Case of aneurism of the innominata, treated by ligature of the right carotid artery; with observations / [Sir William Fergusson].

  • Fergusson, William, Sir, 1808-1877
Date:
1841]
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the innominata, treated by ligature of the right carotid artery; with observations / [Sir William Fergusson]. Source: Wellcome Collection.

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    examined carefully, it was observed to pulsate strongly, and its pulsations were synchronous with those of the arteries: it was very compressible and seemed filled with fluid blood only; it was situated immediately behind the lower extremity of the sterno- cleido-mastoid muscle of the right side; its pulsations could be distinctly felt on the outer margin of this muscle; it occupied a part of the space between the two mastoid muscles, and extend¬ ed about two inches above the upper margin of the sternum. The right carotid and subclavian arteries could be felt beyond the tumour, each pulsating regularly in its normal situation. Pressure on the carotid, opposite the larynx, caused sudden di¬ minution in the size of the swelling, and singular slowness in the pulsations, with a feeling of giddiness, sickness, and faintislmess. Pressure on the subclavian, outside of the scaleni muscles, caused less perceptible change, and produced no other marked effect. Simultaneous pressure on both vessels caused a rapid decrease in the size of the tumour; the skin over it wrinkled, and the pul¬ sations seemed almost to cease. The pulse was less perceptible in the right radial artery than in the left. The veins at the root of the neck and fore part of the right shoulder, were fuller and more conspicuous than on the left side. The viscera of the chest seemed healthy; the action of the heart was natural; and there was no reason to suppose that the arch of the aorta, root of the innominata, and arterial system, elsewhere than in the seat of the tumour, were not in as healthy a condition as is natural at the patient's period of life. As there could be little doubt that this tumour was an aneu¬ rism of the innominata, and as the case seemed in every respect favourable for the ligature of one or both arteries beyond the disease, I determined, after having taken the opinions of my colleagues, of Mr Arnott, Mr Wardrop and others, to place a ligature on the carotid; entertaining the hope that obstruction of this vessel might alone suffice for the cure; having however the intention, should this expectation not be fulfilled, of tying the subclavian at some future period. The patient, who had, previous to his arrival in town, been under the care of Mr Pulley of Reading, was placed upon a spare farinaceous diet; had several doses of laxative medicine; was ordered a fourth of a grain of tartarized antimony thrice a-day; was bled from the arm to eight ounces, and kept quiet for ten days, during which time no marked change occurred, either in his health or in the condition of the tumour, unless it wa«, that the latter had slightly increased in size. On the 22d of June 1841, at one o'clock p.m., he was carried into the operating theatre of the hospital, and, in the presence of my colleagues, Mr Wardrop, Mr Arnott, Mr May of Read¬ ing, Mr Pulley, a number of other professional friends, and