A MANUAL 
MEDICAL JURISPRUDENCE; 
INSTRUCTING HOW TO CONDUCT 
INQUESTS AND POST MORTEMS, 
AND HOW TO GIVE 
OFFICIAL AND EXPERT TESTIMONY, 
BEFORE COURTS OF LAW, IN CASES OF HOMICIDE. 
- BY- 
C. H. VONKLEIN, A. D. 
EZazziiltoxi, Ohio. 
1883. A MANUAL 
• OF; 
MEDICAL JURISPRUDENCE; 
INSTRUCTING HOW TO CONDUCT 
INQUESTS AND POST MORTEMS, 
AND HOW TO GIVE 
OFFICIAL AND EXPERT TESTIMONY, 
BEFORE COURTS OF LAW, 
IN CASES OF HOMICIDE. 
- BY- 
C. H. vonKLEIN, A. M., M. D. 
ZEZaixiilton., oa.10. 
1882 . 
DAILY NEWS JOB PRINT. PREFACE. 
This little book was read by the author 
before the Butler County (Ohio) Medical 
Society, November, 1882. 
Through the encouragement of many 
leading members of the bar, who were of 
the opinion that it would be a very useful 
and instructive work concerning the con- 
ducting of Inquests and Post Mortems 
and giving of official and expert testimony 
before courts of law in cases of Homicide, 
I concluded to publish it in book form, 
under the title of "A Manual of Medical 
Jurisprudence." For the foundation I am indebted to a 
text book of a learned professor of Geneva, 
entitled, "Joh. Fred. Faselii Elementa 
Mediciniae Forensis." 
As nothing of the kind has ever been 
published in this country I was willing 
to take the assistance of a learned foreign- 
er, rather than travel a track unbeaten by 
myself. I need say nothing concerning 
the utility of such a work ; it will readily 
be apparent to every serious mind. Life 
and death are objects too important to be 
sported with in the manner they some- 
times are; nor should the lives of our 
fellow citizens ever be sacrificed to the 
ignorance of the faculty, the caprice of a 
court, or the artifices of revenge and dis- 
appointment. 
vdnK-LEIN. HOMICIDE. 
That wonderful machine the human body, 
which is supposed to be directed and ordered 
by a contrivance unknown to the wisest of men 
and which gives birth to all our pleasures and 
enjoyments, contains nothing in itself to 
perpetuate its existence. A very little de- 
rangement of its functions, or of its acting 
principle will deprive it of life, and destroy all 
its powers of action. The most common causes 
of the loss of life are diseases, and they are 
generally and implicitly attributed to the hand 
of a God. But owing to what we incur by our 
own vices and imprudence, by the passions and 
evil dispositions of others preying upon our 
spirits, and by bad customs and habits we 
must attribute death oftener to other causes 
than to the one assigned. Where death is 
occasioned in any other manner than by disease, 
it is unnatural, or if it arises from some acci- 
Human 
body. 
How de- 
prived 
of li . 
By dis- 
ease. 
Natural 
cause. 6 
dent, which shall immediately cause a dissolu- 
tion of our powers; or homicide where it is 
effected by the violent hand of another. In 
such a case, the law justly retaliates upon the 
offender, where it is committed from anger and 
malice, and is not (as in the case of war) pro- 
tected by the sovereign influence of princes. 
Homi- 
cide. 
Where a homicide comes under the cogni- 
zance of a court of judicature, the greatest cir- 
cumspection and attention are required, and the 
laws of all countries have appointed proper offi- 
cers to conduct investigations previous to any 
trial; and as soon as possible after the murder, 
to inquire into the causes and nature of it, how 
it was committed, and what appearance the 
body and members present upon inspection. 
Officers 
to in- 
quire. 
Direc- 
tions 
how to 
examine 
In the examination which is made, (before a 
decision is pronounced), the following directions 
should be observed. 
I 
The examination of the dead body should be 
as soon as possible after death, in the day time, 
at a proper place, where a dissection, if neces- 
sary, (and it is almost always necessary) may be 
performed and not according to vulgar custom, 
where it is found; and likewise by proper in- 
struments, such as are generally used by sur- 
geons in their dissections, and not by coarse and 
When 
to be 
made 
and 
where. 7 
rude knives and scissors which may mangle and 
tear the body. 
II 
Before a dissection is proposed, a very ac- 
curate inspection should be made of the entire 
body in order to discover how far the death was 
occasioned by, for instance, suffocation from 
mineral vapors, the fermentation of new liquors, 
the burning of charcoal, or the electric shock of 
lightning. In such cases, except the last, and 
there they do not seem to be the cause of the 
death, no marks are to be found. 
Accu- 
rate in- 
spection 
of 
sound 
body. 
