Few medical men there are who have long engaged in practice who have not been compelled to take part in some medico-legal controversy in cases of accidental or alleged homicidal gunshot wounds. So soon as death occurs the surgeon ceases to work as such, but may continue to work as a medical jurist, and in preparation for this event must be ready to answer any questions bearing upon the case which, though possibly ridiculous in surgery, are or may be necessary in law. He may be called upon to testify as to the precise nature of a wound inflicted upon the body of a man seen before or after death; as to the means by which it was inflicted; whether the purport was suicidal or homicidal; how much blood was lost; whether the weapon was near to or at a distance from the body when fired; whether it were possible that the deceased could have fired it himself; whether after the reception of the wound the person could have moved or performed any act—in other words, whether death was instantaneous. He may be asked also as to genuine or spurious blood-stains, whether genuine blood-stains were human or from some other animal; whether possibly they were from the body of the deceased. He will be expected to tell from what direction the bullet or missile was fired; which the wound of entrance and which of exit, and many other things possible concerning the circumstances under which death occurred. It is unnecessary to state that questions of this nature call not only for conventional surgical skill, but for the highest degree of shrewdness and general information, as well as sometimes for expert knowledge with regard to small-arms and their ballistics.

It has been well said that the first duty of a medical jurist is to cultivate a habit of minute observation. When this is combined with a knowledge of what the law requires and with the results of a technical education, he will be able to meet all or nearly all of the scientific questions which may be asked of him. A learned judge once said that “a medical man when he sees a dead body should notice everything.” Certainly he should make a minute scrutiny of the body to note whether there are upon the dress or hands of the deceased marks of blood, or whether blood-stains are noted in different parts of the room; whether the body or any part of it is cold or warm; whether the limbs are cold or rigid or pliant, since by these means the accurate date of death may be more accurately determined.

EXAMINATION AND DESCRIPTION.

In determining facts attending a suspicious case of gunshot wound, there should be noted, if known, 1st, the exact time of death, as well as of infliction of the wound; 2d, location and attitude of the body; 3d, condition of clothing; 4th, anything of importance in its environment; 5th, external appearance of the body, as well as state of countenance; 6th, exact description of all marks of violence and of blood-stains; 7th, the presence of cadaveric rigidity and the surface upon which cadaver has been lying, as well as its age and condition of general nourishment; 8th, time when deceased was last seen alive or known to have been alive; 9th, time after death at which examination is made; 10th, all physical circumstances corroborating or arousing suspicions of suicide or homicide; 11th, account of an accurate internal post-mortem examination, in which direction of the bullet or missile is noted, along with a careful description of parts disturbed or injured in its course, large vessels or nerves cut across, effusions of blood, and in every way as accurate a description as possible of the exact damage done. To this also should be added a minute scrutiny of other parts, in order to establish clearly that death was due to the alleged injury, or on the other hand that it may have resulted from natural causes, and that the injury in question was only a consecutive and contributing cause. Especially should there be examined those organs in which occur the most common causes of death, namely, the brain, the heart and great blood-vessels, and the viscera. Moreover, if an operation has been performed the post-mortem examiner should be prepared to speak with reasonable positiveness as to whether said operation was, in the first place, necessary if life were to be preserved, and, in the second place, whether death were due to the injury proper or to the attempt to save life thus made necessary. For the determination of all this, obviously the best time for the performance of the examination is the earliest possible moment after death. Nevertheless, bodies are sometimes exhumed for this purpose, and much information is obtainable even after a considerable interval of time.

If death has been caused by a bullet which has not passed through the body, but lodged, it should by all means be obtained, since evidence of the greatest value may inhere in it. Moreover, in first noting the position of the body, the direction of the wound, or the location of a blood-clot upon the floor or clothing or elsewhere, may indicate to the surgeon or other astute person the point at which the bullet may be found concealed or buried in some soft or hard object. This bullet should be recovered, if possible, at all events, although if taken from the body itself the evidence it conveys may possibly weigh more heavily than if removed from some object outside the body. The exact number of gunshot wounds with a minute description and location of each should be committed to paper at once, as well as any statement, if at all reliable, concerning the number of shots fired, since valuable deductions may be reached as to the number of bullets which have passed through or which have lodged within the body. It is well sometimes, also, before dissecting out the bullet-wound, to insert first a stiff and then a flexible probe or something which shall, if possible, follow the bullet-track, since occasionally a question comes up of the direction in which it was fired. Even though surgeons well know that such questions are impossible of satisfactory answer, owing to the manner in which a bullet is diverted in its course by the various tissues of the body, it will nevertheless create a good impression as to the thoroughness and exactness of an examination should it be brought out, in answer to questioning, that this had been done. Many an excellent surgeon has been surprised upon the stand by the question from one of the counsel as to whether he knew that some certain writer had stated that it was always well, in trying to determine the course and direction of a bullet, to put the patient or the body, as the case might be, in the exact position in which it was when the shot was fired, providing this be known. The accomplished surgeon knows that this is a matter of very trifling import, but the witness’ status will be much better established with the jury if he can show himself familiar with this possible method of examination.

When a suspected person is brought before a magistrate, accused of homicidal attempt, it is very likely that the judge will require a written statement or opinion from the surgeon in attendance as to the extent and danger of the victim’s injuries, and especially as to whether these are of a character dangerous to life. The meaning of these words is left entirely to the sagacity of the surgeon. A mere naked declaration of this fact is insufficient. He must, if called upon by the court, give his grounds for his belief, and these may be rigorously examined by counsel. He will also probably be asked as to the presumable duration of life and possibly the effect of operation. Thus the prisoner’s immediate liberty or restraint may depend upon the surgeon’s words. Perhaps the only advice which can be offered here is to qualify between injuries directly dangerous to life and those in which life is endangered merely by possible complications, such as sepsis, gangrene, etc. Still, aside from wounds which are either fatal or may be nearly completely recovered from, there is another quite large class of those causing grievous bodily harm in which it is a question for the jury always to decide what was the intent of the accused. A medical witness may thus in such a case be of great assistance to the court by giving an account of the injury devoid of technicalities, and of its possible consequences. It should also always be stated, if known, whether the patient was under the influence of liquor or any narcotic at the moment of injury.

In the examination of wounds either of the living or dead body, it should always be determined for medico-legal purposes whether there is about them fluid or coagulated blood or ecchymosis, that is, livid discoloration of the skin from effused blood. The color of the ecchymotic spot will give a valuable clew as to the time between the infliction of the wound and death. Putrefaction of such a wound must not be mistaken for gangrene. In giving reports on such cases care should be taken to distinguish between facts and inferences. In fact, the inferences had better be kept unreported or confined to a separate statement.

Should there be any possible suspicion of a combination of poisoning and gunshot wound, the stomach contents should be carefully preserved and sealed up in the presence of witnesses before turning over the same to the analytical chemist, whose receipt for the package, with a careful description of the same, will probably have to be placed in evidence. Any fact on the condition of the stomach with regard to digestion is always worth noting. In the case of Reg. v. Spicer (Berks Lent Assizes, 1846) a most important point hinged on the examination of the stomach. The body was found at the foot of a stairway. The prisoner stated that after he and his wife had had their dinner he heard a fall. The woman had died instantaneously and the death occurred about the dinner-hour. Upon examination the stomach was found empty, without a trace of food. It was, therefore, clear that a part at least of the prisoner’s story was untrue.

