Cases of homicidal suffocation, with remarks / by Henry D. Littlejohn.

  • Littlejohn, Henry Duncan, 1828-1914.
Date:
1856
Catalogue details

Licence: Public Domain Mark

Credit: Cases of homicidal suffocation, with remarks / by Henry D. Littlejohn. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    introduction of instruments into the larynx, is the forcible dragging forward of the tongue, followed by the pressure of the finger at its ! root, to maintain it in its protruded condition. The effect of this is \ well marked, if the experiment be made on such a section of the head as is shown in fig. 3. The epiglottis is raised, exposing the upper strait of the larynx. The whole organ, however, is i dragged upwards, and, what is important, slightly backwards, so as l to bring it more into the mesial line from the position that it occupied, almost under the back part of the tongue, which in the ordinary condition of the parts considerably overlaps it. Should an attempt be made to pass an instrument or foreign body, without | previously bringing the tongue forwards, the very effort of intro- ducing it into the throat pushes the tongue backwards over the : larynx, forces the epiglottis downwards, and renders the operation ; one of difficulty. There is no doubt that, under these circum- > stances, the passage of an instrument by the nares, affords a better ■ chance of the larynx being entered from the peculiar curve forwards, j caused by the instrument impinging on the front of the vertebral column. The direction now given affords an almost certain chance | of the upper orifice of the larynx being reached, as it lies concealed behind the back of the tongue. The position of the head of the patient has no small influence in faci- litating the introduction of instruments into the larynx. A recent : author, M. Follin,1 has directed attention to the subject with more especial reference to the oesophagus, but his experiments and conclu- sions apply almost equally well to the orifice of the larynx. “ If,” says M. Follin, “ the head of a dead body be forcibly extended, the cervical region is observed to describe a curve, the summit of which corres- ponds to the level of the fifth and sixth cervical vertebrae ; the superior orifice of the oesophagus also corresponds to the apex of this curve, and if while the body is maintained in this position, we attempt to insert the point of the index finger into the superior oesophagus, we feel it strongly squeezed; a sound introduced by the mouth is then found to penetrate the canal with difficulty, and has a great tendency to engage itself in the larynx” M. Follin concludes that catheterism of the oesophagus ought never to be practised while the head is forcibly extended, but rather when it is in a flexed condition. In our medical report, the opinion was expressed that the deceased herself could not have inserted the foreign body. Setting aside her advanced age, the state of intoxication in which she was proved to j have been very shortly before her death, and the severe injuries she had received, the manipulation which, on experiment, was required for the introduction of the cork into the larynx of even a dead body in which all the exquisite sensibilities of the parts are abolished, justified, in our opinion, the statement of the report. Many cases, no doubt, are on record of maniacs and others, where death was ; 1 Des relrccissemcnts do I'cesopliage (these dc Concovrs). Par M. 8vo, 18) 5. Paris.