ivided, and the pharynx
thus opened. As the depressor muscles of the hyoid are divided, there
is interference with deglutition and phonation, but respiration is not
affected. In such cases the upper portion of the epiglottis is often
cut off, and the base of the tongue, the tonsil or the soft palate may
be injured. The lingual, external maxillary and superior thyreoid
arteries, and the hypoglossal nerve are also liable to be divided at
this level, but the main vessels of the neck usually escape. There is
pain and difficulty in swallowing, and food and saliva tend to escape
through the wound. Particles of food may pass into the air-passages
and cause violent fits of coughing.

In more severe cases the knife enters the _larynx_ or the _trachea_.
Sometimes the thyreoid cartilage is divided--as a rule only
partly--and the vocal cords are injured; in other cases the trachea is
opened, or it may be completely cut across. The bleeding is serious,
as the superior thyreoid arteries are usually damaged. If the common
carotid and the internal jugular vein also are wounded, the haemorrhage
usually proves fatal. The fatal issue may be contributed to by blood
entering the air-passages and causing asphyxia, or by air being sucked
into the open veins and causing air embolism. The laryngeal branches
of the vagus may be divided and paralysis of the larynx ensue.

In all cases there is more or less dyspnoea and persistent coughing.
The voice is husky, and the patient can only express himself in a
hoarse whisper. There is difficulty in swallowing, and the food may
enter the trachea. When the external wound is small, there may be a
considerable degree of emphysema of the cellular tissue.

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 oedema 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 haemorrhage, and this
may be done by applying digital compression over the bleeding points.
The bleeding vessels are then sought for and ligated, the wound b