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BLOOD-STAINS ON CLOTHING.

the blood-corpuscles, and chemistry does not enable us to apply any so as to make a satisfactory distinction between them. In this defici of microscopical and chemical evidence, an attempt has been made to tablish a distinction by noticing the physical appearance of the b stains. Thus, it is alleged, the arterial blood will be indicated by its be sprinkled over surfaces upon which it has fallen, while the venous b is always poured out in a full stream. In most wounds which prove f by hemorrhage, the blood is poured out simultaneously from arteries veins. The sprinkled appearance of the blood, when it exists, will, cat paribus, create a strong presumption that it was poured out from living body-for after the heart has ceased to act, the arteries lose power of throwing out the blood in jets. The sprinkling is usu observed when the wounded artery is small, and the blood is effused a distance. This is a fact which a medical jurist should not overl although, for the reasons stated, too great a reliance must not be pla on it. The spots of blood, if thrown out from a living bloodve speedily consolidate, and the fibrin, with the greater portion of the co ing matter, is found of a deep-red color at the lower part of the spot, upper portion being of a pale red. The lower and thicker part has c monly a shining lustre, as if gummed, when the spot is recent, and w it has been effused upon a non-absorbent surface.

When blood falls upon porous articles of clothing, it is often absor and produces dull stains. In dark-colored articles of dress, it is someti difficult by daylight to perceive these stains. The part appears stiffen and has a dull red-brown color, which is sometimes more perceptible wi seen by the reflection of the light of a candle. In trusting to the coa lation of the sprinkled blood as evidence of its escape from a living ves it must be remembered that three hours may elapse before it coagulate: the healthy body after death. Hence blood which has escaped from recently dead body, although it would not be found diffused as if spurting, might, in so far as coagulation is concerned, assume the appe ance of having been effused from a living body.

In spite of the great advances made in the construction and use of microscope, there is no method known by which the blood of a man be distinguished from that of a woman, or the blood of a child from that an adult. The blood of a child at birth forms a thinner and softer coa lum than that of the adult. A medico-legal question has arisen, on m than one occasion, as to whether there were any means of distinguishi menstrual blood from that of the body generally. This liquid contai fibrin, although the proportion is less than in venous or arterial blood, r coloring matter, and the other constituents of blood. The only differen noticed are of an accidental kind: First, that it is acid, owing to its admi ture with vaginal mucus; and, second, that under the microscope it mixed with epithelial scales, which it has derived from the mucous mer brane in its passage through the vagina. In the bodies of women w had died suddenly while menstruating, Webber found coagulated blo upon the uterine mucous membrane. If, therefore, menstrual blood de not coagulate, it is simply because it has already coagulated within t uterine cavity, and cannot do so again; it is more fluid than ordina blood, because during its trickling descent it becomes mixed with water uterine and vaginal mucus. (Schmidt's Jahrb., 1849, 7, 139.) A ca occurred in France, which induced the Minister of Justice to refer the co sideration of this question to the Academy of Medicine. The reporter Adelon, Moreau, and Le Canu, came to the conclusion that there were means of distinguishing menstrual blood dried on clothing from that whi

WOUNDS-CAUSE OF DEATH.

285

might be met with in a case of infanticide or abortion. (Ann. d'Hyg., 1846, t. 1, p. 181)

For a very full description of the methods to be adopted in the examitation of supposed blood-stains under various circumstances, the reader is rred to a memoir by Dragendorff. (Maschka's Handb. der Gerichtl. lied, bd i. p. 481, et seq.)

CHAPTER XXVIII.

COOPER MEDICAL

COLLEGE

San

Francisco.

Cal

THE CAUSE OF DEATH FROM WOUNDS.-WOUNDS DIRECTLY OR INDIRECTLY FATAL.-DEATH FROM HEMORRHAGE.-INTERNAL BLEEDING.-DEATH FROM MECHANICAL INJURY FROM FROM NUMEROUS PERSONAL INJURIES, IRRESPECTIVE OF ANY MORTAL

SHOCK.-DEATH

Ir is important for a medical witness to bear in mind that, in all cases of Wounds criminally inflicted, the cause of death must be certain. No man is ever convicted upon mere medical probability. In general, there is only o real cause of death, although other circumstances may have assisted in bringing about a fatal result. Thus a person cannot die of disease in the bowels and a stab in the chest at the same time, nor of apoplexy from disease and compression of the spinal marrow at the same instant. Hence is our duty, when several apparent causes for death exist, to determine which was the real cause; and, in stating it to the court, to be prepared to offer our reasons for this opinion. In most cases of local injury, when A person dies speedily, there will be no great trouble in settling whether hase or the injury was the cause. A difficulty may, however, exist. when a person has recovered from the first effects of a wound, and has sequently died. Besides, there may be cases in which the cause of death, in spite of the most careful deliberation, will be still obscure; or Sometimes it may happen that the death of a person appears to be as much dependent on bodily disease as on an injury proved to have been received the time he was laboring under the disease

