Medical Jurisprudence, Forensic medicine and Toxicology. Vol. 1

by R. A. Witthaus; Tracy C. Becker

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.