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INQUESTS AND MEDICAL TRIALS.
Medical Jurisprudence.
Mr. Trotter, resident-surgeon of the hospital, made a postmortem examination. He found no external mark of injury, nor any remarkable morbid appearances in the chest or abdomen ; but the fifth cervical vertebra was found fractured in
several places, and the spinal cord enclosed by it Was completely broken up and disorganized. It may be incidentally remarked as surprising that so few DEATHS FROM FRACTURES AND OTHER INJURIES OF THE fatal accidents occur to bricklayers’ labourers similarly engaged CERVICAL VERTEBRÆ. on scaffoldings, which are often very imperfectly secured. CASE I.-G. A. R.-,ayoung artizan, about nineteen Notwithstanding the vast amount of building which has for years of age, on the evening of July 8th, 1852, went to bathe some years been going on in the parishes of St. Pancras, Padin one of the ponds on Hampstead-heath. He undressed, and dington, Kensington, Hammersmith, and other parts of the dived head-foremost off a bank into the pond, where the depth western division of Middlesex, inquests in cases of death fromfalls such as that described are comparatively rare. of water was about four feet. A companion, who observed CASE 3.-W. G--, an elderly man, an omnibus driven, with surprise and apprehension that he did not rise again, on stated to be both careful and sober, about twenty minutes past bubbles of air to imthe surface of the water, rising noticing eight o’clock on the evening of May 7th, 1853, took his omnimediately called to another who was partially undressed, and bus home to the yard in Kentish-town through a very narrow who presently plunged into the pond and brought out the in- lane, which had never been properly made into a road. In jured person in a position "doubled up," as described by this consequence of a sudden jolt whilst guiding his vehicle through witness at the inquest. With great and praiseworthy prompti- deep ruts, he was thrown off his box, and fell upon his back tude the young men briskly rubbed the surface of their friend’s with his head curved forwards. He was removed first to his and on the next morning to the University College body as it lay on the bank until some signs of animation home, where he was found to be paralysed from the nipples Hospital, were restored, procured assistance, brandy, &c., from a neigh- downwards. His intellectual functions were quite unim-bouring public-house, and without delay sent for a surgeon, paired. He had a cough, and his breathing was difficult, but who arrived before the young man was removed from the verge he improved in both these particulars. He died, however, on of the pond. By the direction of the surgeon, Mr. Shaw, of the 4th of June, twenty-seven days after the accident. On a examination, a fracture of the fourth cervical Hampstead, the patient was immediately removed into the post-mortem vertebra was discovered. public-house above-mentioned, and placed in bed. In about a doubt whatever existed that this man had died .Zi’e}M
INQUESTS AND MEDICAL TRIALS.
"
died on the next day, about twenty-eight hours from the time he had met with his accident. He continued to be sensible until within half-an-hour of his death.
it was ascertained that the spinous process of the fourth cervical vertebra had been broken off, and the laminas of that bone were also fractured; the broken
post-mortem examination,
85
congested. In the head, a considerable effusion of coagulated blood was found outside of the dura mater at the base of the brain, and this was continuous throughout the spinal canal, down to the lumbar vertebr. The extravasation of blood in the spinal canal was greatest in the neck, and particularly within the fifth cervical vertebra, to which occurrence the loss of power and the death was obviously attributable. In this case it was not stated that any cervical vertebra was found fractured. It may be mentioned that, as the testimony of all the witnesses exculpated Miller from any intention to do injury to the deceased man, and the evidence went unanimously to prove that no blow had been struck during the scuffle, the jury returned a verdict of Death by misadventure, and Miller was speedily released from custody.
