Medical Jurisprudence, Forensic medicine and Toxicology. Vol. 1

by R. A. Witthaus; Tracy C. Becker

(6) The sides of the wound do not gape and their surfaces are smooth and even, as the tissues are not unevenly retracted.

Résumé.—It is very easy from the foregoing to distinguish between a wound inflicted before death and one ten or twelve hours after death.

If the hemorrhage has been abundant and arterial, if it has infiltrated between and deeply stained the tissues and the stain cannot readily be washed off; if the blood coagulates completely and the coagula are firm and are found lying in the wound, plugging the vessels, and incorporated with the tissues between which they lie; if the edges of the skin are everted and the sides of the wound are retracted and uneven—under these circumstances, we may be sure that the wound was inflicted during life or a very short time after death. If, on the contrary, the hemorrhage is slight in amount or almost fails altogether; if it is venous in character; if the edges of the wound are only stained by imbibition of the blood, which is not infiltrated between the tissues, and the stain may be washed off; if the blood is not at all or only slightly clotted and the clots are soft; if the skin is not everted and the sides of the wound are smooth and lie nearly in contact; if there are no clots plugging the divided arteries on the surface—then we need have little hesitancy in saying that the wound was produced after death, but probably not later than ten or twelve hours after death. If the wound was inflicted still longer after death and before putrefaction, then we would have a lack of the signs due to hemorrhage, clots, staining, etc. If we find the conditions more or less midway between the first two, we may be left in some doubt as to the date of the injury. Thus if the hemorrhage is moderate, the blood mostly but not altogether clotted and the clots moderately firm, the skin slightly everted, and the sides slightly separated and not altogether smooth on their surface; if the surfaces are fairly deeply stained and the stain cannot be easily washed off—then we can only say that the wound was inflicted during life or within two hours or so after death, and this fact is often enough for the purposes of the medico-legal inquiry.

The same is the case with contusions where there is no bleeding externally. If we have a bluish, violet, green, or yellow tumor with or without more or less superficial œdema; if this tumor fluctuates or is hard, but in either case is elastic; if on incision the skin and the tissue spaces are infiltrated with blood which is coagulated, or if there is a cavity filled with clotted blood, the coagulum being firm and the entire amount of blood coagulated—then the wound was inflicted during life. If, however, the surface shows a bluish or violet color, little or no swelling of the skin, which is of natural thickness, and the ecchymosed area is not tense and elastic to the touch; if further the blood is found on incision to be fluid or if coagulated only partly so, and the blood is not infiltrated into the tissue spaces, but merely imbibed by the tissues—then the blow was inflicted after death, and probably more than two or three hours after.

In contusions especially we may have difficulty, as the sign of fluidity of the blood may fail and putrefaction may modify the conditions of the wound unless parts deep beneath the surface be examined.

We see, then, that in some cases it is very easy to say that a wound was inflicted post mortem. If a wound was not inflicted until ten or twelve hours after death or even sooner, we cannot easily mistake it. But in many cases it may be hard or impossible to say whether a wound was inflicted during life or within an hour or two after death. Here we must be cautious in expressing an opinion which should be guarded. But we should remember that it is important to be able to state that a wound was inflicted before or immediately after death, as no one but a murderer would think of inflicting a fatal injury on a body immediately after death. In such cases a well-guarded medical opinion may often meet all the requirements of the case.

Granted that a given wound was produced before death. There are, then, one or two questions which may arise, and which depend for their answer on the length of time the wounded person could have lived and the physiological or muscular acts which he could have performed after receiving the injury and before death. The first of these questions may be expressed as follows:

Could the Victim have Performed Certain Acts after having Received his Fatal Injury? The term “certain acts” here refers to almost any thing or things which would require time and strength—in other words, the continuance of life with bodily and mental powers for a certain time after receiving a mortal injury.

This question may be raised in relation to an attempted alibi of the accused, who may have been proved to be in the presence of the victim a moment before death. If after this moment the victim has moved from the spot or performed certain acts before death, the attempted alibi may depend upon the answer to the question as to whether the given acts of the victim were compatible with the fatal character of the wound. An alibi can aid in the acquittal of the accused only when the nature of the injury was such that death would be supposed to be immediate or nearly so. Great care should be taken on the part of the medical witness in answering this question, for after very grave wounds, proving speedily fatal, the victim sometimes can do certain acts requiring more or less prolonged effort, as shown by numerous examples. Wounds of the brain are especially noticeable in allowing a survival of several hours, days, or even weeks, during which time the injured person may pursue his occupations. Where the survival has lasted days or weeks, the alibi has no importance, but not if the survival is of shorter duration. The following case is cited by Vibert[1] and may be mentioned in this connection, though the wound was caused by a bullet which traversed from behind forward the entire left lobe of the brain. After the injury the victim was seen by several witnesses to climb a ladder, though with difficulty, for he had right-sided hemiplegia. He was found insensible more than half a mile away, and did not die until six or eight hours after the injury. Severe injury of important organs is sometimes not incompatible with an unexpectedly long survival. Devergie cites two illustrations of this which are quoted by Vibert.[622] A man received several extensive fractures of the skull, with abundant subdural hemorrhage, and rupture of the diaphragm with hernia of the stomach. The stomach was ruptured, and nearly a litre of its contents was contained in the left pleural cavity. Notwithstanding all this, he was able to walk about for an hour or so and answer several questions. He died only after several hours. Another man, crushed by a carriage, received a large rupture of the diaphragm, complete rupture of the jejunum, and rupture and crushing of one kidney. Yet he walked nearly five miles, and did not die until the next day.