SECTION 3. SUMMARY OP THE SURGICAL HISTORY OF THE INTERN'AL AND (Part 6)

when reached in the operation. Autopsy: Clavicle partly absorbed ; 2d and .Sd ribs cut ihto by absorption from pressure; thrombi on both sides of ligature; lung inflamed. the ovier edge of the Scalenus Anticus and the lower border of First Bib). 33 34 3.5 Nov. 9, 5th day. Exhaust'n. 4th day. Exhaust'n? 5th day. Exhaust'n. Autopsy: Firm thrombus on both sides of ligature; 2 lbs. of clot- ted blood in sac. 1809. 1811. 181.5 or Delirium and rapid gangrene of limb followed operation. Au- topsy: No clots had formed which occluded the artery on proximal or distal side of liga- ture. 1813? 12 178 PRIZE K38AY. Ligature of the Subclaoian Artery in its Third Surgical Dioision (betwee ... »,=; >.;=i. FiTIBJtr. .s;.Ti h 5f It t a :- 4 s in OhIIIl-, 1S14. Hottlt roBlrih. ; ArcU. KliD, Chlr., M. iirHr"' 'loL''' -IT •■'S.'- ... M. L. Ailllary a.en. Ini'Dtli. ... ,......,.. Jsuuary', ISa", p, IS. F. " L. '■'■'7- -SIS'-- ,.. PlrtlB, IMS. KsokPaiie, Am. Jr. mi. 8cl., July, 1B.-.S. |i. aafl. L.noot.XMO,p.a7fl. Arrh- EliB. Chlr., Bi). I. p.a-2fl. M. M. M. a L. AxllUry iinfti- rltm (itcminl. 1 io. do. do. 1 ft Ih""""^™' t f' 1 ".il?.",' "'""" '" Tr,.™,18a3. Oii7'« Hoip. KspoTta, Till. XT. p. «9. U. 73 ^' Subclur. ailllat? Bnooriam. '""■■■ do. n Bullon. TliDi., Land. Med. RepDB.. 1823. Yol. »I, p. ISO. M, eo H. SnKoliT. BillUr; dg. T„dii, lasa. LnngBUbock, Sowlnkoff, 1853 NoiTl. CQi.lrib.,p.am. Bd:.. P.IK2. ■' Oa^V Hoap. Seport VnrbillVloauihor. U. :, B. AxMliTy aoeu- aiillary Miery. SalmlaT. ■xlllar; 81i"l wonad of ■ilUa. 1 ra'iith :: H. to L. B da/«. dn. 1 .. Ch.inbBrlBlaa Abernptby Ln Wad. M. Mia L. rlsni (pnnclurBd byadu.la..). do. i'bI4.' p-V- 4B Pi>st, lfil7, Tr'Z%il'.i,:i>J: M. 37 L. SiitielBi. aiiUarj aw'k» do. r . Wlihirt, 1923. Gn;r'sHii(p. RBporl. M, " - d. 6Wki do. ..... .1. 1 INNOMINATE AND SUBCLAVIAN ARTBRIES. 179 s of Scalenus Anticus and lower border of First Rib) — continued. f 9 i; rt ►< o 3 © « O «} RESULT. Recovery. Condition. Canse of death, date after op. REMARKS. 14. Oc- I curred. '» I, 96 9, 3, Oc- curred. 16,17, 26, 75. 17 47 20 322.1. 21 2,3. 7. ' None. 817. i5, 6. !2, 12 11 13 13 18 Recovered. Recovered. Recovered. Recovered. Recovered. Relieved. (Small tu- mor per- sisted.) Cured. Cured. Cured. 3d day. Hem. 8th day. Cerebral symptoms (proba- bly pyaemia). Cured. Recovered. Recovered. Recovered. Recovered Recovered, Cured. Cured. 4th day. Exhaust'n. Cured. Recovered, 16 Recovered. Cured. Cured. Cured. After resection, amputation and ligature of axillary ; hem. and ligature of subclavian ; death 3d day. Autopsy showed ulcer- ated hole in axillary one inch to central side of first ligature, accounting for hemorrhage. 