Ligature of the subclavian artery, in a case of hemorrhage from the axillary artery / by R.J. Mackenzie.

  • Mackenzie, R. J. (Richard James), 1821-1854.
Date:
[1846]
Catalogue details

Licence: Public Domain Mark

Credit: Ligature of the subclavian artery, in a case of hemorrhage from the axillary artery / by R.J. Mackenzie. Source: Wellcome Collection.

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    when we proceeded to examine the wound, with the view of ascer¬ taining the state of the parts in the axilla. On removing the compress, no blood flowed from the wound, the edges and sur¬ face of which were sloughing, and the dressings were saturated with a thin and fetid discharge. On introducing the finger into the opening, it was found to pass upwards and inwards into the axilla, to the depth of about three inches, and at the bottom of the wound the axillary artery and surrounding nerves were found lying bare, the vessel being exposed to the extent of about half an inch. The parts in the neighbourhood were much infiltrated with blood, and the shoulder and upper part of the arm were con¬ siderably swollen and ecchymosed. The depth of the wound and infiltrated state of the tissues ren¬ dering any operation here (at any time perplexing,) now one of ex¬ treme difficulty; and, moreover, the chance of our being able to reach the vessel at a sound point being very small, the idea of resorting to this proceeding was at once abandoned, and Dr Dun¬ can readily concurred in the proposal to place a ligature on the subclavian artery above the clavicle. As the room, where the patient resided, was small, ill ventila¬ ted, and badly lighted, it was thought advisable to remove him, previously to the operation, to a comfortable lodging in my own vicinity, which was accordingly done on the same afternoon. Pre¬ vious to his removal, however, the compress was replaced in the axilla, and the limb supported by a bandage carefully applied from the fingers to the shoulder. When I visited him the following morning, he was pale and exhausted, restless, and anxious that something should be done for his relief. He complained of the tightness of the bandages, which had again become saturated with blood during the night. He willingly assented to my proposal of tying the vessel, and ex¬ pressed himself as anxious for the performance of the operation as soon as possible. The operation was performed at 10 o’clock, a.m. (Nov. 19th), in the presence of Dr Davidson, Dr Duncan, Dr William Robert¬ son, Dr Graham Weir, Dr H. Douglas, and Mr Howden, to whom I was much indebted for their kind and able assistance. The integuments being drawn down by the hand of an assistant, an incision was made over the clavicle, the skin divided, extending from over the outer border of the clavicular portion of the sterno- mastoid for about three and a half inches outwards, parallel with the clavicle, and about half an inch above that bone. A few fibres of the platysma-inyoides were divided, and the external jugu¬ lar vein, which lay in the outer third of the wound, was slig htly separated by the knife from its cellular connections, and held by a copper spatula to the outer side of the incision. The rest of the platysma engaged in the wound, and a few fibres of the clavicular portion of the sterno-mastoid were next divided. After a little