pieces of bone pressed upon and indented so much of the spinal
were
almost to divide it in two. CASE 5.-S. W-, a man rather beyond middle age, a painter, on the evening of August 1st, 1854, was seen walking, -or rather staggering, in a state of intoxication, along the road from Uxbridge to Hillingdon, when, as he himself stated, in endeavouring to pick up something, he stumbled and fell forward, pitching with his head against the ground, as was proved by a scar on his right cheek. Some men, who shortly afterwards came up, turned him over on his back, and then left him on the footway, in the charge of a tradesman who lived close by and had come to the spot. The latter gave him some water to drink, washed his face, and tried to put him on his legs; but on finding that he had no power to walk, he set the man against a wall, untied his neckcloth, and soon had him removed home. The patient was seen that evening by a medical student, who supposed him to be merely suffering from the effects of drink; but on the next morning he was visited by Mr. Rayner, surgeon, of Uxbridge. From the want of motion in the limbs, and of sensation all over the lower part of the body, distension of the bladder, and* inability to pass urine, as well as pain complained of in the neck, Mr. Rayner was led to suppose that the man had fractured one or more of the cervical vertebrae. On examination, Mr. Rayner detected, as he believed, that the fifth cervical vertebra had been broken, as, on pressing the spinous process of that bone with the finger, increased pain was occasioned. Some sensation remained about the shoulders, but none in the arms. Considering it to be a hopeless case, in which impression Mr. Rayner was confirmed by the opinions of Mr. Stilwell and the late Mr. Cane, little was done in the way of treatment beyond withdrawing the urine night and morning. The bowels relieved themselves involuntarily and unconsciously. The patient was perfectly sensible until within a short time previous to his death, which occurred on Aua;. 7th, six days after the receipt of the injury. As the nature of the accident appeared clear, and no other person was involved in blame on account of it, a post-mortem examination was not required for the purposes of the inquest, and accordingly none was made. This instance presents an analogy with Case 1; in both cases it will be noticed how very short a fall was sufficient to produce fatal injury in the spinal column. CASE 6.-R. Mnllins, an excavator, thirty-one years of age. In this case, a man being in custody on a charge of having killed the deceased, the notes relative to the occurrence were taken more fully than in some of the preceding instances. The inquest was held at Hampton, January 1st, 1855. The deceased man and some of his fellow labourers were in the tap-room of a public-house between five and six o’clock on the evening of December 18th, 1854. Some dispute arose, and Mullins, in an intoxicated state, advanced towards a man named Miller, who was standing with his back-to the fireplace, and he struck Miller twice on the face. Miller, who was said to be even more intoxicated than the other man, with much forbearance took no notice of the first blow, but after the second he ran towards Mullins, and they had what was termed a "rally" together, at the end of which both men fell on the floor. No blow was alleged to have been struck on either side during this rally, or wrestle. The witnesses differed materially in their statements as to the position in which the men lay on the ground after their fall; some asserting that Miller fell on his back, and Mullins upon him; others,-and this was more probable,-that Mullins fell on his back; and others, again, stated that the men fell side by side. Mullins was raised up by some of the bystanders and set upon a bench, but he said that he could not sit, and was then laid by some of them upon the ground. He complained of being hurt, but he could not describe where, or in what manner; and as soon as a cart could be procured he was removed to his home, about a mile distant, unable to move any of his limbs, although he could turn his head. As he was supposed to be suffering simply from intoxication, he was merely placed in bed, and no surgeon was sent for until the next day. Mr. Woodd, assistant to Mr. Holberton, surgeon, of Hampton, being then accidentally near his residence, visited him, and found him propped up in bed, destitute of motion and sensation throughout the trunk and extremities, but still quite sensible. No treatment adopted could be effectual, and the man died shortly after five o’clock on the ensuing day, December 20th, about forty eight hours after sustaining his injuries. On the post-mortem exa-’ mination, a slight bruise was visible at the back of the neck, but the skin was unbroken; no mark of contusion existed elsewhere. The organs in the chest, and some in the abdomen, marrow as
CASE 7.-T. F-,a workman in a carpet manufactory, aged forty-three years. Inquest at Middlesex Hospital. The deceased was brought into the hospital about mid-day on the 16th of April, 1855. He was then sensible, and complained of
cold; he could not move any of his limbs, but no external injury was visible. He became insensible at about half-past nine o’clock on the night of that day, and at a quarter past eleven
he died. It was deposed in evidence that about two o’clock on the afternoon of the preceding day his master met him intoxicated in the street, and desired that he would accompany him to the warehouse. The deceased went within sight of his master up a ladder-staircase to the first floor, and from a height of about twelve feet he fell backwards over his master, who was on the lower steps of the ladder, and down to the ground, as it was supposed, from giddiness or unconsciousness produced by intoxication. On being taken up, he was found to have lost the use of all his limbs, and was at once removed to his home, where he remained until taken to the hospital the following day. His death occurred about thirty-one hours after the accident. Mr. Norton, house-surgeon to the Middlesex Hospital, made a post-mortem examination. The lungs and heart were found healthy, and the brain was in a natural condition, except that some bloody serum existed in its ventricles. Some extravasated blood was seen beneath the scalp over the left parietal bone. The seventh cervical vertebra was fractured across its articuand the spinal cord opposite this injury was lating softened for about an inch of its extent, and presented a clot of blood in its substance. To these injuries in the neck the cause of death was assigned.
