Incised Wounds And Those Accompanied By Solution Of Continuity
These comprise incised, punctured, and lacerated wounds. In a recent
incised wound inflicted during life there is copious hæmorrhage, the
cellular tissue is filled with blood, the edges of the wound gape and
are everted, and the cavity of the wound is filled with coagula.
Lacerated wounds combine the characters of incised and contused wounds.
They are caused by falls, being ridden over, machinery crushes, bites,
blows from blunt weapons, etc. The wounds heal by suppuration.
Punctured wounds come intermediate between incised and lacerated. They
are greater in depth than in length, being caused by sword or rapier
thrusts. They cause little hæmorrhage externally, but death may be due
to internal hæmorrhage. They may be complicated by (1) the introduction
of septic material adhering to the instrument; (2) the entrance of
foreign bodies which lodge in the wound, not only carrying in septic
matter, but acting as mechanical irritants; (3) injury to deeper parts,
which may at the time be difficult to detect.
An apparently incised wound may be produced by a hard, blunt weapon
over a bone--e.g., shin or cranium. It is often difficult to
distinguish between a wound of the scalp inflicted with a knife and one
made by a blow with a stick. A puncture with a sharp-edged, pointed
knife leaves a fusiform or spindle-shaped wound. A wound from a blow
with a stick might be of this character, or it might present a jagged,
swollen appearance at the margin, with much contusion of the surrounding
tissues. If the wound is seen soon after it is inflicted, examination
with a lens may disclose irregularities of the margins, or little
bridges of connective tissue or vessels running across the wound, and
so be inconsistent with its production by a cutting instrument.
Lacerated wounds as a rule bleed less freely than those which are
incised. Symptoms of concussion would favour the theory of the injury
having been inflicted by a heavy instrument. Again, it is often
difficult to decide whether the injury which caused death was the result
of a blow or a fall. A heavy blow with a stick may at once cause fatal
effusion of blood, but this might equally result from fracture of the
skull resulting from a fall. The wound should be carefully examined for
foreign bodies, such as grit, dirt, or sand. The distinction between
incised wounds inflicted during life and after death is found in the
fact that a wound inflicted during life presents the appearances already
described, whereas in a post-mortem incised wound only a small quantity
of liquid venous blood is effused; the edges are close, yielding,
inelastic; the blood is not effused into the cellular tissue, and there
are no signs of vital reaction. The presence of inflammatory reaction or
pus shows that the wound must have been inflicted some time before
death, probably two or three days.
Self-inflicted wounds are made by the person himself in order to
divert suspicion, or in order to bring accusation against another. Such
wounds are always in front, not over vital organs, and superficial in
character. Note the condition of the clothes in such cases.