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MEDICO-LEGAL SOCIETY

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665 workers, hairdressers, grocers, electro-platers, brass- tube moulders. Dr. F. E. FREMANTLE (President of the Section of Epidemiology), proposing a cordial vote of thanks to the speakers, referred to the value of the Society as a body of experts to whom the Government could refer on subjects such as that now discussed. He hoped this would be done in the future in increasing degree. MEDICO-LEGAL SOCIETY. AT a meeting of this Society on March 21st, the chair was taken by Sir WILLIAM WILLCOX, the President, and a paper on the INVESTIGATION OF FiBE-ARM INJURIES was read by Prof. SYDNEY SMITH. The investigator, he said, often wanted to know whether a given injury was due to fire-arms or not; the type of fire-arm responsible ; the direction taken by the shot, and the distance of the muzzle from the body. Sometimes it was necessary to say whether one particular weapon had been used. The effects of fire-arms were very variable ; a rifle bullet at the beginning of its tra- jectory, before it had settled into its regular spin, would wobble and cause a wound like a severe explo- sive injury ; similarly a spent bullet, turning over and over, would cause injuries quite unlike those of a bullet wound. A small high-velocity bullet bored a clean hole; a slow large bullet often made a ragged one. Besides the projectile, the weapon produced a wave of gas, wads, unburnt powder, smoke, and flame, all of which (when the discharge was close enough) left their distinctive marks to aid diagnosis. Powder made tattoo-like marks on the skin, and left traces which could be chemically analysed. At a slightly longer range the wound made by a rifle bullet was a round, clean, punched-out hole surrounded by a zone of tissue denuded of its epithelium but showing little sign of blackening or burning ; outside this there might be powder-tattooing. The hole itself might be surrounded by a black ring due to fouling from the bullet; this was sometimes mistaken for powder- marking. Local bruising due to hydrostatic pressure was also apt to be mistaken for the marks of a close discharge. These distinctions were important, as they might turn the scale between the theories of suicide or murder. Automatic pistols caused very much less blackening and burning than any other type of weapon, because of the completeness of the combustion of their " smokeless " powder. They produced a typical clean entrance wound. Exit wounds were nearly always torn, as the bullet was forced through the tissues. A low-velocity bullet caused the same kind of wound that might be made by a poke from a stick. In bone, such as that of the skull, the entrance was clean-cut and the exit had an excavated appearance. A line between entrance and exit, if produced, nearly always gave a good indication of the track of the bullet, but deviation sometimes occurred within the body if the projectile struck a bone. The appearance might give a guide to the direction ; when the bullet entered at an angle the wound tended to be oval, and if the discharge had been at close range there might be much bruising and burning on the angle of fire. A shot-gun dis- charged within one yard caused a single wound, and within three yards slight scattering with burning and blackening, but above that distance the wounds of the separate shot were discrete and there was little discoloration. A sharp-pointed bullet might often inflict a wound very like that of a stabbing weapon, but the latter when pulled out tended to disturb the tissues, and their outward deviation distinguished the stab from the bullet wound. In bone the excavation effect of the dagger would be both inwards and outwards. Bullet wounds made at an angle might simulate cuts, but some portion of the tissue was generally removed, and there was often denudation of epithelium and bruising. More- over, the