Case of suicide in which death resulted from a wound in the neck by an earthenware jug: with remarks / [Robert Spittal].

  • Spittal, Robert, 1804-1852.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: Case of suicide in which death resulted from a wound in the neck by an earthenware jug: with remarks / [Robert Spittal]. Source: Wellcome Collection.

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    was obtained only after the operation had been performed, the symp¬ toms not haying been sufficient to warrant the conclusion that these very minute foreign bodies were actually there. Indeed all the symptoms might have arisen, and probably did arise, from the lodg¬ ment of particles of sand in the mucous folds of the larynx, above the rinia glottidis, or even from what was not unlikely, the presence of a quantity of the sand in the lower part of the pharynx, behind the larynx; —as the lodgment of a foreign body there has been known to cause,—independent of the pressure which it exerted,— complete and fatal spasmodic closure of the glottis. Supposing, however, that in such a case, the existence of a few particles of sand in the trachea could be actually ascertained, the operation of tracheotomy would not even then be warrantable, as the rima glottidis itself would be a sufficient aperture for their ex¬ trusion by the expiratory efforts, when the paroxysm of the dysp¬ noea was over; unless, as occurred in this case, the dyspnoea was so severe and continued, as to demand immediate operation. In regard to the true pathology of this case, it differs from that of the one first related, in so far as the first case presented some of the characters of laryngismus stridulus; whereas, in the second case, the spasmodic affection of the muscles of the glottis was severe and unintermitting,—the cause not being of internal or of idio¬ pathic, but of traumatic origin. It required accordingly immediate operative interference. The errors in practice which might arise from confusing such cases with those of true laryngismus stridulus, are sufficiently evi¬ dent ; since operative measures are not warrantable in cases coming strictly under the latter denomination, until, after repeated attacks of the dyspnoea, between which there have been intermissions, the patient is at length unable to struggle through the fit, and is in imminent danger of suffocation. Whereas, in cases such as that which forms the subject of these remarks, the operation is demand¬ ed almost at the beginning;—just as in the somewhat similar case of a foreign body of considerable size in the larynx or trachea, g ing rise to so severe and continued dyspnoea as to demand the per¬ formance of tracheotomy to obviate impending suffocation; and I need hardly remark, that to these cases also, the term laryngis¬ mus stridulus is inapplicable. The acute laryngitis which subsequently occurred, in this case, is to be ascribed to the violence of the primary irritation, and also, to some of the particles of sand having lodged in the neighbourhood of the glottis until they were removed by the viscid mucus which was expectorated. And it was not attributable to the entrance of unheated air by the wound, as an acute bronchitis would have been the more likely consequence of this, and as every precaution was taken to prevent the entrance of unheated air. The suppuration which afterwards occurred in the neck, it is worthy of remark, took place rapidly, and from this circumstance, c
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