The prognosis depends largely on the general condition of the patient. The majority of those who attempt to take their own lives are in a low state of health from alcoholic excess, mental worry, privation or other causes, and many succumb even when the wound in the neck is comparatively slight. Shock, loss of blood, asphyxia from blood entering the air-passages, and œdema of the glottis are the most frequent causes of death soon after the injury. Cellulitis, inhalation, pneumonia, and delirium tremens are later complications that may prove fatal.
Treatment.—The first indication is to arrest hæmorrhage, and this may be done by applying digital compression over the bleeding points. The bleeding vessels are then sought for and ligated, the wound being enlarged if necessary.
If the food and air-passages are intact, any muscles that have been divided should be sutured.
When the epiglottis is cut across in wounds opening into the pharynx, it should be united, preferably with fine silk sutures, as catgut is absorbed before healing has time to take place. The wall of the pharynx and the muscles should then be sutured layer by layer.
When the air-passage is opened, it is usually advisable to introduce a tracheotomy tube ([Fig. 273]), and pack gauze round it to avoid the risk of œdema of the glottis and to prevent blood entering the lungs. The soft tissues may then be brought together layer by layer.
Fig. 273.—Recovery from Suicidal Cut-throat after low tracheotomy and gastrostomy.
(Mr. J. M. Graham's case.)
In all cases the superficial part of the wound should be drained, and in applying the bandage the head should be flexed on the chest to take all tension off the stitches. The patient must be kept under constant supervision lest he should interfere with the dressings, or make a further attempt on his life. In some cases it is necessary to feed him through a tube passed into the stomach either through the mouth or through the nose; when this is not feasible, nourishment must be given by the rectum, or by a gastrostomy tube ([Fig. 273]).
Wounds of the thoracic duct have been described with affections of the lymphatics (Volume I., p. 324), and wounds of the brachial plexus with injuries of individual nerves (Volume I., p. 360).