Part I., p. 539. (Part 2)

oz. ; 3d (lay, do. 6 oz. Autopsy : Axillary wounded in 2d divi- sion ; diffuse aneurism ; gan- grene of arm (slight). 206 PRIZE KSSAT. Ligalure of the Subclavian Artery in its Third Surgical Division {between .--.::. ,£si. .»,.„. C.n« of P ^t nf =." l|l|l a» AtiiH. isea. Aoiort. do. Lsnnelongue, Mlddeldorpt. Nnsibnum. O'Kplllr, Plrogiiir, Aceh. Kiln. Clilr., Bi. X. p. ssa. (dt.),p. Clm»«iniiM tmiti r.s:,s,;;Krii.. BphmldlJshrbnth.. Bd. .■X.., 1S02, p. a7M d-irpife. ISflS, p. «!; Ar^L, Klta. Chit., A4'h.''^iru.^^-,r., {dl.). p.MB. Schmldl Jmhrbnoh., Arch. Klin. Cblr., Bd. s. p. 239. Bd'.":, isaS; p. aas. Rvolop. of Anil. f£j...,^.o1. Iv. p. (Ju.); PiJpgoff-'.' u. H. U. u. M. lol- Sol- am- dlar It. L. L. Joiol tnwtnre), AlilUry »nsiir. Stib.l»v._»xilUrr Pnnctnrnd woood of HXllU. 'd1™5^o^or'''fl" tlons io liillUI). 3d dl.i. do. da. do. ail DfUD. M. P. I. Sol- L. 1. K. ^knol^di-'loo^ [leina'rr'RS (after Hem. dnrtng rem cblal far triimi ■■IT 3d divi- ™i M, M. Sol die L. INNOMINATE AND SUBCLAVIAN ARTERIES. 207 r edge of Scalenus Anticus and lower border of First Bib) — continued. Date of )peratioii. 9 u a u o B a> at o ct ® • ft KBBULT. Recovery. Condition. Caase of death, date after op. BEMAR&S. ul7, 1866. 1866. Oc- curred. 13, 14 >..y.... None. ? ? ? ? ? ? Once. 18a3. Once. Recovered. One recovered. Cared. Cared. Recovered. 2d day. Pneumo- thorax ; pneamo- nia. Hemorrhage. 22d day. Hemor rhage; pneumonia. 8th day. Gangrene. One died. Cured. Recovered. Recovered. Recovered. Recovered. Died. Pysemia. Several days. Hem. Fnncture of pleura during pas- sage of needle around nrtery ; violent Influx of air to pleural* cavity. Autopsy: Right lung completely collapsed and presM- ed against vertebral column ; pleuritis ; pneumonia of left lung. Pneumonia accompanied with cough supervened and hemor- rhage occurred 1.3th and Hth days after operation. Autopsy : Pneumonia ; rupture of artery at seat of ligature. Did well until 4th day, when gangrene ensued, causing death on 8ih day. I can find nothing more definite concerning these two cases than this short extract in Chasnaig- nac's work cited : " Deux tois J'ai pratique la ligature de la sous-clavidre ; une fois avec SQcc^s chez un malade qui avoit subi le disarticulation de Tepaule suivie d'hemorrhagie consecutive. Une autre fois chez un humme qui apres la section d'un bride inondulaire deTaisselle avoit en des hemor- rhagies recidivees." — {Author.) (I could not obtain the Journal de Bordeaux, where a full ac- count of this case is given. The Jahrbuc.h only contains an- nouncement. — Author.) Cured. ? Cured. Died. Rupture of sac ; death. Autop- sy: Arteria dorsalis scapuls opened into sac. Cured (lost two fin- gers.) Cured. Died. (Dr. Wilhelm Koch gives this as a fatal case. Nasbaum says the operation was unsuccess- ful. As the probability is that Dr. N. told Prof. Gurlt it was fatal (see Archiv), I have so marked it. — Author.) Thrown by runaway horse dis- location of shoulder; reduction; aneurism appeared (due to in- j ury bv fall or reduction ?); 4th and 5th fingers were destroyed by gangrene. 