The examination should then proceed as 
follows: 
1st. Into any deviation from the natural 
state of the external superfices of the body, 
such as spots which are caused by escaping 
blood ; ecchymoses,which are stagnations arising 
under the skin; or pericranium; or any other 
spots in the external surface. Of these we are 
to examine the situation, magnitude, figure and 
number. 
Ill 
Spots 
on the 
body. 
Examination must likewise be made into the 
nature of any tumors which may appear, and 
whether they are owing to violence, or what 
cause. Their size and figure should also be de. 
scribed. 
Tum- 
ors. 8 
Putre- 
faction. 
Lastly, W'e should inquire into the state of 
putrefaction of the body. In making this in. 
quiry note should be made of such conditions as 
the following, if they appear: 
1st. Bladders filled with a yellow or brown- 
ish liquor. 
2nd. The external cuticle separated from 
the true skin. 
3d. Lividity and blackness of the skin. 
4th. Foetid, or disagreeable smell of the 
whole body. 
5th. A considerable swelling of the carcass. 
6th. A particular lividity and blackness of 
the scrotum of male subjects. 
7th. A blackness of the nails. 
Wounds 
etc. 
2nd. Scrutinize any wounds which are con- 
spicuous, and remark whether they be over 
the whole body, or confined to a particular 
part; and here no probe or other instrument 
should be inserted which may enlarge them and 
alter their nature. 
Blood 
or other 
humour 
flowing 
from 
carcass. 
3d. Whether from the carcass in general, 
or from any wound or aperture, as the mouth, 
anus, etc., there be a flowing of blood, urine, 
or insconium. 
4th. Ascertain the habit of the body, 
whether it be fat or lean, or swelled from any 
cause. 
Habit of 
body. 9 
IV 
The directions to be attended under a dissec- 
tion are the following: 
Dissec- 
tion. 
1st. The integument of the body, and es- 
pecially of those places which require examina- 
tion, where any wounds are present, is to be dis- 
sected away, and the muscles are to be cut 
through, in order to lay open a way to the 
parts where injury is supposed to be done. 
Integu 
ments. 
2nd. All the chief cavities of the body as 
the head, the chest, and the abdomen, are to 
be opened. 
Cavities 
3d. That cavity is to be penetrated first 
where the injury is supposed to reside. 
Where 
injury 
received 
4th. The parts circumjacent to a wound are 
not to be dissected before the progress of the 
injury is traced to its utmost extent. 
Parts 
circum- 
jacent. 
5th. Any bowel contained in the cavity is 
to be examined according to its situation, con- 
nections, constitution, and any wounds which 
it may have received, in their length, breadth, 
and depth. 
Bowels. 
6th. We should inquire if the bowel opened 
contain any foreign bodies, either fluid or solid: 
if the former, their nature and quantity is to be 
determined ; if the latter, their quality, num- 
ber, quantity, figure, and situation. 
Foreign 
bodies. 
7th. All the great blood vessels passing 
through a cavity are to be examined whether 
Blood 
vessels. 10 
they be entire or not, and whether they con- 
tain blood or not. 
Nerves, 
etc. 
8th. The great nerve, likewise, the medulla 
spinalis, or spinal marrow, etc., should undergo 
an examination, and also the thoracic duct as 
the receptacle of the chyle, vessels which carry 
the nutriment from the stomach, and from the 
external surface into the mass of blood. 
Head 
opened. 
9th. Before the head is opened, it should 
be discovered whether there are any wounds in 
the skull by fracture, fissure, intropression, etc., 
and if such the situation, size, depth, number 
and figure should be marked. 
Skull. 
10th. When the head is opened the skull 
should be carefully taken off with a saw. 
Brain. 
11th. When the brain is examined, regard 
must be had to its substance, to its vessels, and 
whether they be full or empty of blood; to the 
sinuses of the dura mater, those large recepta- 
cles of blood which lie under the skull; to the 
ventricles or cavities, to see whether any fluid 
is contained in them, and of what nature, and 
in what quantity; to the base of the skull, to 
discover if any foreign body lies upon it; aud 
lastly to the thickness of the bones, whether it 
is ordinary or extraordinary. 
Chest. 
12th. When the chest is opened, the ster- 
num is to be separated from the ribs with great 11 
care, lest the arteries or veins lying near it, or 
in the cavity, is injured. 
13th. If a wound should be made in the 
chest, and which penetrates either side, then 
we should not only determine the ribs between 
which the wound is made, but whence we 
reckon. 
Ribs. 
14th. When the heart is examined we 
should take notice whether polypous concretions 
occur in its cavities, or in the greater vessels. 
Heart. 
15th. When a rupture of any of the bowels 
is discovered upon dissection, we should care- 
fully examine whether it is recent, or whether 
it is gangrenous, and have the signs of putre- 
faction. 
Rupture 
of bow- 
els. 
16th. When the bowels of the lower abdo- 
men, which are large cavities, are submitted to 
examination, we should inquire with the utmost 
care into their contents, and this not only by 
simple inspection, but by the fire and chemical 
mixtures. 
