s considerable risk of septic
pneumonia.

_Treatment._--As the immediate risk to life is from suffocation, it is
usually necessary to perform tracheotomy at once. In fracture of the
hyoid the fragments may be replaced by manipulation through the mouth,
after which the head and neck are immobilised by a poroplastic collar.

#Wounds--Cut-throat.#--The most important variety of wound of the neck
met with in civil practice is that known as "cut-throat"--an injury
usually inflicted with suicidal, less frequently with homicidal
intent.

Suicidal wounds are usually directed from left to right (if the
patient is right-handed), and they run more or less obliquely from
below upwards across the neck; the wound being deepest towards its
left end, that is where the weapon enters, and gradually tailing off
towards the right. In most cases the would-be suicide throws his head
so far back at the moment of inflicting the wound, that the main
vessels are carried backward under cover of the tense sterno-mastoid
muscles, and so escape injury. The knife may even reach the vertebral
column without damaging the contents of the carotid sheath.

Homicidal wounds are usually more directly transverse, and are of
equal depth throughout. The main vessels are generally divided, the
oesophagus and trachea opened into, and in some cases the vertebral
canal is opened and the cord and its membranes injured.

_Clinical Features._--The clinical features vary with the level of the
wound and with its depth. In all cases the contraction of the platysma
causes the wound to gape widely, and its edges tend to be turned in.

In a large proportion of suicidal attempts the patient only succeeds
in inflicting one or more comparatively superficial wounds across the
front of the neck. In many cases the haemorrhage from these is
trifling, but if the external jugular and other large superficial
veins are divided, it may be fairly profuse, although it is seldom
immediately fatal, unless the blood is sucked in to the wounded
air-passage.

Occasionally, but rarely, the wound is made _above the hyoid bone_,
and opens directly into the mouth. There may then be sharp haemorrhage
from the base of the tongue or from the lingual and external maxillary
(facial) arteries or their branches in the submaxillary region, and
asphyxia may result from the base of the tongue and the epiglottis
falling back and obstructing the larynx.

The _hyo-thyreoid membrane_ is frequently d