208 PKIZB ESSAT. Ligature of the Sttbdavian Artery in its Third Surgical Dioieion {between oi«™»r. ,,...,., ,.„•„. opentloo. ■s II It •? illli "1 •Wl Pir^goff. Bro». 18M. Seyppcl, ISM. Or.!7E., IflM. nalllionrifl,19«4 Arrb, KllP.Chlr. (olt.); l-irugglTt MlliHry Snrgsty LaBiel, JulyS,18Tn, Arch. BUn.rblr.. do. t'2a. da. (ctl'lfjourn. Med, do. do. Sr'tfin of SorKBTT, PhlU,, 187S, pfiui. H. T K.d. Jr., Oct. H. Y. Mm. Record, SchmidlJahrbDch., Bd. cJmW. 8. 36B. Arcbl. riir Klin. Chir.,Bd. lY. p. 475. T. HolmeilnUncal, •■■■■■•iffi'""- M 's 1 1 Iw-mcn-™ lnfl..r 3d dtTi . 1 M. 1 ehi»l fur tnnio kncuri.n]). H. AiUluT usar. sHer pDngtnred wound. ISdlJl. 10d»]'«. aloii. do. do. do. do. do. ■wt Ul) H. M. " L. L.' A^maiV utat do. do. do. do. rliDi. ampnliiLlini oF Wonnd mlllsiT lylgotti bjr ^ Won. Ti.nni, 18U. Almoldi, IMS. ,„ Brj-snl, Thtn. Burt, W. (On- Bannslt. E. P. (Conn.). iSST. Bntelior. u. M. 42 338 DM. Oct. 7. S:5 L. (KitorrBQI). INNOMINATE A outer edge of Scalenus Anticus ND aUBCLATlAK ABTKRIE3. 2{ and lower border of First Bib) — continued. ... n.„. 1 Ill .,.,„, SEUABECa. R...,.„, Condition. 1 °i';;Vft,J"i''' ■HI ' Oo- eaini HgnUTTlitga. ttbdnj. TMaMdi Hear, pj-amii. Oo- cntn.4 K...,„.a. Cured. rminnt Ited & good whllr< tflgr jjrshe.TliBCBroiid aniTy.whirli B.p(.30, " kii klfrir ; hem. and mnrted i,'.'';;"i:t";b™;:'.'.','J,4S- 1«M. fab. ID, im Oct. as, ing. 1871. Julj 1ST3. 184 1 mhd.T. Hbdi. ana. .mputnilQii <if upper ililrd humerus: I wceki Inter ih« atump beuDB Kn!tlyinfl(tri.l. d-ya."" Beooiemd. '="""■ 6iit«a lBllid»r. Hem. .,«..„,. Cured. Ml Di.d. SereraUsy.. RocoTsted. Imprnved. "V Nona. None? ai Pntlenl Etil] UiIdi. Hipld eoD- .»\«MBce roUowed. Witt, sre.t >heMsu(t.id. Brunt; run OT«rl)irlg«)niollT«, ::r''p'S!»?.d=i5d,v3;i'-f„^?s.''- lefi. u aboDlder.jolnt. Ilem- Died. 711. d.j- BxbABi. (lou (pyBmlil). oporaiioTi. Probably cuoueclod M dUloly. AnlopBy: Lnngs ge- ortnf»r«LDn7| ^'a. in modi,,. SLight. „ BeooTBred Cq«d. preHniiBly. 210 PRIZE ESSAY. 'Ligature of the Subclavian Artery in its Third Surgical Division (fieto Wonod BillUrr IdlalHBtlou of dJiJ 3d II Sddja.'SdllTl-. . G«.Hebdotn.,Oci.lS, Cri 1H7S. r. 689. Lmmi, 1672, p.»7. .... IHNOMINATEI AND SDBCLATIAN ARTERIES. 211 yuter edge of Scalenus Antious and lower border of First Mib) — continued. -"■Oi ',S6i', .-.r.,. D»le of tt = <i REHABKS. op«.lton. III l!| Hecoverr. ' Condlllda. j '^J'X»'fL''r''J''' m 187»-7T. Neitdif. Exliaas- AmpnlntioD at ehoaidsr Biiont- IWer: rnplure or axlLUTT Hi nrtglD at ^nlBCapuUrli. M. iM,t\ tS"f,'^MjtaT% hid""™- 1874. Stlidar- Ham- oiirrBd »t llils point." m Nona. g&tlaa (lisuteil in llimar), or VBH aSei^Ied iy Uttninrn of Ibla Teasel. M7 Oct. IS, 18,22. 