Sometimes death is due to want of medical skill, or, worse, wrong treatment by attending physicians. The case of James Fisk, Jr., presented a notable case of this character. Modern surgery would have had Lo serious obstacle in treating the wound (gunshot wound of the abdoLeb), then by many regarded as fatal. Had Dr. James R. Wood, the Cuiuent surgeon, who was sworn on the trial as an expert in the case, a in charge, he would have had no serious difficulty in securing a re

every

The monograph of Dr. Eugene Perugnet, read before the Medico-Legal Sciety of New York, demonstrated that the death was directly due to ea, caused by large doses of morphia. The bullet might have caused 4th, but for want of proper surgical treatment the morphia interposed, and actually caused the death: Series 2, Medico-Legal Papers, p. 294. The case of President Garfield presents similar considerations and reflections. Did he die from the bullet of the assassin, or was his death due to other causes!]

How is an opinion to be expressed in such a case? The course that a medical witness ought to pursue, provided he has duly deliberated on the circumstances before he appears in court, and his mind is equally balanced

286

WOUNDS-DEATH FROM HEMORRHAGE.

between the two causes, is to state at once his doubt to the jury wit circumlocution, and not allow it to be extracted from him in cross-ex nation. It is the hesitation to assign a satisfactory cause, or the assig of many causes for death, that gives such advantage to a prisoner's even when the general evidence is entirely against him. Occasion several causes of death are vaguely assigned by a medical witness, an which some have a tendency to exculpate, and others to inculpat accused person in a greater or less degree, and it is left to the jury to s from the number one upon which to found a verdict. In a case of kind an acquittal is commonly obtained.

Wounds Directly or Indirectly Fatal.-A wound may cause d either directly or indirectly. A wound operates as a direct cause of a when the wounded person dies either immediately, or very soon afte infliction, and there is no other cause, internally or externally, to ace for death. In wounds which cause death indirectly, it is assumed the person survives for a certain period, and that the wound is follo by inflammation, suppuration, pyæmia, gangrene, tetanus, erysipela some other mortal disease which is a direct, and not an unusual, co quence of the injury. Under this head may be also placed all those which prove fatal by reason of surgical operations rendered imperati necessary for the treatment of an injury-presuming that these operat have been performed with ordinary skill and care. We shall for present consider only the direct causes of death in cases of wounds. T are three in number: 1. Hemorrhage, or loss of blood. 2. Great chanical injury done to an organ important to life. 3. Shock, or con sion, affecting the nervous centres, whereby the functions of one or m vital organs are arrested, sometimes with but slight injury to the struck or wounded. From any one of these causes a wounded person die immediately or within a few minutes.

1. Death from Hemorrhage.-Loss of blood operates by produ fatal syncope (p. 63). A quantity of blood escaping from a ve although insufficient to cause death by affecting the heart and circulat may readily destroy life by disturbing the functions of the organ or into which it is effused. Thus a small quantity effused in or upon substance of the brain, or at its base, may prove fatal by inducing compression; and, again, if in a case of wounded throat blood should into the windpipe, it may cause death by asphyxia; i. e., by stopping respiratory process (p. 63). In these cases it is obvious that the bl acts mechanically; and in respect to the last condition a medical n unless circumspection is used, may involve himself in a charge of m praxis. If he allows the wound to remain open, the wounded person may through hemorrhage; if he closes it too soon, the person may die thro suffocation; and, in either case, the counsel for a prisoner will not fail take advantage of a plausible objection of this kind. In wounds of chest, involving the heart and lungs, death is frequently due, not so m to the actual quantity of blood effused, as to the pressure which it duces upon these organs. A few ounces effused in the cavity of the enclosing the heart (pericardium) will entirely arrest the action of

organ.

The absolute quantity of blood required to be lost in order to pr fatal, will, of course, vary according to numerous circumstances. young, the aged, and those who are laboring under infirmity or dise will perish sooner from loss of blood than others who are healthy & vigorous. Women, cæteris paribus, are more speedily destroyed bleeding than men. Infants are liable to die from this cause, as a res

DEATH FROM INTERNAL HEMORRHAGE.

287

fight wounds. An infant has been known to bleed to death from the te of a single leech, or from the simple operation of lancing the gums. Even the healthy and vigorous, when their vital powers have been depressed by maltreatment or by brutal violence, will sink under the loss of a comparatively small quantity of blood. A medical jurist must not forget. that some persons have a predisposition to excessive bleeding from slight juries; and this condition is often hereditary. The slightest wound or puncture-the bite of a leech or the extraction of a tooth-will be attended with a loss of blood which cannot be arrested, and which will slowly lead death by exhaustion. Cases have been frequently recorded of fatal hemorrhage following the extraction of teeth, when there had been preYously nothing to indicate the probable occurrence of death from so rivial a cause. Such cases are without difficulty detected; since a surgeon may always infer from the part injured and the extent of the injury Whether the bleeding is likely to be copious or not. When a person bleeds to death from what would, under common circumstances, be a simple wound, the admission of this fact may in certain cases lessen the responility of an accused party.

