Text-book of forensic medicine and toxicologyBuchanan, R. J. M. (Robert James McLean)
Science
Text-book of forensic medicine and toxicology
Buchanan, R. J. M. (Robert James McLean)
Medical jurisprudence; Poisons
=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; or homicidal, inflicted by
another?_ The solution of the question of the dangerous character of
the wound is left to the professional knowledge of the witness, who may
be required to state his reasons for considering the wound dangerous
to life. His mere assertion will not be accepted. “The safest course,”
says Elwell, “for the witness, in regard to all these questions, is to
give a true and plain account of the wound, describing it minutely,
and the probable consequences that may attend it.” In relation to
their danger to life (apart from so-called “simple” wounds which are
not usually extensive, heal easily, and cause little trouble in their
course), wounds may be considered dangerous to life when they are so
extensive, or on account of their position and relation to important
structures when they would prove fatal without the intervention
of surgical skill; and when the danger is _imminent_. 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”; but where the danger is more remote, as in the
probable supervention of tetanus, erysipelas, &c., the medical opinion
must be more guarded. But the medical witness should always bear in
mind that death may follow the slightest injury. A case is recorded of
death in forty-eight hours after extraction of a tooth. The contrary
also holds good, for the most fearful injuries have been followed with
recovery.
The following suggestions may help the practitioner in the formation of
his opinion as to the probable danger of a wound:
1. The extent of the injury. 2. The character of the
instrument used in the infliction of the wound. 3. The
violence suffered by the parts. 4. The size and importance
of the blood-vessels and nerves injured. 5. Is the wound
healing or likely to heal well, and is the constitutional
disturbance severe or slight? 6. Age of the sufferer. 7.
Is there any constitutional taint likely to render even a
slight wound more severe, or even dangerous to life? 8. Has
the previous medical treatment been skilful or otherwise?
Should the injured party be found dead, a careful _post-mortem_
examination will alone determine the probable part the injury bore in
the production of the fatal result.
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