bullet often left metallic traces. Bullets were sometimes marked by the cloth through which they passed. X rays were often valuable in demon- strating the absence of a bullet where the site of entrance escaped notice, or when great deviation had occurred within the body. When more than one injury was found it was important to pay careful attention to all the anatomical possibilities before deciding whether one projectile or more had been responsible. A bullet had been known to pass in a straight line through the back of a running man, through his abdomen, into the front of his leg, and remain embedded in the back of the leg. Identification of F’ire-a7°ryas. Even if no projectile were found, a chemical and microscopical examination of the traces of metal and powder at the wound might give a clue to the kind of weapon which had been used. Some powders were filled with barium or bichromate. If an auto- matic pistol had been used, cartridge cases were often found at the scene of the crime, and the marks on the sides of these caused by the action of the weapon- might be sufficient to identify one particular nre- arm. The distinguishing marks on a cartridge-case fired in an ordinary revolver were mostly on the base. A bullet which had passed through the bore of a weapon received not only the marks of the rifling, but also many minute scratches caused by individual faults. From the gross markings it was generally possible to tell the type of weapon which had been used, while from the smaller individual markings it was possible to prove whether or not a given weapon had fired the bullet. A bullet found in the body was weighed, had its specific gravity estimated, and its base examined for signs of the maker’s name. The tip sometimes showed other signs which might identify it. The murderers of Sir Oliver Lee Stack in Cairo had been detected entirely by this means, and certain instruments with which they had notched the tips of their bullets had been found with metal still adhering that was identical with that of the bullets used. The apparatus used for the identifica- tion of bullets consisted of two microscopes fitted with a common eyepiece, so that the images of the two bullets to be compared were shown side by side. For macroscopic examination bullets were rolled on a sheet of plasticine ; rifling was examined by taking a casting in sulphur and rolling the casting on plasticine. Bullets, however, were not always fired from weapons of the same calibre as themselves ; a small bullet might be made to fit a large barrel by wrapping it in paper. Some Extraordinary Projecfile8. Criminals had been known to pick up a bullet on a rifle range and fire it from a shot-gun. In one victim’s body the investigators had found two shilling-pieces ; the bullet had struck them when they were in his pocket and had driven them in without itself entering. A shot fired at a railway train had entered the dining-car and nearly killed an important personage. The projectile found had puzzled the officials, for it had appeared to be made of bronze, and to be roughly of 16-calibre. Many persons had been arrested, and all the guns in the district had been examined for traces of a bronze bullet. Closer examination, however, had shown that the projectile was flat on one side and rounded on the other, and that it had a splash of lead at its base. It had proved, in fact, to be a fragment punched cleanly out of a hinge of the table in the dining-car. The actual bullet had then passed through the door of the carriage. Traces of lead had been found, and also traces of some other substance which had at first been thought to be cupro-nickel and which had suggested a rifle bullet. This had thrown suspicion on the troops in the district, but analysis had proved the substance to be steel, a fact which had shown conclusively that the assailant had been the owner
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Page 1: MEDICO-LEGAL SOCIETY