Evidence as to whether the wounds were superficial or deep may be of value. If the edges are swollen or large, or if granulation or cicatrization have commenced, it is evident that the person must have lived some hours or some days after their reception. The same is true of suppuration, adhesion, or gangrene. It must also be remembered in this connection that very few gunshot wounds will show much change in less than ten or twelve hours save that due to the extravasation of blood. Should the question come up as to whether a gunshot wound had been inflicted before or after death, we may remember the principal characteristics of a wound inflicted during life, which are more or less eversion, more or less hemorrhage with diffusion of blood into the tissues, and the presence of clots. In a wound made after death little or no blood is effused, unless it come from some vessel very near the surface, in which case it will be venous in character and will not coagulate as does that which is poured out of a wound in the living. The track of the bullet also will not be found filled with coagula. In these respects a little will depend upon whether the body has lost its animal heat or not. The gunshot puncture of a divided artery in a dead body will present a very different appearance from one inflicted before death, even though it be the cause of death. Bleeding after death is exclusively venous, and there does not occur extravasation of blood in the cellular tissues, nor does it coagulate. Questions of this character come up sometimes in the case of multiple wounds or injuries, and it is, at times, of importance to be able to determine whether the assault or injury has been continued after death. Changes in color of an ecchymosed spot rarely begin until after the expiration of twenty-four hours, when its dark margins become lighter, and as time goes on the whole area passes through successive shades of violet, green, and yellow; its area may also increase sometimes to remarkable proportions, but the central portions are always darker than the periphery, the darkest spot corresponding to the centre of violence. Ecchymosis is longer in disappearing in the old than in the young. Its various features also will vary a little in accordance with the tissues bruised.

Gunshot wounds pertaining to spurious suicidal attempts are usually found not to involve vital parts, while they will have most of the characteristics of injuries inflicted from a weapon near at hand. The skin or the clothing will show powder-marks, and if a wad is a feature of the cartridge used, it may be found in one place or the other. In these cases there is also relatively more laceration and bruising, while sometimes the hand which held the weapon may be blackened or burnt by the discharge of the same. Self-inflicted wounds, in other words, must necessarily partake of the character of near wounds.

EVIDENCE FROM THE SITUATION OF THE WOUND.

It has been generally noted that suicidal wounds are for the most part confined to the front or lateral parts of the body; gunshot wounds of this character being found usually in the region of the heart, the face, and the temples. The presence of an injury to these parts is not necessarily indicative of suicide, but the existence of such injuries in other parts of the body is at least negative evidence of homicidal attempt. Moreover, Orfila has observed that it is not so much the situation as the direction of the wound which gives evidence for or against the presumption of suicide. The question has been raised whether it were possible to have a gunshot wound without external evidence. There has been recorded more than one case where a bullet entering through the open mouth has penetrated the brain without passing through the vertex of the skull and has killed instantly without leaving any external mark.

It is very necessary to establish, if possible, the direction of such a wound, and this may be coupled with a knowledge of the right-handedness or the left-handedness of the person who inflicted it, or may shed light in this way upon some personal peculiarity which may lead to the detection of the guilty person. Thus it is said of Sir Astley Cooper that in one instance he remarked that a certain wound could not have been inflicted except by a left-handed person, and that his observation led to the detection of the murderer. It has been stated that for the detection of the weapon or instrument used it should be placed first in one hand of the deceased and then in the other, while the other extremities are so manipulated that it may be clearly determined whether suicidal attempt were possible or no. There is ordinarily little difficulty experienced in distinguishing suicidal from accidental wounds. In the former case extraneous signs and circumstances point more clearly to the intent of the deceased than do, perhaps, the peculiarities of the wound itself. This is to be settled mainly by the evidence of those who find the body; in other words, by circumstantial evidence.

In suicides ordinarily one wound only is met with. At any rate, probably one only that has destroyed life. Consequently the presence of several wounds, each of which was necessarily fatal, constitutes almost conclusive evidence of murder, the strength of the same depending upon the necessary fatality of more than one of these. Thus it is hardly conceivable that a suicide should shoot himself through the heart and through the brain; the coexistence of two such wounds would be almost conclusive of homicide. The existence of multiple wounds is a rather strong presumption of insanity or drunkenness of the person who inflicted them. Men who kill when under the influence of liquor not infrequently inflict injuries enough to be several times fatal.

The coexistence of wounds made by cutting weapons, as well as firearms, is not unknown. These are occasionally suicidal, ordinarily they betoken murderous attempt. If suicidal the deceased will ordinarily be found to have been a lunatic.

But evidence is to be obtained also from signs and circumstances separable from the wound itself. Thus the position of the body may be such as to invalidate the theory of accident or suicide. The position of the weapon, too, is something to be noted with great care. Whether, for instance, this be firmly held within the hand of the corpse, or whether it had been simply placed there after his death; whether it be found where it would seem to have been most naturally dropped after its discharge, or found somewhere where it could scarcely have been placed or thrown by the deceased; whether it be found at such a point that it is clearly evident from other signs it could not have been dropped by the deceased, since death must have been caused too quickly for him to have traversed the intervening space.

EVIDENCE FROM THE WEAPON AND PROJECTILE.

Evidence of great value may be obtained often from the weapon itself. First of all, from the position in which it is found, as stated above; second, from a careful examination of itself. It should be noted whether there be any blood upon it, and whether this be so fresh as not to have caused any rust; whether it may possibly be so smeared with blood as to indicate a hand-to-hand conflict; or whether any part of the weapon may have been used as a club or bludgeon, as would be shown by the presence upon it of hair entangled in dry blood. When such blood is removed from the weapon it should be carefully examined with the microscope, since from the detection and identification of hair or fibres of fabric evidence of the greatest value may be adduced. Next it should be ascertained whether a weapon shows signs of having been recently discharged or whether it be evident that it could not have been so, and such determination of the time element as may be afforded by a study of this kind should be contrasted with that made after a study of the wound. If the weapon be a revolver or a repeating arm of any kind, it should be determined if possible how many cartridges or bullets have been fired, and whether at or about the same time, and this information should be compared with the evidences obtained from the body and from the room or locality in which the suicide or murder occurred. If, for instance, it be determined that three cartridges have been fired and but two bullet-wounds are found in the body, an examination of the room may show where went the third bullet. Next the calibre of the weapon should be noted and the weight of the ball which it discharged and its dimensions should be compared with any which may be found in or about the body. The weight of the bullets attached to cartridges of various sizes and makes is usually stamped upon the packages in which they are sold, or can readily be obtained from the makers of the same. A bullet taken from a body weighing after its removal more than do the other bullets undischarged in the weapon by which an injury is alleged to have been inflicted is rather presumptive evidence against the injury from that source.

