Page:The American Cyclopædia (1879) Volume XI.djvu/352

 340 MEDICAL JURISPRUDENCE question for the medical expert, when disease has succeeded to the injury, whether death resulted from the one cause or the other. If malignant or inflammatory symptoms follow upon slight wounds, the inference is ordinarily not difficult that the injury was not the cause of death. The habitual use of intoxicating liquors tends to induce a diseased condition of the system, and in a state of actual drunk- enness the vessels of the body are in that con- dition in which an external injury is apt to produce rupture, and a less violent blow will cause it than would otherwise be required. Legal responsibility rests on the clear and direct consequences of the injury inflicted. This principle must always be borne in mind. For disease, though developed in organs far from the seat of the wound, may yet be its immediate result; as, for example, injuries on the head may promote a deposition of pus in the lungs, or give rise to abscesses of the liver ; and on the other hand, death may re- sult from improper medical treatment, or from the negligence or excesses of the injured par- ty himself. (For the subject of malpractice, see SUBGEBY.) Though external marks fail, the skilful anatomist may discover upon dis- section internal signs of mortal injuries. Blows or wounds upon the surface of "the body may possibly rupture the heart. Ruptures of aneu- risms may be produced by the excitement of passion, and laceration of the spleen or liver by a fall or other sudden external vio- lence. Death from starvation is characterized by distinctive phenomena. The body is ex- tremely emaciated, and, even though death were recent, exhales an acrid and fetid odor ; the eyes are red and open, the tongue and throat dry, the stomach and intestines empty, and the gall bladder distended with bile ; the blood vessels and internal organs are compara- tively destitute of blood. When life has been destroyed by the inhalation of noxious vapors, as for instance of carbonic acid or sulphuretted hydrogen gas, the head and face are found to be swollen, the eyes protruded, and the tongue fixed between the teeth. The face, if observed soon after death, may be pale, but generally soon becomes livid. The blood vessels of the head and lungs and the right vessels of the heart are filled with dark fluid blood. Pure carbonic acid gas is irrespirable, and inhalation of it causes death rather by asphyxia than by poisoning. When mixed with atmospheric air, 20 per cent, of this gas is very promptly fatal to life, and even a smaller proportion may produce the same result. Death from asphyxia is caused in various ways. When respiration is checked by mechanical com- pression of the organs which perform that function, or when it ceases either from want of air, as in casas of suffocation and strangu- lation, or from failure of vital air, and the inspiration of mephitic or deleterious gases, death is caused by asphyxia. Properly speak- ing, death ensues in those cases from non-aera- tion of the blood. It is preceded and accom- panied by marked phenomena, more marked and evident in proportion to the rapidity with which death advances. In a violent struggle for breath, the eyes become distended, the veins swollen, and the face is fully suffused. On dis- section, the pulmonary vessels and the right auricle and ventricle of the heart are found charged with blood, the liver, spleen, and kid- neys are gorged, and the lungs expanded. In cases of less violent death, where, for exam- ple, it is brought about by inhalation of nox- ious gases, these appearances are less strongly marked. Hanging sometimes causes death by producing congestive apoplexy, the pressure of the cord preventing the return of blood from the brain, while it does not check the circu- lation by the intervertebrals ; but more fre- quently the destruction of life is due to as- phyxia. Luxation or fracture of the cervical vertebrae speedily causes death. The signs of strangulation are a livid depressed circle upon the neck, made by the cord ; the face is dis- torted ; the eyes are open and protruded ; the face, shoulders, and chest swollen. The ec- chymosis produced by the cord is an impor- tant sign, for, as has been already observed, ecchymosis is possible only when contusion of the tissues takes place in the living body ; yet in inferring the mode of death it is to be remembered that as death in hanging may suddenly result from luxation, the cord may have had no time to act on living tissues. The condition of the genital organs also affords very important proof of death by hanging. The color of the countenance is also to be re- garded. If the trachea or larynx was alone compressed, the face is pale ; but when the veins of the neck were pressed, as by the cord, and the heart continues its action for some time, the blood is propelled into the head and causes suffusion of the face. The question may arise whether, if the deceased came to his death by hanging, it was his own work, or the work of a homicide. An examination of cases of sui- cide has shown in a large proportion of them the absence of ecchymosis; and this because from the employment of less violence the con- tusion of the neck was less. Fracture of the vertebrae of the neck is often caused in execu- tion by the fall of the body or even by force which is sometimes applied by the hangman. But luxation is of course not conclusive evi- dence of homicide. An examination of the po- sition of the body and of the objects which surround it, of its elevation above any possible support, and any marks which show resistance, must be made in all suspected cases. In stran- gulation, in. its ordinary sense, death results not from fracture of the vertebrae, but from interruption of respiration. This is a rare mode of suicide, and when appearances indicate that it was the means of death they raise a violent presumption of assassination. Because death ensues from interruption of the breath, the mark of the cord must be quite distinct, and ia