Part I., p. 539. (Part 1)

Part I., p. 539. do. do. p. 539. do. do. 162 Unknown, Dr. H. L. Thomas in Surgeon C.S.A.Med. Sur«. Hist. Reb., p. 540. 163 164 Mosely, N. R., 1864. Townseod, T. B., r 1864. Med. Surg. Hist. Reb., p. 540. do. M. M. M. M. M. 20 23 21 28 19 M. ! 21 M. 28 L. Aneurism, shot wound left axil- la. 7 days. ! 3d dlvi. sion. Shot wound left 15 days, axilla. R. Shot wound right 43 days, axilla. R. Shot wound right axilla ; aneur. R. ,Shot wound axil- i lary artery. R. ,Hem. shot wound axilla. 106 days. R. do. M. Mid R. ;Hem. wound of ago. right shoulder. M. M. 21 35 R. 11 days. 12 days. do. do. do. do. do. 28 days. do. 22 days, Hem. shot wound 14 days, right axilla. do. do. L. Shot wound left !29 days, shoulder and ax ilia. do. April 7, 1862. July 2, 18U3. M'ch25, 1865. June 5, 1864. Nov. 30, 1864. May 9, 1864. June 27. Sept. 19, 1863. June 3, 1864. April 8. Imme> diate. Mch29. None noted. Oc- carred. do. JalyM andS4. Oct. 10. Oc- curred. May 20, 1864. do. INNOMINATE AND SUBCLAVIAN ARTERIES. 197 outer edge of Scalenus AnticuH and lower border of First Bib) — continued. No. Date of operation. 2 S ® o o cs ffl 9 . &• a o o bet 5 RBSULT. Recovery, Condition. Cause of death, date after op. REMARKS. 155 156 April 14, 1862. July 17, 1863. 157 May 7, 1865. 168 159 160 161 Sept. 19, 1864. Dec. 11, 1864. May 31, 1864. July 25, 1864. Imme- diate. None. 5th day. Three times. 36 13 Recovered. Recovered. Recovered. Recovered. 162 163 Oct. 11, 1863. June 17, 1864. 164 June 18, 1864. 2 days. None. 12th day. Partial dis- ability of left arm. Cured Total disa- bility of arm. Not cured of aneu- rism. None. 50 hours. Exhaus tion; hemorrhage. " Ball entered near collar bone, cut out lower edge of scapula, atrophy of muscles of arm and shoulder. Disability one-half temporary. Still a pensioner in 1872." Great tumefaction in region of wound ; as hemorrhage did not cease with ligature of subcla- vian, the supra-scapular was also tied ; ligature from supra- scapular on 10th dav: no bad symptoms followed ; ball enter- ed 1>^ inch below left scapula, ranged forward, and lodged. Musket ball through the right shoulder and axilla ; disability total ; still pensioned in 1872. Ball entered one inch below cen- tre of right clavicle, and passed directly through. In 1867 '* no use of right arm, total disaoility from aneurism alone, liable to death, by rupture, upon any ex- ertion." In 1872, still a pen- sioner. Hem. occurred from sloughing of axillary artery. Minnie ball, iu through pecto- ralis major, and ont 2 inches above posterior fold of axilla; 2 days after ligature of subcla- vian, a vein was tied at seat of wound. Autopsy : dluugh had destroyed portion of supra-sca- pular artery and axillaiy vein. 16th day. Exhaus- Ball entered right shoulder pos- teriorly and lodged in axilla, passing through scapula just below spine ; 17 days after wound, hemorrhage 3 pints, ligature of axillary ; 10 days later, hemorrhage, and on the next day, 28 days after injury, ligature of the subclavian. Au- topsy not given ; hemorrhage reported as from distal side uf ligature and from distal end of nxiUary. Ball fractured head of humerus, near coracoid process, and pass- ed out above spina sefipwla. Fever and suppuration follow- ed; after ligature of subclavian (9 days) gangrene supervened. Patient was of