665

workers, hairdressers, grocers, electro-platers, brass-tube moulders.

Dr. F. E. FREMANTLE (President of the Section ofEpidemiology), proposing a cordial vote of thanksto the speakers, referred to the value of the Societyas a body of experts to whom the Government couldrefer on subjects such as that now discussed. Hehoped this would be done in the future in increasingdegree.

_________

MEDICO-LEGAL SOCIETY.

AT a meeting of this Society on March 21st, thechair was taken by Sir WILLIAM WILLCOX, thePresident, and a paper on the

INVESTIGATION OF FiBE-ARM INJURIES

was read by Prof. SYDNEY SMITH. The investigator,he said, often wanted to know whether a given injurywas due to fire-arms or not; the type of fire-armresponsible ; the direction taken by the shot, and thedistance of the muzzle from the body. Sometimesit was necessary to say whether one particular weaponhad been used. The effects of fire-arms were veryvariable ; a rifle bullet at the beginning of its tra-jectory, before it had settled into its regular spin,would wobble and cause a wound like a severe explo-sive injury ; similarly a spent bullet, turning over andover, would cause injuries quite unlike those of a

bullet wound. A small high-velocity bullet bored aclean hole; a slow large bullet often made a ragged one.Besides the projectile, the weapon produced a waveof gas, wads, unburnt powder, smoke, and flame, allof which (when the discharge was close enough) lefttheir distinctive marks to aid diagnosis. Powdermade tattoo-like marks on the skin, and left traceswhich could be chemically analysed. At a slightlylonger range the wound made by a rifle bullet wasa round, clean, punched-out hole surrounded by azone of tissue denuded of its epithelium but showinglittle sign of blackening or burning ; outside this theremight be powder-tattooing. The hole itself might besurrounded by a black ring due to fouling from thebullet; this was sometimes mistaken for powder-marking. Local bruising due to hydrostatic pressurewas also apt to be mistaken for the marks of a closedischarge. These distinctions were important, as

they might turn the scale between the theories ofsuicide or murder. Automatic pistols caused verymuch less blackening and burning than any othertype of weapon, because of the completeness of thecombustion of their " smokeless " powder. Theyproduced a typical clean entrance wound. Exitwounds were nearly always torn, as the bullet wasforced through the tissues. A low-velocity bulletcaused the same kind of wound that might be madeby a poke from a stick. In bone, such as that ofthe skull, the entrance was clean-cut and the exithad an excavated appearance. A line betweenentrance and exit, if produced, nearly always gave agood indication of the track of the bullet, but deviationsometimes occurred within the body if the projectilestruck a bone. The appearance might give a guideto the direction ; when the bullet entered at an anglethe wound tended to be oval, and if the dischargehad been at close range there might be much bruisingand burning on the angle of fire. A shot-gun dis-charged within one yard caused a single wound, andwithin three yards slight scattering with burningand blackening, but above that distance the woundsof the separate shot were discrete and there waslittle discoloration. A sharp-pointed bullet mightoften inflict a wound very like that of a stabbingweapon, but the latter when pulled out tended todisturb the tissues, and their outward deviationdistinguished the stab from the bullet wound. Inbone the excavation effect of the dagger would beboth inwards and outwards. Bullet wounds madeat an angle might simulate cuts, but some portionof the tissue was generally removed, and there was

often denudation of epithelium and bruising. More-over, the bullet often left metallic traces. Bulletswere sometimes marked by the cloth through whichthey passed. X rays were often valuable in demon-strating the absence of a bullet where the site ofentrance escaped notice, or when great deviation hadoccurred within the body. When more than oneinjury was found it was important to pay carefulattention to all the anatomical possibilities beforedeciding whether one projectile or more had been

responsible. A bullet had been known to pass in astraight line through the back of a running man,through his abdomen, into the front of his leg, andremain embedded in the back of the leg.

Identification of F’ire-a7°ryas.Even if no projectile were found, a chemical and

microscopical examination of the traces of metal andpowder at the wound might give a clue to the kindof weapon which had been used. Some powderswere filled with barium or bichromate. If an auto-matic pistol had been used, cartridge cases were oftenfound at the scene of the crime, and the marks onthe sides of these caused by the action of the weapon-might be sufficient to identify one particular nre-arm. The distinguishing marks on a cartridge-casefired in an ordinary revolver were mostly on the base.A bullet which had passed through the bore of aweapon received not only the marks of the rifling,but also many minute scratches caused by individualfaults. From the gross markings it was generallypossible to tell the type of weapon which had beenused, while from the smaller individual markingsit was possible to prove whether or not a given weaponhad fired the bullet. A bullet found in the body wasweighed, had its specific gravity estimated, and itsbase examined for signs of the maker’s name. Thetip sometimes showed other signs which mightidentify it. The murderers of Sir Oliver Lee Stackin Cairo had been detected entirely by this means,and certain instruments with which they had notchedthe tips of their bullets had been found with metalstill adhering that was identical with that of thebullets used. The apparatus used for the identifica-tion of bullets consisted of two microscopes fitted witha common eyepiece, so that the images of the twobullets to be compared were shown side by side.For macroscopic examination bullets were rolledon a sheet of plasticine ; rifling was examined bytaking a casting in sulphur and rolling the castingon plasticine. Bullets, however, were not alwaysfired from weapons of the same calibre as themselves ;a small bullet might be made to fit a large barrel bywrapping it in paper.

