THE

MEDICO-LEGAL CONSIDERATION

OF

WOUNDS,

INCLUDING

PUNCTURED AND INCISED WOUNDS, AND WOUNDS MADE BY BLUNT INSTRUMENTS OTHER

THAN GUNSHOT WOUNDS.

BY

GEORGE WOOLSEY, A.B., M.D.,

Professor of Anatomy and Clinical Surgery in the Medical Department of the University of the City of New York; Surgeon to Bellevue Hospital; Member Medical Society of the County of New York, New York Academy

of Medicine, New York Surgical Society, etc., etc.

WOUNDS.

GENERAL CONSIDERATIONS. THE DIFFERENT KINDS OF

WOUNDS.

THE surgical and medico-legal ideas of wounds are quite different, the latter including the former as well as other varieties of injuries.

Definitions.—Surgically a wound means a solution of continuity and refers to every such lesion produced by external violence or developing spontaneously. The medico-legal acceptation of the term is much broader and includes any injury or lesion caused by mechanical or chemical means. Vibert' quotes Foderé as defining a wound medico-legally as, “Every lesion of the human body by a violent cause of which the results are, singly or combined, concussion, contusion, puncture, incision, tear, burn, twist, fracture, luxation, etc.; whether the cause is directed against the body or the body against the cause." The same author quotes another definition of a wound as, "Every lesion however slight, resulting in concerning or affecting the body or health of an individual." Taylor" defines a wound in a medico-legal sense as "a breach of continuity in the structures of the body whether external or internal, suddenly occasioned by mechanical violence." Thus, the term wound in its medico-legal acceptation includes not only surgical wounds but contusions, fractures, burns, concussion, etc. In France at least the voluntary inoculation of syphilis has been considered as coming under the category of wounds."

Medico-legally, the severity of a wound is much more important than the kind of wound. Thus we may consider wounds according to their comparative gravity, as mortal, severe, or slight.

1"Précis de Méd. Lég.," 2d Ed., 1890.

2"Med. Jurisprud.," 11th Amer. Ed., 1892.

Arrêt du tribunal de Lyon, 8 et 15 décembre, 1859.

A mortal wound is one which is directly fatal to life in a comparatively short time, usually from hemorrhage, shock, or the injury of a vital part. A wound may result fatally without being a mortal wound, as when a slight wound causes death on account of some wound infection.

Severe wounds, or "wounds causing grievous bodily harm," as they have long been called, do not put life in imminent danger, though they may be inconvenient or detrimental to health. Pollock, C. B., says that a wound causing grievous bodily harm is "any wound requiring treatment."

A medical opinion or certificate may be required as to the danger of a given wound, and on this opinion may depend the question of bail for the prisoner. By the danger of a wound in such a case is usually meant imminent danger, as any wound may be remotely dangerous to life.

Slight wounds, as already stated, may result fatally under certain conditions. Under the French practice a slight wound is one which does not incapacitate one from work for more than twenty days. Looked at in another way, slight or severe wounds may be classified according as they are completely curable, leaving no infirmity or disturbance of function, or not completely curable. The latter are such as are necessarily followed by permanent or temporary infirmity.

The question as to the severity of any given wound may sometimes be left to the jury to decide from the description of the wound, or a medical opinion may be required.

Although the intent of the assailant is often of equal or greater importance than the severity or kind of wound, yet this can only occasionally be inferred from the surgical aspects of the wound.

The classes of wounds to be treated in the following pages are incised and punctured wounds and wounds with blunt instruments, some of the characteristics of which we will now consider.

Incised wounds are such as are produced by a cutting instrument, and they are distinguished by the following characteristics: They measure more in length than in the other dimensions. They are usually straight in direction, though not infrequently curved, and they may even be zig-zag, especially where the skin lies in folds. The edges of an incised

INCISED WOUNDS.

461 wound are linear, and show no signs of contusion. They are either inverted or everted and the edges and sides of the wound are retracted. The eversion of the skin is due to its elasticity, but in some regions of the body, e.g., in the scrotum, etc., the skin is inverted owing to the contraction of the muscle fibres immediately beneath. The gaping of the wound is due to the retraction of the divided muscles and fibrous structures. It varies according as the muscles are cut directly across or more lengthwise, and in proportion to the distance of the wound from the points of attachment of the muscles.

The fibrous tissues, fascia, and aponeuroses retract less, and so give a somewhat irregular surface to a large wound.

Ogston' divides incised wounds into three parts, the commencement, centre, and end, of which the end often has two or more serrations differing from the commencement, which has but a single point. There are often one or more slight, superficial, tentative incisions situated almost always, though not invariably, near the commencement. The deepest part of the wound is more often near the commencement. If there are angular flaps on the edges their free angles point to the commencement of the wound.

Coagula and clots of blood are to be found in the wound, more or less filling it up if it has not been interfered with. On examination the ends of the divided vessels are found plugged with clots which may protrude somewhat from their openings.

If the wound is seen very shortly after its infliction, hemorrhage is in progress, and the divided arteries show their position by their individual, intermittent jets of blood. The sever

ity of incised wounds depends upon the amount of hemorrhage, which is greater the deeper and larger the wound, and the more vascular the tissues in which it occurs, especially if large and important vessels are concerned. In the latter case an incised wound may be very rapidly fatal.

Incised wounds present the least favorable conditions for the spontaneous arrest of hemorrhage of any form of wounds. The edges of an incised wound may be quite rough and even dentated or lacerated if the edge of the weapon be rough and irregular. The kind and condition of a weapon which has produced a Lectures on Med. Jurisprud.," See Figs. 10 and 11.

1878, pp. 422, 423.