Gambar halaman
PDF
ePub

Tardieu, which was cured by belladonna pushed far enough to produce convulsions.

Though there are no laryngoscopic observations in these cases, their history would prevent their being confounded with other vocal troubles of hysteria or with "chorea laryngealis," so called. Their history corresponds so well with that of my case, in which I made numerous and complete laryngoscopic investigations, that it may be safely assumed that they also had no laryngeal derangements. It would be idle to theorize concerning these cases. We may believe with Jolly that "we have to do with a diseased reflex action, whose reflection takes place in the brain and whose cause is to be conjecturally sought for in a condition of exalted irritability of the sensory portion of that organ;" and meditate on the law of reflex action, according to which irritation of centripetal fibres in the central organs may be transferred to centrifugal fibres -motor, vaso-motor and secretory nerves-and exhibit their special action at the periphery.

[merged small][ocr errors][merged small]

BY W. P. STRICKLAND, A. M., LL. D.,

Professor of Medical Literature and Forensic Medicine in the Eclectic Medical College, of the City of New York.

(Continued from page 295, July, 1880.)

HOMICIDE.

In discussing the various forms of violent death, without regard to the facts as to whether they were accidental, suicidal or homicidal, we enter upon a wide range of subjects, such as wounds, the different forms of asphyxia, as in drowning, strangulation, hanging, cold, heat, starvation, death by lightning and poisons.

Such injuries as the above, when homicidal, are ranged under one or the other of the following categories, namely, wilful homicide or murder, culpable homicide or manslaughter, casual homicide and justifiable homicide. Murder implies the intentional infliction of mortal injury; culpable homicide the infliction of such an injury without the intention of killing, but with the design of doing some bodily injury, or by culpable negligence; casual homi

[ocr errors]

cide, where the injury, though not itself of a fatal character, has indirectly proved to be such; and lastly, justifiable homicide, the effect of such injuries inflicted in self defence.

The crime of murder in this country is classed under one or the other of two forms-murder in the first or second degree-the former being where the crime is intentional, or where it is committed in the perpetration of or an attempt to perpetrate burglary, arson, rape or robbery, or where it is by poison. When not falling under any of these heads, it is murder in the second degree. It is by the evidence of the medical jurist the jury are enabled to find out whether the injury sustained was one of a mortal character or had proved fatal from subsequent accident, or by previous or acquired disease, infirmity or improper treatment. Circumstances which may modify the legal character of a homicidal act are various. Among these may be noticed constitutional peculiarities, such as malformations, transpositions of abdominal or thoracic viscera, attenuation of cranial or other bones, preternaturally philogistic or hemorrhagic diathesis, weak and unhealthy constitution, whether from natural causes or intemperance, or from the effects of previous injury or disease. A more important and difficult class of causes are set down as malum regimen.

In addition to evidence of intent, which the expert may be called upon to prove, is that the person died of the injury inflicted, whatever it may have been, and that directly, or by its usual and probable consequences. If this can be proven, it is a matter of no consequence how long a time has intervened between the injury and the death. English law, however, has fixed a limit, so that if the injured person live a year and a day after its infliction, a charge of homicide will not be against the assailant.

Among the various forms of homicidal violence, a place must be assigned to wounds, as understood in legal medicine. The term wound is made to include all those local alterations of any part of the body which are produced by violent means, whether the cause has been directed against the body or the body against the cause. Such wounds are classed as incisions, lacerations, contusions, frac tures, dislocations, sprains and burns, whether by fire or escharotics. A wound denotes an accidental solution of continuity of the soft parts occasioned by a mechanical cause. It may be termed

a scratch, excoriation, puncture, cut, contused wound, gunshot wound, bite, laceration or venomous wound. To constitute a wound the continuity of the skin must be broken, an abrasion of the cuticle not being sufficient. In a surgical and generic sense it may be spoken of as an incised, punctured, lacerated, contused or gunshot wound.

In speaking of the distinctive characters or the diagnosis of wounds, and other allied injuries, with certain inquiries arising out of them, we also speak of their prognosis, in which are taken into account their extent, the part or parts of the body in which they are situated, and the organs involved. Lastly, the post mortem examination of fatal cases. In the diagnosis of wounds in a medico-legal sense, we first consider penetrating or punctured wounds, such as are caused by sharp pointed instruments. The depth of such wounds will be greater than their superficial extent; they rarely even heal by first intention. Incised wounds are those made with a sharp instrument of cutting edges, drawn across the surface. The superficial extent of such wounds is greater than their depth, and they bleed more copiously than others. After the lapse of forty-eight hours, if the wound has not healed by first intention, it will be difficult to tell whether it was inflicted by a sharp or blunt instrument. In the case of incised wounds, there is the commencement, the termination and the centre. The commencement has only one point and the termination is bifurcated.

