Account of the dissection of a patient in whom the subclavian artery had been tied for axillary aneurism : with practical remarks / by William Fergusson.

  • Fergusson, William.
Date:
[1841]
Catalogue details

Licence: Public Domain Mark

Credit: Account of the dissection of a patient in whom the subclavian artery had been tied for axillary aneurism : with practical remarks / by William Fergusson. Source: Wellcome Collection.

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    of the most legitimate and valuable in the treatment of axillary aneurism. In 1831, however, only two successful operations of the same kind had been published by Scotch surgeons, one by Mr Liston, the other by Mr Wishart of Edinburgh; and, as I had every reason for supposing that this case was the third of the kind which had occurred in Scotland, I naturally felt anxi¬ ous to lay the case before the profession, more especially as I was then a very youthful aspirant to be considered one of the Edin¬ burgh school of surgery. In the course of years, though the Hunterian operation came to be more frequently performed, and more extensively and boldly applied, the surgeon was still slow and cautious, in putting trust in the anastomosing arteries of a limb being equal to carry on a sufficiently vigorous circulation, to save the part from mortifica¬ tion; but in modern times he no longer dreads such an unfortu¬ nate result, for, though aware that such an event does occasion¬ ally occur, he has the oft-repeated proof before him, that, the current of blood may be arrested by ligature, through the iliacs, carotid, subclavian, and innominata itself, with the fullest assur¬ ance that this casualty is the least likely to happen, in the chap¬ ter of accidents incidental to such operations. We know that even the aorta may become obstructed, and yet the blood will find its way to the lower part of the body; such obstructions, however, have probably been of slow occurrence, thus allowing time for the gradual increase in size of the collateral branches, and the cases in which the abdominal aorta has been tied, have survived too short a time, to allow them to be taken as proof, that this vessel may be closed by ligature with the same immu¬ nity. From what we know of the vast capabilities of the colla¬ teral branches, we would be justified in anticipating such a re¬ sult, and we would be further encouraged in hopes of safety, by what we know of such obstructions in dogs. I have seen a puppy, within a few hours after I had applied a ligature to its abdominal aorta, frisk about as if no such cruelty had been perpetrated; but though such experiments have a certain degree of value, I do not deem it consistent with sound discretion, to draw any close analogy between such operations on the arteries of dogs, either young or old, and on the corresponding vessels of man beyond the meridian of life, the period when aneurism is of most frequent occurrence. However fully convinced of the powers of nature to keep alive and nourish a limb under the circumstances alluded to, the surgeon nevertheless looked with great interest on the state of the anastomosing vessels ; and every dissection, whether in the lower animals, or in his own species, which could throw light on the subject, was examined with eagerness. There are few mu¬ seums now-a-days in which such specimens in the lower animals