processes,
Of the seven patients whose cases are above detailed, one lived only five hours and a half after the accident; three died in little more than twenty-four hours; one lived for two days; another for six days, and another for twenty -seven days afterwards. In a case detailed by Dr. Eade, (THE LANCET for 1855, vol. ii. p. 520,) the patient lived for nearly four months. But by far the most remarkable case of this description with which we are acquainted is narrated in a memoir of one John Carter, of Coggeshall, in Essex,* who lived for fourteen years after the injuries which deprived his limbs of motion and senat the age of twenty-one years, in 1836, slipped ’, sation. Carter, from a tree at the height of about forty feet from the ground, and fell to the earth upon his back. He was taken up senseless, and moved none of his limbs afterwards. Muscular power in the neck and head was, however, retained, and, it is added, The a slight power of motion in the chest and left shoulder. brain appeared to have suffered no injury from the fall. His mental faculties remained unimpaired during the rest of his life, and he partially supported himself by drawing, by means of a pencil placed between his teeth, upon paper adjusted for the purpose upon appropriate machinery. Some of his drawings, made in this way, copies of which are given in his Memoir, have singular excellence, and one is said to be in the possession of Her Majesty. His death was occasioned by pulmonary disease, accelerated by his being overturned with a small chaise in which he was being drawn. At a post-mortem examination, the fifth, sixth, and seventh cervical vertebrae were found thrust out into an arch, and the seventh was dislocated so as to press upon the spinal cord. We learn that a considerable quantity of extravasated blood was found in the immediate region of this dislocation, which effusion was probably a result of his last fall; but as the Memoir is written by a non-professional gentleman, we have no more precise account of the anatomical peculiarities of the injuries sustained than that just
I,I’
,
86
given. * Memoir of John Carter. By William James Dampier, Vicar of Coggeshall. London, Parker, 1850. 12mo, pp. 44.
,
Mr. Trotter, resident-surgeon of the hospital, made a postmortem examination. He found no external mark of injury, nor any remarkable morbid appearances in the chest or abdomen ; but the fifth cervical vertebra was found fractured in
several places, and the spinal cord enclosed by it Was completely broken up and disorganized. It may be incidentally remarked as surprising that so few DEATHS FROM FRACTURES AND OTHER INJURIES OF THE fatal accidents occur to bricklayers’ labourers similarly engaged CERVICAL VERTEBRÆ. on scaffoldings, which are often very imperfectly secured. CASE I.-G. A. R.-,ayoung artizan, about nineteen Notwithstanding the vast amount of building which has for years of age, on the evening of July 8th, 1852, went to bathe some years been going on in the parishes of St. Pancras, Padin one of the ponds on Hampstead-heath. He undressed, and dington, Kensington, Hammersmith, and other parts of the dived head-foremost off a bank into the pond, where the depth western division of Middlesex, inquests in cases of death fromfalls such as that described are comparatively rare. of water was about four feet. A companion, who observed CASE 3.-W. G--, an elderly man, an omnibus driven, with surprise and apprehension that he did not rise again, on stated to be both careful and sober, about twenty minutes past bubbles of air to imthe surface of the water, rising noticing eight o’clock on the evening of May 7th, 1853, took his omnimediately called to another who was partially undressed, and bus home to the yard in Kentish-town through a very narrow who presently plunged into the pond and brought out the in- lane, which had never been properly made into a road. In jured person in a position "doubled up," as described by this consequence of a sudden jolt whilst guiding his vehicle through witness at the inquest. With great and praiseworthy prompti- deep ruts, he was thrown off his box, and fell upon his back tude the young men briskly rubbed the surface of their friend’s with his head curved forwards. He was removed first to his and on the next morning to the University College body as it lay on the bank until some signs of animation home, where he was found to be paralysed from the nipples Hospital, were restored, procured assistance, brandy, &c., from a neigh- downwards. His intellectual functions were quite unim-bouring public-house, and without delay sent for a surgeon, paired. He had a cough, and his breathing was difficult, but who arrived before the young man was removed from the verge he improved in both these particulars. He died, however, on of the pond. By the direction of the surgeon, Mr. Shaw, of the 4th of June, twenty-seven days after the accident. On a examination, a fracture of the fourth cervical Hampstead, the patient was immediately removed into the post-mortem vertebra was discovered. public-house above-mentioned, and placed in bed. In about a doubt whatever existed that this man had died .Zi’e}M
INQUESTS AND MEDICAL TRIALS.