Con- 
tents of 
bowels 
of abdo- 
men. 
There are besides these, some other circum- 
stances to be attended to, as the constitution of 
the dead person, the instrument by which his 
death was occasioned, the symptoms under 
which he labored, the means used to restore 
him, the time when assistance was called to 
him, his situation when wounded, his diet be- 
Other 
circum- 
stances. 12 
fore and after, and lastly, whether he was ad- 
dicted to drunkenness. 
Differ- 
ent 
kinds of 
murder. 
The different kinds of homicide, or the differ- 
ent means by which it is committed, may be 
reduced to poisons, wounds, bruises, drowning 
and strangulation. The two first seem to be 
the most common; the third is often rather a 
remote than a proximate cause, and the two 
others are chiefly discovered by the facts rather 
than by any peculiar marks they leave on the 
body. 
V 
Of pois- 
ons ; de- 
fined. 
But first of poisons: a poison may be defined 
as any substance, which applied to the human 
body internally, is injurious to its preservation, 
or procures its dissolution by its own proper 
qualities. * The ways by which poisons get into 
the body, are by the mouth, nose, lungs, and 
sometimes the external surface of the skin, and 
these modes of action may be explained in the 
following manner: 
Ways 
by 
which 
they act 
Health supposes a natural state or constitu- 
tion of the fluids and solids of the animal body. 
All poisons, then, must act in destroying this 
natural constitution of parts, and changing it 
into a preternatural one. There are various 
ways by which this is done; the principal are 
the following. 
Mode of 
action. 13 
1st. By acrid things, which constringe and 
erode the solids; or sometimes coagulate, some- 
times resolve, the fluids. 
By ac- 
rids. 
2nd. When they possess a power of stupefy- 
ing or destroying the powers of sensation and 
emotion in the nerves, which are the great 
agents of the animal machine. 
Stupe- 
fyers. 
3d. When they possess a sharp and acute 
figure, tear and lacerate the tender parts of 
the stomach and bowels. 
Figure 
sharp. 
4th. When they induce a powerful suffo- 
cation. 
Suffoca- 
tion. 
5th. When they act not only from acri- 
mony, but from a power of thickening the blood 
at the same time. 
Tanaci- 
ty. 
6th. When they have the power of thicken- 
ing and of drying also the humours. 
7th. When they act by some unknown 
power, which is not yet discovered. 
It would be useless, nay perhaps injurious to 
society, to enumerate all the poisons which be- 
long to the different heads. It is dangerous to 
entrust such materials in the hands of mankind 
in general; we hope therefore, we shall be ex- 
cused if we mention only the principal ones, 
according to the foregoing araangement. 
They are all taken from the animal, vegeta- 
ble and mineral kingdoms. 
Un- 
known 
power. 14 
Acrids; 
what. 
The first class of acrids, include acids and 
alkalis; among the last of which may be in- 
cluded the effects of the putrefactive process, as 
being exposed to its influence. 
Those poisons of an acrid nature which have 
a mixed quality, are the metallic salts, or some 
of the semi-metals themselves, as arsenic; and 
some vegetables which are of a highly drastic 
nature, and which, used in small quantities, 
may produce useful evacuations, in case of 
disease. 
Stupe- 
fyers. 
2nd. The poisons which have a stupefying 
quality are of the vegetable kind, as the Cicuta 
lauro cerasus etc. 
3d. Those which act mechanically by the 
sharp points and edges with which they are en- 
dued are the powder of glass, diamonds, etc. 
Mech- 
anic 
powers. 
Suffoca- 
tions. 
4th. Those which have a suffocating power, 
are the vapours of new and fermenting liquors, 
the smoke of charcoal and of sulphur, the air of 
close and damp places, etc. 
Viscid. 
5th. Those which have a viscidity joined 
with acrimony, are generally vegetables, such 
as Cicuta major, solanum, etc. 
Dryers. 
6th. Those which are of a thickening qual- 
ity, and a drying one at the same time, are 
quick-lime, Cerusse; and among the vegetables, 
several of the class of fungi, etc. 15 
7th. Those having a secret quality, not easily 
discovered, are the various tribes of animals 
which live around us, such as spiders, toads, 
vipers, etc. 
Un- 
known 
quali 
ties. 
The effects which poisons produce upon the 
body vary, according to the nature of their 
qualities, the place which they effect, and the 
subjects to whom they are applied, according 
to age, temperament, habit of body, etc. 
How 
poisons 
affect 
the 
body. 
Thus the aconite affects the lips, mouth, 
forehead, tongue and stomach, by making 
them to swell, and causes anxieties, vertigoes, 
faintings and convulsions 
Aconite 
The cicuta occasions enormous vomitings, 
hiccups, heat of the stomach, swelling of the 
abdomen, delirium and convulsions. 