Beyond a limited time we have no data to enable us to fix the. date of an existing cicatrix. At first it has a pink hue, but after forty days it is white. A question of greater importance in legal medicine is, whether the wound was inflicted before or after death. Wounds made after death are attended with a small effusion of blood, while, if made during life, they will bleed freely. If made during life, clotted blood will be found in the surrounding tissues or about the lips of the wound; while, if made after death, this will almost invariably be found wanting. The difference in the blood drawn from a living body and that from a dead body, is seen in the fact that in the living it coagulates, and in the dead it does not. If coagula have formed after death in any case, it must have been but a very short period after. The forcible contact by which a contused wound is produced, may give rise to effects on

the human body of three kinds: First, concussion; second, contusion; and third, disorganization. The extent of these effects may vary from a simple excoriation up to the most extensive solution of continuity. It has been held, that one effect of the sudden contact of the body with some hard substance, is best characterized by the term concussion. This contact results in the disorder of the functions of the nervous system amounting, when it has been slight, to a mere disturbance, and when it has been more severe to a temporary suspension, and, when it has been intense, to a complete cessation of its functions. When the concussion is on the brain, it may extinguish momentary sensation and power of motion, or death may supervene. A stroke over the epigastrium may prove suddenly fatal by arresting the action of the heart, or its effects may derange the functions of the stomach, liver and heart, to be followed by tedious recovery. Blows on other parts, as the bladder, intestines, kidneys and uterus, may lead to like derangement, or the entire arrest of their functions. With the exception of concussion of the brain, where death has ensued, there may not be left any indications at the part struck.

The idea of contusion involves in it the previous application to the body of sudden pressure, accompanied with concussion or of pressure continued for some time. It may be effected without involving the rupture of the capillaries of the part struck. When the contusion has involved the rupture of the capillaries, it is accompanied by echymosis, which is one of the phenomena of contusion. Confusion has arisen on this subject from the intro duction of such terms as vibices, suggilations, lividities and hypostases, all having the same meaning. Extensive injuries may be received and leave no mark, and often the discoloration of the skin in a different and sometimes opposite part of the body or limb. The last result, we have seen, which followed a contusion, was disorganization of the part struck, which is termed attrition, and differs from contusion and laceration, because in the former the structure is preserved, while in the latter it is more or less completely destroyed. In the former case the tissues are ruptured, and in attrition they are broken down. The more important of the consecutive disorders which follow are, lacerations of internal organs and rupture of blood vessels and other deep seated parts.

Ruptures of viscera are more easily produced when the organs involved are naturally dense, voluminous and readily displaced; hence the frequency of these accidents to the liver, kidneys and spleen, and their rarity in the heart, lungs, brain, bladder and alimentary tube. The various causes of these ruptures and the appearances presented are, of course, known to the pathologist. Spontaneous ruptures sometimes occur, and especially of the heart, which cannot be referred to injury or disease. Lacerated wounds are frequently attended with marks of contusion, and there may likewise be clotted blood effused into the parts in their vicinity. It is only when these exceptional appearances are present that we can speak with any confidence as to their having been produced during life.

MEDICAL INTOLERANCE.

BY PROF. J. R. BUCHANAN.

That important and revolutionary scientific discoveries are in the medical profession compelled to "run the gauntlet" through a fierce and stubborn hostility, is as true to-day as in the days of Harvey. Hence it is, that after establishing the science of the brain on an experimental basis, I have seldom attempted to effect its introduction into allopathic medical colleges, since I foresaw that it would require the devotion of my whole life to a discordant and thankless task. The bigot who has been compelled to abandon his errors is never grateful to his teachers.

That the public might see clearly the existing relations of medical colleges to medical progress, it was necessary that I should again make a formal tender of scientific demonstration, and cordially invite the critical investigation of the profession, if there was any mode of approaching the leaders of the old school profession, not already barred by the proscriptive jealousy which assumes that whoever brings discoveries essentially new is either fraudulent or deluded, and therefore unworthy of notice.

Hence, during the session of the American Medical Association in New York in the first week of June, 1880, I addressed a letter to Prof. Gross, who had filled and still fills the leading positions of the profession. No answer being received, I learned from him that

« SebelumnyaLanjutkan »