on the back of her head, on which at the time she wore a bonnet. She appeared stunned, was raised up by the man, some brandy was given to her, and she recovered sufficiently to walk home and eat her supper as usual, after which no one saw her until she was found dead in bed on the following morning. Some suspicion arose that the violence done to the head was too great to be accounted for by a mere fall, and it was a question whether, with such an amount of injury, the deceased could have walked to her home, a distance of a mile and a half, and have eaten her supper before going to bed. At first it was thought that it was a case of murder, and a man who lodged in the house with deceased was suspected. His room was searched, and a hammer with two claws was found. On comparing these claws with the two indentations and fracture, the medical witness thought that this weapon would at once account for their production. Deceased and this man had been in the habit of quarrelling, and they were the only persons in the house on this occasion. It was only at the adjourned inquest that the bonnet worn by the deceased at the time of the fall was called for by the coroner. Two indentations were then found upon the back part of it, corresponding to those on the skull of deceased. The indentations on the bonnet contained dust and dirt, thereby confirming the statements of the witnesses, and rendering it probable that the fall in the road had caused the fatal injury to the head.

The examination of the dress, in this case, cleared up what might have been otherwise doubtful. It is probable that the large internal effusion of blood which caused death did not take place until deceased had reached home, and perhaps as a result of the exertion made. She must have died very soon after she went to bed, as her body was found cold at seven o'clock the next morning. In addition to the caution which this case conveys respecting medical opinions on the origin of wounds, it shows that persons may walk and die at a considerable distance from the spot where serious injury to the head has been sustained.'

VOL. II.

D

CHAPTER XXVII

Distinction of homicidal, suicidal, and accidental wounds -Rules for investigating a case of death from violence -Examination of weapons-Causes of death from wounds-Medical responsibility in the treatment of wounds-Malapraxis.

IN order to arrive at a decision as to whether a wound is of homicidal, suicidal, or accidental origin, attention should be especially directed, and very careful consideration given, to the following particulars and details:

I. The situation of the wound.

II. The nature and extent of the wound. III. The direction of the wound.

I. The situation of the wound.-Wounds inflicted by a suicide are usually confined to the front or lateral parts of the body. If cutting implements are used by suicides, the wounds are generally found on the throat or chest. If wounds are suicidally inflicted by firearms, the chest, mouth, orbit, and temples are the parts to which the weapon is most frequently directed. Wounds, however, in any of these parts may be of homicidal origin, and, in fact, there is no wound which a suicide can inflict upon himself which may not be produced by a murderer. On the other hand, there are many wounds of homicidal origin which, from their situation, a suicide could not inflict upon his own person. So that the discovery of wounds on a part of the body difficult of access by the individual himself would not be suggestive of suicide. To this statement an exception must be made as regards the insane, who are known to destroy themselves by self-inflicted wounds

of the most astounding character, which may be confined to the back of the head and neck. An insane person has been known to shoot himself with a pistol fired from behind the ear. In the case of suicidal wounds inflicted with firearms, the fingers of the suicide are sometimes discoloured by the explosion of the powder. Wounds that are accidental or suicidal in origin are generally in exposed parts of the body; so that if a wound be found in a part of the body not easy of access, it may be presumptive of homicide. Again, an exception must be made to this statement as regards the insane.

II. The nature and extent of the wound. - Suicidal wounds are generally incised or punctured. With the exception of those cases in which persons commit suicide by throwing themselves from a height, contused wounds are rarely seen in cases of suicide, because, in inflicting them, there is not that certainty of speedy death which a suicide generally desires. To this exception must be made as regards the insane. In some cases of self-destruction by the insane, contused wounds have been produced by butting the head against a wall. Smith relates the case of a man who stood before a lookingglass, and then struck repeated blows on the top of his head with a hammer weighing nearly three pounds. An area three inches in diameter was divested of scalp, and a fracture of the skull two inches in diameter, with a depression of three-quarters of an inch, was produced, the bones being splintered around. It should be carefully borne in mind that the insane frequently inflict upon themselves wounds of so extraordinary a nature, as to lead occasionally, from a mere examination of them, to a suspicion of murder. An insane person has been known to tear open the abdomen with the hands, so as to cause the protrusion of several feet of intestines. An insane pregnant woman has ripped open the abdomen, so that the gravid uterus has protruded. Taylor and Stevenson 2 describe the case of an insane gentleman who was found lying in a state of insen