Cicuta. 
The acid spirits, wherever they touch, cause 
erosions, most grievous pains, vomiting and 
hiccups. Arsenic and cobalt excite inflamma- 
tion of the stomach, etc., the most acute pains, 
heat in the mouth and jaws, nausea or sickness, 
vomiting, spasmodic contractions of the chest, 
swelling of the abdomen, coldness of the ex- 
tremities, cold sweats, convulsions, etc. 
Acids. 
Arsenic 
etc. 
When a medical practitioner therefore, is 
called to a person who is suspected to be poison- 
ed, if he is alive, he may judge from the follow- 
ing observations: 
How to 
judgea 
living 
subject. 16 
From 
sympt- 
oms 
above. 
1st. From comparing the symptoms which 
present themselves with those which generally 
attend the taking of poisons mentioned above. 
From 
sudden- 
ness of 
some 
sympt- 
oms. 
2nd. From the sudden appearance of some 
symptoms, such as spasms and violent pains, 
great thirst, sickness, vomiting, fainting, colic, 
the throwing up some foreign matter from the 
general contents of the stomach, and univer- 
sal convulsion of all the muscles. 
Previ- 
ous 
health. 
3d. From the health of the patient fore- 
going this attack, and his not having any con- 
nection with a person laboring under any con- 
tagious or epidemic disease. 
No er- 
rors in 
diet. 
4th. From the patient having committed 
no errors in diet, etc. 
From 
odor 
and 
taste. 
5th. From an ungrateful odor and taste of 
what has been taken. 
There are few poisons but what are attended 
with a very disagreeable smell and taste; hence 
a suspicion soon arises from this source, which 
if immediately taken notice of, the patient may 
soon receive the proper relief 
How to 
judge in 
a dead 
person. 
But if the person is dead, a very minute ex- 
amination must be made, and the following 
particulars attended to. 
From 
external 
habit. 
1st. The external habit of the body is to be 
inspected with the greatest accuracy and atten- 
tion, to discover whether there, is any livid 
spots upon the surface of the skin; whether 17 
there are any premature signs of putrefaction, 
and whether there is any swelling of the abdo- 
men, or of the face; for experience evinces 
that these changes are soon induced by poison- 
ous substances. 
2nd. The passages by which the poison has 
been conveyed into the body, are to be ex- 
amined ; these are the mouth, the throat or 
gullet, the stomach and the intestines; but 
cheifly the stomach, as the same effects will be 
produced as in the other parts. We must ex- 
amine then first into its constitution, and 
then into its contents. 
The 
pas- 
sages. 
Princi- 
pally 
the 
stomach 
When we examine the constitution or form 
of the stomach, we must consider : 
1st. Whether it is inflated or corrugated in 
an extraordinary manner. 
2nd. Whether it is inflamed, or in a state 
of gangrene or mortification. 
3d. Whether it exhibits upon its external 
surface supernatural spots either of a red color, 
black or livid. 
4th. Whether it is perforated into holes, 
either one or many. 
5th. Whether its veins are tinged with 
blood more than usual. 
6th. Whether it is eroded, and its inner 
coat be stripped off and bloody and swim- 
ming amongst the other contents. 
In its 
consti- 
tution. 18 
7th. Whether there is any eschar in its sub- 
stance, of a black or yellowish color 
All these marks afford very strong suspicions 
of poison, especially of those which are acute 
and acrid. 
The next observations are to be made upon 
the contents of the stomach, previous to which 
two circumstances must be attended to : 
1st. All the contents of the stomach are 
to be thrown into a vessel prepared for that 
purpose. 
2nd. The surface of the stomach is to be in- 
spected more carefully, to discover if possible, 
whether particles of the poisons may not stick 
to it, which are to be collected. 
Con- 
tents of 
the 
stomach 
The contents of the stomach are to be consid- 
ered as more or less fluid. If they are not entire- 
ly so, but consist of many solid substances, then 
a portion of them is to be dried and put into an 
iron vessel lined with tin and, being previously 
weighed the following experiments are to be 
made upon it: 
Solid. 
To be 
tried by 
burning 
1st. It is to be thrown upon burning coals ; 
which, if it produces a vapour of a blue color, 
and an odor like that of garlic is perceived, it 
may be nearly ascertained that an arsenical 
matter was mixed with it. But in order to 
clear up this point with greater satisfaction. 19 
2nd. Another portion of the dried mass is 
to be given to other animals, such as fowls, 
dogs, etc., which, if it causes their death, it is 
a proof that poison made a part of its con- 
tents. 
By 
other 
animals 
3d. Another portion of this mass is to be 
mixed with a quantity of suet and salt of tartar, 
which being put into a crucible, and melted 
over the fire, if a reguline metallic substance is 
produced at the bottom, it is clear that arsenic 
is contained in it. 
Mixed 
with 
suet 
and salt 
of tar- 
tar and 
melted. 
