the trail, which must have been accidental.[[107]] An idea long existed that a ball might produce injury without striking any part of the body; this was supposed by some to arise from the violent commotion produced in the air by the rapid motion of the ball; and by others, to depend upon an electrical shock on the parts, in consequence of the ball being rendered electrical by friction in the calibre of the gun, and giving off the electrical matter as it passes by. This, however, is contrary to all our received notions respecting electricity; metals can never acquire such a property by friction.
In avowing our total disbelief in the existence of such wind-contusions, as they have been called, we are well aware that we shall oppose many very respectable authorities. “Amicus Plato, sed magis amica Veritas.”
An important question, connected with the present subject, still remains for elucidation; where a body has been found dead with wounds and contusions, by what signs we are to determine whether they were inflicted during life, or after death. As the solution of this interesting problem requires various data, its consideration will be reserved for that part of our work, where all the Objects of Inquiry, in cases of sudden and mysterious death, are considered in their various relations to each other, with a view to appreciate their individual and joint importance.