2 days after operation suppura- tion of sac ensued ; 7th day, rupture and discharge of con- tents of sac. Autopsy: Throm- bus on both sides of ligature. Radial pulse returned on 4th day ; aneurism very much re- duced in size, but a small tumor containing fluid persisted for some time after operation. Phlebitis resulted after opera- tion. In passing needle the sac was penetrated; hemorrhage, which did not cease with the ligature, but was controlled by compress. (No anesthetic.) Radial pulse, which was scarcely perceptible before ligature, was very dis- tinct after ; 2d day, venesec- tion 12 oz.; 16th, hem. from wound; 17th, do.; 18th, tumor began to increase in size ; 26th, it was punctured ; day before patient had coughed up contents of sac ; 7dth, hem. ; numbness of arm during convalescence. Severe hemorrhage followed wound ; ligature of the axil- lary; new hem. and ligature of subclavian; right arm remained weak after convalescence. Load of bird shot entered axilla at close range (2 feet) ; 5th day after injury, subclavian tied as it crossed 1st rib (incision be- low clavicle); 2 days after ope- ration, arterial hemorrhage; pressure;3d, hemorrhage again; recovered; fixation of fingers in flexed position as a result of in. jury to nerves by shot. Below clavicle, at first rib. Artery tied behind clavicle ; Ab- ernethy gives it as subclavian, as ** shoulder was pushed up." No bad symptoms. Below cla- vicle, at 1st rib. 5th day, hemorrhage (slight) from wound ; 6th, do.; 9th, sac bursted, discharging 3 oz. dark coagulated blood ; 12th, do. 4 01.; 13th, 14th 15th, febrile paroxysms; slight numbness in arm and hand during convales- cence. Did well until 10th day, when febrile symptoms ensued ; ab- scess in axilla after convales- cence. ISO PRIZE E8SAT. Ligature of Ike Subelaoian Artery in its Third Surgical Division (betweei Source or „T.,.T. C»B.B Ot i! » IE •J i iliil « n i If !>». fl. 1 < u^ rh- « «' . '* III 1,^ ^i 1 1 1 NormCoiilrlb..p.2a3 ""■|s^,p!m. ""' ^E^Un- M "d^A'saVg. M«l. Chlr. Tt.111., vol. xlil. p. 1 ,1 «,. Nor:liCoutrib.,p.!22. '"■'»'■"■-"■■ OoY'iHop. Baport>. Uim. Had. Soo. de vol. 11. iio«. p. isa; Norrn'uoBttlb. LsteM, 1838, vjl. xli fu^.'Bd.",'p.aS: Am. Jr. Med." lei.. Am. Jr. Med. Scl. „ .. rt.m ir eumii- AnllUr, .nou- riim. ..... ■ton. do. ad.t 1 (UsriMlbo). 1 U IsSU. do. 1 822. .... R. AittlBrr snan- eiettlon). .... Ananrlom. L. Snbolav. iillUry ■ wlthropa). a mo,. Ahw dWi. 2daj.. do. do. do. do. do. do. do. 1 68 -' j^,-"' 6J 1 BrodlB. 1S31. BB BMdBl, J8M. « Arendl, ifl'e. 1 ....,„,„. 39 1 . --1 1 S2 Wirdrop, ISM Gibson, W., B. L. A Hilary iineii- Wound of nxllln- Ihou"de"]oinl)° 1 i INNOMINATE AND SUBCLAVIAN ARTERIES. 181 outer edge of Scalenus Anticus and lower border of First Bib) — continued. No. Date of operation. ** a ** or S O C8 n Si © o RBSULT. Eecovery. Condition. Cause of death, date after op. BEMABKS. 61 Harr-hlQ, 6,10,11, I 1S21. 12. £2 ! April 12, I 1828. S3 54 55 April 3, 1S20. Sept.. 19, 18-23. 1822. 56 Jan. 5, 1823. 67 1831. 58 Jan. 17, 1823. 50 60 61 62 63 Jnne 6, 1826. June 21, 1827. July, 1823. 6. 