4th. It may be inquired whether this me- 
tallic substance being melted again with metals 
of a red color turn them to a white, for this is 
likewise proof of arsenic. 
Melted 
with 
other 
metals. 
The remainder of the dried contents, if 
poison be found upon experiment, must be 
nicely and accurately weighed. This is to dis- 
cover whether the proportionate quantities 
would be sufficient to produce the effect. But 
in general, where arsenic has been administered 
so small a quantity is sufficient to produce the 
most dreadful influence, that it will be nearly 
satisfactory if any of it be found upon a chem- 
ical examination. 
Re- 
main- 
der 
weighed 
When the fluid parts of the stomach are ex- 
amined, the following experiments are to be 
made : 
Fluid 
parts 
examin- 
ed. 20 
By alka- 
lines. 
1st. An alkaline liquor, as oil of tartar per 
delinquim, for instance, is to be thrown in, 
and ift it take a brownish color, it is a proof 
that mercury, in the shape of corrosive subli- 
mate, or precipitate, has been mixed with it; 
if it ferments, that an acid has been exhibited. 
This however, is no certain sign, as an acid 
may subsist very innocently in the stomach. 
aX 
2nd. An acid may be applied, and here, if 
an effervescence be produced, it is a proof of al- 
kaline substance, and then as in the last case, 
it must be by the quantity and acrimony of the 
substances that we determine concerning their 
poisonous nature, as in themselves, and when 
well diluted, they are innocent and sometimes 
salutary. 
By 
color. 
3d. The color is likewise to be attended to, 
as it may determine the exact nature of the 
poison which is given. 
By 
chemi- 
cal 
analysis 
4th. Some portion of the poison found may 
be sent to a chemical laboratory, to examine 
more particularly its nature. 
These observations, it should be remarked, 
however, relate more particularly to poisons 
which produce their effect more immediately, 
than those which lie a long time first in the 
stomach. But we may, from the injuries done 
to the stomach itself, determine likewise in 
some measure concerning even those more slow- 21 
ly acting poisons. The remains of inflamma- 
tion, gangrene, perforations, etc., will continue 
for a long time, and if the patient should die of 
poison at ever so great a distance, whilst the 
cause subsists some effects will evidently be per- 
ceived, or some change from a natural state. 
Second, of wounds. Under wounds may be 
comprehended every disorder which arises from 
some external violence offered to the human 
body. 
wounds 
defined. 
To this head, therefore, may belong contu- 
sions, luxations, fractures, and wounds, more 
properly so called, being a division of the mus- 
cular parts of the body. The first division of 
wounds is into mortal, and the contrary. 
Divi- 
sion. 
Every wound is of such a nature, that death is 
absolutely the consequence of it or not. In the 
latter case it may be called mortal by accident. 
This also we may divide into two kinds of or- 
ders. That wound which is so inflicted that it 
may be relieved by the means cognizable by 
art, is of the first order. That where it hap- 
pens that the death which is incurred is owing 
not to the wound, but to other causes, then the 
wound is said to be of the second order of such 
as are called mortal by acident. 
From what has been advanced, the following 
propositions may be deduced: 
Mortal, 
•what. 
Mortal 
by acci- 
dent. 22 
Posi- 
tions. 
1st. Every wound, absolutely mortal, will 
admit of no relief, will certainly destroy either 
by a sudden of lingering death. 
2nd. Death is always the inseparable effect 
of a wound absolutely mortal. 
3d. A wound absolutely mortal is always 
the sole cause of death to the injured person. 
4th. The consequence here avails nothing; 
the wounded person, after the wound is inflicted 
is to all intents and purposes a dead man ; the 
injury, then, is absolutely mortal. 
5th. Wounds are by accident mortal when 
the cause of death arises partly from the wound 
and partly from other concurring causes. 
Reasons 
for such 
distinc- 
tions. 
These distinctions are necessary, though not al- 
ways attended to; for it may so happen where 
men judge alone from consequence that a per- 
son may be punished for a death occasioned by 
a wound which was not absolutely mortal. It 
is highly important that in a deposition for 
murder such distinctions should be made of 
these kinds of wounds as to place them in their 
proper light. In order to do this more effect- 
ually it is necessary to make the following di- 
visions : 
Divi 
sions of 
rules. 
1st. To consider those wounds which are 
absolutely mortal, or mortal by accident. 
2nd. In what parts of the body such 
wounds are most likely to be inflicted. 23 
3d. Some circumstances which may occur 
to distinguish such wounds more accurately. 
I. 
It appears, then, that because a mortal 
wound cannot be cured by any art, every 
wound which entirely takes off the influx of 
the blood into the heart from the veins and its 
egress from the heart into arteries, or which 
entirely destroys the power of circulation and 
the action of the heart, must be absolutely 
mortal. From the elements of physiology it 
appears, that the following circumstances are 
necessary to promote the action of the heart. 
