WOUNDS. 



conne<Sled with each other, being all inclofed in one mafs of 

 cellular fubftance, which forms fomething like a fheath for 

 them. Now, fays Mr. John Bell, fince this eighth pair is 

 one of the greatelt nerves of the vifcera, and fince, by ex- 

 periments upon animals, we know well that a wound of it is 

 more fatal than a wound of the brain itfelf, this puts an end 

 at once to all queftions about the way of managing wounds 

 of the carotid artery, or of the great vein. No doubt thefe 

 may fometimes be partially wounded and the nerve efcape ; 

 but, in general, the nerve will be cut along with them ; and, 

 at all events, the fatal confequences which would arife from 

 including this nerve in a ligature, make it abfolutely necef- 

 faiy that whenever the carotid is tied, it be firft carefully 

 feparated from every other part. See John Bell's Difcourfes 

 on Wounds, p. 415. edit. 3. 



That the internal jugular vein, or the carotid artery itfelf, 

 may fometimes be partially injured, without a wound of the 

 par vagum, or the patient inttantly perifhing, has now been 

 fully proved. The writer of this article knew of a cafe, which 

 happened in the campaign in Holland in 1 814, where the in- 

 ternal jugular vein was ruptured by the paffage of a muflcet- 

 ball down the neck ; and yet the patient lived more than an 

 hour after the accident, and when he died it was from fuf- 

 focation, in confequence of the prefFure of a large mafs of 

 extravafated blood upon the trachea. M. Larrey has related 

 a very fingular cafe : an officer received a gun-lhot wound, 

 which cut the external carotid at iis feparation from the in- 

 ternal, and in its paffage through the parotid gland. Pref- 

 furc made by an intelligent foldier at the moment, and 

 fubfequent bandages, faved the patient. (See Memoires de 

 Chir. Militaire. ) This cafe is fingular, becaufe it is very 

 uncommon for hemorrhage from fo large a vefiel as the ex- 

 ternal carotid to be permanently flopped by fimple prelTure, 

 nor Ihould we recommend the method to be imitated ; for 

 there is not in all furgery a better rule than that of trufting 

 only to the ligature in every wound of a great artery. Mr. 

 Hennen, however, informs us, that he knew of an Enghfh 

 officer, who was alfo faved in India from the effefts of an 

 arrow wound in the carotid by the fame means. (Obf. on 

 Military Surgery, p. i8o. ) Such a mode of treatment we 

 believe would fail a thoufand times in fucceffion ; and the 

 alleged cures would be more valuable, if it were always 

 ' quite impoffible to miftake hemorrhage from a branch for a 

 ' bleeding from the trunk itfelf. 



' The writer of this article is acquainted with an army 

 I furgeon, in whofe veracity he pcrfcdlly confides, who ftates, 

 ] that he was once called to a foldier who had wounded the 

 •trunk of the carotid with a bayonet. The vefl'el was in- 

 ' ftantly taken up, and the man's life faved. In a modern 

 ' publication may alfo be found anotlier example, in which 

 I the carotid burlt, and was taken up on the Ipot by Mr. 

 ' Fleming, a naval furgeon. See Medico-Chir. Journal, vol. iii. 

 Ip. 2. 



! Without pofitively maintaining, as Mr. J. Bell does, that 

 'it is impoffible to cut through the trachea fo as to open the 

 jCefophagus, without wounding the carotid artery, the jugu- 

 jlar vein, and the eighth pair of nerves, we join him in be- 

 ilieving that fuch an accident muft be exceedingly rare. 

 I How then are we to explain the many alleged cures which 

 lare faid to have been effefted, notwithftanding the windpipe 

 land oefophagus are ftated to have been both cut through ? 