22 12 12 12 16 12th day. Hem. Recovered. Cared Recovered. Cared Recovered. Recovered. Dec. 4, 1827. Repeat- edly. March 17, 1828. Recovered. Recovered. Recovered. Recovered. Cured. Cured. Cured. Cured. Cured. Temporary relief. 7tb day. Inflamma- tion of sac; pluu- ritis ; pericardits. 7th day. Exhaus- tioD. (Pyaemia.))? 60th day. Exhaus tion and hem. from sloughiug of sac. 6th day. Exhaus tion ; gangrene. (Pyaemia f) Pulf<e returned in sac 2d day, and venesection to 18 oz.; Hd day, vene«ctionl6oz. and leech- es ; 6th, hem. from wound (over a pint) : 10th, venesection 16 oz., and calomel, jalap, and salts, also hemorrhage 14 pint; 11th day, hem. from wound ; 12th, do. and death. Autopsy: Artery divided by ligature; central end open ; distal closed by clot; slight pleuritis and ad hesions ; first three ribs partly absorbed Patient thought aneurism was caused by severe horseback ex- ercise ; arm remained weaker than the other; patient died three years later of ulceration of the bladder. (As the scalenus anticus was partially divided, this might be classed with the 2d division group ; practically it is in place here.) Violent hem. from the external jugular occurred on 5th day: controlled by com- press. No unfavorable symptoms super- vened. (Details not given farther.) Preparatory treatment by vene- section and cathartics ; no bad symptoms noted. Suppuration about wound and high febrile symptoms. Autop- sy: Coagnla on both proximal and distal f>ide of ligature; pur- ulent infiltration near wound. (In the Gazette Medicale, 1835, is a simple notice of this case as here given ; I can find no fur- ther account.) Same day of operation, venesec- tion 24 ounces ; 2d day, hemor- rhage 30 oz.; 17th day, venesec- tion 12 oz.; 4 months after ope* ration, no pulsation in radial. Symptoms of dyspnoea which had existed previous to operation in a severe form, disappeared after operation ; patient died of the aneurism 2 years later ; cause of death, bronchitis, anasarca, diarrhoea, and aneurism. Au- topsy: Subclavian occluded: aorta and great vessels athero- matous ; large aneurism of in- nominate extending into neck. This operation is stated to have lasted only lo minutes ; repeat- ed hemorrhage followed. 4th and r)th day arm much swol- len ; gangrene ensued ; d»^liri- um. Autopsy : Extensive in- flammation of axilla ; cardiac end of artery was not filled with clot. 182 Ligature of PRIZS ESSAY. Ike Subclarian Artery in its Third Surgical 1 IfHMDf ,.■=:;. P.rl..^. c...... h r 1! It t: 1 ill » „ T„»„,»l Bd!..p.2M.''' M diTt- II'— -•"■'I- do M A ri «ma- 1 Dr. Jaii«> In Lancet, F TOl.I'i.,1628-S,;i.2IO. do. 1 „ , ji , i„5„ Korrls Contrtb.; K Arch. Klin. Chir., Bd. I. p. aw. K, 3 mm. do. 1 88 Portar. 1829. Croialng, ISW. t"i. v. p°'Es;Xy''' 10 L. Snbcl&T. bxIIIi- iJptthU). " riaiii^l7lOFHthti!|. do. do. i " Delpech, 18S0. 