hemorrhagic dia- thesis and was suffering from a cough ; artery gave way I'ith day, and death was almost in- stantly the result. ♦•There were sli&fht fibrinous exudations on either side of where the liga- ture cut through." (I judge from this that the hemorrhage was at the seat of ligature, and probably from cardiac side — Author.) Ball entered under spine of left scapula and ranged toward chest ; gangrene and hemor rhage followed ; after ligature of subclavian, no hemorrhage, but rigors and pyemic symp- toms. tion; hemorrhage. 10th day. Gangrene; exhaustion. 12th day. Hem. 6th day. Gangrene; exhaus'n; pysemia. 198 FBIZR ESSAY. Ligature of the Subolauian Artery in its Third Surgical Division (between Ko. Ssr,' ,„,.„. CaiiMof operaUon. ■s •si If ^i 3 1 i ^1 1«S 1S8 188 170 .,..., J.H.., ShelilDD, A. V. isrfi. A1]en,H.rri»ii flroM, Prof. e. u.. 1863, M8Clell»n,B.,t •"""■«■"■• '•"a."- Med-Snrj-HiM-Heb. do. do. UBd. Surg. Hilt. Keb. P»«.l„ p. Ml. Dr. P.P. BrawnBlii Med. Sarg.MiK.Keb. p. 641-2. Surg. Hiat. Rob,, H U. M. M 52 Kid 29 L. S, L. H. and HiUlo. Shnt wonnd l8(t atn, Md shgol- dec. Sb^t B.oqnd left »illU;heinor'ge Sliol nannd left Shet^woood righ Bhut wound l.n l»d,y. 11 dws Bd.r.. aod^J;' S8d.7. S9d»!r.. ■ Ion. do. do. do. do. Nov. 8 Jnnell, 18«. Ot- St™1 tlDU. ■ud protuM. INNOMINATE AND SUBCLAVIAN ARTERIES. 199 outer edge of Scalenus Anticus and lower border of First Bib) — continued. No. Date of operation. ''^ u o u, ^ ** ® O eS u • «« « BBBULT. Recovery. Condition. Cause of death, date after op. REMARKS. 165 166 167 June 23, 1862. Oct. 22. May 29, 1861. 169 170 171 172 None. 7-9 ? 17-21. 168 Nov.5, 1864. 10. H. 13 days. March 15, 1863. May 30, 1865. Dec. 16, 1863. July 23, 1864. 10 None. 9. Next day. None. 4th day. Pyiomla.(?) 9th day. Exhaus- tion; hemorrhage. 2lBt day. Hem. 13th day. Hem. 2d day. Exhaustion; (shock f) 12th day. Exhausn. 18 hours. Exhaus- tion ; hemorrhage. 8th day. Hemor- rhage ; erysipelas ;i pleuritis. Ball entered left arm at del- toid insertion, out at posterior border of axilla ; bone not in- jured ; great prostration at time of operation, from previous hemorrhage. No autopsy. 21 days after injury, hem. 40 oz. occurred ; hem. when ligature ca me away ; arrested by com- pression, but recurred fatally. No autopsy. Tied beneath the clayicle. Given as subclavian. Ball entered near lower edge of clavicle and emerged at upper angle of scapula; extensive slough and suppuration ; did well for 10 days aft-r ligature, then on ligature coming away, slight hem.; compression. Au- topsy : Nothing of interest. (Tied below clavicle. From di- rection and location of wound it is evident that the subclavian was tied on first rib, and very likely in the wound of entrance — Author.) Three mouths after injury, both wounds (of exit and entrance) were healed; Feb. 1st, swell- ing in axilla began ; March Ist, there was perceptible fluctua- tion, but no thrill ; March 14, profuse arterial hemorrhage ; after ligature extreme prostra- tion. ' Reaction never fairly net in." No autopsy. Ball entered j ust below clavicle, emerging at inferior angle of scapula; secondary hemorrhage several times ; after ligature, tumor decreased very rapidly ; 9th day, hemorrhage. Autopby: Ligature still on artery, and clot on either side ; no clot in sac. (Fatal hemorrhage was very probably from