1 Med. Times and Gaz., 1878.

2 Med. Jurispr., vol. i.

1

sibility in the kitchen of his house, with a cleaver by his side. On examining the head, upwards of thirty wounds were found over the back part of the skull. The wounds, many of which were superficial, had a horizontal direction from behind forwards. One, however, had removed a portion of the skull from the middle of the lambdoidal suture, so that some of the brain had escaped. This person died four days afterwards, but recovered so far as to admit that he had produced the wounds on himself, of which, from other circumstances, there could have been no doubt. This was a most unusual way of committing suicide. A case of this kind should be borne in mind when a medical witness is called upon to speak to the possibility of certain wounds, found on a dead body, having been self-inflicted. Staples relates a case of remarkable self-inflicted injuries to the head. A man drove into his head two stone chisels, each eight and a quarter inches long and three-eighths of an inch in diameter, using for the purpose a wooden mallet. One of the chisels was driven through the head from right to left, entering in the right temporal region, and emerging on the left nearly in a direct line, the point projecting an inch and a half, the head of the chisel being close down to the scalp. The other chisel was driven into the centre of the forehead, and penetrated at least half an inch into the frontal lobe. After inflicting the injuries, the man, with the chisels in his head, approached and endeavoured to open a locked glass door, through which he was seen by two persons. When the door was broken open, he walked a distance of forty feet with but little aid, and was able to talk. The chisels were withdrawn with considerable difficulty, and he died about five hours afterwards. Such a case is an important one to remember, since, although repeated blows were struck on the head, and severe injuries were inflicted on the brain, yet the patient not only remained conscious, but was able to talk and walk. Stephens 2 records an unusual case of suicide, which in the absence of

1 Jour. Am. Med. Assoc., 1887.

2 Bristol Med. Chir. Jour., 1888.

witnesses to the act would have probably given rise to a suspicion of homicide:-A man suffering from melancholia (who not long before had been discharged from an asylum), whilst at work forging nails, made an iron rod, about two feet in length, white hot, and thrust it four or five inches into his abdomen; he died on the following day. Prall1 records the case of an Indian groom who committed suicide by stabbing himself in the abdomen, inflicting a wound about three inches in length; from this wound some of the small intestines protruded, and the man then had the determination to cut off three pieces of the gut, each about three inches long, and then to push back the remainder of the protruded gut into the abdominal cavity. Maschka 2 relates a case which is illustrative of the excessive violence that a lunatic may inflict upon himself. A male lunatic, aged fifty-one, who had partially recovered, was allowed the use of a knife for the purpose of cutting an apple. He was afterwards found bleeding profusely from no less than 285 punctured wounds, of which 200 were on the left half of the chest, 50 on the inner side of the left forearm, and 28 on the inner side of the right forearm. The left radial and ulnar arteries were divided. Six of the chest wounds penetrated the thorax, the left lung being compressed by blood collected in the pleural sac. The man survived nearly twentyfour hours, eventually dying from hæmorrhage. Mathie 3 relates a singular attempt at suicide, which, on first consideration, led him and Ashley Smith, who saw the case with him, to suspect attempted homicide. A man, aged fifty-eight, was found lying injured at the back door of the kitchen of his house. The forehead showed two ragged wounds, one extending two inches and a half from the root of the nose upwards, whilst, crossing this transversely, was another three inches long. The tissues round the wound were beaten to a pulp, and an area of bone, the size of a crown piece, was exposed. Two transverse fractures were visible on the exposed frontal bone. 2 Prag. Med. Wochenschr., 1888. 3 The Lancet, 1890.

The Lancet, 1894.