1S3U. 7 ' "3'. X. p. "224/'" Luncel, 1B30-1, p. o2. M •;■ umputEtloD). do. ds. \ » Mo«,V..lS30. ROBI, Ph. J., Hoi, from P^f. A. B. M Ar'ci;. Kllnfchlr'., M ,, H. AilUarj- BDBO- 9 daj.. do. Miro, 1831- Norri<COBtiib.,p.S24. M. 4ft L. im'nth do. 78 BMdLe, 1823. Wm.,lBSl. Arrh. Kiln. Chlr., M. Bd.i. p. 322. : K. AsllUr? anen- ''■•"' do. do. 78 Por«r. 1831. SorriiContrlb.,p.2M. M 63 L. AnoiirLim. w'ka. da. 79 Bli>ln>. ''£.?».";ai'- • 33 H. '="— lyair. do. 80 BoM,g«, 1632. do. :m .■. P,.nrtnr.d,r<.aad d«. . " LHllemsiiJ, F., Atch. Opn., 18M, t. 7 iprll,p.47T*(,<5. " Sword Ihrost in 24 hVi. F-h. -■ 1S3J- INNOHIKATS AND SUBCLAVIAN ARTERIES. 183 outer edge of Scalenus Anlicus and lower border o/ First Sib) — continued. _ ?|& ...,. "»■ op..rnll<,Q. 1^- E.»,.,. c,.dnion.|<'--,'J-^. Ill Ang. 1S2B. Dee. 17, 1S30. ISM. M», 1,1830. '■&"• ';&-■ Harsh W. MirohT, Dec. 31, 1931. issa. p.b. i». Jtl.d.T. I N 11 f d h 1 „ .1 H.„,.,.l, Cnrad, found within Iho Ilgelure. CDl-ICd. SI <]lB,te]y nfter api-rnlioo,but wu ipl cnrPd. Aulopny- BohijlB- Ali not arrest ksde»elopni™t. idlopKy; The cwnlrsl «l>d of UtA ri^^d°fl'n''ofX dUW^ Rec.BrBJ. Rmoforefl. Cured, Cured. Cured. tlon. IKOOII 21ita dA.7; Urge kbtceee opeuedoj.iSihd.)'. Mlbdhj, BliBlithoBiQrrhBeofrOin -wonnj aed Tenoieotlon li! ni.; HlhdBy,YeneBoMionasBiBl6oi. 10 "{h^dey. I-R.«r»- i ll°o v" elbSw'l'h'" lorrh'ige "a" ™-d. noco.ered. Cured. bBfors op. «boro clBttola. fith d.y. Eshin.- boforo operaliuii, heniorrli»»a ; XI una. Ian tied b.'Inn cln.lnl.; eounl of hoiBDirbaga, patient -waj traniirnned, bi.1 died In > few mlnutoB. Anlop-y: Plenro. below tlie Drat llKBtnre. Cgred. Antop-y; Thromhi on both aldei oniKitarp. n 18,17, ~ Cured. TS anih dey. Sepliea- J'.ad ^»o"men'?''ot '^lie 'arir^ a-ltli, d^; mih, 1,'gl liimTiu •slUi. poactnred, ^omorMBiiiiorblowiBtiidai, ifj:; 'drac'LirCat'^re- ?nTini"i"!io'",s'i'a»foS'^r'';'o;r;'; Tl fli 12 Bib dar.dlBrrlnwi ; 121h dn., and on Ibin daj Ibe lai'^D ab>ceB> In BilUa WM punolnred, Bi.lnit lornei'wih d«V. 184 PBrZE B83AT. Ligature of the Subclavian, Artery in its Third Surgical Dii-ision (belwm «.,„.or P1T,.„. Cmm of oporstioil. ■s It ■si if Si ti" «|K.n.lor. Infonualioii. 1 5 1 it 1 Ki Kubl, 18M. Nl«.l. Jno. I-. I.KilT.. I«.-U, N«rl». KU. Iliibarl. INIH. HontHul. IMil, Hlxlikoll. whiw, \m. Bdix. p.'sas. " Ed. Med.4Sars.Jr., .,U, nil., lsa4,p.l. OdT'.lloip. Reporl., l,i..i.;rl.l(i,^>, Tol.lt. Arcli.'K'lll. (!&■["■ f»1. >v.p.7t-i. AtfM',, (j;.B.ir»lM, Arch. Klin. Chlr., U.I.(.F.m '"im, p'm''' f. H. 31 111 B. L. L. B. R. B. AxllUiT >■>■>'- ModnlUrj wroo- (.uppoied aneii- SnholiiT. HXlilH- (.yphill.). iiLILrj Aaen- r J iia8Btl.rii. do. AIllUi? Iin«"- rinni ipoaglDnd, Ihuugbl to bsab- Punotorod-wonnd lod >ciipal> for wound). Udifi. lOj-'ru. 4i Bica. ■iOD. do. do. '"■ da. do. ... do. do. do. . I Juaeia x: . j INNOMINATE AND SUBCLAVIAN ARTERIES. 185 er edge of Scalenus Anticus and lower border of First Rib) — continued. Date of operation. 9 0) O c3 n RESULT Eecoveiy. Condition. Cause of death, date after op. REMARKS. Feb. 25, 1834. Jan. 17, 1834. 