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As a principal branch of the fourth cervical nerve of the left side, after having joined a branch of the third and of the second cervical nerves, descending between the subclavian vein and artery, is received in a groove formed for it in the pericardium, and is obliged to make a considerable turn outwards to go over the prominent part of it, where the point of the heart is lodged, in its course to the diaphragm; and as the other phrenic nerve of the right side has a straight course to the diaphragm; and as many other considerable branches of this fourth pair of cervical nerves are spread on the arms; does not a pain in the left arm distinguish a disease of the pericardium, as in the angina pectoris, or in the dropsy of the pericardium? and does not a pain or weakness in both arms distinguish the dropsy of the thorax?
Telegrams came to her at intervals during the journey, and, after a most distressing delay at Kansas City, she finally reached Leavenworth at midnight, May 14, and was gladly received by her brother who had watched the clock and counted her progress every hour. The shooting had grown out of some criticisms in his paper. The ball had fractured the clavicle and severed the subclavian artery.
#Subcutaneous rupture# of veins occur most frequently in association with fractures and in the reduction of dislocations. The veins most commonly ruptured are the popliteal, the axillary, the femoral, and the subclavian.
During these attacks the large arteries femoral, brachial, and subclavian can be felt as firm cords, while pulsation is lost in the peripheral vessels. Gangrene eventually ensues, is attended with great pain and runs a slow course. It is treated on the same lines as Raynaud's disease.
Jessop records a remarkable case of multiple aneurysm. This case was particularly interesting as it was accompanied by a postmortem examination. Pye-Smith reports an extremely interesting case in which death occurred from traumatic aneurysm of an aberrant subclavian artery. The patient fell from a height of 28 feet, lost consciousness for a few minutes, but soon recovered it.
#Wounds of the Thoracic Duct.# The thoracic duct usually opens at the angle formed by the junction of the left internal jugular and subclavian veins, but it may open into either of these vessels by one or by several channels, or the duct may be double throughout its course. There is a smaller duct on the right side the right lymphatic duct.
Amputation of the limb is indicated in cases complicated by suppuration, by secondary hæmorrhage after excision or ligation, or by gangrene. Amputation at the shoulder was performed by Fergusson in a case of subclavian aneurysm, as a means of arresting the blood-flow through the sac.
Route taken by the Fat.—The fat is conveyed by the lacteals from the villi to the receptacle of the chyle. At this place it mingles with the lymph from the lower parts of the body, and with it passes through the thoracic duct to the left subclavian vein. Here it enters the general circulation.
It may extend beneath the clavicle into the neck, or, extending inwards may form adhesions to the chest wall, and, after eroding the ribs, to the pleura. The usual symptoms of aneurysm are present, and the pressure effects on the veins and nerves are similar to those produced by an aneurysm of the subclavian.
The ball had passed through the shoulder, and had cut the subclavian artery: the body was warm, and as his friends had left it covered with some boughs and fern, it was probable they did not intend either to bury or burn it. It proved to be the man who had thrown the fiz-gig; and as there was a necessity for firing on him, the taking place of the ball was rather to be wished for.
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