Can a Bullet Lose in Weight between the Time when it Leaves the Bore of a Gun and its Discovery in a Body?—Here springs up a question upon which some very interesting evidence has been adduced in different trials. To discuss this matter completely the question should be divided into two, the first being:

Does a Bullet Suffer Loss of Weight during its Course through the Piece and the Air before it comes in Contact with the Body?—A personal letter received from Captain Charles Shaler, of the Ordnance Department of the United States Army, in reply to certain questions, tends to fully settle that a lead bullet suffers a certain loss of weight in the barrel due to the friction between the bullet and the bore; this is known as “leading” and varies according to circumstances. “Patching” the bullet is often resorted to in order to reduce the leading; lubrication is also practised. The fusing of a bullet takes place especially with lead bullets. A ball which has been partly fused in the bore will lose the fused portions in the bore or in flight, and will move irregularly on account of the resulting irregularity of form. A .45-calibre, 500-grain service bullet, lead alloyed with tin, was weighed without lubricant and was found to weigh 500.5 grains. It was then lubricated in the cannelures and was fired into a butt composed of three barrels placed end to end and filled with sawdust. Tho bullet was recovered, no lubricant being found in the cannelures, and re-weighed, the weight obtained being 485.5. The loss of weight was, therefore, 15 grains or three per cent, some of which may have been due to the bullet penetrating the sawdust. A German-silver “jacketed” .30-calibre bullet, weighing before firing 231 grains, fired without lubrication, when recovered and re-weighed was found to have suffered a loss of weight of one-half grain or one-quarter of one per cent. The other part of the main question is:

Does the Bullet Lose in Weight in its Course through the Body?—This is, of course, intended to pertain only to those instances in which there is no evidence of splitting or division of the bullet, and refers only to the effect of friction or attrition. June 5th, 1878, in Saratoga County, Mrs. Jesse Billings was accidentally killed by a bullet. Her husband was arrested and tried for murder. On the first trial he was acquitted. A second trial, however, was held, and some very interesting expert testimony was brought out on matters pertaining to these questions. The medical evidence is published in full by Dr. Lewis Balch, of Albany, in the Transactions of the Medical Society of the State of New York for 1881. The rifle from which the bullet was supposed to have been fired was found in a well, and was sworn to have belonged to Jesse Billings. In it was found a cartridge of the type known as the Commercial Long No. 44. This gun became an important factor in the case, and most of the evidence as to whether it was the weapon with which the murder had been committed was referred to the medical experts. The defence in the first trial claimed that all the lead fired was found in Mrs. Billings’ head. On the second trial the same claim was not made, but that it was a smaller bullet than a .44 and its weight less than 220 grains; that in consequence this rifle could not have been that from which the shot was fired, for it only called for a .44 ball, and that it would have thrown a bullet with such force that it must have gone entirely through the head. They further claimed that powder-marks and grains of powder were found in the window-sash, showing that the weapon was fired near the window, and that the hole in the glass was not large enough to admit a full-sized .44 ball. The verdict was mainly won upon these statements. A question for the medical experts to answer was, what would be the effect upon the skull of a .44-calibre ball fired from a Ballard rifle, the ball weighing 220 grains and the charge of powder being 28 grains? also what would be the effect upon the ball? Experts from the Ordnance Corps and from the rifle factories were able to testify that the bullet found in Mrs. Billings’ head was originally a .44-calibre ball; also that its markings showed the peculiar left-handed twist used in rifling this particular arm. The defence maintained that it could not have been a .44, claiming that the hole in the window-pane showed that. The original window produced in court was no criterion, since from repeated handling the hole made by the bullet had become enlarged and changed in shape. Both of the experts for the defence believed that the ball could not make a hole smaller than itself when passing through glass. This necessarily supposes that the ball after being fired is the same calibre as before, which, as shown above, is not always the case. So Dr. Balch fired forty-five rounds from the Billings rifle with 220 grains of lead and 28 grains of powder. The shots were fired through glass set in sashes, the glass being 28×13¼, double thick and American make. The rifle was discharged at varying angles and at distances varying from two to seventy feet, and he obtained one shot where the hole made would not admit a full-sized ball. His summary was as follows:

Other rounds were fired from a Colt’s navy revolver, old style, .36 calibre, at distances varying from ten to twenty feet. The holes made were so large that the barrels and ramrods could be passed without touching. The examination of the one instance noted above where the aperture in the glass was smaller than the ball is explained by Balch as follows: “A ball conoidal in form, passing with great velocity, strikes glass, penetrates, but does not break the glass at the point of entrance. The point struck is instantly disintegrated, and so rapid is the stroke that it has not time to call upon the surrounding particles for support; hence the smallness of the hole. As glass is made it varies in elasticity; some parts which are to be cut into panes cool faster than others. A bullet striking the portion of the glass which has cooled quickly strikes an object which will yield somewhat to the force; in doing this a hole will be made smaller than if that more brittle had been struck. Furthermore, all rifles taper more or less from breech to muzzle, that is, the muzzle will measure one or more thousandths or hundredths less than the breech. The bullet being forced through the narrow aperture yields to the pressure and becomes smaller. The gun under consideration was measured at the New York Armory, and found to be .44 at the breech or chamber and .423 at the muzzle. Considering these various facts, statements that a ball of known size will make a hole through glass smaller than the size of the ball when fired do not admit of doubt as to their verity. Some statements bearing on this same point contained in a recent letter from Captain Shaler, of the United States Army, deserve mention here. The following experiment was made in Washington by Captain Lyon in October, 1880:

“Noticing a statement in a newspaper to the effect that a ball fired from a rifle would, in passing through glass, make a round hole smaller than the diameter of the ball used, the following experiment was made:

“Service ammunition used, in a calibre .45 Springfield rifle to penetrate glass.

“From the above it will be noted that there is no uniformity in the size of the holes and that they all exceed the diameter of the bullet.

“These experiments were supplemented by some made recently in which a sash containing six panes of ordinary window-glass was placed at twenty-five yards from the firer and the glass was successively penetrated (a separate pane being used in each case) by bullets from a service .45-calibre Springfield rifle, a .30-calibre Springfield rifle, a .45-calibre Colt’s revolver and a .22-calibre revolver. In every case the hole made was much larger than the bullet making it.”

With reference also to the effect of a ball being smaller than its original diameter after it leaves the piece, Captain Shaler states: “All very compressible bullets forced by inertia lose a certain amount even though they also gain force by slugging. Forcing by inertia tends to shorten the bullet and increase the diameter, while slugging tends to lengthen the bullet and reduce its diameter. Whether the bullet is smaller after it leaves the piece depends upon the bullet used and the method of forcing employed.”

To return to the Billings case, it was claimed that the bullet was also too small. It weighed 165 grains, 55 less than when it was fired from the rifle. Balch found in firing at human skulls, the subjects in all the trials but two being placed in a sitting posture, sometimes with a sash like the Billings window in front of the subject, that the ball lost lead in accordance with the resistance it met with and the amount of bone ploughed in its passage. These experiments conclusively prove that the weight of a ball taken from a body after being fired, it having traversed a bone in its flight, is by no means evidence of its weight before firing; in other words, a ball always loses some lead when passing through bone. With the same rifle as that produced at the trial he made a series of experiments in the dissecting-room, endeavoring to make a bullet enter the skull at the same point and in nearly as possible the same direction as in the case of the murdered woman. In six such experiments there were varying losses of lead, all the bullets used being the same general weight. In two trials the distance was but ten feet from the muzzle, yet more lead was lost than in any of the other four. The least loss recorded took place at the longest distance, thirty-five feet. This in part accounts for the loss of lead, for at ten feet the bullet has not acquired its greatest penetrating power, for he showed by experiment that a 220-grain bullet fired at a human skull will lose more lead than was missing from the Billings bullet, thus disposing of the question raised by the defence that a ball could not have weighed 220 grains before being fired.

Just how to account for the missing lead has never been clearly established. We have to remember that a few grains may be left in the bore of a rifle, especially if rusty; that in passing through glass another portion is lost, and finally it is scarcely conceivable that any bullet should penetrate an adult skull, especially in the neighborhood of the mastoid processes, without losing quite a perceptible percentage of its mass by friction.

