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I was removed from my brigade and attached to the Berkshires, with whom I served at the fatal battle of Maiwand. There I was struck on the shoulder by a Jezail bullet, which shattered the bone and grazed the subclavian artery.
It is less successful than the proximal ligature, and is therefore restricted to aneurysms so situated as not to be amenable to other methods; for example, in aneurysm of the common carotid near its origin, the artery may be ligated near its bifurcation, or in aneurysm of the innominate artery, the carotid and subclavian arteries are tied at the seat of election. Compression.
The removal of diseased supra-clavicular glands is not to be lightly undertaken, as difficulties are liable to ensue in connection with the thoracic duct, the pleura, or the junction of the subclavian and internal jugular veins.
The larger of the lymph tubes is called the thoracic duct. This receives lymph from all parts of the body not drained by the right lymphatic duct, and empties it into the left subclavian vein. Connection is made with the subclavian vein on the upper side at the place where it is joined by the left jugular vein.
The facial artery can be distinctly felt as it passes over the upper jaw at the front edge of the masseter muscle. The pulse of a sleeping child can often be counted at the anterior fontanelle by the eye alone. About one inch above the clavicle, near the outer border of the sterno-mastoid, we can feel the pulsation of the great subclavian artery.
If this is present at the end of fourteen days, operation should not be delayed. Access to the cords of the plexus is obtained by a dissection similar to that employed for the subclavian artery, and the nerves are sought for as they emerge from under cover of the scalenus anterior, and are then traced until the seat of injury is found.
From the white color of the contents of these vessels, they have been named lacteals or milk-bearers, from lac, which signifies milk. These lacteals ultimately converge into one trunk, called the thoracic duct, which terminates in the great vein under the clavicle or collar bone, hence called the subclavian vein, just before that vein reaches the right side of the heart.
The lymph is said to be "sucked in," which means that it is forced in by the unbalanced pressure of the atmosphere. Some advantage is also gained by the lymph duct’s entering the subclavian vein on the upper side and at its union with the jugular vein.
Sometimes the vein also is injured and an arterio-venous aneurysm established. Owing to the laxity of the tissues, it increases rapidly, and it may soon attain a large size, filling up the axilla, and displacing the clavicle upwards. This renders compression of the third part of the subclavian difficult or impossible.
This method is suitable to sacculated aneurysm of the limbs, so long as they are circumscribed and free from complications. It has been successfully practised also in aneurysm of the subclavian, carotid, and external iliac arteries. It is not applicable to cases in which there is such a degree of atheroma as would interfere with the successful ligation of the artery.
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