SPIKE AND SPINAL CORD 261
Wounds of the larynx and trachea are not necessarily fatal, if the large
blood vessels are not injured. They may, however, cause death by suffo-
cation due to the flow of blood into the air-passages, though most of it is
coughed up. They may also cause death by subsequent oedema or inflam-
mation blocking the air-passages or by septic pneumonia.
In the case of a wound of the larynx, speech is possible, if the wound
is above the vocal cords, even if it is gaping. But in a wound of the larynx
below the vocal cords, and in that of the trachea, no speech is possible. In
such a case one may be able to speak in a whisper, if the wound is not
gaping sufficiently to allow air to pass into the mouth. Prof. Harvey
Littlejohn10 describes the case of a woman, aged 45, who, after making a
transverse incision, 2J" long, in the front of the neck cutting the trachea
completely through 2" below the vocal cords, was found sensible, and said
that she had torn the tumour out of her neck because it was choking her,
and that she wanted to die. On the bed was a small tumour which was'
encapsuled and consisted of the right lobe of the thyroid gland, hyper-"
trophied, and of fibrous consistence. She was removed to hospital, but was
dead on arrival. At the post-mortem examination the upper end of the
divided trachea projected from the wound, along with the oesophagus. The
protruding oesophagus measured 6f".
Wounds of the oesophagus are usually accompanied by wounds of the
larynx, trachea or large blood vessels. Rupture of the oesophagus may
rarely occur spontaneously in middle-aged, alcoholic individuals after severe
retching or vomiting. The rupture usually occurs in a vertical direction at
its lower end just above the diaphragm. The oesophagus is inflamed or
ulcerated or may be normal. Mediastinitis, empyema and pneuniothorax
pre likely to result from food particles and acid gastric contents having"
been forced into the mediastinum, left pleural cavity and sometimes even
into the right pleural cavity,
Wounds of the sympathetic and pneumogastric nerves may be fatal,
and those of the recurrent laryngeal nerves cause aphonia. A forcible
blow on the front of the neck may cause unconsciousness or even death by
a reflex inhibitory action or by fracture of the larynx usually involving the
•fhyroid and cricoid cartilages, and consequent suffocation from hsemorr-
hage or oedema of the larynx.
A man was brought to me on the third day of his receiving a blow over Adam's
apple. On examination a swelling was found over the right side of the thyroid cartilage,
and the laryngoseopic examination revealed the presence of submucous haemorrhage in
the larynx on the right side involving the right vocal cord and ventricular band as also
SPINE AND SPINAL CORD
Wounds and injuries affecting the spine and the spinal cord are gene-
rally accidental, are occasionally homicidal and are rarely suicidal.
Fractures of the Spine. — These are produced by (1) direct violence, e.g.
a blow on the back from a heavy weapon or a fall from a height on the back
over some hard projecting substance, or by collision with a motor car or
some other heavy vehicle, and (2) indirectly by forcible bending of the
body or by a fall on buttocks or feet. Fractures of the cervical vertebrae
may. in certain cases, be produced bv a sudden forcible twisting of the neckf
as during wrestling. They may also be caused by a very slight twist1"
especially if a person happens to be suffering from Pott's disease.
In January 1912, a Hindu male, about 20 years old, took a somersault in w
and died immediately. On examination dislocation of the fifth cervical verteto
_ _____ __ ______ _ ' ''
10. Forensic Medicine, 19254 p. 196.