Anatomico-chirurgical remarks on the different portions of the axillary artery : with a case in which this vessel was successfully tied / by G.C. Monteath.

  • Monteath, George Cunningham, 1788-1828.
Date:
[1827]
Catalogue details

Licence: Public Domain Mark

Credit: Anatomico-chirurgical remarks on the different portions of the axillary artery : with a case in which this vessel was successfully tied / by G.C. Monteath. 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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    extends to the base, or lower opening of the axilla. Its length is equal to the united lengths of the two former. The artery now approaches to, and lies pretty close upon the head, neck, and commencement of the os humeri, against which it can be compressed, and the circulation of the arm suppressed during a high amputation, where the tourniquet could not be used. I have repeatedly, in the capacity both of operator and assistant, put this to the proof on the living body, and think it is much more to be depended on than pressure of the artery either against the 1st rib above the clavicle, or the 2d rib below it. The vessel is here protected in front by the lower part of the pectoralis major. Below, the entrance to the cavity of the axilla is covered merely by the commoji integu- ments, and a thin fascia, by dividing which in a line parallel to and over the course of the artery, the whole of this 3d portiofi may be exposed, and a ligature passed around any part of it. The relation of the axillary vein to the artery is here much the same as in the two upper portions. It lies on its internal and sternal aspect. The nerves now no longer form a sheath or plexus around the artery, but having divided into the distinct nerves of the arm and forearm, they course along the different sides of the artery, nearly surround- ing it, but so loosely as to render it perfectly practicable to isolate the vessel, and pass a ligature around it. This portion gives off at least four considerable arteries, viz. the thoracica longior, the great and important subscapularis, and the two circumflexm, all of which are extremely uncertain in regard to the exact site, and mode of their origin, and yet must, if possible, be avoided in any operation on the trunk of the artery. The artery has been here repeatedly tied with success. This may be necessary when it has been recently wounded, or at the very commencement of a diffused aneurism from wound or rupture, also in cases of aneurism high in the arm. There may be also cases of severe laceration, contusion, or tumour, high in the arm, which may require the ligature of the axillary artery. Mr. Samuel Cooper, in his invaluable Surgical Dic- tionary, states that this artery was tied about a century ago, by a Mr. Hall of Cheshire, where it had been wounded by a scythe. On referring, however, to the first mention I find of this case, in the 4th vol. of the London Medical Journal for 1784, p. 169, I find that the wound was not of the axillary, but of the humeral artery, just below the axilla. As the wound was free and large, the artery was laid hold of with the finger and thumb, and a ligature tied around it, at the wounded spot, and not in the axilla. The patient recovered. Mr. White of Manchester, (see the same vol. p. 159), seems VOL. j.— NO. i. b