appear discordant and improbable. Each medical witness may put together in a different manner the materials with which he is required to reconstruct the scene immediately preceding death; and a successful result will most naturally reward him who, with the most acute perception, unites the largest and most familiar acquaintance with similar facts. In estimating the probabilities in reference to the manner of death, the physician has need of all aid which a general observation of the workings of the human mind can afford him; his psychological knowledge and his medical experience must here go hand in hand, for it is his task and duty to offer an explanation of the mutual dependence of motives and results, and that, in the same disinterested and merely scientific manner that would be required in the demonstration of any curious facts in physics. That portion of the indicatory evidence upon which medical testimony may possibly throw some light, we may now cursorily allude to. 240. Position of body.-The position of the body and that of the weapon (if the latter be found) sometimes throw light upon the mode of death. These two circumstances serve also, generally, to explain each other; separately considered they are not of so much importance. In cases of suicide the weapon may be found grasped in the hand or not, according to the manner of death. Thus, if death ensue upon sudden and abundant hemorrhage, as in wounds of the throat, stabs in the heart or great vessels, the person dies of syncope, and hence, the hand being relaxed, the weapon falls from it. When, however, death is occasioned by a pistol-shot through the head, the weapon may, in cases of suicide by this means, be found firmly grasped in the hand. In other cases, where death has not been immediate, it is purely a matter of accident whether the weapon be still held by the deceased or not. In like manner, the position of the body will be affected by the suddenness and mode of death. Where death is sudden, the body will usually be found lying upon the back; but if it has not been immediate, the face and trunk will generally be turned to the ground. The position of the body alone cannot be considered as indicative of the voluntary, accidental, or homicidal character of the injury, but if it be found in a position indicating immediate death from hemorrhage or from the instantaneous loss of muscular power, and the weapon be found at a distance from it, the act may be considered in all probability as homicidal. Where, on the contrary, it is found in this position and the weapon by which death apparently was caused lies close to the body, it is impossible, of course, to de termine whether it has been placed there by another after assassination, or has fallen from the hands of the suicide. Should the weapon be found firmly grasped in the hand of the deceased, there can be little doubt that the act was suicidal. The only objection which can be made to the supposition is, that it might have been placed in the hands of the person before life was extinct, and instinctively grasped by him. Where, after death by assassination, a weapon is placed in the hand of the victim, it cannot be forcibly grasped, but will lie there loosely. Sometimes the fact of the razor being shut (when this has been the weapon used) has been considered as indicative of homicidal interference; but such an inference is not justifiable, unless it can be shown from the position of the body and the character of the wounds, that death must have been instantaneous, and even here the question might naturally arise whether the fall of the razor to the ground might not sufficiently account for its being closed. Thus, for example, in a case of suicide related by Dr. Casper,51 the man, after having first inflicted, with a razor, some superficial wounds at the bend of both elbows, stood before a mirror and, drawing down his cravat, cut his throat in an oblique direction from left to right, dividing the larynx and both external jugular veins. The razor was found bloody and closed, two feet distant from the body. The same author reports another case of suicide by a pistolshot in the breast, traversing the diaphragm and spleen, and subsequent drowning. In this case the pistol was found in the pocket of the deceased, and the fact of its having been fired against the naked chest was shown by the circumstance that his coat and shirt were not perforated, and the former was buttoned up to the chin. The following case illustrates the nature of the difficulties which sometimes environ the questions treated of in this chapter. At Paris, in 1858, an auctioneer and appraiser, thirty-one years of age, arrived at the Lyons railroad station, about six o'clock in the morning, and, having engaged a coupé and placed his luggage upon it, entered the vehicle, carrying a double-barreled fowling-piece in his hand. At some previous period he had been twice convicted of official misconduct, and his present position was not a prosperous one; but there was nothing to indicate his being humilitated or desperate; on the contrary, his habitual behavior was gay and even frivolous. On the way to its destination an explosion was heard in the carriage; it was stopped and the body of the occupant was found "Gericht. Leichenöff. Ites Hund., p. seated in the left-hand corner, the legs crossed, and in the posture of a person seeking repose. The greater portion of the left side of the skull from the centre of the forehead was carried away; the legs were crossed, and between them lay a cane and a double-barrelled gun, the left barrel of which was still loaded and cocked. The thumb and index finger of the left hand were bloody, and the fingers clenched. Within the skull were found numerous grains of shot. The deceased had, several months before, insured his life for about $30,000, which sum the insurance company refused to pay to his family, on the ground that his death was suicidal. Hence a lawsuit, in which the facts of the case were investigated. It was evident that at the moment of the explosion the forehead must have been upon or very near the muzzle of the gun, which was also grasped by the left hand. From these facts, M. Tardieu concludes that the death was suicidal,52 and M. Brierre de Boismont draws the same inference, chiefly from the fact that there was no evidence of a previous inclination to this crime.53 The court, however, condemned the insurance company to pay the amount of its policy. To us it seems perfectly natural that a sportsman, weary with a night's ride in a railroad car, should, when seated in a hackney-coach, have leaned his head upon the muzzle of his gun, embracing but not covering the end of the barrel with his hand, and that a jolt of the vehicle should have caused the trigger to catch in his pantaloons and explode the charge. Too many accidents of a similar nature have occurred, displaying an almost inconceivable negligence of the simplest precautions in handling firearms, for us not to adopt this conclusion in the present case as not only the most charitable, but also the most logical. 