II. Was the Wound the Cause of Death Necessarily?
This brings up a number of interesting questions to be considered. In medical jurisprudence there is probably no condition so common as that the injury is admitted, but death is attributed to some other cause. Thus if there are several wounds it may be hard to decide on the relative degree of mortality of any particular one, so as to be able to say that death was directly or necessarily due to this or that one. The defence may plead that death was not necessarily due to the particular wound attributed to the prisoner. This brings up the question—
Which of two or more Wounds was the Cause of Death? No general rule can be laid down for all cases, but each case must be judged by itself. Another way of putting the question is: “Which of two or more wounds was mortal?” The questions are not quite synonymous, for two or more of the wounds might be “mortal” but not equally the cause of death. In fact, as we have already seen, no one of the wounds if they are multiple may be of itself mortal, but taken together they are so. Consequently we will suppose that there are but two wounds, and not multiple ones, and the question remains which of these wounds was the cause of death. A wound may be said to be of itself mortal when it is the cause of death directly or indirectly in spite of the best medical assistance. In some continental states mortal wounds are divided into two classes, those absolutely and those conditionally mortal, the former including those in which the best medical assistance is at hand, sent for or timely rendered without everting the result. The mortal result in the second class is conditional on want of treatment, improper treatment, or accidental circumstances. As Taylor says, it is better to look at the effect of the wound and the intent of the assailant, as is done in English law, rather than at accidental relations of the wound.
To return to the question, we can readily imagine that a man may receive two wounds at different times or from different persons, and die after the second wound. Taylor[629] mentions the following case in which the question arose as to which of two injuries caused death: In Reg. v. Foreman (C.C.C. February, 1873) the prisoner had struck the deceased some severe blows on the head. A fortnight later, having partially recovered, another man gave him some severe blows on the head. A fortnight later still he had left hemiplegia, and died a few days later of a large abscess in the brain. The question arose which set of blows had been the cause of the abscess. The prisoner, the first assailant, was acquitted, as the deceased had had no serious symptoms until the second assault, and there was no satisfactory medical evidence as to the relation of the two assaults to the abscess formation. The same author also supposes the following case: A man having received a gunshot wound of the shoulder is doing well, when in another quarrel he receives a penetrating stab-wound of the thorax and abdomen. He dies after lingering for a time, under the effects of these wounds. If the wound of the shoulder could be proven to be the cause of death, the second assailant could not be convicted of manslaughter, and so too with the first assailant if it could be shown that the victim died of the stab-wound. It might be possible for a surgeon to decide the question definitely at once if death occurred soon after the stab, which was found to have penetrated the heart, a large blood-vessel, or one of the viscera; or, on the other hand, if the stab-wound was found to be superficial and not penetrating, and the wound in the shoulder had suppurated and caused septicæmia.
In either or any case, everything would depend upon the evidence furnished by the medical witness. His knowledge and judgment are required to distinguish the guilty from the innocent.
Again, sometimes death may appear to be equally the result of either or both wounds, in which case, as far as the medical evidence goes, both assailants would be liable to the charge of manslaughter. Or the second wound may be accidental or suicidal, and again the question would arise as to the cause of death. A case illustrating this is told by Taylor[630] substantially as follows: A grocer’s assistant pursued a thief, who had stolen from a cart, into a coal-shed, where he was stabbed twice in the abdomen. The larger wound suppurated, the smaller wound healed up, and the man died of peritonitis. On post-mortem examination the suppurating wound was found not to involve a vital part, while the small healed wound had wounded the liver and gall bladder and had set up the fatal peritonitis. The large suppurating wound had apparently been inflicted purposely; the fatal wound, directed upward and backward, might have been accidental by the deceased rushing upon the knife held more or less in self-defence. The case never came to trial, as the assailant was never found, but it can be readily imagined what complications might have arisen.
Furthermore, the wounded person may have taken poison or been subsequently ill-treated, and he may have died from these causes rather than the injury. But the question arises as to whether the wound was necessarily the cause of death. Here, in order to exculpate the assailant, the supervening disease or maltreatment must be such as to account for sudden or rapid death under the symptoms which actually preceded death.
Was Death Due to Natural Causes? Again, the injury may be admitted, but it may be claimed that death is due to natural causes. It is not unusual for wounded persons to die from natural causes, though the case may appear otherwise to laymen. This is often seen with suicidal wounds, especially those inflicted during the delirium of a disease, or the disease may supervene later and cause death without relation to the wound. Where the wound was inflicted by another, accurate discrimination is especially important in order to save the accused from imprisonment under false accusation and consequent loss of character. A careful examination is the only way to determine such cases, which depend therefore on the medical testimony.
Again, the question may arise as between DEATH FROM WOUNDS OR LATENT DISEASE, the wound perhaps being admitted, but death being attributed to latent disease. Here a close attention to symptoms and a careful post-mortem examination can alone decide. A man may die from the rupture of an aneurism, from an apoplexy or some other morbid condition after receiving a severe wound. Or a man with a hernia may receive a blow upon it causing a rupture of the contained intestine followed by peritonitis and death, or the recipient of a blow may have a calculus in the kidney which may perforate a blood-vessel or the kidney tissue and set up a fatal hemorrhage as the result of a blow.
Thus, medically speaking, the result of the injury is unusual and unexpected, and due to an abnormal or unhealthy state of body of the wounded person.