138 
COMPLICATIONS OF WOUNDS IN THE NECK. 
winch is favoured by the negative blood pressure in this vessel, and by 
its liability to gape in consequence of attachment to neighbouring 
tissues. The escape of dark-coloured blood in a strong steady stream 
points to injury of the jugular vein, and calls for its complete section, or 
secure ligation, which latter must be performed on both sides of the 
wound; on the peripheral side to stop bleeding, on the central side to 
pi event entiance of air into the blood stream. 
h lec bleeding in jeiks indicates injury of the carotid or of some other 
of the larger arteries, and necessitates ligation of the injured vessel. 
Hie closure of small skin wounds in no way removes the danger, 
because the blood accumulating under the skin and loose connective 
tissue of the throat presses on the trachea, and may cause suffocation, 
-there should, therefore, be no hesitation in ligaturing the carotid. At the 
point of bleeding, a cut must be made parallel with and a little behind 
le jugular, dividing the skin and subscapulo-hyoideus muscle. The 
loose connective tissue is pressed to one side with the index finger, and the 
vessel, easily recognised by its distinct pulsation, sought, drawn forward, 
separated from the vagus, sympathetic and recurrent, and after being 
twice ligatured, cut through between the two threads. The peripheral 
igature is necessary on account of the collateral communication with 
arteries of the other side of the neck (occipital and innominate arteries). 
Section of the vessel is intended to prevent tearing away at the point of 
igation, which is favoured by the natural tension of the carotid 
It is necessary to remark that the blood may flow in a regular stream, 
and not in jerks, even in injuries of the carotid. This is the case where 
the blood does not find exit directly, but flows under the skin or into 
the cavities of the connective tissue. A red colour and powerful stream 
always suggest injury to the carotid. 
(3) The larger nerve trunks, like the vagus, sympathetic and recur¬ 
rent, may be injured. One-sided division of the vagus, or even of the 
sympathetic and recurrent, do not endanger life, but cause unilateral 
paralysis of the larynx. Prom such injuries roaring has repeatedly 
been seen to result in the horse. Where injury to the nerve exists, or 
is suspected, the strictest antiseptic precautions must be observed to 
pi event extension of inflammatory processes to the nerves named, and 
w ab °l "I 8 ar an Umon of the nei ' ve end “gs as possible. 
(4) Wounds m the neck may be complicated with perforation of the 
trachea; and though such a condition is seldom directly fatal it 
occasionally leads to death, from blood entering the trachea and lungs 
and producing suffocation. The emphysema often seen about the neck 
after injuries to the trachea is an unpleasant, if not an actually 
angeious, complication. Tracheal injuries are recognised by the blood¬ 
stained discharge from the nose, the frothy condition of the wound 