vessels com- municating with sac. — Author ) About one month after injury, aneurism appeared ; after the ligature, the sac was opened and clot turned out, and ineffec- tual attempts made to secure the bleeding vessels ; tampon was used. Autopsy : Ligature was firmly tied around artery; hem. had occurred through col- lateral circulation through sac.) Although axillary artery was divided, patient rode 8 miles, closely pursued for • 3 ; hem. profuse but ceased spontaoeous- Iv ; did well, suffering only slightly from aneurismal swell- iug until 22d day, when hem. took place, I pint ; 3 days after ligature, eiysipelas ensued; 6th day, pleuritis ; died 8th day. Autopsy: Axillary vein and artery cut in two by ball ; no clot un either side ot ligature; copious effusion in left pleura ; no fibrinous clot in aneurismal sac ; pericarditis. !U0 PRIZK ES8AT. Ligature of the Subclavian Artery in its Third Surgical Division (belweej\ Aniniilim, shot 3S iBja. Dr. C. Wasner in id. BurE. Hiat. Rel). Pmil n., p. 4J(I. Hed.anrg. Hill. Rob Med. SnrK, Htm. ■Bob. INNOMINATE AND SUBCLAVIAN ARTERIES. 201 outer edge of Scalenus Anticus and lower border of First Bib) — continued. No. Date of operation. 9 -I © P« ^ 2 o h S k o 5 « 9 O 03 H fl o o RESULT. Recovery. Condition. Cause of death, date after op. REMARKS. 173 174 175 176 July 14, 1863. Aug. 17, 1863. 177 178 179 Oct. 21, 1864. Aug. 23, 1863. 24,28,29 None. None. 9th day. July 1,1864. Sept. 1,1864. Feb. 7, 1863. 18 Oc- curred during, and prob'ly after. Not noted. None. 46th day. Hemor- rhage ; suppura- tion. 6 hours. Hem. be- fore ope' n. Shock? Dyspnoea. Slst day. Hem. be- fore op'n ; exhaus- tion. 9th day. Hem. 1 hour. Exhaust'n; hemorrhage. 2d day. Cause ? 20th day. Exhaus- tion. Ball entered axilla from in front, wounding axillary artery and some of brachial plexus ; hem. immediate to syncope ; ceased spontaneously: 19th day after wound, aneurism was noticed, no thrill; had felt something " give way" on moving his arm; 21 days after wound, ligature of subclavian ; tumor diminished immediately;. 5th day, sac burst, and on this and following day discharged several ounces of bloody pus ; 18th day, ligature loose ; 24th day, profuse hem. from sac; liq. ferri persulph. locally arrested hem.; 28th and 29th, hemorrhage ; 40th, 41st, and 42d days, suppuration as- sumed very offensive character; death, 46th day. Autopsy: Firm clot on both sides of ligature ; cicatrices (seemingly tubercu- lous) on apices of lungs. Autopsy: Large nerve included in ligature; (Patient had died with symptoms of great dys- pnoea.) (Itismost probable that this nerve was the posterior thoroHc, which had been press- ed by the aneurism toward the scalenus. Simple ligature of a cord of the brachial plexus go- ing to the arm would not pro- duce such symptoms of dys- pnoea. This last accident has happened quite frequently. — Atithor.) Hemorrhage twelve days after wound ; brachiaUtied ; 9 days later, hemorrhage again ; sub- clavian tied ; patient improved for a while, but died of exhaus- tion .31 st day. July 23d, hem. from brachial, and this vessel tied ; Aug. 2, amputation of arm for hem.; Aug. 23, hem. from axillarjr, and ligature of subclavian; did not do well, and died from hem. Sept. 1. Autopsy: Proximal side of ligature c'osed by clot; hemorrhage was distal. Below