It was also claimed by the defence that the ball taken from Mrs. Billings’ head had been fired from a weapon of low velocity, which was held to account for the fact that the ball failed to pass out of the skull. The rifle when tested at the Government Arsenal showed a mean velocity of 999 feet per second. Had it been as high as was supposed by the defence, namely, 1,300 or 1,400 feet, the argument that a bullet driven with this force would always go through the skull would have more weight, but with the velocity found by actual test the energy of the ball was lessened to nearly one-half of that supposed. The bullet which killed Mrs. Billings did not pass entirely through the skull. It ploughed into the opposite side and broke before it a triangular piece of bone which broke the skin externally. This shows the resistance of external fascia against perforation. A study of the lines of fracture in this particular case proved very interesting, but perhaps would be somewhat irrelevant here. A measurement of the skull and of the bullet-track through it shows the former to have been of more than ordinary thickness and density, and the channel ploughed in the bone by the bullet along the base of it to have been nearly two inches in length. Dr. Balch gives the following conclusions to his very interesting evidence: 1st. A leaden ball passing through bone loses lead in proportion to the amount of bone traversed. 2d. If the petrous portion of the temporal bone be the part struck by the ball and struck squarely at the base, that portion of the bone is crumbled or broken in such exceedingly fine pieces as to defy restoration. 3d. That if the ball struck any part of the skull the petrous portion will be broken, but can be usually recognized and generally put together again. 4th. That a ball of given calibre fired through glass may make a hole enough smaller than the full size of the ball before firing to prevent an unfired ball of like calibre passing.

In all this kind of experimentation upon cadavers for the purpose of eliciting evidence by reproducing as nearly as possible ante-mortem injuries, we must not forget that Casper has strongly insisted that “it is extremely difficult to break up the organic cohesion of dead organs.... If we endeavor to fracture the skull of a dead adult we shall find that an amount of force which if applied in life would indubitably produce fissures if not fracture, or complete crushing of the skull, leaves the dead skull quite uninjured.... The most powerful blows struck down upon the body, laid down horizontally, were without result, and only after repeated violent blows were we able to produce perhaps one or a few fissures in the occipital or parietal bone, or in the temporal bone (squamous portion), and usually in the latter. We were unable to produce more considerable effects, such as complete smashing of the skull or fissures of its base, even in one single instance. The dead skull seems to have considerably more power of resistance, and after its removal fissures of the bone were more easily produced by similar blows” (Vol. I., p. 245). And again: “The result of my experiments on the dead body in regard to gunshot wounds could only be to make more complete the proof of the resistance of the dead corporeal tissues, in contradistinction to the tissues when alive. After I had already learned this peculiarity from my experiments with contused wounds, this peculiar resistent property was found to be confirmed in a most remarkable manner” (“Forensic Medicine,” Vol. I., p. 271).

If the number of bullets known to have been fired, or, more important still, which have been found exceeds the number which could have been discharged from the weapon in question, a very large element of doubt and uncertainty is introduced which must be quieted by other and more circumstantial evidence. Should two different weapons be in question, it is very necessary to establish from which of them the bullets have been discharged. This can be done mainly by weight and evident calibre of the bullets, or some other peculiarity; possibly in disputed cases even by analysis of the metal.

Wounds by Shot-Guns.—In most of what has been said it has been supposed that the injury has been inflicted by an arm of the kind commonly described under the terms pistol, revolver, or rifle. Gunshot wounds are, however, occasionally inflicted with shot-guns and a charge of shot varying in size from small bird-shot up to that generally known as buck-shot. It is characteristic of such missiles that they separate after their discharge from the gun, and a determination of the degree of their separation is approximately a determination of the distance of the mark from the muzzle of the weapon. In suicide or accidental discharges of a shot-gun the muzzle is so near the body that the charge of shot acts very much as would a single bullet of the size of the bore of the gun, and near wounds thus inflicted, while necessarily large, have about them a minimum laceration and disturbance of tissue, so that perhaps only by their size could one say, viewing the wound alone, that the weapon used had been a shot-gun. On the other hand, at a distance of a few feet the shot begin to separate to such an extent that there is much more laceration of tissue, and after separation to an indeterminate, because variable, number of feet we get such marks as individual shot may make. This distance is indeterminate because it is predicated on the size of the gun, the dimensions of shot, and the weight of the charge of powder. The writer, for instance, has recently seen one case where the muzzle of the gun could not have been more than two feet away from the surface of the foot at which it was discharged, the consequence being a round and very slightly ragged hole through the mid-tarsal region from dorsum to sole.

It is possible for a single grain of shot to produce death. Such a case is related by Ollivier d’Angers: a thief scaling a wall received at a distance of fifteen paces a charge of shot from a fowling-piece; he fell dead immediately. The charge had struck him in the breast, centring over a space of three or four inches, but one shot had penetrated the aorta over the attachment of the sigmoid valves, and another had traversed the entire wall of this vessel.

Powder-Marks.—A very important part of evidence in case of near wounds of gunshot character pertains to the powder-marks upon the clothing and skin. Naturally every one knows that when a weapon is discharged near a given surface there will be more or less powder-marking upon that surface, the same being due to particles of gunpowder which are incompletely or not at all consumed, and which are black because of the charcoal they contain; but the circumstances under which powder-marks of a given character can be inflicted are so extremely variable that no statistics or information of value in a general way can be given. Thus the fineness of the marks will depend upon the fineness of the powder, and the area covered and the depth of the marking upon the same, upon the distance of the muzzle from the surface; and the only way to make out the exact distance of the muzzle from the surface at the time of the infliction of a given wound is to use the same weapon, if possible, with cartridges or charges out of the same lot as that used at the time of injury. Distances could, perhaps, be stated in round numbers, but their value would only be remotely approximate, and in a given case the best evidence is to be obtained by experiment with the fire-arm in question.

Dimensions of Perforations.—At different times a great deal of weight has been attached to the dimension of the perforation through such objects as wood, glass, or even through the bones of the body, made by the bullet which is supposed or known to have destroyed life. Wrong inferences have been drawn sometimes from a study of undischarged bullets or cartridges similar, at least before firing, to that which has been taken from a given body. It has been stated, for instance, that such a bullet was too large to have passed through such an aperture or to have made such a hole, or that it was so much smaller than a certain hole that it was not the particular missile which made that perforation. Upon this matter has hinged a great deal of uncertainty and consequently a good deal of study. The size of opening which a bullet of given calibre will make through wood depends upon the distance of the weapon, the firing charge, the velocity of the bullet, the extent to which its shape has been altered by passing through the given barrier, by the heat of the explosion, by the impact of the air upon the heated and consequently softened metal, and by the density and thickness of the wood, as well as by the resistance which it may have offered mainly from its being fixed in place or movable. There is, however, ordinarily less question about the size of a similar hole through a piece of glass or bone. It is generally supposed that a bullet passing through a window-pane will shatter it. This depends, however, mainly upon the perfection of fixation of the glass in its resting-place. If for purposes of experiment panes of glass be tacked into a shutter and bullets be fired at them from varying distances, they will be practically invariably shattered. It is, however, quite different if the pane of glass be firmly fixed in a frame by means of putty which has become old and hard, and especially if the window-frame itself be closely fitted in the casing. Under these circumstances a bullet will often make a clearly punched hole, or one with very few radiating lines of fracture. Experiment, therefore, to secure evidence should be made under circumstances exactly parallel to those which necessitate such evidence.