 I We are to account for thefe extraordinary narratives in the 

 j manner fo well pointed out by Mr. John Bell. " The faft 

 .is (fays he), that neither the refophagus nor the trachea is 

 I touched in the lead degree, but the wound is much above 

 I them ; for a fuicide always ftrikes immediately under the 

 jchrn. This wound, as far as I have obferved, commonly 

 I Vol. XXXVIII. 



falls in the line which divides the neck from the chin ; that 

 is, the place where the os hyoides lies, and he commonly 

 cuts the OS hyoides away from its connexion with the thy- 

 roid cartilage, or pomum Adami. In that cafe, the thyroid 

 cartilage, forming the uppermoll part of the larynx, is not 

 touched ; the rima glottidis lies below the wound quite fafe. 

 The wound indeed feparates the epiglottis from the glottis ; 

 but it leaves the glottis and the larynx quite fafe. It only 

 feparates the larynx from the root of the tongue ; it is 

 properly a wound in the root of the tongue ; it is rather a 

 wound of the mouth than of the throat ; and when the food 

 comes out, along with fpittle and froth, it is by rolling over 

 the root of the tongue." On Wounds, p. 417. 



That, however, the trachea and oefophagus may be both 

 cut in a few cafes, without immediate death from hemor- 

 rhage, we decidedly believe, becaufe there are too many 

 fads on record to admit of any doubt on the fubjeft. See 

 Default's Journal and Saviard, obf. 58. Hennen's Mili- 

 tary Surgery, p. 386. 



In thefe high wounds of the throat, it is the fuperior 

 thyroid artery which is moft frequently cut. This veflel, 

 after quitting the external carotid at the angle of the jaw, 

 paffes along the fide of the upper part of the trachea, in- 

 clining forward towards the thyroid gland in its defcent, 

 and being therefore much expofed to the edge of the razor. 

 The bleeding from this artery is profufe, and if not 

 fpeedily ftopped is as fatal as hemorrhage from the carotid 

 itfelf. In fome of thefe cafes, the bleeding alfo proceeds 

 from branches of the lingual artery. 



Wounds of the carotid artery, or jugular vein, cona- 

 monly prove immediately fatal from lofs of blood, before 

 any affiftance can be obtained. If a furgeon, however, 

 were to arrive in time to render aid, it would be his duty 

 immediately to apply a ligature both^below and above the 

 wound of the vefTel. This is the only plan which affords 

 any chance of faving the patient's life, and, as we have al- 

 ready noticed, it has actually been done with fuccefs in a few 

 uncommon inllances, in which the furgeon was not too late. 

 In pafTing the ligatures beneath either of thofe veffels 

 great caution is requifite ; for the eighth pair of nerves lies 

 clofe to it, included in the fame fheath of cellular fubftance, 

 and the inclufion of fo important a nerve in the ligature 

 would have fatal confequences. Its fituation on the out- 

 fide of the artery, between it and the jugular vein, fhould 

 therefore be always carefully remembered. According to 

 Richter, the internal jugular vein has aftually been tied with 

 fuccefs. Small wounds of the fame vefTel, if we are to 

 credit the accounts of this author, may fometimes be healed 

 by means of a graduated comprefs, which muft be retained 

 on the part with a bandage, or, if that prove irkfome, with 

 the finger. One thing, however, is effential ; namely, the 

 prcfTure muft on no account be remitted, until the wound in 

 the veflel is clofed. Richter's Anfangfgr. der Wundarzn. 

 b. iv. p. 173., and Cooper's Firfb Lines of Surgery, p. 386. 

 edit. 3. 



M. Pelletan once faw a wound of the throat, which 

 proved fatal in confequence of hemorrhage from the exter- 

 nal jugular veins ; and the fame eminent furgeon met with 

 another curious inftance, in which a boy, who was conva- 

 lefcent after a cut of his throat, fuddenly fell down in a 

 ftate of fuffocation and died : on examining the parts after 

 death, it was dil'covered, that the left fide of the epiglottis 

 had been detached from the glottis and root of the tongue, 

 and that in this loofe unconnefted ftate it had fallen upon 

 the rima glottidis, and clofed it fo completely as to caufe 

 inftantaneous fuffocation. See Leveille's Nouvelle Doftrine 



Chir, torn. i. p. 342, 343. 



5 B Wounds 



