Ligature of the innominata, 0'2' brachio-cephalic artery.—Frotn a table in an essay awarded the second prize by the American medical association in 1878 to Dr. John A. Wyeth of the university of Louisville, Ky., there are recorded. 16 cases of ligature of this artery, the largest of the branches of the aorta, and which divides into the right subclavian and right common carotid. One of these operations was attended with suc cess, that by Dr. A. W. Smyth of New Orleaus, in 1864, in a case of aneurism of the .subclavian artery. The following note is taken from the table: " Aneurism resulted' from violent stretching of the arm; three months later innominate and carotid were tied simultaneously• did well until the 14th day, when hemorrhage (16 oz.) occurred, which was controlled 'by compress; 15th and 16th days, continued slight liemorrhao•e; 17th day, wound was filled with small shot; 51st day, terrible hemorrhage: 54th Say, vertebral artery tied; 55th day, shot removed from wound; patient continued to do well, and recovered." The man died 10 years afterwards of hemorrhage from the original sack of the aneurism. The first ligation of this artery was by Valentine Mott, in 1818, and marked an era in surgery. The patient survived till the 26th day. Four years later Von Graefe of Berlin performed the operation, and the patient lived till the 67th (lay.
Ligature of the aubclavian artery . —ln a report made to the American medical associa tion in 1867 by Drs. Willard Parker, George W. Norris, J. H. Arrnsby, and Williani H. Mussev, there are tabulated 157 well-authenticated cases. The first operation was per formea by Keate, in 1800, for traumatic axillary aneurism, four months after the injury. The patient recovered. The next operation was by Ramsden, in 1809, also for axillary aneurism. The patient died on the fifth day. Four other fatal operations followed, till, in 1815, Chamberlayne was successful. The eighth case was by Dr. Wright Post of New 'York, in 1817, which also terminated favorably, the patient recovering, The ninth and tenth cases were by the celebrated French surgeon, Dupuytren, both in 1819, one being successful and the other fatal. These early and pioneer operations are sur rounded with great interest. They were careful steps in the art of surgery, taken by great men. The second American operation for ligature of the subclavian artery was by Valentine Mott, in 1830, for axillary aneurism, and was successful. Dr. -Mott's second case, in 1831, was fatal on the 18th day. The first distal ligature of the sub clavian artery was by Wardrop, an English surgeon, in 1827, for aneurism of the inno minata. This distal operation on arteries was conceived by Brasdor, but first carried out by Deschamps. See BRASDOR'S OPERATION, ante. The next operation on the distal
side of the aneurism was performed by Dupuytren, in 1829, but (lid not result in recovery, the patient dying of exhaustion on the 7th day. There were 10 distal cases, 8 of which died. The two successful ones were by Wardrop and Heath. Between 1831 and 1844, not inclusive, ligature of the subclavian artery was performed 41 times, with 16 favorable and 25 unfavorable results. Dr. Mott's third operation for ligature of the subclavian was in 1838, and resulted in recovery. Drs. John C. 1Varren of Bos ton, Valentine Mott and A. C. Post of New York, each tied the artery with successful results in 1844, all of the patients recovering. Dr. Mott's fifth case, in 1850, was also successful, making a record of five cases of ligature of the subclavian artery, two being upon the left, the most difficult side, with only one fatal result. Dr. Willard Parker has also tied the subclavian artery five times, with but two fatal results, in one of which the patient survived till the 42d day. Of the whole 157 cases, 79 were successful and 78 fatal. The committee reported 39 additional cases, with 28 fatal results. They also remark that the subclavian artery, in its first division, has been tied 13 times without a single recovery; in its second division, 9 times, with 4 deaths; and in its third division, 174 times, with 89 deaths.
In the essay of Dr. Viryeth, above quoted, there is a tabulated collection of 286 cases of ligature of the subclavian, which he comprises in three sections: those in which the ligature was applied to the first division of the artery; those in which it was applied in the middle part of its course; and those in which the third division was the seat of operation. This report agrees with the preceding in regard to'the 13 cases of ligature in the first division of the vessel. One of these cases, that of Rossi, in 1844, possesses uncommon interest, from the fact that the autopsy showed that the only artery going to the brain which was not obliterated, and therefore capable of carrying blood, was the left vertebral, and yet the patient survived six days, dying of cerebral ancemia. In its second division, the subclavian has been ligated 13 times, with four cures, the first by Dupuytren in 1819; the second by Nichols of Norwich, England, in 1832; the third by J. C. Warren of Boston in 1844; and the fourth by T. G. Morton of Phila delphia in 1869. The subclavian has been tied in its third division, that next the axilla, in 254 cases. The first was Ramsden's case in 1809. Recovery followed in 120 cases, or nearly 50 per cent.