EVIDENCE FROM EXAMINATION OF THE DEAD BODY.

Fractures.—Considerable evidence of great interest with respect to the effect of a bullet-wound upon the skull and the possibility of fractures being produced at the base by contre coup will be found in the statement of the case of The People v. Elisha B. Fero, published by Dr. Charles T. Porter, of Albany, in the Journal of Psychological Medicine, April, 1870. Mrs. Fero was murdered while in her bed and was found to have been bruised about the head and body, her husband claiming that the deed was that of a robber who had attacked them both. He was found with slight bruises or scratches about the face and black marks as if from burnt powder between the middle fingers of his right hand. The first autopsy appears to have been carelessly made, but a flattened conical ball weighing twenty-six and one-half grains was found lodged in the middle of the right cerebral hemisphere. It had not gone completely through the brain. Its base fitted the shells of the metallic cartridges used in Fero’s revolver. Eight days after death a second examination was made, after which the head was removed and preserved in 95% alcohol. A theory of the prosecution was that Mrs. Fero was murdered by her husband; that he shot her, as well as struck her numerous blows upon both sides of the head and its front and back with some broad, heavy, and elastic body, making fractures found on autopsy. Not the least interesting part of the testimony is that referring to the condition of tissues alleged to have been bruised after long preservation in alcohol. The expert testimony in this case appeared to show that such fractures as were found, without reference to the fact of external bruises, were due to the unskilful manner in which the skull-cap was removed. In this connection it is well right here to emphasize the fact that fresh fractures can be produced in the skull by too forcible or injudicious efforts to remove the calvarium when making autopsies, or that fractures previously existing can be extended or complicated in the same way. Shaw in his “Manual of Anatomy” says: “The question whether there has been a fracture of the cranium previous to death is sometimes more difficult to decide than a person not accustomed to make dissections might imagine. If the fracture has occurred immediately before the patient’s death, there will be found coagulated blood upon the bones and in the fissures. If the patient has survived for some time, there will be marks of inflammation and, perhaps, pus in contact with the skull, but if a fracture has been made in making the examination, which sometimes happens in even very careful dissectors’ hands, the blood in the fracture will not be coagulated, nor will there be any effusions around the portions. In Beck’s Medical Journal, Vol. XXII., p. 28, Mr. Alcock some time since stated in a public lecture in London that he had known a fracture of the base of the skull produced by the awkward and violent tearing of the upper portion by the saw in penetrating enough to divide the bones, and this to be mistaken by the inexperienced operator for fracture of the skull producing death. Being a medico-legal case, it might have led to melancholy consequences had not the error been detected by an observer.” That an extensive and often complicated fracture by contre coup can occur as the result of gunshot injuries of the skull is a fact well known to all surgeons of experience and laid down in all text-books and illustrated in all large museums.

In view of these well-known facts, it would always be well to insist in cases of this kind that the saw alone should be used and not the hammer nor the chisel. When a cranial bone is fractured blood is poured out from the ruptured vessels, as is always the case with any bone. Its amount varies indefinitely with the number and size of the ruptured vessels, the activity of circulation, the length of time a person lives, etc. The blood may collect in circumscribed masses or become infiltrated in the surrounding tissues, although usually both phenomena are observed. The extent to which infiltration takes place depends upon the quantity of blood and the nature of the surrounding tissues. In loose tissues like those about the orbit infiltration is much more rapid and extensive.

Examination of the Weapon.—French medical jurists have tried to indicate how we may determine the time elapsed between the death of a person and the discharge of a weapon found near the body, but exact statements in this matter are utterly out of the question. Certain facts bearing on the subject are these: When recently discharged there will be found adhering to the barrel of the piece and consisting of the fouling of which sportsmen complain, a quantity of potassium sulfid mixed with charcoal. This is shown by its forming a strong alkaline solution with water, evolving an odor of hydrogen sulfid, and a dark precipitate with a solution of acetate of lead. Depending upon the degree of exposure to air and moisture, after some hours or days this sulfid becomes converted into potassium sulfate, which forms a neutral solution with water and gives a white precipitate with acetate of lead; but if a considerable time has elapsed since the discharge of the piece oxid of iron (iron rust) with traces of sulfate may be found (Ann. d’Hygiene, 1834, p. 458; 1837, p. 197; 1842, p. 368).

Was the Weapon Fired from a Distance or Near By?—A gunshot injury from a bullet implies at least one wound, namely, that of entrance, and perhaps another, that of exit. It does not always happen that the bullet passes through the body. The appearance of the wound of entrance is usually one of irregular circular puncture, its edges perhaps slightly torn or lacerated, with a purplish or dark areola, varying in width from a line or two to one-half inch. When the weapon is fired close to the body there are likely to be more or less powder-marks, and possibly actual burning from the heat and flame of the gunpowder. If the part of the body injured had been covered by clothing at the time, the marks of powder and of burning would probably be confined to the same. Bleeding is usually slight and occurs more commonly from the wound of entrance than from that of exit. Regularity of either of these wounds depends in large measure upon the angle at which the bullet has struck the surface. When striking very obliquely the wound may be more oval or the bullet may have ploughed a furrow or a channel, by a study of which the relative position of the assailant and the assailed at the moment of injury may, perhaps, be determined. It is of importance to determine if possible the approximate distance at which the bullet was fired, since the question of self-defence, for instance, may hinge upon evidence of this character. The charge of powder and the weight of the bullet being known, one may sometimes estimate this distance by the depth of penetration or the appearance of the bullet. Still, the nature of the tissues must figure largely in such consideration. Many suicides who shoot themselves in the head show only one wound of entrance and none of exit.

Experiments Testing Powder-Marks.—Powder-marks and burns from weapons ordinarily used will scarcely appear when the distance has exceeded ten or twelve feet. LaChese, of Antwerp, found that in firing a gun even from a distance of only four feet the skin was only partially blackened.

As the result of experiments made with a Ballard rifle, old style, .44 calibre, with bullets of 220 grains and 28 grains of powder, Dr. Balch, of Albany, found that powder-marks were made at distances as follows:

At two feet, particles too numerous to count, with some of the lubricant blown upon the board;

At four feet the same;

At six feet the same;

At eight feet, nine grains of powder;

At ten feet, five grains of powder in one case and six in another.

That these were powder-grains were shown in court by picking some of them out, placing them on a glass, and igniting them with a galvano-caustic point. From those at ten feet no distinct flash could be elicited; from those obtained at eight feet distinct flashes were seen (Trans. New York State Med. Soc., 1881).

In the celebrated case of Peytle, brought in 1839 for the murder of his wife, who had been killed by two bullets entering near the nose, the eyebrows, lashes, and lids were completely burned, and a large number of powder grains were imbedded in the cheeks. Experiments being made in order to ascertain the distance necessary to produce these effects, it was found that the weapon must have been held within a distance of twelve inches.

