Case of successful deligation of the subclavian artery for the cure of a large axillary aneurism / by William Pirrie.

  • Pirrie, William, 1807-1882.
Date:
[1858]
Catalogue details

Licence: Public Domain Mark

Credit: Case of successful deligation of the subclavian artery for the cure of a large axillary aneurism / by William Pirrie. Source: Wellcome Collection.

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    whizzing bruit, and pulsation of a distensile, eccentric, and expand¬ ing character, which raised the hand, when laid upon any part of the tumour, by a distinct impulse from within. The pulsations were arrested by pressure upon the subclavian artery, which, how¬ ever, caused great pain ; and it was evident that the moment the pressure was removed, the swelling suddenly became enlarged. Professor Ogston and 1 agreed that a most careful examination of the chest and abdomen should be made; and, in the event of discovering no signs of a second aneurism, the patient should, for a few days, be put upon a somewhat restricted diet, and enjoined the use of some mild saline aperient; after which, a ligature should be placed upon the subclavian artery, where it passes over the first rib. The very plethoric appearance of the patient seemed to indicate the propriety of this treatment, before proceeding to tie the subclavian artery ; and this was instituted for one week previous to the 4th of January, on which day, with the assistance of my twTo colleagues, Professors Ogston and Lazars', I tied the subclavian, Professor Ogston taking the whole charge of the administration of chloroform, and Professor Lizars assisting in the manipulation the operation. The operation being on the left side, \ eirig pushed upwards, the patient being of a full liabr i ro' i the neck being very short, all tended to increase the depdi < i > vessel at the point of deligation ; but, .notwithstanding ts re a: depth, the artery was exposed, without any difficulty, any neurism- needle placed under it,—every part having u;os stincltly visible it was desirable to see : and, what is als s- ory in such an operation, no part wTas brought into view not v ' to be seen. The instant the ligature was drawn tig ; col¬ leagues simultaneously pronounced the pulsat ■? the aneurism. When the outer edge of the anterio de was exposed, the inner portion of the brachial pk v dit into view ; but, as the muscle was seen proceedin' * -u v , - wards, there was no danger in this instance, eve the finger to feel for the tubercle of the first rib, . mista! that portion of the plexus for the artery. The path as well as could be desired, until the morning of the after the operation, when he was observed to be sir y con¬ fused. On the succeeding night, he became exceedh slept none—required two attendants to keep him in b k notwithstanding their efforts to prevent him, he tore th ings from the wound; but, fortunately, did not get hold ligature. On the morning of the fifth day he was still slet restless, and agitated—expressed himself as anxious to escape . strangers and enemies he fancied in his room—his thoughts were troubled—be looked suspiciously to the back of his bed—his skin was damp his pulse soft, and his tongue moist and creamy. This assemblage of symptoms led to a most searching inquiry into the patient’s history ; and from the members of his-family, it was learned t/ z