Bodily injury

“ In a healthy person the violence necessary to prove fatal ought to be greater than in one diseased, and pathological conditions may be found post-mortem, which were pre-existent to the injury, e.g. degeneration of blood-vessels, aneurysm, valvular disease of the heart, phthisical cavities which may have bled, gastric ulcer which may have ruptured. ”

“ 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 [601] 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. ”

“ Severe mechanical injury of a vital organ, such as crushing of the heart, lungs, brain, etc. This crushing may be accompanied by hemorrhage, but death may be more immediate than the hemorrhage would account for. The mechanical injury done to the vital centres in the medulla by the act of pithing is the direct cause of the sudden death which follows it. Exceptionally slight violence to a vital organ is fatal, but this may be better explained by attributing it to shock. ”

“ Similar internal lesions may be caused by the compression of the chest and body by the knee of a murderer, which may occasion rupture of the internal organs, fractures of ribs, etc. Thus, too, from the pressure of a crowd the ribs may be fractured and the lungs injured. It is particularly in these cases of injury from crushes or falls from a height that we may have most difficulty, as far as the medical evidence goes, of distinguishing between accident, suicide, and murder. ”

“ Wounds of the chest are dangerous, on account of the amount of the hæmorrhage which may take place, and the importance of the organs which may be injured. Death may result more from the mechanical action of the blood effused than from the depressing effect of the quantity evacuated. Penetrating wounds of the thorax injuring the lungs cause emphysema, pneumo-, pyo-, or hæmothorax, any of which may prove fatal; pleurisy and pneumonia may occur. A fracture of the ribs may give rise to injury of the lung substance or to inflammation of its coverings. ”

“ INCISED, PUNCTURED, AND CONTUSED WOUNDS OF THE EXTREMITIES.
These may be fatal if a large blood vessel or vessels are opened, or sometimes if a compound fracture or wound of a joint becomes infected. They may also in some cases be fatal from shock, from the severity of the injury. As a rule they are the cause of civil suits, not of criminal ones. The various injuries may cause disability for a longer or shorter time, or even permanently, and more or less deformity may also remain. ”

“ All wounds of the chest, though not involving bloodvessels of a large size, are productive of severe consequences—effusion of blood or bloody fluids into the cavities, escape of air into the external cellular tissue, collapse of the lung, and inflammation and its results, are always to be dreaded. The danger is not uniformly tantamount to the extent of injury inflicted. ”

“ A mortal wound is one which is rapidly followed by death. Wounds, however, which in themselves could not be regarded as dangerous to life, may become so by intercurrent complications, such as erysipelas or other infective process. As a general rule, only those wounds in which the danger to life is imminent should be stated as dangerous to life. Compound fracture of the bones of the cranium, injury to any large arterial trunk, or to any of the internal organs, may be considered as “dangerous to life” ”

“ You had no bones broken, but the injury to your muscles and ligaments was sufficient to kill a man only ordinarily strong, while the blows affecting your kidneys, liver and other internal organs were in themselves, without the bruising of all your surface, enough to cause death. ”

“ Severe blows, or contusions from falls or from the concussion of foreign bodies, may give rise not only to injury of the internal parts of the abdomen, followed by inflammation, but to rupture of the hollow as well as of the more solid and fixed viscera, and death. ”

“ 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. ”

“ The extraordinary effects produced on the internal organs by an extensive burn on the surface of the body, consisting in violent inflammation of the tissues of the abdomen, chest, or head, which, when death ensues from this kind of injury, is one of the most frequent causes of it ”

“ If the patient, after the external wound has healed, complains of a throbbing and roaring in his head, not merely in the region of the actual injury but involving the entire head, and if the symptoms tend rather to increase than to diminish, and eventually become so severe that the patient is almost beside himself with the pain, then is the surgeon justified in believing that a clot of blood is imprisoned somewhere beneath the cranium and is gradually being converted into an abscess or a condition of ulceration. ”

“ The horn, dirty with blood and animal excrement, often breaking into splinters at the blow, tore the flesh, scratched it, perforated it, making at once a deep penetrating injury and a bruised contusion, and yet these atrocious wounds healed with greater ease than those in ordinary life. ”

“ When an external injury is the cause, if an incision is made early in the diseased part, it will be found insensible, and nothing but extravasated blood will be discharged. In all cases of MORTIFICATION, the disease, with its concomitant symptoms, proceeds with a rapidity that sets every medical interposition {115} and exertion at defiance, till DEATH closes the scene. ”

“ Great swelling occurs almost immediately, attended with excruciating pain, and extends upward along the limb; vision becomes impaired, the patient lies in a state of stupor, and ultimately succumbs under convulsions and delirium; the symptoms vary in particular instances according to idiosyncrasies and the state of the constitution when the injury is inflicted.22 In this country, the bites of rabid animals are more dangerous than those of animals naturally poisonous. ”

“ The lesions or injuries of the body which form so prominent a part of disease vary in kind, degree and situation, depending upon the character of the injurious agent, the duration of its action and the character of the tissue affected. The most obvious injuries are those produced by violence. By a cut, blood vessels are severed, the relations of tissues disturbed, and at the gaping edges of the wound the tissue usually protected by the skin is exposed to the air, resulting in destruction of the cells contained in a thin layer of the surface. ”

“ BRUISES, or contusions, being frequently neglected at first, may produce consequences more alarming than those of wounds. Blows received on the head, pit of the stomach, hip, or the knee, are the most dangerous. A violent inflammation, in consequence of injured nerves, or the destruction of blood vessels, often occasions the mortification of those parts, which the most skilful treatment cannot retrieve, if the accident be neglected for many hours or days. ”

