The Medical and scientific archives of the Adelaide Hospital. No. 2.

  • Adelaide Hospital (Adelaide, S. Aust.)
Date:
[1923]
Catalogue details

Licence: Public Domain Mark

Credit: The Medical and scientific archives of the Adelaide Hospital. No. 2. Source: Wellcome Collection.

    42/50 (page 40)
    day. No testicle could be found. Although the cavity dis¬ charged serous fluid for some time, it gradually lessened its capacity, partly because of the decrease in size of the scrotum, and partly by attempts at repair. When discharged, the wound had almost ceased to discharge. At no time during the treat¬ ment did the patient show any pyrexia. The patient was of normal mentality, had a knowledge of first aid, and had cas¬ trated animals. He made no comment as to the pain during the operation. (4) ANEURYSM OF THE SUBCLAVIAN ARTERY; LIGA¬ TION; SUBSEQUENT RUPTURE AND DEATH. (Under the care of Dr. Cudmore, Honorary Surgeon. Notes by Dr. W. A. Fleming and Dr. D. L. Barlow.) H. C., male, cet. 75, was admitted on June 27th, 1922, com¬ plaining of a lump in the left infra clavicular region. It had been first noticed about nine months earlier, when it felt about the size of a marble. It had gradually increased in size, giving rise to pain in the forearm and in the little and ring fingers. Latterly he had been unable to sleep owing to the pain. Examination showed a swelling about the size of a billiard ball in the left infraclavicular region. Pulsation was visible, and its expansile nature could be detected on palpation. The tumor was well defined and smooth, and most prominent at a point corres¬ ponding with the junction of the sternal and clavicular heads of the pectoralis major. Ascultation revealed a systolic mur¬ mur. No history of syphilis was obtained. There was some thickening of the radial vessels. Blood pressure 150. Under a general anaesthetic a transverse incision was made above the clavicle. The third part of the subclavian artery was found and ligated. Some pulsation could be felt in the tumor beyond, subsequent to the operation, although it had decreased in size. The patient was discharged on July 17th. He was again admitted on September 25th, 1922. He said that the swelling had begun to enlarge again about 10 days previously. It was now much larger than ever, the pulsation seemed much greater, and the shooting pain in the left arm was intense. Examination showed the 'swelling to be about 34in. in diameter. It was pulsating vigorously, and a thrill could be detected above the clavicle on palpation. Pressure above the clavicle diminished the pulsation. Oedema of the arm was present. On September 24th, about 8.30 a.m., the patient com¬ plained of sudden intense pain in the region of the swelling, and examination showed the axillary fossa to be distended and tense. The pulsation had decreased to some extent; the pec¬ toralis major was pushed forward. The patient was obviously suffering from shock. An immediate operation was performed, the transverse incision made at the previous operation being reopened and a large suprascapular artery found. Obliteration of its lumen did not decrease the pulsation. A U-shaped in¬ cision was then made below the clavicle, the pectoralis major was separated from the clavicle, and the pectoralis minor cut- transversely. The aneurism was freed as much as possible. Free blood was present in the fossa, and a rent found in the lower part of the sac. The subclavian artery was ligated from below the clavicle, the aneurism opened, and the clot removed. Small vessels entering the sac were ligated. The incision was then closed. The patient’s condition was low on leaving the theatre and he died at 3.30 p.m. on the same day.