clavicle. Hem. from brachial June 2.5, and axillary tied ; Jane .30th, hem. and compression ; July 1, hem. from axillary at ligature ; sub- clavian tied ; lost 30 oz. blood in operation, and died in one hour. Dr. W. P. Moon tied the axillary. Autopsy not given. Below clavicle. Shot passed through left axilla and aneurism resulted ; sub- clavian tied at amputation. (Cases Nos. 178 to 184, inclusive, were most likely ligatured be- neath the clavicle. — Author. ) Right arm torn off by shot ; pro- fuse hem.; immediate amputa- tion by Dr. G. C. Harlan; 7 days later, profuse hem.; Feb. 7, lig. of subclavian, by Dr. Humphrey. 02 PRIZK ESSAT. Ligature of the. Subclavian Artery in its Third Surgical Division (between ... operator. ,.!=i ,.„..,. C>t»e or Is ■si if It o9 i 5 1 iitn Ha..aii, A. B, MoHon, J, C, D.T, W.B., Howard. B., Leiii, i. J. MortoOj^J.C, Wsgner. C, Odkw, T. F., 18U. otii, a. A., d.. 186*. Honipbr«7, ir 1 t Aftor iimpniatlon ■LLhooldsHoiot Hein.»UIi>;>bot SDii tcupiil*. Sh„[ «„ui,a rool da. do. do. 181 1S3 IBS Pan n., p. «u. do. p. sw. do. p. 848. do.PMtI.,p.M;. a*, p. I io. P.rt II., p. 7IB. do. p. 850. da. p. HS. do, p. 780. Sf'd. Sngr. Hl.t, Rob., 1>T Dr. H. L. Tfaomiia. Med. Surg. Hi.t. Bab. do. Am. Med. Tlmei. lol, lii., p. 181, 1SB4. , H Oct.8, mcR I^Lamorn.. ^ ^ ^ .. L. L. R. L. R. R. L. Tbuif il\Kt e»et- exrlalon of hn- BiDtX'ii knai .bat (wcure of J^por aa^ifter ,b.,t waond of hBn.oru.(h«i«.^. Shot wiitrnd of Cruflh of »rm 38 4.7.. few dw*. addiTt- do. do. O01.8. A«,l : IM ISllu INNOMINATE AND SUBCLAVIAN ARTERIES. 203 outer edge of Scalenus Anticus and lower border of First Bib) — continued. No. Date of operation. H So o BBSULT. Recovery. Condition. Cause of death, date after op. BEMABKS. 180 181 82 83 84 85 Aug. 6,1864. Sept. 27, 1862. Sept. 26, 1864. Dec. 14, 1864. May or Jane,? 1863. Aug. 8, 1864. 186 187 188 168 ido 191 102 m m Sept. 21, 1864. Nov. 21, 1864. July 30, 1864. March 24, 1862. June 7,1862. Aug. 1862. Jan. 12, 1863. Soon after. Not given if it oc- curred. 7th. Not noted. Be- fore 28. Becovered. Becovered. Cured, am- putation at shoulder. Cured. Becovered. 11th day. Exhaus- tion. Few hours. Exhaus- tion; gangrene. 4th day. ? July 18th. Exhaus- tion. 2d day. Not given. Exhaustion. 6th day. Exhaus'n. 9th day. Exhaus'n. 22d day. Pyeemia. (April 15th.) nth day. (Exhaus- tion ?) Died. Amputation at shoulder, June 15, for shell wound ; July 13, hem. ; axillary artery tied ; hem. asrain, Aug. 5th and 6th ; death, Aug. 17th, 1864. Frftcture of humerus, Sept. 17 ; ball extracted, Sept. 23 ; Sept. 26, hemorrhage from sloughing; gangrene ; died few hours after last ligature. Dr. J. £. Chesely amputated the arm on same day. Ball passed through neck at outer edge of left sterno-mas- toideus, about 2 inches above clavicle. Humerus was amputated at up- per third. Amputation at upper 3d, on June 18;(?) hemorrhage from and ligature of axillary July 25th, by Dr. G. B. Boyd ; Aug. 8th, hemorrhage from ligature, and ligature of subclavian over Ist rib ; hem. again on 7th day, controlled by pressure; (Dr. T. U. Squire amputated arm;) af- ter ligature of subclavian, pres- sure was continued for 6 weeks. Shot fracture head of left hu- merus, much destruction of tis- sues. After excision, arm amputated at shoulder, by Dr. J. C. Mor- ton ; 10 days later, hemorrhage and ligature of subclavian. Ball wounded spinal cord, caus- ing paralysiR. Cured. 