Ligature of the left subclavian artery for subclavian aneurism : with a remarkable deviation of the vessel and consequent change of its relations / by J. Mason Warren.

  • Warren, Jonathan Mason, 1811-1867.
Date:
[1849?]
Catalogue details

Licence: Public Domain Mark

Credit: Ligature of the left subclavian artery for subclavian aneurism : with a remarkable deviation of the vessel and consequent change of its relations / by J. Mason Warren. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    The patient, a person of much fortitude and force of character, agreed at once to the course advised. The operation was perform- ed, on December 24th, in the presence of Dr. J. C. Warren, Dr. Brown, Dr. Buckminsler Brown, Dr. Bartlett, of Roxbury, Dr. Morland and Dr. Slade. An incision, about two inches long, was made, extending from near the outer and upper edge of the sterno-mastoid muscle down- wards, in the direction of the scapulo-clavicular articulation, and an inch from the edge of the trapezius muscle, the pulsations of the vessel being the principal guide, as the other anatomical marks Avere wanting. This incision divided the skin and superficial fascia; a second cut opened one of the branches of an artery given off from the thyroid axis, which was tied. A nervous band of some size was now encountered, and at its side and directly over the artery a large vein, apparently the external jugular. The vein was car- ried to the upper part of the wound with a silver hook, and the nerve to the lower ; the dragging upon the latter caused a disagree- able and somewhat painful sensation in the arm. The sheath of the vessel was next opened, the cellular membrane around it cleared away, and the aneurism needle, unarmed, passed from below upwards, on account of the difficulty of introducing it in the contrary direction from the interference of the scalenus anti- cus, which had its insertion just below. The needle at once en- countered and raised the lower nerve of the brachial plexus, which was in the most intimate contact with the artery. By depressing the handle and urging the point forwards, with careful manipulation the eye of the needle was without difficulty brought out between these two organs. The instrument was now threaded with the liga- ture and withdrawn. Careful exploration was made to ascertain if any nerve was included in the ligature, the painful sensations in the arm caused by drawing the ligature downwards at first leading to the supposition that this might be the case. But when the same traction was made directly upwards, no pain was felt; the former