Account of the dissection of a patient in whom the subclavian artery had been tied for axillary aneurism : with practical remarks / by William Fergusson.

  • Fergusson, William.
Date:
[1841]
Catalogue details

Licence: Public Domain Mark

Credit: Account of the dissection of a patient in whom the subclavian artery had been tied for axillary aneurism : with practical remarks / by William Fergusson. Source: Wellcome Collection.

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    The vertebral, internal mammary, and inferior thyroid arte¬ ries were of their usual size, in proportion to the subclavian, which, with the carotid and innominata, was somewhat larger than usual; the supra-scapular, transversalis colli, and deep cervical, were all considerably enlarged, and I have no doubt that these vessels formed the principal currents towards the humeral artery. Unfortunately, from the manner in which the dissection was, of necessity, conducted, a complete view of the anastomosing branches could not be obtained; but from the in¬ creased size of the subscapular artery, I concluded that this ves¬ sel had a large share in carrying on the blood in its novel course. The extremity of the pervious portion of the subclavian was adherent to the posterior surface of the anterior scalenus muscle, and the vessel seemed to taper away, until it was lost in the circumference of the deep cervical. The heart and lungs were in a natural condition; the aorta was somewhat dilated, its inner and middle tunics being slightly thickened ; on laying it open, a patch of calcareous matter might be here and there ob¬ served, as was also the case with the innominata. Having no suspicion of any other cause of death than that already alluded to, I did not proceed farther with tho examination. The case and the preparation, (which is now placed, with the rest of my collection, in the museum of King’s College, London,) have often served the purpose of illustrating my lectures on aneurism ; and as some of my observations are, in my opinion, not unwTorthy of the notice of the practical surgeon, I hope I may be allowed the recapitulation of them here. It will be observed in the history of the operation and its imme¬ diate results, published soon after the patient was dismissed from under my care, that, among others, these remarkable circumstances occurred, viz. the ligature remained in the wound for an extraordi¬ nary period ; the aneurismal tumor suppurated ; and, lastly, ulce¬ ration suddenly came on in the wound, at a time when cicatrization was nearly completed. The first of these I have referred to as a proof of the fact, that a ligature may remain on an artery of this magnitude for more than a month, though no other texture is included in the noose; but I have deemed it of more value, as illustrating the propriety of not fretting the artery and its sur¬ rounding textures, new and old, by frequently tugging at the liga¬ ture to bring it out of the wound. Had I been over-anxious on this score, I think there can scarcely be a doubt, taking into con¬ sideration the size of the dead portion of artery which came away with the ligature, as represented in the annexed cut, —the proximity of the thread to such a large vessel as the deep cervical is proved to be by the preparation, and also the somewhat enlarged condition of the subclavian itself, that hemorrhage must have been the result. It is always