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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    dissection, and tlie opening of tlie deep cervical fascia, tlie lower border of the posterior belly of the omo-hyoid was brought into view, below which a mass of adipose tissue protruded ; this being rather in the way of the knife in clearing the deeper parts, was dissected out and removed, when a branch of the brachial plexus was seen running across the bottom of the wound. On now in¬ troducing the finger, the insertion of the scalenus anticus into the tubercle of the rib was easily recognized, and the artery was felt pulsating to its outer side. A blunt hook being now introduced at the inner part of the wmund, and the parts slightly retracted towards the sternum, a very slight dissection exposed the coat of the artery. This was laid bare to the extent of about a sixth of an inch, and a common aneurism needle easily passed around it from within outwards. The ligature was then tightened, and tied with a double knot. The edges of the wound were brought to¬ gether by three points of suture, and a piece of lint, moistened in cold water, applied. One small vessel was divided at the first incision, which was twisted. The patient bore the operation re¬ markably well, and showed his want of consciousness of the tight¬ ening of the ligature, by inquiring, after the knot was secured, if “ the tying of the thread would give him much pain.” An opiate, consisting of a drachm of solution of muriate of morphia was given. Some oozing of blood took place about two hours after the operation, by which slight tension of the sides of the wound was produced. Had the stitches been then divided, and the coagula removed, the wound might have been left in a more favourable state for union ; but, as the patient, though will¬ ing to submit to any thing which might be thought proper, was rather alarmed at any further interference, I thought it better to be satisfied with the continuance of the cold applications. At 8 P.M., he felt quite comfortable, and had slept for three hours in the afternoon. Pulse 80; skin cool. He complained a little of heat in the arm and hand of the side on which the vessel had been tied, and the temperature of the surface of these parts was higher than the rest of the skin. The bandages, which were saturated in blood, had become dry and hard, the oozing from the axilla having evidently ceased. The compress was left in situ^ but the bandages retaining it were cut, so as to remove, as far as possible, all pressure from the axilla. There was faint pulsation perceptible in the brachial and radial arteries. The opiate, as above, was repeated at 11 o’clock, p.m. 20th.—Slept nearly all night, and expresses himself as being free from pain and much better. Pulse 72 ; tongue clean and moist. The bandage was taken off from the arm and hand, and the compress gently removed from the wound in the axilla. The surface of the arm felt hot and dry, and on raising himself to sit up in bed, the limb assumed a livid colour from venous con¬ gestion. On laying him down, however, and slightly raising the