261h daj-. HtiBor- Citalid IIki lured almullsiieaTia- PODttaud dllBpnIl deglnllllon. Dlxlmiis. icdide or broiolde ul Ilh and^Blh'd'aj.l liule ten- leai. gtb, inth, lllh, beiier. laih. 131h, nonghs n grut de.i, hi walsr oluiet, Bsa rupinred, Compranorllnt tMaruei Willi ael qiQUitiiiD ID j Acted infa Boe ; lame dHf, 5Ti]>n mans laiesled. IsdidiT. oarrled h^nie; ligilnce cam iwi)' : DO beitiorrliago. ■JOHiday, ellBlill/dflllrinua; si aid^df '■ X^'e'' BdVd'^nd'dU' rhBrgeJVlDl o°ATood "lia of 3 (InKBra: lalcr hemurrhage, a utflt. 2£Ih diT, died. AalDpuT: Aoru slherumatEiUB: manlli of of Innam. ; au lertloallj d| inobea. In1p.ver.el7 ■ anieru- po.L3.ndflYe-»Httqen,h.lncb. of blood by eslernal hamor. rhage, 3a ouncea. CIol iu xae (equivalonl la bloed), S lbs. It eii= did.« of deaih. Frof. 1 indasU oBlinmte. blugd itf. m&lDiiiitiii boilj 1 Ib.W cuniea. (The Botbor ie Indebted io Dr. (i.A.Oil. foraWmlfnIphu. 1 togrBphoflhl.lerJ'In.eresttDiI 1 1 once.aDd lo-elherlilndneBieH 212 PRIZE ESSAY. Ligature of the Subclavian Artery in its Third Surgical Division (betwt No. Name of operator. Source of information. PATIENT. • • m H 9 9 9 U) T3 QQ < CG Cause of operation. o « 2 o o ^K O (0 •» i 55 S ee at «**:? o5 Q •a 248 Ensor, F., 1874, South Africa. 249 Farquharson, R. J., 1876. 250 251 252 263 FerguRson, Sir Wm.,1871. do. do. 1872. Farrand, D. 0. Lancet, 1875; Am. Jr. Med. Sci., April, 1875. Am. Jr. Hed. Sci., April, 1877. Lancet, March, 1871 ; Am. Jr., July, 1871. Med. Timeft & Oaz., 1871. Lancet, 1872. Detroit Rev. Med. & Pharm.; N. Y. Med. Record, Oct. 1866. M. M. M. M. M. M. 50 48 53 40 36 R. R. R. L. R. Aneurism of aorta and innominate. Axillary- aneu- rism. do. Axillary aneu- rism (thrust of pitchfork). Sabclayian aneu- rism. Axillary aneu- rism (rebound of cannon). Sd divi- I sion. 1 year. do. do. do. do. (Close to scale nus.) do. d INNOMINATE AND SUBCLAVIAN ARTERIES. 213 7uter edge of Scalenus Anticus and lower border of First Bib) — continued. No. Date of operation. 9 6 eC 9 o cS H ^» ~ »> BB8ULT. Recovery. Condition. Cause of death, date after op. REMARKS. US Sept. 8, 1874. 349 350 231 252 3S3 Sept. 28, 1876. Feb. 1871. April 11, 1871. 1872. 46,53, 54,68, 63. Oc. curred, Often. 22 43 (re- mov- ed.) 65th day. Plearitis; hemorrhage. 62d day. Exhaus- tion; hem. ISth day. Pyiemia. Died. (?) Died. 42d day. Hem. Patient was a Hottentot. Carot- id tied simultaneously. Silk ligature. Plenritis from reck- less exposure on part of patient Autopsy: Inflammation of pleu- ra ; sac ruptured J ust below seat of carotid ligature. P. S. — Oct. 24tb, slight hemorrhage from carotid. Oct. SI, fever, cough, and free hemorrhage from the carotid. Nov. Ist, do. Nov. 5th, do. Nov. 9th, cornea gave way (ulceration), and lens and vitre- ous humor escaped. Facedraton to l^ side slightly. Nov. 10th, hemorrhage again. Died Nov. 12, comatose. Subclavian was closed firmly: Pericardium full of fluid. On 26th day after operation, sac ruptured. 36th, hemorrhage one quart. 46th, ligature removed. 48th, again hemorrhage. 