Notes of cases illustrating surgical lesions of the vascular system / by Rudolph Matas.

  • Matas, Rudolph, 1860-1957.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Notes of cases illustrating surgical lesions of the vascular system / by Rudolph Matas. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    f I i of the neck and upper extremity, I ligated the axillary artery below the sub-scapular to prevent venous choking of the limb. The hand and arm were cold for a few days, but no notable circulatory phenomena followed this operation. The axillary wound healed partially by first intention and by granulation. The rapidity with which the axillary gap was closed was ex- traordinary and was only accounted for by the unusually vig- orous physique of the patient. Cicatrization had barely taken place, however, when the scar became hard, brawny and mani- festly diseased. The movements of the arm were seriously crippled, and in two weeks after convalescence lymphatic edema of the arm and of the whole extremity soon gave it an elephantine appearance. Neuralgic pains, which followed the course of the median and musculo-spiral branches, added greatly to the distress of the patient. The scar assumed a fungous appearance ; emaciation and cachexia supervened and multiple nodules of malignant infiltration appeared on the chest and neck. Morphia in enormous doses was the only agent that mo- mentarily relieved the patient, who continued to live through this constantly increasing torture until nearly four months after the second operation, when death closed a scene that I have never seen paralleled by its horrors as well as by the heroic fortitude of the patient in all my surgical experience. I have selected this unfortunate case from a list of thirteen cases of malignant diseases of the breast which have been treated by modern operative methods simply to call the attention of the members of this society to the propriety of advising disarticu- lation at the shoulder in this especially unfortunate class of patients who, being still young, vigorous and robust, are pre- pared to offer a long resistance when attacked by axillary growths which involve the vascular sheath and nerve plexus and in whom lymphatic edema and neuralgia are sure to fol- low attempts at radical extirpation. These cases are practically incurable, but they are often operable, and there is no doubt in my mind that a more satis- factory effort at radical extirpation can be attempted if the useless preservation of a worthless limb is left out of considera- tion. If disarticulation is performed, as advocated by Watson