What 
kind of 
wounds 
mortal. 
Actions 
of the 
heart 
promo- 
ted by. 
1st. The soundness of the sides of the cavi- 
ties of the heart, so as to be able not only to 
contain the blood but to push it forward into 
the system. The strength required here is 
amazingly great. 
Sound- 
ness of 
walls. 
2d. A free action of the brain and nerves 
going to the heart, called the cardiac nerves. 
3d. The motion of the blood through the 
coronary arteries which surround the heart. 
Action 
of the 
brain. 
Coron- 
ary ar- 
teries. 
4th. A free motion of the blood through 
the lungs. 
Lungs. 
5th. A proper return of blood through the 
veins. 
Proper 
return. 
6th. A renewal by the aliment of nutriment 
to restore the expense which is incurred by the 
Aliment 24 
Mortal 
in that 
order. 
several secretions, etc. It appears, then, that 
all wounds are absolutely mortal: 
1st. Which injure the cavities of the heart 
so that they cannot contain the blood. 
2nd. Which take away the free action of 
the brain and nerves going to the heart so that 
neither sense or motion can be promoted in that 
organ so essential to life. 
3d. Which destroy respiration, for then the 
blood cannot be carried through the lungs. 
4th. Which stop the motion of the blood 
through the coronary arteries. 
5th. Which prevent its return through the 
veins. 
6th. Which prevent the use of nutriment 
and consequently the accession of chyle, 
It appears, then, that the subject of wounds 
absolutely mortal are those parts, whose sound- 
ness cannot be taken away and life continue; 
and that many of those wounds which happen 
in internal parts, which medical aid can not 
reach, are to be considered as absolutely 
mortal. 
wounds 
mortal 
by acci- 
dent. 
When a wound is mortal by accident death is 
either to be attributed to it in part as a concur- 
ring circumstances, or not at all, as in such 
cases as the following : 
When 
left to 
1st. Where death is occasioned by wounds 
being left to themselves, as for instance, wounds 25 
of the head, which may be cured by the use of 
the trepan; those of the greater blood vessels 
where access may be acquired ; those of viscera 
where the hand may be applied and medicines 
may be administered ; those which induce death 
by evacuations into cavities which might be 
prevented or from which they may be easily 
discharged. 
them- 
selves. 
2nd. Where other causes may be the oc- 
casion of death, as the particular constitution or 
habit of the wounded person as well as his neg- 
lect and want of prudence, the fault of the 
medical practitioner, the blunders and careless- 
ness of bystanders, or some previous disorders 
which may have prevailed. 
Where 
there 
are 
other 
causes. 
II. 
We are now to consider the second gen- 
eral division, or those, wounds of the different 
parts of the body which are to be accounted 
absolutely mortal or not; and here we shal 
treat of them in the following order: 
1st. Wounds of the head and neck. 
2nd. Wounds of the chest. 
3d. Wounds of the abdomen. 
4th. Wounds of the extremities. 
Parts 
where 
wounds 
are 
mortal 
or not. 
I. Of wounds of the head. These are ex- 
ternal or internal, which may be again dis- 
Of the 
head 26 
tinguished according to any injury done to the 
brain, etc., or not. 
Exter- 
nal. 
1st. External wounds of the head, whether 
they are wounds of the integuments, or of the 
pericranium, or of the bones composing the skull 
or of the face, are not absolutely mortal. 
Internal 
2nd. Internal wounds of the head, unac- 
companied with injuries of the brain, etc., are 
not to be accounted absolutely mortal. 
Where 
brain 
etc., af- 
fected. 
3d. Those wounds of the inner part of the 
head, where the brain, etc., likewise are injured 
are to be accounted absolutely mortal or not, 
according to the following distinctions: 
1st Wounds of the dura mater, where there 
is no sinus or branch of the great artery run- 
ning across it that is injured, are not absolutely 
mortal. 
2nd. Wounds of the dura mater in its sinus, 
and the greater artery, are not to be accounted 
absolutely mortal. 
3d. All wounds of the contents of the skull 
which are attended with great extravasations 
of humours which cannot be evacuated, as in 
the ventricles of the brain, and the base of the 
skull, are to be accounted absolutely mortal; 
such are, what are made at the bottom of the 
skull, in the bones of the temples, the ethnoid 
bones and the inferior orbits of the eyes. 27 
4th. Slight wounds of the brain itself, or of 
the superficial part of the cerebellum are not 
absolutely mortal. 
5th. All wounds of the cerebellum which 
are deep, and of the medulla oblongata, are ac- 
counted absolutely mortal. 
6th. All injuries of the origin of the spinal 
marrow, and all deep wounds through its whole 
length may be pronounced absolutely mortal. 
II. With regard to- wounds of the neck, we 
may make the following observations: 
wounds 
of the 
neck. 
