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It is possible for the diseased cerebral arteries to rupture from mere
excitement caused by alcohol or struggle, but it is rare in the young and
healthy, unless such excitement is associated with extreme congestion of
the cerebral vessels. Spontaneous rupture is, however, contra-indicated, if
there is any evidence of violence, such as a bruise or a wound on the scalp
or a fracture of the skull.

2. It is difficult to give
the exact date of an effusion
of blood, but an approxi-
mate idea may be formed
±rom its colour and consist-
ence as to whether it is
recent or old. The colour of
a recent effusion is red,
which changes to chocolate
or brown after some days,
and turns to an ochre colour
generally in from twelve to
twenty-five days. The con-
sistence of the coagula
becomes firmer and more or
less laminated with the pro-
gress of time, and the com-
pressed lymph may be
between the laminae or
around the coagula. Owing
to the blood clot resting
upon the surface of the
brain a depression equal to
its size and shape is formed
on the brain substance.
Wilfred Trotter6 quotes a
remarkable case where an
area of the brain that had
been bruised by the glanc-
ing contact of a bullet with
the skull no less than 4
years earlier showed a
bruise that appeared as
fresh as if it had been in-
flicted within a few weeks.

Fig. 121.—-Nose cut off with a knife.


Wounds of the face heal, as a rule, rapidly owing to its great vascula-
rity, but they are grievous if they are severe and cause permanent
disfiguration or deformity,

Face Bones. — The nasal bones are often fractured by a blow with a fist
or a blunt weapon, such as a lathi. When caused by considerable force
they may involve the fracture of the ethmoid bone and its cribriform plate
forming part of the base of the skull, and may cause death by meningitis
Fractures of the superior maxillae and malar bones are produced by a blow
with a blunt weapon, such as a heavy stone. Sometimes in addition^ t
fractures of these bones the whole face is reduced to a pulpy cojao
when struck with a heavy stone slab.

6.   Lancet, May 10, 1924 p. 936.