62d day, death. Autopsy: True an- eurism of axillary If inch in length. Diffuse sac filling en- tire axilla. Incipient aneurism of innominate at origin. Aortic arch atheromatous. Pressure of aneurism on bra- chial plexus has caused '^wrist- drop." External jugular vein was tied aH precaution against hemor- rhage. After operation a whitish fluid was seen in bottom of wound ; was thought to have been tho- racic duct. Ligature ^ inch outside scalenus. Pulsation in tumor and wrist ceased immediately after opera- tion, but returned in a few min- utes, and could be felt | inch below ligature. 2d ligature | inch lower, and pulsation ar- rested. Hemorrhage toas from distal end, ** One thing was found which mystified us not a little ; the thyroid axis was ab- sent. That it had been present, was easy of demonstration, as the cicatrix was plain. Verte- bral, int. mam., sup. iutercost.. were found." (I am of the opinion that this was one of the not infrequent anomalies given in the notes of the 52 dissections accompanying this paper. There was no axis. Inf. thyroid from innominate. Trans, colli and sup. scapular from usual origin of axis. Posterior scapular from 3d division and beyond ligature. 1 he pulsation noticed was felt as soon as the collateral route through anastomosis of suprascapular and trans, colli with the posterior scapular was established, and ceased when the ligature was applied beyond this last vessel. — Author.) 214 PRIZE B88AT. Ligature of the Subclaoiati Artery in its Third Surgical Division (belwee- Mo, NimBof opsntor. SonrcBor Informstign. P.T,>,T. Can« of i| II -o'S H i 1 H F(rQ, 1833. aurtnsr, 1889- 70 (Bmllgarl). Holnei, T., Hnghi..,A. H. l>ha'r, im. ' Hodg», 1S6S. Karri. Con!riliaUon> PhlU,,lST3,p.lW3. •■ . ,. Aslllary aoan- ri.m. nam (redootion of .houldet). AxilLity uiD- riam |ao[>po.8d) riim. do. »rLerre.eolloD).' Imoi. jddiTi- ■iou. do. do. do, do. do. Laneel, 1833. "April, iVs-"' Lancet, ims, and jbiAib™ Boat. Hod. Snrg, Jr., Lanoel. Jan, 11, ISTS. WiBi..HBd!.ii..-WOBh. Aid. Jr. Mad, Sol., July, we. M, », p, u. 30 to n. E. H. R, „ „ do. lion! ' do. ^"")"'"' '"'' j ''°'"'' INNOMINATE AND SUBCLAVIAN ARTERIES. 215 outer edge of Scalenus Anticus and lower border of First Bib) — continued. No. Date of operation. •2 »H o O P 9 o o <s S 9 &0 RB8ULT. Condition. Recovery. Canse of death, date after op. REMARKS. 254 Oct. 22, 1866. 255 Ang. 2, 1838. 256 1869-70. 257 258 259 !60 i61 >62 :63 1870. ? 24 Recovered. Recovered. 13, 33. Oc- curred. 1872. 1865. April 11, 1868. Sept. 20, 1871. Feb. 22, 1873. 1868. 8th day. Next day. 12 18 19 Cured. Improved. Recovered. Recovered, Recovered. Recovered. Cured. .3.3d day. Hem. 57th day. Hem. (Improv'd.) Worse. Cured. 