"
died on the next day, about twenty-eight hours from the time he had met with his accident. He continued to be sensible until within half-an-hour of his death.
it was ascertained that the spinous process of the fourth cervical vertebra had been broken off, and the laminas of that bone were also fractured; the broken
post-mortem examination,
85
congested. In the head, a considerable effusion of coagulated blood was found outside of the dura mater at the base of the brain, and this was continuous throughout the spinal canal, down to the lumbar vertebr. The extravasation of blood in the spinal canal was greatest in the neck, and particularly within the fifth cervical vertebra, to which occurrence the loss of power and the death was obviously attributable. In this case it was not stated that any cervical vertebra was found fractured. It may be mentioned that, as the testimony of all the witnesses exculpated Miller from any intention to do injury to the deceased man, and the evidence went unanimously to prove that no blow had been struck during the scuffle, the jury returned a verdict of Death by misadventure, and Miller was speedily released from custody.
pieces of bone pressed upon and indented so much of the spinal
were
almost to divide it in two. CASE 5.-S. W-, a man rather beyond middle age, a painter, on the evening of August 1st, 1854, was seen walking, -or rather staggering, in a state of intoxication, along the road from Uxbridge to Hillingdon, when, as he himself stated, in endeavouring to pick up something, he stumbled and fell forward, pitching with his head against the ground, as was proved by a scar on his right cheek. Some men, who shortly afterwards came up, turned him over on his back, and then left him on the footway, in the charge of a tradesman who lived close by and had come to the spot. The latter gave him some water to drink, washed his face, and tried to put him on his legs; but on finding that he had no power to walk, he set the man against a wall, untied his neckcloth, and soon had him removed home. The patient was seen that evening by a medical student, who supposed him to be merely suffering from the effects of drink; but on the next morning he was visited by Mr. Rayner, surgeon, of Uxbridge. From the want of motion in the limbs, and of sensation all over the lower part of the body, distension of the bladder, and* inability to pass urine, as well as pain complained of in the neck, Mr. Rayner was led to suppose that the man had fractured one or more of the cervical vertebrae. On examination, Mr. Rayner detected, as he believed, that the fifth cervical vertebra had been broken, as, on pressing the spinous process of that bone with the finger, increased pain was occasioned. Some sensation remained about the shoulders, but none in the arms. Considering it to be a hopeless case, in which impression Mr. Rayner was confirmed by the opinions of Mr. Stilwell and the late Mr. Cane, little was done in the way of treatment beyond withdrawing the urine night and morning. The bowels relieved themselves involuntarily and unconsciously. The patient was perfectly sensible until within a short time previous to his death, which occurred on Aua;. 7th, six days after the receipt of the injury. As the nature of the accident appeared clear, and no other person was involved in blame on account of it, a post-mortem examination was not required for the purposes of the inquest, and accordingly none was made. This instance presents an analogy with Case 1; in both cases it will be noticed how very short a fall was sufficient to produce fatal injury in the spinal column. CASE 6.-R. Mnllins, an excavator, thirty-one years of age. In this case, a man being in custody on a charge of having killed the deceased, the notes relative to the occurrence were taken more fully than in some of the preceding instances. The inquest was held at Hampton, January 1st, 1855. The deceased man and some of his fellow labourers were in the tap-room of a public-house between five and six o’clock on the evening of December 18th, 1854. Some dispute arose, and Mullins, in an intoxicated state, advanced towards a man named Miller, who was standing with his back-to the fireplace, and he struck Miller twice on the face. Miller, who was said to be even more intoxicated than the other man, with much forbearance took no notice of the first blow, but after the second he ran towards Mullins, and they had what was termed a "rally" together, at the end of which both men fell on the floor. No blow was alleged to have been struck on either side during this rally, or wrestle. The witnesses differed materially in their statements as to the position in which the men lay on the ground after their fall; some asserting that Miller fell on his back, and Mullins upon him; others,-and this was more probable,-that Mullins fell on his back; and others, again, stated that the men fell side by side. Mullins was raised up by some of the bystanders and set upon a bench, but he said that he