241. Mode of death; throat cutting. Traumatic suicide is most often accomplished by cutting the throat, the person standing or sitting in front of a mirror. Very rarely is the person lying down. The cut is, as a rule, made with the head extended, the knife in the right hand. The cut begins above, on the left sternomastoid muscle, and cuts down and across. It may be transverse, or, if the knife is held in the left hand, the wound may slope in the other direction. Hofmann considers54 that the vast majority of the cases show the wound to be between the larynx and the hyoid bone; rarely above the hyoid or over the trachea. The depth of the wound depends upon the strength of the hand and the sharpness of the knife. It is usually deeper at the point of insertion. Unless it is pretty deep the great Ann. d'Hyg., Avril, 1860, p. 443. "Hofmann, Ger. Med., 1903, p. 395. vessels of the neck are not cut. Usually the wound involves, of the blood vessels, only the superior thyroid artery and the external jugular vein; while the big vessels-the carotid arteries and the internal jugular vein escape uninjured. The small vessels, however, are effective in causing death in many cases, either from the loss of blood, or the entrance of blood into the air passages, or possibly from the aspiration of air into the veins of the neck. The wounds in the neck are often multiple or associated with cuts at the blood vessels in the bend of the elbow or the wrists. In the cases of homicide by cutting the throat, which are not rare, on account of the ease with which death can be produced during sleep or unconsciousness, a single stroke is more often effective than in suicide. The appearance of the wound may not be characteristic, but is likely to extend so far to the right as to bear evidence of a stranger's hand. Resistance is usually shown by cuts on the fingers or in the palm of the hand. The finding of a knife in the hand of the dead man is more frequent in cases of homicide than of suicide. 241a. Gunshot.-Suicide by a gunshot wound has little that is characteristic in the appearance of the wound except the powder marks that are characteristic of all such wounds when the muzzle of the gun is held close to the body. The instrument generally used is a pistol or revolver, and the bullet may be identified as coming from such a firearm. The most frequent sites of such injuries are about the head, the forehead, temple, behind the ear, or in the mouth. If the clothes have been pushed away from any portion of the body, and the muzzle of the gun has been applied directly to the skin, the probabilities of suicide are much greater than of homicide, where such a preparation for the shot is rarely possible. If the shot wounds are multiple there must have been life enough after the first shot to allow of the subsequent ones. Some of the instances of multiple injuries in known cases of suicide are most astonishing, in showing how much can be done after a wound that is generally considered as promptly mortal. Hofmann,55 cites a case of two shots in suicide, one penetrating the right side of the heart, and the other the left side of the heart. He also cites another instance of five shots, one a nonpenetrating wound of the skull, situated over the glabella, a second starting from the right zygoma, and cutting both of the optic nerves in their orbits, and then three around the heart, one of these through the left lung, one through the thoracic aorta, and one through the left ventricle of the heart. In 5 Hofmann, Ger. Med., 417. this case the shots in the head evidently had preceded those in the region of the heart. Naegeli reports a case of two penetrating wounds of the skull: the first going from the left supraorbital notch, through the frontal and parietal lobes of the brain; the second, from below the angle of the left eye backwards and slightly to the right of the occiput. As pointing, also, to suicide, may be the multiple modes of ending life; as in the cases where, combined with some of the distinctly traumatic methods, there are also evidences of poisoning, hanging, or drowning. IV. ANTE-MORTEM VERSUS POST-MORTEM WOUNDS. 242. In general.-In many cases it is desirable to know when the wound was inflicted,-whether it was inflicted ante mortem or post mortem, and, if it was inflicted ante mortem, how long before death, or before the time of examination. 243. Ante-mortem open wounds; hemorrhage.-Fresh, open wounds inflicted upon the living body show a distinct gaping of the edges of the wound, with a protrusion of the underlying structures. At first there is an active bleeding, depending in its character upon whether a large blood vessel or merely the small capillaries have been severed. If only the capillaries, there is an oozing of the blood more or less rapidly; but in all large injuries large blood vessels are also injured. If an artery is cut there is profuse and rapid hemorrhage, on account of the great pressure under which the blood circulates in the arteries. Moreover, if this arterial stream can escape freely to the surface, without impinging upon the edges of the wound, it will be seen to escape in rhythmic jets, which, if they fall upon the wall or clear floor, may leave the tracing of the jets in drops of blood which is characteristic of arterial hemorrhage. If a vein is cut the bleeding is also profuse, but there is not so great a loss of blood as from an artery, nor are there the tracings of the jets of blood. As the blood remains in contact with the tissues there is a diffuse infiltration of the edges of the wound with blood, so intimate that the blood can not be washed off. Then, as the blood clots, it becomes intimately adherent to the edges of the wound. 243a. Clotting.—The clotting in normal blood begins in about three minutes after it is shed, and is complete in about eight minutes. The evidence of the infiltration of the edges of the wound and the "Naegeli, Vierteljhrschr. f. Ger. Med., 1884, XLI., 231. |