Wounds of Entrance and of Exit.—A great deal has been written in time past about the peculiarities of the wounds of entrance and of exit, much of which cannot be maintained under expert criticism. It is true that the wound of entrance will usually be well defined, the skin slightly depressed and appearing as above noted. It is true also that powder-marks will appear about this wound rather than that of exit. Usually, too, the orifice of exit is larger, less regular, its edges everted slightly, with more or less laceration of the skin, and quite free from any powder-marks or evidence of burning. The depression at the border of the wound of entrance differs after some days, by which time the contused margins slough away, and its appearance is daily changed by a process of granulation providing the individual recover or live long enough. According to Dupuytren, the hole in the clothing is smaller than that made by the same bullet in the skin. These are all points worth remembering when fitting bullets into wounds which they are supposed to have made; but the conditions under which gunshot punctures occur are constantly varying, and the significance of local markings is mainly the product of experience, care, observation, and reasoning. Thus the shape of either of these wounds will depend naturally upon the integrity of the bullet and its original shape and dimensions. Matthysen’s experiments give the following: A pistol fired at twelve paces distance, with a ball 15 mm. in diameter, made a wound in chest of 8¼ mm. diameter, and at its point of exit at the back one of 10 mm. In two experiments at the same distance as above, the entrance wound was 4 mm. larger in diameter than that of exit, and when a larger ball with a diameter of 17 mm. was used the same results were preserved, both wounds being less in size than the ball which made them. A spherical ball will usually cause more loss of substance than a conical, while the latter will cause usually more irregularity of outline and may even give the wound of entrance a slit-like appearance. Complications may also occur from other sources; a single wound of entrance may give rise to two or more wounds of exit due to splitting of the bullet, or if the bullet have been divided and the larger part lodged in the bone, only the smaller portion passing out, the wound of exit may in reality be much smaller than that of entrance. Again, a bullet may split into fragments before striking the body, and of these one may enter the body, or one or more of them lodge. Multiple wounds are possible even from one bullet, as when it passes through two different parts of the body. Again, when two wounds, for instance, are discovered, one of them may be regarded as that of exit, when in reality they may be two wounds of entrance, neither bullet having left the body. So while it is possible in some cases to decide which is which, too much dependence should not be placed upon appearances of this kind, least of all until after a careful autopsy has been made.

Course of the Projectile.—When a bullet traverses a body the two apertures may be nearly opposite to each other, although the bullet may not have taken a direct course between them, having been deflected by tissues of varying density in its course. This leads to the mention of the effect of animal tissues upon the course of bullets, with which works on military surgery deal extensively.

The following is a remarkable illustration, yet authentic, of a devious path of a ball. In a duel with pistols between two students at Strasburg one fell, apparently mortally wounded in the neck, but recovered without feeling any inconvenience from his wound. It was found that the bullet had struck the larynx and had gone completely around the neck. It was taken out by simply making an incision over it. Other instances may be cited where bullets have made a circuit around the head, thorax, or abdomen. The ball may make a half circuit of the body and lodge or emerge at a point opposite that at which it entered, thus leading one to suppose that it must have passed directly through (Wharton and Stille).

As the writer of a chapter on the effect of projectiles of small-arms, in the Third Surgical Volume of the “Medical and Surgical History of the War of the Rebellion,” p. 709, says: “Such bullets attain great range and effectiveness as oppose least frontage of resistance to air; their velocity consequently is greater. Rotation upon their long axes tends to give them steadier flight and more direct course. By their pointed apices they pierce more easily the structures opposed to them. Such bullets, owing to the elasticity of the skin, make a wound of entrance perhaps a trifle smaller in diameter than themselves, while spherical balls are more likely to carry a portion of the integument in with them.”

The differences of structure and density of the muscle tissues and their aponeuroses encountered by a bullet in its passage materially influence the directness of its course unless its velocity be very great, while round bullets are the more easily deflected from their course. The track of a small conical bullet passing swiftly through a muscle is more cleanly cut than that made by a round bullet, but in all gunshot wounds there is usually found a regular canal, with lacerated walls, with more or less destruction along the area of injury, shading off concentrically until lost in healthy tissue. There is always loss of substance dependent on muscle tension or direction of the bullet, whether transverse or obliquely to the direction of the muscle fibres; the more fibrous structures are torn and lacerated or simply perforated, mainly owing to their different tension at the instant; their openings seldom correspond to those of the muscle tissues or those upon the surface of the body, because of the constant change in the relation of the parts due to muscle action. This makes it often difficult to follow the course of a bullet with accuracy. The irregularity of a bullet-track due to these causes constitutes one of the great sources of danger, since cavities and pouches thus formed give lodgment to foreign matter driven in with the bullet, by retention of which a fertile source of sepsis is maintained. Gunshot injuries of bone may be classified as contusions, simple fractures, partial fractures, penetrations, perforations, and complete fractures with more or less comminution or loss of substance, all of these, of course, in the surgical sense compound. These are all manifestations of mechanical force acting in accordance with established laws. On autopsy these will be ascertained, while one or more portions or all of a bullet may be found imbedded in or attached to some bone. The best illustration of such accidents will be found in the “Medical and Surgical History of the War of the Rebellion.”

Such questions as pertain to the position of the wounded person when shot or that of his antagonist, and other similar inquiries, can only be settled by reference to particular circumstances of individual cases. Position of the wound may help a little. A bullet-wound directly in the centre of the top of the head could scarcely be received by a person standing unless his assailant occupied an elevated position. If accompanied by evidence of severe blows by which the deceased might have been knocked down, it might show that he had been shot after falling.

Wounds by Small Shot.—Small shot rarely traverse the entire body unless discharged from such proximity as to make a clean, round opening. Paley relates the following instance: A boy was shot in the neck by the accidental explosion of his own gun, No. 8 shot. He died instantly. He was lying forward of the muzzle so that it was nearly in contact with the skin of the neck. A large round hole was produced, in diameter one and one-half inches, whose edges were slightly darkened by powder. The wound of exit at the back of the neck, at the third vertebra, was a mere slit in the skin scarcely an inch in length with the diameter placed vertically. The smallness of this aperture may have been owing to the greater part of the charge being lodged in the body. Dr. Lowe states that in some experiments it was found that a round aperture might be produced by a discharge of small shot at a much greater distance than that assigned by Dr. LaChese, namely, ten to twelve inches. Even admitting such exceptional instances, it will scarcely ever occur that a wound from a small shot can be mistaken for one produced by a leaden bullet.

De Vergie has shown that when the ball enters a portion of the body well covered with fat, this often protrudes between the edges of the wound and may alter its character. If clothing have been carried in some shreds of it may show upon the wound, and such fragments of texture will nearly always characterize the wound at once as that of entrance.

Wounds by Blank Charges.—Experience has shown that no matter with what the piece is charged, it is capable, when fired close by, of producing a wound which may prove fatal. Thus a gun loaded with wadding or gunpowder only may cause death. A portion of clothing may be carried into the wound and lead to death from hemorrhage, or death may occur from many secondary causes, such as tetanus or sepsis. Accidents so frequently occur from weapons discharged in sport, not loaded with ball or shot, that it is worth while to bear this in mind. It has been observed, for instance, that persons attempting to commit suicide have forgotten to put a bullet in the pistol, nevertheless the discharge of the weapon into the mouth has sufficed, from the wadding alone, to produce a considerable laceration and hemorrhage (Taylor). Many fatal accidents have taken place by the discharge of wadding from cannon. LaChese has ascertained by experiment that a piece charged with gunpowder alone is capable of producing a penetrating wound somewhat resembling that produced by gunshot, when the piece is large and fired within six feet of the body (Ann. d’Hygiene, 1836, p. 368). This arises from unexploded grains of powder acting as pellets of small shot. Sweet has experimented with pistols loaded with gunpowder and wadding in order to determine the effect of their discharge at different distances. At twelve inches he found that the clothing was lacerated and the skin abraded, but the wadding did not penetrate; at six inches the clothes were lacerated and the wadding penetrated to the depth of one-half inch; at one and one-half inches from the chest the wadding passed into the thoracic cavity between the ribs, and at a second experiment carried away a portion of the ribs.