could not sit, and was then laid by some of them upon the ground. He complained of being hurt, but he could not describe where, or in what manner; and as soon as a cart could be procured he was removed to his home, about a mile distant, unable to move any of his limbs, although he could turn his head. As he was supposed to be suffering simply from intoxication, he was merely placed in bed, and no surgeon was sent for until the next day. Mr. Woodd, assistant to Mr. Holberton, surgeon, of Hampton, being then accidentally near his residence, visited him, and found him propped up in bed, destitute of motion and sensation throughout the trunk and extremities, but still quite sensible. No treatment adopted could be effectual, and the man died shortly after five o’clock on the ensuing day, December 20th, about forty eight hours after sustaining his injuries. On the post-mortem exa-’ mination, a slight bruise was visible at the back of the neck, but the skin was unbroken; no mark of contusion existed elsewhere. The organs in the chest, and some in the abdomen, marrow as
CASE 7.-T. F-,a workman in a carpet manufactory, aged forty-three years. Inquest at Middlesex Hospital. The deceased was brought into the hospital about mid-day on the 16th of April, 1855. He was then sensible, and complained of
cold; he could not move any of his limbs, but no external injury was visible. He became insensible at about half-past nine o’clock on the night of that day, and at a quarter past eleven
he died. It was deposed in evidence that about two o’clock on the afternoon of the preceding day his master met him intoxicated in the street, and desired that he would accompany him to the warehouse. The deceased went within sight of his master up a ladder-staircase to the first floor, and from a height of about twelve feet he fell backwards over his master, who was on the lower steps of the ladder, and down to the ground, as it was supposed, from giddiness or unconsciousness produced by intoxication. On being taken up, he was found to have lost the use of all his limbs, and was at once removed to his home, where he remained until taken to the hospital the following day. His death occurred about thirty-one hours after the accident. Mr. Norton, house-surgeon to the Middlesex Hospital, made a post-mortem examination. The lungs and heart were found healthy, and the brain was in a natural condition, except that some bloody serum existed in its ventricles. Some extravasated blood was seen beneath the scalp over the left parietal bone. The seventh cervical vertebra was fractured across its articuand the spinal cord opposite this injury was lating softened for about an inch of its extent, and presented a clot of blood in its substance. To these injuries in the neck the cause of death was assigned.
processes,
Of the seven patients whose cases are above detailed, one lived only five hours and a half after the accident; three died in little more than twenty-four hours; one lived for two days; another for six days, and another for twenty -seven days afterwards. In a case detailed by Dr. Eade, (THE LANCET for 1855, vol. ii. p. 520,) the patient lived for nearly four months. But by far the most remarkable case of this description with which we are acquainted is narrated in a memoir of one John Carter, of Coggeshall, in Essex,* who lived for fourteen years after the injuries which deprived his limbs of motion and senat the age of twenty-one years, in 1836, slipped ’, sation. Carter, from a tree at the height of about forty feet from the ground, and fell to the earth upon his back. He was taken up senseless, and moved none of his limbs afterwards. Muscular power in the neck and head was, however, retained, and, it is added, The a slight power of motion in the chest and left shoulder. brain appeared to have suffered no injury from the fall. His mental faculties remained unimpaired during the rest of his life, and he partially supported himself by drawing, by means of a pencil placed between his teeth, upon paper adjusted for the purpose upon appropriate machinery. Some of his drawings, made in this way, copies of which are given in his Memoir, have singular excellence, and one is said to be in the possession of Her Majesty. His death was occasioned by pulmonary disease, accelerated by his being overturned with a small chaise in which he was being drawn. At a post-mortem examination, the fifth, sixth, and seventh cervical vertebrae were found thrust out into an arch, and the seventh was dislocated so as to press upon the spinal cord. We learn that a considerable quantity of extravasated blood was found in the immediate region of this dislocation, which effusion was probably a result of his last fall; but as the Memoir is written by a non-professional gentleman, we have no more precise account of the anatomical peculiarities of the injuries sustained than that just
I,I’
,
86
given. * Memoir of John Carter. By William James Dampier, Vicar of Coggeshall. London, Parker, 1850. 12mo, pp. 44.
,