1834. April 27, 1S34. April 13, 1835? 1836. Jane, 1836. 1836. 1836-7. Sept. 28, 1837. 1837. Sept. 17, 1838. 6th. 21. 26 and after, aDd35. 22 20 None. 28-29. 16 23 13 13 Recovered, 6th day. Hem. 25th day. Diarrhoea; hem.; exhaustion. Cured. Recovered. Recovered. Recovered. Recovered. Recovered 17 Recovered. Cured. Cured. Cured. Cured. Cured. Cured. .S.)th day. Hem. 15 days before operktion, sword thrust in duel ; hero, next day, and swelling in axillary region ; 25th Feb., ligature ; 2d day, ab- scess opened, and 4 lbs. of blood and pus escaped ; 6th day, vio- lent hero, from wound of liga- ture, and patient died before Dr. K. arrived. Autopsy: Nothing of interest. 5th day, patient became lethar- gic ; 10th day, inflammation of wound and suppuration; vene- section 8 oz.; after this did well until 21st day, when after for- bidden exertion he was '* de. luged in blood." Autopsy: Car- diac end of artery closed by clot, distal tnil opfn. Tumor full of fibrin; 2d rib eroded ; purulent infiltration of parts above wound ; no clot on cardlMC or distal side of ligature. Last six months before operation, tumor had grown rapidly: 8 days before, 'felt something give way in the axillary re- gion ;" pulse in radial in to hours ; operator subclavian was scalenus anticus ; was not pos- itive ; tumor at last account had diminished ^ in size. thought the in front of Suppuration of sac after opera- tion. 46lh day. Exhaus- Venesection in onrse of treat- lion, ment after operation ; 18th day, large abscess formed in sac. 29th day. Hemor- hage, exhaustion. 19 years previously, metacarpal bone had been removed for dis- ease ; 11 years later, arm ampu- tated at shoulder for same affec- tion ; 6 years after last opera- tion, subclavian tied in opera- tion for removal of clavicle and scapula; wound united by 1st intention; during the operation, subclaviau vein was wounded and air entered. 5 days after operation, aneurism developed on cardiac Hide of ligature; abscess formed on shoulder. Autopsy : Purulent infiltration among tissues; both ends of artery open and in pus : general atheromatous condition of vessels. Following the wound, severe hemorrhage which was arrested by compression ; 4 days later, aneurism appeared ; after the ligature, the abscess in axilla was punctured with great re- lief. 1S4 PBIZB B8SAT. Ligature of the Subclanan Artery in its Third Surgical Dirision (belimn -»•"• ,»„»., ,„...,. CHOW of 11 ll '' 1 lii H 82 ■ KDhl, IBM. 1 ■;.,«s,.,X.';:' Ooy'iiHoip. BBpofH, «l. lY. p. 72-3. LmmI, 1S3S-«, lol. II. Non4.Conlrlb p.I-'l; Arcb. Klto. dhlr.. Bd. X. p. 2M. Unr's Ho>p. Reporli, Areh, Kiln. Ctlr, Bd. .. p. iBJH. Am. Jr. Uoa. Bel,, 1837, p. 3»0. Oor'a Hoip. R«porti, M. H. M. H. U. u. «e »8 31 40 L. L. R. E. B, Ailllary tn«i- Me.lolliiry >"oo- BnbclBT. itllla- AillUry inaa- o"°t»ill«r"°»^ .nd .c^pnl. ror SddtTl- ■ioD. do. do. da. do. do. do. do. do. do. T.b. W. 8«ulln,18M. LiiHi, 1S34. Earle, Uxy ■fOBtSEl, 1816. Blgund, ISM. HLcbHllg, JobeH, 1S37. While, 1838. s« 58 SB Jnooll iitu- „ INNOMINATE AND SUBCLAVIAN ARTERIES. 