1st. Wounds of the internal jugular veins 
are absolutely mortal; those of the external, 
only so by accident. 
Internal 
jugular 
veins. 
2nd. Wounds of the carotid and vertebral 
arteries may be pronounced absolutely mortal. 
Carotid 
arteries. 
3d. Wounds of the iuternal maxillary ar- 
tery and the sublingual artery belong to those 
esteemed absolutely mortal if they cannot be 
healed. 
Internal 
maxill- 
ary. 
4th. Wounds of the branches of the carotid 
artery, which can be tied or compressed so as 
to stop the blood, may be accounted mortal by 
accident. 
Branch- 
es of 
carotid. 
5th. Wounds of the intercostal nerves, and 
of the parvagune and of the phrenic nerves, 
which run through the neck, induce absolute 
death. 
Inter- 
costal 
nerves 
etc. 
6th. Wounds of the plexus nerves, which 
From 28 
spinal 
marrow 
to arm. 
reach from the spinal marrow to the arm, are 
causes of death. 
Luxa- 
tions. 
7th. All luxations of the first and second 
vertebrie bring absolute death. 
Oeso- 
phagus. 
8th. Small wounds of the oesophagus, or 
gullet, are only mortal by accident, but if the 
gullet be cut through they are amongst those 
which are accounted absolutely mortal. 
Wind- 
pipe. 
9th. In the same manner slight wounds of 
the aspera arteria, or windpipe, belong to those 
which are mortal by accident; but if it be cut 
through, they are always mortal. 
Larynx. 
10th. All violent strokes upon the larynx 
or cartilaginous muscles, on the top of the 
windpipe so as to destroy their tone and power 
of action, will speedily induce the death of the 
sufferer. 
wounds 
of the 
chest. 
11th. Those of the cardaic nerves, etc. 
III. 
I. Wounds of the chest are of two kinds, 
as they are made in the cavity or in the parts 
surrounding it. Of the former: 
Heart. 
1st. All wounds of the heart which pene- 
trate into its cavities, i. e. into its ventricles or 
auricles, are absolutely mortal. The same may 
be said: 
Coron- 
ary ar- 
teries. 
2nd. Of all wounds of the coronary arteries 
which surround the heart, and all the great 29 
arteries and veins which carry blood from the 
heart and bring it back again. 
3d. Wounds of the intercostal arteries or 
small vessels which pass between the ribs, are 
only mortal by accident. 
Inter- 
costal 
arteries. 
4th. Wounds of that part of the gullec 
which lies in the chest are absolutely mortal. 
The same may be said: 
Gullet. 
5th. Of wounds of the windpipe in the 
same situation. 
Wind- 
pipe. 
6th. All wounds of the pericardium, or bag 
containing the heart, are not absolutely mor- 
tal. 
Pericar- 
dium. 
7th. Wounds of the lungs which pierce the 
great blood vessels are absolutely mortal, but 
those which penetrate the smaller vessels are 
only accidentally so. 
ungs. 
8th. Wounds of the air vessels of any 
magnitude are absolutely mortal. 
Bron- 
chia. 
9th. Superficial wounds of the muscular 
part of the diaphragm, or midriff, are mortal 
only by accident, but those which pierce the 
tendinors are absolutely so. 
10th. Injuries to the thoracic duet, which 
convey the chyle, are absolutely mortal, as are 
11th. Those of the cardiac nerves, etc. 
Dia- 
phram. 
II. Wounds made upon the parts surround- 
ing the chest are to be judged by the following 
decisions : 
wounds 
to be 
judged. 30 
1st. All external wounds of the chest are 
not absolutely mortal. 
2nd. A simple luxation or fracture of the 
ribs is not absolutely mortal. 
3d. Considerable bruises and injuries of the 
walls of the chest with dilacerations of the in- 
tercostal arteries are absolutely mortal. 
4th. A wound of the chest, where one side 
only is penetrated in a certain place, is mortal 
by accident. 
5th. Every wound which is of any size, 
that pierces both sides of the cavity of the chest, 
is absolutely mortal. 
As the chest is the seat of the great fountain 
of blood it is no wonder that injuries commit- 
ted there should be mortal, and even in these 
cases where the exceptions are made the hem- 
morhage of itself may cause death. 
IV. 
Wounds of the abdomen are judged by the 
following rules: 
1st. Every wound of the abdomen which 
does not penetrate into its cavity, whether it be 
a wound of the integuments or of the muscles, 
or of the linea alba as it is called, or of the 
navel, or of the abdominal ring, are not abso- 
lutely mortal, nor are they such when they do 
wounds 
of the 
abdo- 
men. 31 
penetrate the cavity, if none of the contents are 
injured. 
2nd. Wounds of the omentum or caul where 
its blood vessels are hurt, so that the hem- 
morrhage cannot be restrained by any art, are 
absolutely mortal, otherwise they are mortal 
only by accident. 
