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Full text of "Medical Jurisprudence And Toxicology"

262

MEDICAL JURISPRUDENCE

found. There was no external injury, nor was there any disease of the vertebrse. A
similar case occurred in August 1912, where a Mahomedan male, 20 years old, died
from fracture-dislocation of the third, cervical vertebra caused by a sudden powerful
muscular contraction of the neck during wrestling.

These fractures are generally associated with dislocations except in
injuries of a minor degree, such as fractures of the spinous processes,
laminae, etc. Owing to the displacement of the parts they cause com-
pression, laceration or crushing of the cord, which produces paralysis of the
body below the seat of injury. In such cases haemorrhage occurs in the
substance of the cord, or
around it, between or
outside its membranes.
These cases are very
rare. In the Agra District
during twelve years, out
of about one thousand
medico - legal autopsies
death was found to be
due to the fracture of the
spine in only five cases.

Spinal injuries are, as
a rule, immediately fatal,
owing to implication of
the phrenic nerves, if
fracture occurs above the
fourth cervical vertebra,
though death may be de-
layed a few hours even
after fracture of the odon-
toid process of the axis
with forward displace-
ment of the atlas. Death
usually occurs within
twenty-four hours, if the
three lower cervical ver-
tebrse are injured. In rare
cases death may not
occur for some months,
but the trunk and the
limbs will be paralysed,
if the spinal cord is com-
pressed by displacement
of the fractured portions.

A boy, 10 years old, regularly attended school, and took part hi games for five
weeks dislocating his neck. He merely complained of stiff neck and it was only when
he made a sudden movement with his neck that the cervical cord became compressed,
and he died immediately.—W. G, A. Robertson, Practitioner, Aug. 1923, p. 121.

A Mahomedan male, aged 60 years, who was knocked down by a motor car on
September 17, 1932, sustained a dislocation of the third cervical vertebra from the fourth
cervical vertebra with a transverse fracture of the body of the latter, suffered from loss
of sensation and paralysis of all the limbs, and died on November 20, 1932.

When the dorsal vertebrse are injured, the patient becomes bed-ridden
on account of paralysis of the lower limbs. He also suffers from paralysis
of the bladder and rectum, and is always in danger of getting bed-sores and
septic infection of the bladder and kidneys, which generally hasten death.
Thus, death may occur after two or three weeks, if the upper dorsal
vertebrse have been injured; while life may be prolonged for years with
partial paralysis of the limbs, if the lower dorsal or the lumbar vertebrae
itave been fractured.

Fig. 126.—Cervical vertebrse showing a cut
by a gandasa  (chopper).