11th day. Hemor- rhage and exhaus tion. Exhaustion. ? Ou account of suppuration, the sac was opened and 18 ounces of bloody pus were discharged. This same patient had had his left subclavian tied for aneu- rism 3 years previous (see No. 146) bv D r. Furner. The trans- ver satis colli on both sides was tied, as it VHis derived directly from the subeJavian. No doubt this vessel was the posterior scapula. — Author. ) Aug. 30, 1836, Dr. F. had tied the right carotid in tbis patient. By Sept. 9, tumor had dimin- ished notably in size, and two years after, although there was no tumor visible, the symptoms pointing to its re-development internally, the subclavian was tied. Recovered ; symptoms mitigated, but she died of pleu- ritis on Nov. 27, 1838, nearly 3 months after the last operation. Autopsy showed innominate alone to be the seat of the difs> ease, and the sac was filled with dense coagulam, except a chan- nel burrowed through its centre about the size of the innominate. Carotid tied simultaneously. Carbolized catgut used, and not seen after operation. Tumor treated by galvano- puncture after ligature. Sac suppurated, and death. After ligature, tumor consoli- dated and pressed upon nerves to such an extent that Dr. H. induced suppuration and rup- ture of sac, which was success- ful in every respect. Right carotid simultaneously. 15 months after ligature, tumor was reduced in size, and patient much improved, notwithstand- ing she was of dissolute habits, having slept in the streets, drunk, all night, put in jail, etc. etc. In Lancec for July 2, 1870, 1 see this patient died Dec. 8, 1869, from the "external bursting of an aortic aneurism." Autopsy : Innominate healthy ; aneurism of ascending aorta. 8th day, rupture of internal jug- ular vein, which was tied im- mediately. No autopsy. Carot- id was tied simultaneously. Tumor at first decreased, but afterward became larger. Ca- rotid was tied simultaneously. 12 weeks after fracture, resec- tion. For two mouths after this last operation, hemorrhage was frequent, and occurred the day after ligature, but was arrested by compress. Axillary artery tied first, but hemorrhage occurring, the sub- clavian was secured. 216 FBIZE £SSAY. Ligature of the Subclavian Artery in its Third Surgical Division (belueen Ko. K...., '•'""■■"•■ r.r,K»T, II l3 1 < 4 So op«ra.Lou, s -rt MDtt,Vml=ptine. do. do, do. Sudi, Fral. H. B.. 1883. Btockfl, J. W., 1S72-.S. ■Weir, R. F., OM.des Hop., 1870, Onllj to SDthur. Operslor'n noles, do. "mmtb.T'Iii.' ■ Rriog'a Cblr. Erfalir. do. U. M. SO S. L. L. Aiillary auBn- rlBm (HUb w'd). OBOS. SddiTi J (Ion. do. do. (ClOH lona."} do. do. do. pnta (UOlBd"lrK("). SsbclBV. Axillary menrism (fall of dor]. " BiioepbnloLd of AtiViirlim or lub- BluTLn. b7 t4li). W'nd of mlllatj' (rod a II lion o( HBHorrhsgo shol WOUllii »lilU. Anenriim.Biills- ry.iliol wound. (supposed Id- ■ WdBy.. 17 dw,. 41 coos. + d»y.. M. M, t ..., ail 1.1. T. d.'ji. ST3 Bol- dlei Jo. 21 L. is,i6,i;. STS July 11. li 378 do. Fob. IS. Tmir. dBl iilstol' .hot woond). 1 1 INNOMINATE AND SUBCLAVIAN ARTERIES. 217 outer edge of Scalenus Anticus and lower border of First Bib) — continued. ITo. Date of operation. 9 C J; fc. O 9 « O eS 9 • P RBSULT. KecoTory. Condition. Cause of death, date after op. REMARKS. !64 K65 266 267 268 269 270 271 272 273 274 J75 J76 577 VIS 879 July 1, 1865. 