185 ?r edge of Scalenus Anticus and lower border of First Bib) — continued. Date of operation. rh'ge rred op. Hemor OCCU] after ".^- .2?^^ ^^ BB8ULT Recovery. Condition. Cause of death, date after op. REMARKS. Feb. 25, 1834. Jan. 17, 18:^4. 1834. April 27, 1834. April 13, 1835? 1836. Jane, 1836. 1836. 1836-7. Sept. 28, 1837. 1837. Sept. 17, 1838. 6th. 21. 26 and after, and 35. 22 20 None. 28-29. 16 23 13 13 Recovered, Cured. 17 Recovered. Recovered. Recovered. Recovered. Recovered Recovered. Cured. Cured. Cured. Cured. Cured. Cured. 6th day. Hera. 25th day. Diarrhoea; hem.; exhaustion. 3oth day. Hem. 46th day. Exhaus- tion. 15 days before oper&tion, sword thrust in duel ; hem. next day, and swelling in axillary region ; 25th Feb., ligature ; 2d dav, ab- scess opened, and 4 lbs. of blood and pus escaped ; 6th day, vio- lent hem. from wound of liga- ture, and patient died before Dr. K. arrived. Autopsy: Nothing of interest. 5th day, patient became lethar- gic ; 10th day, inflammation of wound and suppuration ; vene- section 8 oz.; after this did well until 2lHt dav, when after for- bidden exertion he was ' de- luged in blood." Autopsy: Car- diac end of artery closed by clot, distal t-nfl op*n. Tumor full of fibrin; 2d rib eroded ; purulent infiltration of parts above wound ; no clot on cardiMO or distal side of ligature. Last six months before operation, tumor had grown rapidly: 8 days before, "felt something give way in the axillary re- gion ;" pulse in radial in (0 hours ; operator subclavian was scalenus anticus ; was nut pos- itive ; tumor at la^t account had diminished ^ in size. thought the in front of 2flth day. Hemor- hage, exhaustion. Suppuration of sac after opera- tion. Venesection in c'>nrse of treat- ment after operution ; li^th day, large abscess formed in sac. 19 years previously, metacarpal bone had been removed for dis- ease ; 11 years later, arm ampu- tated at shoulder for same affec- tion ; 6 years after last opera- tion, subclavian tied in opera- tion for removal of clavicle and scapula; wound united by 1st intention ; during the operation, subclavian vein was wounded and air entered. 5 days after operation, aneurism developed on cardiac side of ligature; abscess formed on shoulder. Autopsy : Purulent infiltration among tissues; both ends of artery open and in pus : general atheromatous condition of vessels. Following the wound, severe hemorrhage which was arrested by compression ; 4 days later, aneurism appeared ; after the ligature, the abscess in axilla was punctured with great re- lief. 186 PRIZE ESSAY. Ligature of the Subclavian Artery in its Third Surgical Division (betweei No. Name of operator. Source of information. PATIBNT. • 9 O ® to •« QQ < S 9^ Nott, Joslah C. (Mobile), 1838. 9o Syme, 1838. 9S I