Surgical applied anatomy / by Frederick Treves.

  • Treves, Frederick, 1853-1923.
Date:
[1883]
Catalogue details

Licence: Public Domain Mark

Credit: Surgical applied anatomy / by Frederick Treves. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    o branch between the superior thyroid veins is sometimes found. Over the isthmus is a venous plexus, from which the inferior thyroid veins arise, while below the isthmus these veins lie in front of the trachea together with the thyroidea ima artery (when it exists). The inferior thyroid vein may be represented by a single trunk occupying the middle line. In the infant before the age of two years the thymus extends up for a variable distance in front of the trachea. At the very root of the neck the trachea is crossed by the innominate and left carotid arteries and by the left in- nominate vein; and lastly, abnormal branches of the superior thyroid artery may cross the upper rings of the windpipe.* The evil of wounding the thyroid isthmus is greatly exaggerated. I have frequently divided this structure in performing tracheotomy without any in- convenience resulting. Like other median raphe, the middle line of the thyroid isthmus has but a slight vascularity, and it has been shown that one side of the thyroid gland cannot be injected from the other (-i.e., by injection that would cross the isthmus). The difficulty of tracheotomy in infants depends upon the shortness of the neck, the amount of the subcutaneous fat, the depth at which the trachea lies, its small size, its great mobility, and the ease with which it can be made to collapse on pressure. To the finger, roughly introduced, the infant's trachea offers little resistance. Its mobility is such that we hear of its being held aside unknowingly by retractors, while the operator is scoring the oesophagus (Durham). In the child also the great vessels often cross the trachea higher up than in the adult, and some inconvenience may also arise from an unduly prominent thymus. In introducing * See an excellent article on the anatomy of this region by Dr. Pilcher, Annals of Anatomy and Surgery. New York, April, 1881.