Injuries to the spinal cord may cause immediate death; cases, however, occur of life being prolonged for some days, or even longer, after injury to the cord. The symptoms are progressive paraplegia and paralysis of the bladder and rectum, ending in death. Bedsores and septic infection of the bladder and kidneys are complications which add to the gravity of the condition. Spicula of bone in the cord, dislocation of the vertebræ, or extravasation of blood in the membranes of the cord, may be found after death. The presence of blood upon the spinal cord is not necessarily the result of violence, as hæmorrhage may take place spontaneously. The spine should be examined in all fatal cases of supposed injury. Concussion of the spinal cord is a fertile source of differences of opinion in railway cases. In no case should a hasty decision be given as to the probable future result to the patient from the injury.
Wounds of the face are not generally dangerous, unless they penetrate the brain. There is always the possibility of injury to the eye causing detachment of the retina, or inflammation leading to blindness. Punctured wounds in the neighbourhood of the orbit may become septic and lead to secondary meningitis.
Wounds of the Throat and Chest
Wounds of the throat are more or less dangerous, due to the possibility of severe hæmorrhage, emphysema, and bronchitis.
Wounds of the chest are dangerous, on account of the amount of the hæmorrhage which may take place, and the importance of the organs which may be injured. Death may result more from the mechanical action of the blood effused than from the depressing effect of the quantity evacuated. Penetrating wounds of the thorax injuring the lungs cause emphysema, pneumo-, pyo-, or hæmothorax, any of which may prove fatal; pleurisy and pneumonia may occur. A fracture of the ribs may give rise to injury of the lung substance or to inflammation of its coverings. Laceration of the lungs may take place without fracture of the ribs. The ventricles of the heart may be pierced, and yet life may be prolonged for one or two months, permitting of considerable locomotion during that period (Briand et Chaudé, Med. Leg., vol. i. p. 511). Wounds of the heart, however, are, as a rule, rapidly fatal. Rupture of valves may follow blows on the chest, and rupture of the heart may occur from crushes or violent blows. Rupture of the heart has taken place during violent exertion, and this is more likely to occur when the muscle is diseased. It is often difficult to make out the direction of the wound, as the lungs change their position during respiration.
Injuries of the Abdomen
Wounds of the abdomen, penetrating the intestines, although not necessarily fatal, may cause death from peritonitis, due to the escape of the intestinal fluids. Rupture of the intestine may follow blows or crushing; it is generally fatal from peritonitis unless early surgical treatment is carried out. Hernia may also follow wounds of the abdomen. Rupture of the liver is not of infrequent occurrence, and may occur without any external signs of the injury. The rupture is, as a rule, longitudinal, transverse lacerations being rare. It is often followed by pneumonia if not rapidly fatal. The cœliac plexus may be much damaged by a blow or kick on the stomach, especially if this organ be distended with food, and death may result without leaving any trace of the injury externally or internally. The bladder may be ruptured and death result from extravasated urine. Rupture of the bladder may occur from fracture of the pelvis without sign of external injury. Rupture of the kidney may be recovered from if slight, but when severe is fatal. Rupture of the spleen is usually fatal, and is more likely to occur when enlarged from any cause. Coagulable lymph, the effect of a wound of a serous membrane, may be thrown out in twelve hours or less.
Injuries to the abdomen may cause death by—
1. Shock; without lesion of the internal organs, inflammation, or external signs of injury.
2. Hæmorrhage.