Ligations of the left subclavian artery in its first portion / by William S. Halsted.

  • Halsted, William, 1852-1922.
Date:
[between 1900 and 1999]
Catalogue details

Licence: In copyright

Credit: Ligations of the left subclavian artery in its first portion / by William S. Halsted. Source: Wellcome Collection.

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    Harrison,* Flood,! Guthrie,]; and Quain,§ all coincide in this opinion. The opinions of those eminent anatomists and surgeons being so decidedly against the possibility of the operation, it was only left for me to examine with great care the surgical anatomy of this vessel. Having had the thoracic duct injected with wax, I repeatedly dis¬ sected the parts concerned, and operated in every way that suggested itself to me as likely to present any advantages. My opinion of its feasibility was thus confirmed, and having never entertained any doubts of its propriety, I accordingly undertook it. I regret, indeed, deeply, the death of my patient, but the appear¬ ances presented on examination after death, have only strengthened the opinion I had previously formed, and have encouraged me to undertake it with some slight variations, should another case ever present itself. It has often happened with important operations that many of the first cases have been unsuccessful, while the carefully noted observations made on dissection have led to different modes of operating, and.more uniform success. Previously to the performance of this operation many entertained doubts whether the force of the circulation so near the heart in so large a vessel would not prevent the formation of a coagulum, and of course interfere with the obliteration of the vessel. These doubts have now been removed, and I consider that all reasonable objections fall with them, except those arising from the anatomy. Danger to the thoracic duct and pleura are in my opinion the most serious of these, for, with ordinary coolness and care, there will be little danger of including the pneumogastric and phrenic nerves, or carotid artery, in the ligature. The veins may be lacerated by great roughness, but can scarcely be included. The thoracic duct, I think, can almost always be avoided by reach¬ ing the inner edge of the scalenus half or three quarters of an inch above its insertion, and then pressing the finger down towards the rib. The duct is thus kept out of the way of laceration by the finger, and afterwards by the aneurismal needle. I am aware that this duct varies in its course, but this direction I am confident will usually secure its safety. By adopting it in the many times I operated and dissected the parts in the dead body, it was uninjured. *“ Harrison on the Anatomy of the Arteries. Dublin: 1833. Vol. i, p. 125.” t “ Flood. The Surgical Anatomy of the Arteries. London: 1839, p. 84.” t “ C. J. Guthrie on the Diseases and Injuries of the Arteries, etc. London: 1830, p. 396.” § “ Quain’s Anatomy, 3d edition. London: p. 492.” 3