1876. Jan. 9, 1833. Dec. 2, 1850. Sept. 1855. Aug. 13, 1875. 1875. Lig. 17th day. July 18, 1863. July 16, 1868. 1872-3. March 3, 1874. 1876. None. None. 5th day. 5th, 9th day. 12,13,14 10 18 18 42-48. 6th day. 11th day, from sac. 19 Recovered. Recovered. Recovered. Recovered Recovered. Recovered. Recovered. Recovered. Recovered. Recovered. Cured. Cured. Cured. Cured. Marked im- provement. Cured. Cured (loss of arm). Died 2 months. ? 9th day. Hem. 14th day. Hem. 19th day. Exhaus- tion. 12th day. Pneumo- nia. (J) 11th day. Hem. The common carotid was tied one year previous. Patient re- covered. (I examined this pa- tient one year after the ligature of the subclavian. A small hard tumor, about the size of a nutmeg, could be felt to rise with the cardiac systole ; no thrill. I consider the cure as complete as can be expected. The patient was well in every respect.) Tumor situated below and under (i. e. behind) clavicle. Pulsation in tumor ceased after ligature to subclav.,but recom- menced in a few minutes. An- other vessel was seen to pulsate alongside of subclavian, which was tied, and then pulsation ceased and did not return. {Note by author.— This last vessel was, no doubt, the pos- terior scapular, mentioned in the surgical anatomy, which see.) Carotid was tied simultaneously. This case will very likely re- sult in a cure. Wound treated with wash of alcohol and carbolic acid. No pulse was found in radial 3 months after operation. Right carotid tied same time. Died 13 months after operation; aneurism was from aorta and extended in front of the innom- inate. Hemorrhage was from carotid. Solidification of one lung. Ball lodged in axilla ; hemor- rhage ceased spontaneously ; hem. 6th day after operation ; gangrene supervened,, and arm was amputated in lower 3d of humerus, on May 29th. Carotid was tied simultaneously; rupture of aneurism on 11th day into trachea; ilpper part of sac was filled with coagulum. 218 PBIZK E33AT. Ligature of the Subclavian Artery in its Third Surgical Division {betaeet SB. ir^meor inforniiLlion. .,T>E,T. C.Dia or H !! « It- If 3 |i i ^i w,.g.., UMb. a. T., Spetr, B. Fleet, pUsl}. ■■"a.""- Tolind. 1B71. Btlmioii, D. M., Nocrl. C out rib. L«,oel,lE7r,p.384. T, HoImB! In LanoBl, aopl. lgB7, p. 37. Concross, 1878, p. fl-jS FreBby.Hoep. Repori H U-i B ',....,..„ ..... 4S E. R. ft. .laonrUm .orla, l...raliiato, c^ Mdi.i- SlOD. du. m M. " INNOMINATE AND SUBCLAVIAN ARTERIES. 219 idge of Scalenus Anticus and lower border of First Rib) — continued. ite of ration i! S ►< O 3 © « O ei RESULT. Becovery. Condition. Cause of death, date after op. REMARKS. ec. 3, L829. 3V. 28, 1876. ig. 6, 1874. None. 26-27-28 30-31-32 1867. ag. 14, 1877. 1874. 1872. 15 rem'd 20 Reooyered. Recovered. Recovered. Recovered, Cured. Died about 3 mos. 32d day. Hemor- rhage; dyspnoea. Much im< proved. (?) Cured. Died after Sd day. Carotid was tied Sept. 26, 1829. No bad symptoms followed. In March