29th day. Exhaus- Arm amputated at middle third ; tion. hemorrhage recurred and liga- ture of subclavian. Died Aug. 30, 1864. January 17, amputation at upper third humerus; 6 days later, hemorrhage ; 7th, do.; 14th. do. profuse ; Feb. 1. ligature of sub- clavian ; no uniavorable symp- toms except slight surgical fever. 1 infer that this case will appear in the 3d surgical volume of the Med. and Surg. History, as Dr. Otis has given one case by Dr. H. from same source. 204 PRIZE BSSAT. Ligature of the Subclavian Artery in its Third Surgical Dirieion {betaee ...... Son™ of Pil..»T is 5l ?fr tj "'\ "■■'•'■ JiJii '"""'"■ •0\if:lf ^! 11' U k 'u H S HI . B-K « 1 ' 1 do.' d": do. do. d.. p- »T. M. M. M. M. Tbianch. ISGI. Bauh, W. d0.1S«8. do. ISM. rhurch. W. H. ISW. 88 R. BnbeUT. «iUl«fT 1 i landwooad). 1 9dm7t. .10.. ' do. Hi Srulm.'**""! a» do. p. Ml. M. o"i. 1S«, p. 5M." ^ i pnnrlored »d]. i 1 1 1 I Joljs. INNOMINATE AND SUBCLAVIAN ARTERIES. 205 niter edge of Scalenus Anticus and lower border of First Bib) — continued. No Date of operation fa fc o 1 5; K O 3 A « o e( S BB8ULT. ^ ^ ►». Recovery •O ■ Condition. Cause of death, date after op. BEMARKS. 195 Died. Recovered. Recovered. Recovered. do. do. do. At the foot of page 547, of Ist sorK. vulume of his magnificent history, Dr. G. A. Otis says : '* I shall enumerate a total of 52 cases of ligature of the subcla- vian (in a future volume) veith 41 deaths." 1 have been able to find, and have given heretofore (from the 1st and 2d volume), 45 cases, .37 of which were fatal. There is left to be recapitulated in the lid volume, an additional uuiuber of 7 cases, of which 4 ( -|. .S7 « 41 ) were fatal, and H recovered. I have (in order to be as exact as possible) included Dr. 0. M. Humphrey's case, as I am sure Dr. Otis will have this case in the Sd volume. I could not obtain from the Surgeon- General's office advance copies of these cases, on account of the labor requisite to hunt them out in advance. I am under many obligations to Dr. Otis for prompt answers to inquiries and other courtesies. — Author, Recovered. Cured. 14th day. Pynmia; hemorrhage. 6th day. Pyemia. 11th day. Pynmia; hemorrhage. .Sdday. Exhaust'n; hem.; gangrene. In this category I might include 4 fatal cases of ligature of sub- clavian for shot wounds, by Hopkinson, Wells, Kennedy, and Anderson, given by Prof. T. O. Morton, in Am. Journal Med. Sci., July, 1»67. These are doubtless included by Dr. Otis in the above .52 cases, and I have so considered tt em rather than incur the risk of counting them twice. 4th and 5th days, symptoms of poeumonia ; tith and 7th, rigors and pyeemic symptoms ; uufa- vorable conditions iucreased, a diarrhoea occurred, and death on 14th day. The ligature of the subclavian did not arrest the hem. completely, and ope- rator could not tie bleeding vessels in wound on that ac- count. Patient was in 6th week of a spell of low fever, and was consequently much exhausted. Abscesses in various parts of body. Gangrene of forearm just before death ; numerous abscesses in lungs ; artery firmly closed on both, sides 0/ ligature; both axil lary artery and vein wound- ed, the latter most so. Arm slightly paralyzed from in- jury to nerves by missile. Before operation, hemorrhage 16