Omen- 
tum. 
3d. Wounds of the stomach are absolutely 
mortal when many of the nerves are at the same 
time injured, when some of the principal blood 
vessels are cut through, or they are made in 
such a place that the food cannot arrive at the 
hollow part of it, but is thrown into the cavity 
of the abdomen. The same may be observed 
where the bottom or curvature of it is wounded, 
or it is pushed to one side. 
stomach 
4th. A wound in the small intestines, so as 
to separate them from the stomach, is abso* 
lutely mortal. 
Small 
intes- 
tines. 
5th. Wounds of the great as well as small 
intestines at some distance from the stomach 
which do not divide the tube are not abso- 
lutely mortal. 
Great 
intes- 
tines 
6th. Wounds of the liver which are deep 
and broad, and are supposed to be connected 
with injuries done to the large vessels passing 
through, are absolutely mortal; in like manner 
are any wounds of the duct of the liver, of the 
cystic duct, of the gall bladder, of the ductus 
Liver if 
great. 32 
choledochus, of the vena portarum, or of the 
artery of the liver. 
Small 
wounds 
of liver. 
7th. Slight wounds of the liver which do 
not occasion an extravasation of the humours 
are mortal only by accident. 
rupture 
of liver. 
8th. A rupture of the liver is always abso- 
lutely mortal. 
Spleen. 
9th. Deep and broad wounds of the spleen 
are absolutely mortal, as well as a rupture of 
the spleen, but slight wounds are only mortal 
by accident. 
Recep- 
tacle of 
chyle. 
10th. All wounds of the receptacle of the 
chyle are absolutely mortal ; the same may be 
pronounced of, 
Great 
vessels. 
11th. All the great vessels, arteries, and 
veins, and the nerves which run through the 
abdomen. 
Pan- 
creas. 
12th. Wounds of the pancreas or milt, as 
the trunks of many large vessels pass through 
it, are absolutely mortal. The same may be 
said, 
Mesent- 
ery. 
13th. Of wounds of the mesentery or ex- 
ternal covering of the bowels, for the same rea- 
sons, upon account of the vessels. 
kidneys 
14th. Wounds of the kidney which reach to 
the bosom of it and cut off the ureters are ab- 
solutely mortal; slighter ones are only so by 
accident. 33 
15th. Wounds of the urinary bladder, 
where the blood cannot be stopped, are ab- 
solutely mortal, and no excuse can be made 
here for wounds being inflicted by surgical 
operations; such being immediately under the 
eye of the operator can be easily restrained, so 
as to have no ill effect. 
Bladder 
16th. Wounds of the external parts of gen- 
eration in men, in which may be included con- 
tusions of the testicles, are not absolutely 
mortal. 
Gen 
itals in 
men. 
17th. Wounds of the womb are absolutely 
mortal. 
Womb. 
Wounds of the extremities in general are 
not absolutely mortal, but sometimes they 
are, as when they are made upon the trunks of 
the largest vessels, in which case such a hem- 
orrhage may arise as no art can restrain, or 
from the vital powers being weakened a most 
powerful and fatal gangrene or mortification 
may be occasioned, so as to elude the force of 
medicines. 
Extrem- 
ities. 
IV. 
We now come to the last division of rules 
concerning wounds, to examine some circum- 
stances by which the mortality of their na- 
ture may be more exactly ascertained. These 
relate: 
Further 
rules on 
wounds 34 
From 
the 
wound- 
ed 
person. 
1st. To the wounded person himself, in 
whom we should attend to his age, his constitu- 
tion of body, his exemption from former in- 
juries, or his subjection to disease, the sex, and, 
if a woman, whether she be pregnant or not; 
the state of his mind, and how far his imagina- 
tion might increase the efficacy of the wound ; 
aud lastly, whether he was at the time in- 
ebriated with liquor. All these circumstances 
aggravate the mortality of wounds. 
Sympt- 
oms. 
2nd. To the symptoms which occur either 
immediately upon a person's being wounded, or 
which appear some time after; the symptoms 
besides these may be of three kinds : 
1st. Those which acknowledge the wound 
to be their sole cause. 
2nd. Which depend upon the wound partly 
as their cause. 
3d. Which do not acknowledge the wound 
to be their cause at all. 
Now in reviewing the symptoms, it will ap- 
pear that the first alone are objects of attention. 
3d. To the instrument with which the in- 
jury was effected, in which its figure, its size, 
its power of acting are to he taken into con- 
sideration. 
Instru- 
ment. 
Time. 
4th. To the time when death may occur 
after the wound is given. 35 
5th. To the methods made use of to effect a 
cure. 
Cure, 
6th. To many occurrences which may arise 
.from the circumstances of time, and any other 
accident which might render a wound more 
dangerous, such as cold air or a desert place 
where no one might be ready to assist. 
Ex- 
posure.