A handy-book of forensic medicine and toxicology / by W. Bathurst Woodman and Charles Meymott Tidy.

Date:: 1877

Credit: A handy-book of forensic medicine and toxicology / by W. Bathurst Woodman and Charles Meymott Tidy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$SUICIDAL WOUNDS OF THROAT. works already quoted. Opinions differ as to the propriety of trephining, or trepanning, in certain cases of fractured skull. The majority of modern surgeons hesitate to do this in the case of very young children with fractured skull. It is, however, doubtful if the risks are much increased by the operation itself when the fracture is compound. As regards laceration of the scalp, and contused and incised wounds of the same, without fracture, there is no doubt that the risks are greater than those of wounds of the skin in many other parts. There is not only more risk of erysipelas, but there is always more or less danger of injury to the brain supervening, if, indeed, it do not accompany the original injury. Yet hundreds of scalp-wounds are treated at our large hospitals every year which never give rise to very serious symptoms. Besides injury to the spinal cord in tlie neck, which we have just been considering, there is risk to the larynx, or organ of the voice, and to the phrenic, vagus, sympathetic, and fifth nerves, by forcible compression of the neck. Pressure on the carotids (such as is produced by the well- known policeman’s grip, by inserting the fist inside the collar and pressing against the throat with the knuckles) may produce temporary insensibility, and if prolonged, death. The explanation is partly the interrupted blood supply to the cranium; and partly, no doubt, the pressure on the vagus and other nerves shown in Fig. 115. The inner coat of the artery maybe injured by forcible knuckling. The most serious injuries to the neck and throat are produced in what are called cut-throat cases. Both suicides and murderers inflict the most frightful injuries on this part of the body. The weapons commonly employed are sharp table and carving knives, razors, pen- knives, and “ bowie ” knives. A woman was admitted to the London Hospital in 1861 who had cut her throat with a table-knife so severely as to cut the windpipe entirely through, and wound the pharynx and oesophagus. She cut through the muscles covering the spine, and cut deeply into the inter-vertebral substance of three or four of the lower cervical vertebrae. There was frightful haemorrhage, but the knife being a little blunt, had pushed the jugulars and carotids back or to one side, so that only one carotid was wounded, and that slightly.* The Authors know of another suicidal case, in which a lunatic nearly severed his head from the body. In such suicidal wounds of tlie throat the deepest part is usually the beginning of the wound, and consequently on the left side, in right- handed people, and the wound finishes off by a tail-end, involving little more than the skin. Very often the last part of the wound, or that to the right, presents several gashes or jags. Sir Everard Home thought that regularity in a wound, i.e., its being clean cut and even, pointed to suicide. The Authors, from their own experience, cannot agree with this view. Dr. Taylor remarks that the wound in the throat of Lord William Bussell, who was murdered by Courvoisier, in 1840, “possessed all that regularity which has been so improperly regarded as charac- teristic of suicide ” \loc. cit., p. 485, vol. ii.]. How, then, shall we judge whether a wound in the throat or neck be homicidal or not? The answer seems to us to be, not from the mere wound itself (except where a right-handed person has inflicted a left-handed wound, or vice versd), but from the presence or absence of other injuries—for example, frac- * Dr. Ryan quotes a similar case in the “ Medical Times,” Jan. 17,1852, p. 73.$