Symptomatology, diagnosis, and surgical treatment of cervical ribs / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1907
Catalogue details

Licence: In copyright

Credit: Symptomatology, diagnosis, and surgical treatment of cervical ribs / by W.W. Keen. 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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    3. Murphy wi’ites me that in his first case (No. 31) the artery was fattened. 4. In Kammerer’s case, the pulse completely disappeared on deep inspiration and in others it was weakened. 5. It should also be pointed out that the argument has been applied only to the artery. The nervous symptoms, due to the lesion of the brachial plexus, are much more frequent than the circulatory symptoms. As to the nerves, the argument of Sue entirely fails, because the brachial plexus arises in the neck above the level of the cervical rib and the course of the plexus is from above downward and outward. Angulation cannot then be assigned as the cause, as in the case of the artery; but the upward pressure of a longer cage of the thorax certainly exists and this upward pres- sure is constantly repeated, as in the case of the artery at every inspiration. Coote, in the first case ever operated on, expressly 6 2 7 8 9 Eig. 21.—Scheme to show the changed course and the consequent angulation of the sub- clavian artery when it passes over a cervical rib. The dotted line (3) represents the normal gentle curve of the artery. 1. Cervical rib. 2. Subclavian artery passing over the cervical rib. Note its high position, its angulation, and the likelihood of pre.ssure by the scalenus anticus 6. 4. First dorsal rib. 5. Axillary artery. 7. Left carotid. 8. Innominate. 9. .-Vortic arch. states that “the neiwes were flattened upon the upper surface of the rib.” Warren notes that the brachial plexus “had been some- what stretched by the arched position of the bone.” Removal of the bone relaxed the plexus. In my own case the same phenomena were observed. In Thomas and Cushing’s case direct “compres- sion” of the lower cord of the plexus “by a dense fibrous band which passed from the tip of the rudimentary rib under the plexus to its point of attachment on the first thoracic rib” was found. This band represented the continuation forward of the imperfectly developed cervical rib. 6. Moreover, as in the case of the artery, the removal of the offend-