A short manual of surgical operations.

  • Barker, Arthur E. J. (Arthur Edward James), 1850-1916.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: A short manual of surgical operations. 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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    tliis an incision (fig. ••. a) is made for an inch or bo, j on fche border of the jaw. The artery is easily found with its vein behind it, and the needle is passed underneath it from behind forwards. LIGAT1 BE OP THE SUBCLAVIAN ARTERIES. Operations on these vessels in any but their third stages are not now generally considered desirable, and are by most surgeons condemned as unjustifiable. On the left side, the almost vertical course of the vessel, its deep relations to the pleura, thoracic duct, pneumogastric and phrenic nerve in its first stage, offer difficulties to the operator of the first order, while the close proximity of branches to the ligature if applied in the second stage render the formation of a firm clot at either side of it very proble- matical, even where the difficulties and risks of the opera- tion can be overcome. And on the right side, although the artery is, in its first stage at all events, more accessible, its ligation, owing to its relations, is still surrounded with great difficulty and risk, and there is even less probability of clotting around the seat of ligature. Of the eleven cases on record of ligature of the first stage of the sub- clavian artery the result has been fatal in all (Holmes ]). All died either of the immediate effects of the operation or of haemorrhage. Mr. Holmes advises that, if this opera- tion should ever be undertaken again, the vertebral and carotid arteries should be tied at the same time, in order to diminish the risks of secondary haemorrhage from the distal side of the ligature. The procedure in ligation of the subclavian artery is practically the same as that for reaching the first stage of the common carotid in its lower stage (7.'.). But here it will always be necessary to make 1 System of Surgery, vol. iii.