Medico-Legal Aspects of Penetrating Wounds of the Stomach

     In view of the case of our late lamented President, the subject of perforating wounds of the stomach is worthy of special consideration. The medico-legal aspect has been considered in a communication by Dr. Glitsch, of Stuttgart (Allg. Medic. Central Ztg., 1901, No. 3037). He says: 1. If there be found in the topographical limits of the stomach a penetrating wound of the abdominal walls, we may be certain in a case of a gun-shot wound, that the stomach has been injured, and in the case of cut and stab wounds there is, as a rule, but one wound in the stomach, whereas, in the case of a bullet wound, there are in the greater majority of cases, two wounds.
     2. As penetrating wounds are followed by immediate death in the rarest cases only, vital reactionary symptoms will almost always render feasible the differentiation between vital and post-mortem lesions.
     3. Stomach wounds with suicidal intent are extremely rare; if they do occur, it is a question of a gunshot wound intended for the heart. In these cases the form and location of the wound, as well as the condition of the point of entrance will be helpful.
     4. Hematemesis, collapse and shock are not necessarily sequelae of a perforating wound of the stomach; on the contrary, the latter may at the beginning present no symptoms at all, but generally, in the further course alarming symptoms develop sooner or later. Of importance for the sequelæ of a wound of the stomach are the presence of food, a lesion of the larger blood-vessels and the affection of abdominal viscera.
     5. The prognosis of stomach wounds is favorable only in cases of immediate surgical interference; the forensic physician is to designate these wounds as lethal, and cases of spontaneous recovery cannot alter this decision. They are to be considered the exception, the fatal termination the rule.
     6. A successful therapy of a stomach perforation can consist only in laparotomy and stomach suture.
     7. If a case of perforation of the stomach comes under proper care and treatment at once, complete “restitutio ad integrum” may be accomplished anatomically as well as in regard to the faculty of work.
     8. Subcutaneous perforations of the stomach (ruptures) are generally immediately followed by the gravest symptoms. Their prognosis is much more unfavorable than that of penetrating wounds of the stomach; in all cases laparotomy offers the only prospect of recovery. From a medico-legal standpoint a subcutaneous laceration of the stomach is to be considered as simply fatal.