Medico-Legal Aspects of Penetrating Wounds of
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