Physical injury

“ 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. ”

“ 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. ”

“ 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. ”

“ When the soft parts only were affected, even high velocity did not produce much effect; but when to a flesh wound a severe bone fracture or injury to any part of the nervous system was added, shock might be severe or profound. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ This would include dislocations, fractures, either simple or compound, injury to the skin or mucous membrane, and to internal organs. Burns and injuries due to the action of corrosives are excluded from the category of wounds.
Concerning Wounds in general.—Great care must be taken to ascertain the exact site and course of the injury on the body, as this precaution will greatly assist in answering the questions: Is the wound dangerous to life? Does it cause grievous bodily harm? Is it suicidal, that is, inflicted by the person on himself ”

“ 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 ”

“ Let patient lie flat and swallow small pieces of ice, and also take one-quarter teaspoonful of table salt in half a glass of cold water.
BRUISE.
First Aid Rule 1.—Bandage from tips of fingers, or from toes, making same pressure with bandage all the way up as you do over the injury.
Rule 2.—Apply heat through the bandage, over the injury, with hot-water bottles.
Cause, Etc.—A bruise is a hidden wound; the skin is not broken. It is an injury caused by a blunt body so that, while the tougher skin remains intact, the parts beneath are torn and crushed to a greater or lesser extent. ”

“ 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.—A wound is a condition produced by a forcible cutting, contusing, or tearing of the tissues of the body, and includes, in its larger sense, bruises, sprains, dislocations, and breaks or fractures of bones. As ordinarily used, a wound is an injury produced by forcible separation of the skin or mucous membrane, with more or less injury to the underlying parts. ”

“ It is a well-known fact that it is much more difficult to produce a fracture in a dead than a living body (see Wounds, Vol. II., p. 482 et seq.) .
(6) The temperature of the body should be taken.
(7) The rigidity and flexibility of the extremities should be ascertained.
(8) The state of the eyes should be noticed, and the relative size of the pupils.
(9) Attention should be paid to the condition of the cavities of the mouth and nose. The neck should be specially examined for marks of external injury, or signs of ecchymosis or compression. ”

“ Pain.—As an initial symptom the occurrence of pain varied greatly with the idiosyncrasy of the patient, and according to the circumstances under which the wound was received. Some individuals are remarkably insensitive, and in these the fact of a wound being a gunshot injury in no way altered their habitual insensibility, but in persons of what may be termed the normal type in this particular great differences were observed. ”

“ Fractures.—If there are any evidences of fractures, the situation of the bones involved should be noted, and whether they are accompanied by contusions of the soft parts. Fractures which are inflicted during life are always accompanied by much more extravasation of blood, more injury to the soft parts, and more evidences of reaction than those occurring after death. ”

“ 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. ”

“ Yet I saw as many instances of fractured limbs, hernia, and other accidents there, as I ever saw on the earth; for when they fall from great heights, or miscarry in the feats of activity which they ambitiously attempt, it inflicts the same injury upon them, as a fall nearer the ground does upon us. ”

“ 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. ”

“ Still, the man of big swelling words is not always up in the clouds. If called to a case of accident, he examines the injury, and may inform the family in quite a simple and dignified manner that their father was thrown sidewise from his carriage breaking his leg and putting his ankle out of joint, but if he writes out the case for his medical journal, he gets up straightway on his stilts and says, “The patient was projected transversely from his vehicle, fracturing the tibia and fibula and luxating the tibio-tarsal articulation.” ”

“ In this way one may be propelled several feet, and many varieties of surgical injury may be caused. Rarely the force of the contraction is such as of itself to rupture muscles or tendons, and it might even fracture bones or dislocate joints already predisposed. ”

“ You know that you can produce wounds upon the body of the hypnotised patient, in a state of trance. By suggestion lesions are made, burns are caused, inflammation and pain appear by the mere suggestion of a wound. ”

“ However, that every objective permanent injury results in substantial loss of a bodily function does not follow. An easy example is a completely healed fracture without any objective evidence of permanent substantial impairment. ”

“ Yet others, with deep, gaping wounds, in which inflammation had already set in, were delirious from their pain, and implored that they might be put out of their misery, and with drawn faces twisted themselves into indescribable positions in their supreme agony. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Depressed fractures either result from injury received during the birth of the child—whether from forceps delivery or from the pressure exerted on the head by a contracted pelvis—or from blows received shortly after birth. ”

“ Sometimes, as when a large flap has been detached, and the parts not much injured otherwise, approximation176 ought to be accomplished, for the reasons already mentioned. In almost all cases, and most certainly in those in which the mechanical injury has been severe, and its effects extensive, violent inflammatory action is to be dreaded, and measures must be taken to ward it off: notwithstanding the prophylactic treatment, violent inflammation often comes on, and then recourse must be had to the means proper for the subduing of it. ”

“ If a fracture, then, occur in the head, it is discovered by the sharpness, weight, hardness, or violent force of the body which struck it, and by the symptoms which supervene upon the person who has been struck, such as vertigo, loss of speech, and sudden prostration, more particularly if it be a fracture with depression, or contusion, or expression, or the internally-arched fracture, owing to the compression of the brain. ”

“ Concussion, complicated by the symptoms of compression, 298. followed by mania, 300. Illustrative of the after-effects of concussion, 301. Fatal paralysis, caused by compression of the brain, 307. Illustrative of the different forms of paralysis following compression or irritation of the brain, 309. Fracture of the skull without depression, 311. Fracture of the skull, with injury to the middle meningeal artery, 315. Fracture of the base of the cranium, 317. Fracture of the inner table of the skull, without injury to the outer plate of bone, 322. ”

“ The wounds which seem like real wounds, the color of the skin, the contraction of the face, the attitude, the expression,—each thing is terribly real. If you touched the body, you would expect to feel the tremor of the limbs and the warmth of the blood. ”

“ If one must suffer, he may assuage his pain by bearing it bravely. The over-tending of a wound may produce worst consequences. Exposure to the air, frequent ablutions, occasional frictions, create healing processes, reduce sensitiveness, and restore somewhat of the old life and vigor. ”

“ 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. ”

“ 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? ”