Some Extraordinary Projecfile8.Criminals had been known to pick up a bullet on

a rifle range and fire it from a shot-gun. In onevictim’s body the investigators had found two

shilling-pieces ; the bullet had struck them when theywere in his pocket and had driven them in withoutitself entering. A shot fired at a railway train hadentered the dining-car and nearly killed an importantpersonage. The projectile found had puzzled theofficials, for it had appeared to be made of bronze, andto be roughly of 16-calibre. Many persons had beenarrested, and all the guns in the district had beenexamined for traces of a bronze bullet. Closerexamination, however, had shown that the projectilewas flat on one side and rounded on the other, andthat it had a splash of lead at its base. It had proved,in fact, to be a fragment punched cleanly out of ahinge of the table in the dining-car. The actualbullet had then passed through the door of thecarriage. Traces of lead had been found, and alsotraces of some other substance which had at firstbeen thought to be cupro-nickel and which hadsuggested a rifle bullet. This had thrown suspicionon the troops in the district, but analysis had provedthe substance to be steel, a fact which had shownconclusively that the assailant had been the owner

Page 2: MEDICO-LEGAL SOCIETY

666

of some continental ammunition which was knownto possess a steel casing.Sometimes metallic traces, too small in amount to

be analysed, could be identified by means of thespectograph, but this method was still in its infancy.

A brief discussion followed, in which Mr. J. H.RYFFEL, Dr. MORGAN FINUCANE, Mr. BARRY O’BRIEN,Mr. W. M. WALKER, and the PRESIDENT took part;Prof. SMITH replied.

MEDICAL SOCIETY OF LONDON.

AT a meeting of this Society held on March 25th,the chair was taken by Dr. WALTER CARR, thePresident, and a discussion on the

MEDICAL INDICATIONS FOR THE INDUCTION OFABORTION AND PREMATURE LABOUR

was opened by Mr. EARDLEY HOLLAND. Reviewingthe legal and ethical position, he pointed out that theonly lawful object of abortion was to save the mother’slife or prevent serious injury to her health. Themedical profession was trusted implicity and giventhe widest possible freedom of judgment. It hadnever been practicable to lay down strict rules forthe medical indications, which had changed as

medicine had advanced. The advent of insulin, forexample, had made possible many pregnancies indiabetic women. Great difficulties occurred whensocial, personal, and economical factors added theirweight to a medical indication which in itself mightseem inadequate. The ethical standard had notbeen lowered by modern practitioners, but themodern gynaecologist was less fitted than his prede-cessors to form an opinion on the indications forabortion because he leaned more towards surgeryand less towards medicine.The medical indications might be classed as : (1)

positive indications, (2) debatable indications, and (3)a heterogeneous and unclassifiable collection ofcombined medical, personal, and social considerations.Among the positive Mr. Holland put hyperemesisgravidarum of the toxsemic type ; acute and chronicnephritis ; chronic valvular disease of the heartwith failure of compensation ; pulmonary tuberculosis(about which there was great difference of opinion) ;Graves’s disease ; insanity, and certain cases ofBacillus coli pyelitis, which did not yield to treatment.The debatable indications included multiple arthritisdeformans during pregnancy ; hypothyroidism, suchas early myxoedema ; hyperthyroidism ; albuminuriaof pregnancy ; eclampsia in a former pregnancy (asomewhat slender reason) ; certain cases of cardiacdisease, and slight cases of pulmonary tuberculosiswhich might have a bad effect on pregnancy ; formerpuerperal insanity ; severe nervous or mental dis-turbances in early pregnancy due to fear in a formerconfinement, and as a better alternative to Caesareansection than craniotomy. Very debatable were anew class of eugenical indications which might betermed "feetal." One of these was refractorysyphilis, as for example in a case where, in a formerpregnancy, the Wassermann reaction could not bebrought to negative except by what was practicallyan overdose of arsenobenzene. Another was idio-pathic epilepsy in the husband. It was interestingto contrast the hospital figures with those of privatepractice ; the former showed a great preponderanceof " positive " indications. From 1924 to 1927inclusive, out of 4000 gynaecological operations,only thirty-one had been for the induction ofabortion. Twenty-nine of the operations had beenundertaken for " positive " reasons ; eight of thesehad been for uncompensated cardiac disease, sixfor pulmonary tuberculosis, four each for nephritisand Graves’s disease, and the remaining five foi