It is probable that an ordinary wadding such as loosely wrapped paper, rag, or similar material, especially as prepared by one not accustomed to military use of a weapon, would not produce a wound which would resemble that made by a bullet, and it is doubtful whether such a wound could be produced at a greater distance than six inches from the body.

It is on record that in Paris, in 1858, a circus cannon of four inches bore, loaded with three ounces of grain powder retained by a wad of old theatre bills loosely folded together and rammed home with only moderate force, was discharged in the direction of the boxes at a distance of about one hundred and fifty feet. A man seated in one of these boxes opposite the muzzle of the gun, leaning forward, his arms crossed upon the handle of his umbrella, had his arm broken above the elbow immediately upon its discharge. Several portions of wadding were found beneath the place where the man sat, but no marks existed upon his clothing nor upon the anterior part of the arm, which must have been inaccessible to any projectile that did not first strike the forearm. It was concluded that the fracture had been caused by the violent and sudden starting of the man backward, which must have brought his arm against the hard part of the partition. An experiment tried with the cannon proved that any wadding that could be made with paper was dispersed in passing, or lost all power of mischief, at much less distance than one hundred and twenty feet (Annales d’Hygiene, 1859, p. 420, Wharton and Stille).

The Mannlicher Rifle.—It may be of interest here to note the effects of the rifle-bullets used in the most recently invented improved arms. The last new projectile used in the German army, 1892, with the Mannlicher rifle, has an inner core of lead inclosed in a casing of steel or firm metal, which prevents the lead, even when softened by heat, from becoming deformed and enlarged by contact. The weight of the bullet is much less than any of the old, but to its higher rate of velocity and its pointed shape, which is preserved, must be ascribed its greater perforating power. Owing to this immense velocity and the small surface of contact, it meets with little resistance on striking a person, has no time to stretch the various tissues it encounters, causes little or no commotion of the neighboring parts, and merely punches a hole, carrying the contused elements before it clear out of the wound without seriously damaging the surrounding wall of the bullet-track. This absence of contusion must lead to more frequent deaths from hemorrhage, while when this arm is used we shall hear very little of deflection or deviation of the bullet from its path, since it has sufficient power to pass directly through any part of the body which it may meet on its way. The result in battle will be a reduction of the list of wounded, but a terrible augmentation of that of the dead.

IDENTITY FROM A FLASH OF GUNPOWDER.

Taylor states the following: “Among the singular questions which have arisen out of this subject is the following: whether the person who fires a gun or pistol during a dark night can be identified by means of the light produced during the discharge. This question was first negatively answered by a class in physical science in France, whereas later a case tending to show that their decision was erroneous was subsequently reported by Fodere. A woman positively swore that she saw the face of the prisoner, who fired at another during the night, surrounded by a kind of glory, and that she was thereby enabled to identify him. This statement was confirmed by the deposition of the wounded party. Desgranges, of Lyons, performed many experiments on this subject, and he concluded that away from every source of light the prisoner who fired the gun might be identified within a moderate distance; if the flash were very strong, the smoke very dense, and the distance great, the person firing the piece could not be identified. The question was raised in England in the case of Reg. v. White at the Croydon Autumn Assizes, 1839. A gentleman was shot at while driving home on a dark night, being wounded in the leg. When he saw the flash of the gun he saw that the piece was levelled toward him, and the light of the flash enabled him to recognize at once the features of the accused. In cross-examination he said he was quite sure he could see the prisoner and was not mistaken as to his identity; but the accused was skilfully defended and he was acquitted. A similar case was tried at the Lewes Lent Assizes, 1862, Reg. v. Stapley. The prisoner shot at the prosecutor on a dark December evening, and the latter swore that he distinctly saw the prisoner by the flash of the gun and could identify him by the light on his features. His evidence was corroborated and the man was convicted. A case is also quoted, Rex v. Haines, in which some police officials were shot at by a highwayman during a dark night. One of these stated that he could distinctly see from the flash of the pistol that the robber rode a dark-brown horse of remarkable shape, and that he had since identified the horse at a stable in London. He also was positive that the prisoner had on a rough brown great-coat.

There seems to be enough evidence in this direction to show that identification under these circumstances is occasionally possible.

GENERAL MEDICO-LEGAL CONSIDERATIONS.

The result of the wonderful advance in the practice of surgery made during the past fifteen years has been in a large measure to revolutionize the treatment of gunshot wounds, and inasmuch as the result of many homicidal attempts will depend in large measure upon what the surgeon can do for the victim of assault, it may not be amiss to very briefly epitomize in this place something of what modern surgeons believe with regard to the best treatment of bullet-wounds, expressed in a general way. They have learned, among other things, that the harm which a bullet does is done by it during its flight, and that after it has come to a stop it is, per se, an almost invariably harmless foreign body. This is practically always the case unless it has carried in with it foreign material which may serve as a source of septic infection.

In time past there has always been a strong feeling, which had, however, nothing scientific to justify it, that every gunshot wound was a poisoned one. Of late, since bacteriology has attained the proportion of a science, it has been held that bullets were necessarily sterilized by the heat of the discharge of powder behind them. Very recently Dr. B. Von Beck, Medical Director of the 14th German Army Corps, has made experiments upon the amount of heat imparted to leaden and other bullets after firing. After making an allowance for specific heat and the conductivity of the different metals used, he found that even when the projectiles encountered resistance from three to four times greater than that offered by the human body the results were as follows: Temperature of leaden bullets of .45 calibre, when recovered, 69° C.; of .30 calibre, covered with steel, when recovered, 78° C.; of .30 calibre, covered with copper, when recovered, 101° C. He states that these experiments disprove the theory that certain lesions in wounds can be in any way attributed to the heat imparted by the bullet.

While these experiments prove that the bullets may be heated to the above degrees when recovered, they by no means prove that they are so heated at the time when they inflicted the wound. During the year 1892 some very interesting experiments were carried on by Dr. Lagarde, of the Army Medical Department (New York Medical Journal, Oct. 22d, 1892, p. 458). He experimented by deliberately infecting bullets and then firing them into cotton, and animals as well, studying the effect both on the bullets themselves and upon the animals. Some of these bullets were taken from the original packages, while others had been intentionally rolled in dirt. The experiments were carefully carried out and appear reliable, and the conclusions given by the author, which interest us here, are as follows:

(1) The vast majority of cartridges in original packages are sterile or free from septic germs because of the disinfection and absolute cleanliness observed in the process of their manufacture.

(2) The majority of gunshot wounds are aseptic because the vast majority of the projectiles inflicting them are either sterile or free from septic germs.

(3) The heat developed by the act of firing is not sufficient to destroy all the organic matter of the projectile, the cherished notions of three centuries or more to the contrary notwithstanding.