A sudden loss of blood has a much more serious consequence than the same quantity lost slowly. A person may fall into a fatal swoon from a quantity of blood lost in a few seconds, which he would have been able to war without sinking had it escaped slowly. This is the reason why the wound of an artery proves so much more rapidly fatal than that of a vein. Death speedily follows the wound of a large artery like the carotid; but it takes place with equal certainty, although more slowly, from wounds. of smaller arteries. In a case in which one of the intercostal arteries was wounded by a small shot, hemorrhage caused death in thirty-eight hours. The loss of blood which follows the division of the smaller branches of the external carotid artery is often sufficient to destroy life, unless timely assistance be rendered. If a wound is in a vascular part, although no Vessel of any importance be divided, the person may still die from bleedit. It is difficult to say what quantity of blood should be lost in order Lat a wound may prove fatal. The whole quantity contained in the body of an adult is estimated at about one-thirteenth of its weight—i. e., about twelve pounds (Halliburton's Text-Book of Chem. Physiol., p. 220); of this, one-fourth is considered to be distributed in the heart, lungs, large arteries, and veins. In various animals the proportion of the weight of the blood to that of the body has been found to vary considerably and probably this holds good for man also, within certain limits. According to Watson, the loss of from five to eight pounds is sufficient to prove fatal to adults. But while this may be near the truth, many persons will die from a much smaller quantity; the rapidity with which the effusion takes place having a considerable influence, as well as the age, sex, and bodily Condition of the wounded person. It has been found by experiment that a dog cannot bear the loss of more blood than is equivalent to one-twelfth part of the weight of its body.

Internal Hemorrhage. Hemorrhage may prove fatal, although the blood does not visibly escape from the body. In incised wounds, the How externally is commonly abundant; but in contused, punctured, and gunshot wounds the effusion may take place internally, and rapidly cause Geath. In severe contusions, or contused wounds, involving highly vascu ar parts, the effusion may go on to an extent to prove fatal, either in the ravities of the body or throughout the cellular membrane and parts adja est; several pounds of blood may thus be slowly or rapidly effused. The most fatal internal hemorrhages are those which follow ruptures of the

288

DEATH FROM MECHANICAL INJURY-SHOCK.

organs from violence or disease. Ruptures of the heart, lungs, liver, a kidneys have thus caused death. In Nov. 1864, a man who had be run over was brought to Guy's Hospital. He complained of pain in back, but there were no symptoms of severe injury, and no marks of y lence were seen on the skin of the back. He left the hospital, and wall with some assistance to his home. A few hours afterwards he was fou dead in bed. On inspection there was a large quantity of blood effus in the abdomen. This had proceeded from one kidney, which had be ruptured transversely through its whole substance. In these cases bleeding is not necessarily immediate; but slight muscular exertion m increase it and accelerate death. In death from severe flagellation, bl may be effused in large quantity beneath the skin and among the muscl this effusion will operate as fatally as if it had flowed from an open wou The means of ascertaining whether a person has died from bleeding an open wound are these: Unless the wound is situated in a vascular pa we shall find the vessel or vessels from which the blood has issued, divide the neighboring vessels empty, and the body more or less pallid; althou this last condition is, of course, liable to be met with in certain cases disease, as also under copious venesection-points easily determined an examination.. The blood will commonly be found more or less clott or coagulated on those surfaces on which it has fallen. If, with the signs, there is an absence of disease likely to prove rapidly fatal, and other probable cause of death is apparent, this may be fairly referred loss of blood. This opinion may, however, le materially modified reference to open wounds, by the fact of the body not being seen on t spot where the injury was actually inflicted, by the wound having be sponged, the blood removed by washing, and all traces of bleeding stroyed. Under these circumstances, the case must in a great measure made out by presumptive proof; and here a medical witness may ha the duty thrown upon him of examining articles of dress, furniture, weapons, for marks or stains of blood. It must not be supposed that the blood met with round a wounded dead body, or in a cavity of t body, was actually effused during life. As soon as the heart's acti ceases, the arteries pour out no more; but the blood, so long as it remai liquid, i. e., from four to eight or ten hours after death, and the warmth the body is retained, continues to drain from the divided veins and small vessels. The quantity thus lost, however, is not considerable, unless t veins implicated are large, or the part is highly vascular, 2. e., full of vei or small vessels.

2. Death from Great Mechanical Injury done to a Vital Organ.have instances of this becoming a direct cause of death in the crushing the heart, lungs or brain, by any heavy body passing over or falling the cavities, as in railway accidents. The severe mechanical injury sometimes accompanied by a considerable effusion of blood, so that t person really dies from hemorrhage but in other instances the quanti of blood lost is inconsiderable, and the fatal effects may be referred shock to the nervous system. Sometimes a slight amount of violen may prove suddenly fatal. These are, however, to be regarded as exce tional instances.

3. Death from Shock. This is sometimes a direct cause of death und the infliction of external violence; and in this case life is destroyed wit out the injury being to all appearance sufficient to account for so speedil fatal a result. On several occasions persons have died in railway col sions from no physical injury, but purely from shock to the system. a collision, which took place in 1873 at the Durham station, a Mrs. Cobl