hyper- and hypothyroidism, tuberculous disease oj

jhe bladder, congenital syphilis. One had beenfor mental disorder in a previous pregnancy, andonly one, on the grounds of " general bad health,"came into the " doubtful " category. In the speaker’sprivate practice of about 3500 patients he hadinduced abortion on twenty-eight occasions since1919. The number of inductions performed forpositive reasons had been only 19, a much lowerproportion than in hospital. The grounds hadbeen very varied. Of the six operations where theindications were debatable one had been on a womanof 45 suffering from debility, who had undergone asevere operation for an infected gall-bladder twoyears before and who had a family history of tuber-culosis, and one on a patient just recovering from along series of severe ailments which showed a verybad state of general health, and who had complainedof exhaustion and rapid pulse ; another had been forgeneral ill-health, visceroptosis, a very recent bereave-ment and a consequent desire to join her husband inIndia immediately. These cases represented theclass of patients about which the most difficultquestions arose.The induction of premature labour was quite a

different problem. Apart from the toxsemias ofpregnancy, the medical indications were not at allcommon. The principle in cases of later pregnancycomplicated by disease was to treat the disease andneglect the pregnancy. This applied especially topneumonia, in which the extra strain of an inducedlabour was very undesirable. Finally, so long as thephysician were honestly intent on the welfare of hispatient and believed that she would benefit by theoperation, he could not possibly exclude extra medicalconsiderations from turning the scale in doubtfulcases where a medical indication existed.

The Cardiological Aspect.Dr. B. T. PARSONS-SMITH emphasised the very

serious consequences which pregnancy imposed uponpatients suffering from structural heart disease.Even under the most favourable conditions an addi-tional strain was inevitable. The blood volume wasincreased; diaphragmatic excursion was especiallyrestricted, limiting the functions of the thoracicviscera, and metabolic changes took place as a resultof impaired endocrine balance. It might be con-

cluded that, by causing these additional stresses,pregnancy would further deplenish the circulatoryreserve and favour decompensation. Management ofthe patient was a very serious problem ; the physicianmust satisfy himself as far as possible whether thecardiac reserve was likely to be equal to the additionalstrain, or whether compensation might be failingor already exhausted. Either of these events mightnecessitate the termination of pregnancy. Circu-latory failure was, however, an extremely variablequantity. In its minor forms it need not obviatethe successful conduct of pregnancy, but when welldeveloped it might be an indication to terminate.Statistics covering 15 years’ experience at QueenCharlotte’s Hospital showed that, out of 196 cardiaccases, 49, or 25 per cent., had had their pregnanciesartificially terminated. Abortion had been induced infive cases (2-5 per cent.) ; premature labour had beeninduced in 34 cases (17-5 per cent.) ; Caesarean section thad been performed at term in 10 cases (5 per cent.).Of the remaining 147 patients, 119, or 60 per cent.,had gone on to normal labour at term, although allof these had had gross structural disease with somefailure of compensation. Thirteen had had a spon-taneous premature labour after the twenty-eighth

.

week ; three had aborted spontaneously, and 12 haddied undelivered. Excluding these, the death-roll °

was two (40 per cent.) after induction of abortion,C seven (20 per cent.) after induction of prematureL labour, one after Caesarean section at term, three after

; spontaneous premature labour, and seven after. spontaneous delivery at term. The high mortality-i rate after artificial abortion was significant.r One of the most important clinical factors for, assessment was the myocardial degeneration and the


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