The results as set forth justify the assumption that a septic bullet can infect a gunshot wound. The average bullet-wound, however, is sterile so far as infection from the bullet is concerned, and in accordance with this view of its usual innocence there need be no longer the clamor for removal of the missile which the fears of previous generations have nearly always called for; and the best practice among military surgeons of to-day is rather to let the bullet remain where lodged than to make a more serious wound for its removal. Exceptions to this rule occur only in cases where operation is called for on account of injury done by the bullet while still in motion. It is also held to be a violation of simple physiological and surgical rules to probe or carelessly search for a bullet whose location cannot be made out from a study of signs and symptoms in a given case. The act of probing breaks up blood-clot, often brings on fresh hemorrhage, is in a majority of cases unsatisfactory, frequently introduces specific elements from without, and really gives little, if any, more information than can be gathered from a study of the case without the use of the probe. If every ordinary bullet-wound which did not call for immediate operation because of injury to some essential or vital part—such as a large blood-vessel or nerve-trunk, or some of the viscera—were antiseptically and hermetically sealed at the very outset, there would be a much smaller percentage of death from gunshot wounds, either in civil or military practice, than now obtains. And it might be a matter upon which to go to the jury whether violation of such rules, to-day, does not mitigate the offence of the accused.

Recent discoveries in so-called cerebral localization have instigated numerous operations upon the skull and brain for the relief of pressure, as from blood-clot, or for removal of depressed bone or a bullet which twenty years ago would have been impossible. The brain is no longer the terra incognita of the past generation of medical men, and it is now often possible for the surgeon to intervene in such a way as to save life in cases previously considered hopeless; in fact, such is now his duty when consent can be gained, and it should be held that he is culpable when deficient in general knowledge in this respect.

In wounds of the thoracic cavity it should now be held that so long as air has entered through a bullet-wound there are cases where free incision, even with removal of ribs, can scarcely increase the dangers, while permitting opportunity for much more accurate exploration and determination of life-saving methods. The experiments of numerous investigators, the writer included, have shown that bullet-wounds of the heart need not be always and invariably fatal, and have afforded an element of hope from the possible surgery of even this organ. The writer looks forward to the time when some accomplished yet daring surgeon, getting the right patient at the right time and in the right place, i.e., where conveniences are at hand, shall, in some case of perforating wound of the pericardium or of the heart itself, resect some portion of the anterior thoracic wall, lay open the pericardium, maintaining meanwhile artificial respiration if necessary, and suture a wound in the heart-substance, thereafter closing the pericardium and external wound, and save life which would otherwise be surely sacrificed. With others he has done this upon animals, hence why may it not be done in man?

In the mean time for, first, the recognition and, second, the surgical treatment of perforating wounds of the abdominal viscera, American surgeons have won for themselves the greatest credit, and an already long list of successful laparotomies after gunshot wounds of the intestines, with intestinal suture or resection, has shown the very great value of this procedure, even though it has kept some would-be murderers from the gallows.

These lines are inserted here because the time and effort which surgeons have devoted to this kind of surgery deserve only the highest encomiums and encouragement from the legal profession, although to our deep regret they have not always met with the same.

OF THE VARIOUS CONDITIONS WHICH COMPLICATE GUNSHOT WOUNDS AND MAKE THEIR RESULTS UNCERTAIN,

Delirium Tremens is one of the commonest and must always be regarded as one of the most serious. It is well known to surgeons that a slight injury even, and often a severe one, is enough to provoke manifestations of this character in intemperate persons. The medico-legal question under these circumstances is this: Would the same amount of injury have been likely to cause death in a person of ordinary health and vigor? The law as applied to these cases has been stated by Lord Hale: “It is sufficient to prove that the death of a person was accelerated by the malicious acts of the person, although the former labored under a mental disease at the time of the act. The intent of the accused may often be judged by the character of the wound and the means of its infliction. Drunkenness of the victim admits of no excuse when his assailant is aware, or ought to have been aware, of the condition of his victim. It is held that the assailant ought to have known that violence of any kind to such a person is likely to be attended by dangerous results. It is known also that a wound which accelerates death causes death.” The commissioners who were appointed to define criminal law on the subject of homicide have thus expressed themselves: “Art. 3. It is homicide although the effect of the injury be merely to accelerate the death of one laboring under some previous injury or infirmity, for although if timely remedies or skilful treatment had been applied, death might have been prevented” (Taylor, p. 327).

Death from Surgical Operations Necessitated by Gunshot Wound.—The modern treatment of serious or so-called penetrating gunshot wounds where the cranium, thoracic viscera, or the abdominal viscera, especially the intestines, have been perforated one or more times, calls for surgical procedures which are of severity and danger in proportion to the gravity of the wound which necessitates them, and which, while they often save life, must necessarily often fail. Indeed, such operations may prove fatal upon the operating-table, i.e., patients may die before the conclusion of the operation. The question may, therefore, arise whether the person who inflicted the wound should be held responsible for his act, or whether by the intervention of the surgeon the responsibility may not at least be shifted from the shoulders of the accused. The law in this respect is explicit and regards such operation as the outcome of necessity and a legitimate part of treatment, so that if it be undertaken in good faith, with reasonable care and skill, the accused will be held responsible, be the result what it may. The question of necessity and the plan of operation are left to the judgment of the surgeon in charge. Considering the responsibility involved in such cases and the possibility of a suit being raised, we should always advise the operator to secure the counsel of other surgeons or practitioners in his vicinity. The verdict of such a counsel of talent will always stand. According to Lord Hale, when death takes place from an unskilful operation under such circumstances, and not from the wound, the responsibility of the prisoner naturally ceases, but the burden of proof that such has been unskilfully performed rests naturally with the defence. It is much better also in these cases that the primary responsibility be borne by one surgeon from the beginning of the case, though he may associate with himself as many others as he chooses, since the ends of justice have more than once been defeated by a division of such responsibilities. Should it be made to appear that the surgeon in charge has not availed himself of such means as are supposed to be in the hands of every competent practitioner and has neglected ordinary antiseptic precautions, it would not be difficult to show that the operation had been unskilfully performed, and the prisoner would naturally get the benefit of such defence. At the present date of writing there exists a large class of the profession who still continue to do surgery according to the views and practices of twenty or thirty years ago, and who, while perhaps carrying out some of the forms of antiseptic surgery, are still ignorant of its fundamental principles and consequently guilty of neglect, since there is now no reason why all should not practise them. The writer holds to the view that if it can be shown that these precautions were not adopted when others would have adopted them, it constitutes criminal neglect.

On the other hand, circumstances may arise where a simple or a more serious operation would have saved life, as, for instance, in cases of hemorrhage, and where a surgeon from timidity or carelessness has failed to take the necessary steps. Such neglect as this should inure to the benefit of the accused, but when at any time it can be shown that the possible benefits of operation have been offered to the deceased before his death and have been declined, the surgeon at least is relieved of all further responsibility. Among the dangers of operations under these circumstances are of course to be reckoned those pertaining to the use of anÆsthetics. The surgeon in charge, however, is responsible for the selection of his assistants, at least when assistants are at hand, and must be regarded as equally competent in this as in other features of the operation; and even though the patient die from collapse or the anÆsthetic, the burden of proof must rest with the defence to show that it had been unskilfully administered.

Note.—The assistance which the microscope may afford in the procurement of evidence in cases of gunshot wound is beautifully illustrated in the expert testimony reported by Dr. James, of St. Louis, in the presidential address before the American Society of Microscopists, in Washington, August, 1891, printed in Vol. XIII. of its Transactions. It occurred in St. Louis, in the case of The People v. Vail, who had a pistol in his pocket at the instant when his wife fell from a wagon against him, knocking him, as he claimed, against the wheel of the wagon, the pistol being discharged by accident. By a minute study of the fibres of the various textures making up his overcoat and of the effect of the explosion of powder upon textile fabrics almost in contact with it, he was enabled to establish the accident and secure the acquittal of the accused.