“ WOUNDS AND CONTUSED INJURIES OF THE ABDOMINAL WALL AND VISCERA.
Such wounds and injuries of the abdominal wall may be incised, punctured, or due to blunt instruments, etc. They are usually homicidal or accidental, seldom suicidal except in delirious patients or lunatics. The cause of death in such cases may be due to hemorrhage, shock, etc., or to secondary inflammation, which is especially likely to occur in penetrating wounds. The kind of weapon used may often be judged from the nature of the wound. ”

“ Shock.—An injury is often apparently not enough to account for the fatal result so speedily. The marks of external injury may fail entirely or be very trifling. Thus more than once persons have died in railway collisions with no external marks of violence. So, too, a blow on the upper abdomen, on the “pit of the stomach,” has been rapidly fatal without any visible injury to the viscera. Death is attributed to the effect on the cardiac plexus, and there may be no marks externally or only very superficial ones. ”

“ A Simple Wound is that which only opens the Flesh, and hath no other concomitant Circumstances; but a Complicated Wound, on the contrary, is that which is attended with grievous Symptoms, as Hæmorrhages, Fractures of Bones, Dislocation, Lameness, and others of the like Nature.
What is a dangerous and mortal Wound?
A dangerous Wound is that which is complicated the Accidents whereof are dreadful: As when an Artery is open'd or prick'd, when a Nerve or Tendon is cut, or when the Wound is near a Joynt and accompanied with a Dislocation or Fracture. ”

“ Such an accident is followed by rapid and great swelling, violent incited action, gangrene, and severe constitutional disturbance. The progress of the mortification is not in all cases uniform; in some, the swelling and discoloration extend to the groin and trunk in two or three days, attended with furious delirium; in others, the disorganisation of the limb is very slow, some days elapsing before it reaches the knee, and in these the constitutional symptoms are less severe.
In some cases there is extensive wound of the integuments, with584out serious injury of the bone, muscles, or vessels. ”

“ It may, I conceive, be truly said that, viewed in relation to an action for negligence, direct bodily impact is, without resulting damage, as insufficient a ground of legal claim as the infliction of fright. That fright—where physical injury is directly produced by it—cannot be a ground of action merely because of the absence of any accompanying impact appears to me to be a contention both unreasonable and contrary to the weight of authority. ”

“ If not soon relieved by such medical interposition as may be thought most applicable to the state he is in, great bodily debility speedily ensues, the frame gradually declines in flesh, and becomes emaciated, the skin adheres to the ribs, the solids begin to relax, the legs to swell; and if the blood and juices are not properly corrected, by a judicious mode of medical management, a general decay may be expelled in glanders, farcy, or some one of the diseases which terminate fatally. ”

“ In the latter case death may be due as much, if not more, to other causes than the wound, and sometimes not at all to the wound itself. Thus death may be due to natural causes, latent disease, an unhealthy state of the body, imprudence or neglect of treatment, or improper treatment, etc. These various degrees of responsibility of a wound as the cause of death we will now consider more at length. ”

“ Then, too, in the act of falling from the occurrence of a cerebral hemorrhage due to disease the head may be injured and show marks of violence. It should be borne in mind that an injury to the head may be inflicted when disease of the brain, vessels, or membranes already exists. In such a case a slight blow might cause extensive hemorrhage, but as that which accelerates causes, death, even though it might sooner or later have occurred in the same manner without injury, is due to the injury inflicted. ”

“ In anger the eyes are fiery and the pupils contracted; in modesty the cheeks are suffused with blushes; in fear, and under a sense of infamy and of shame, the face is pale, but the ears burn as if for the evil they heard or were to hear; in lust how quickly is the member distended with blood and erected! But, above all, and this is of the highest interest to the medical practitioner,—how speedily is pain relieved or removed by the detraction of blood, the application of cupping-glasses, or the compression of the artery which leads to a part? ”

“ Among the secondary causes of death may be mentioned septicæmia, pyæmia, erysipelas, tetanus, gangrene, that is, wound diseases, also the wound accident—as we may call delirium tremens, and surgical operations rendered necessary to the treatment of the case. ”

“ Let us suppose that a human body is wounded—that is, cut or torn by some outside agency. The tissues, lymphatic and blood vessels, glands, muscles, nerves, and sometimes even the bone, is severed, and the continuity interrupted. The wound bleeds, gapes and causes pain. The nerves carry the message to the brain, calling loudly for immediate help, and the Instinctive Mind sends messages here and there in the body, calling out a sufficient force of repair workmen, who are hurried to the scene of danger. ”

“ Still, people are bitten, and the location of the wound has much to do with the chances of recovery. About 60 per cent. of all persons wounded are struck on the lower limbs, thirty-five on the hand or arm, and five on the trunk and face. Of these, wounds on the lower limbs are the least dangerous and those on the trunk or face, being near large nerve and arterial vessels, most so.83 The more remote from the general circulation, the less danger from the wound. ”

“ The cases of injury to the small intestine are perhaps best arranged in three classes.
1. Those who died upon the field, or shortly after removal from it. In these the external wounds were often large, the omentum was not rarely prolapsed, and escape of fæces sometimes occurred early. Shock from the severity of the lesion, and hæmorrhage, were no doubt important factors in the early lethal issue in this class. Many of the injuries were no doubt produced by bullets striking irregularly, by ricochets, by bullets of the expanding forms, or by bullets of large calibre. ”