SUPRA-RENAL CAPSULES. 



827 



In its third stage, the subclavian artery has 

 very frequently been the subject of operation, 

 and the ligature of the vessel in this situation, 

 in a large number of the cases recorded, has 

 been eminently successful. Mr. Ramsden, of 

 St. Bartholomew's Hospital, in the year 1809, 

 was the first who secured the artery in its 

 third stage, and since then the operation has 

 been successfully repeated by many surgeons, 

 in this as well as in other countries. 



Although the subclavian artery, above the 

 clavicle, is covered by no muscular fibres 

 except those of the platysma, yet it always 

 lies at a considerable depth, which varies 

 much in different persons; the statement of 

 Dupuytren will generally be found correct, 

 viz., " that the third part of the course of the 

 subclavian artery is placed more superficially 

 in those who have long, slender necks, with 

 lean and pendant shoulders, but is, on the 

 contrary, deeply hidden in persons who have 

 short, thick necks, and muscular shoulders."* 



It is an unfortunate circumstance that the 

 disease for which the operation is usually 

 undertaken, should so constantly be the 

 cause of great difficulty in its performance, 

 for an axillary aneurism of any considerable 

 size cannot fail to elevate the clavicle con- 

 siderably. This fact is well illustrated in the 

 embarrassments experienced in a case where 

 the subclavian artery was tied by the late 

 Professor Todd, one of the surgeons of the 

 Richmond Hospital, and which are recorded 

 in the third volume of the Dublin Hospital 

 Reports. So great have been the difficulties 

 experienced in the operation, that on one 

 occasion Sir A. Cooper was obliged to abandon 

 the attempt, and on another (already alluded 

 to) Mr. Listen was compelled to tie the 

 artery between the scaleni, finding it im- 

 practicable to expose the vessel in its third 

 stage. 



(B. Gco. M'-Dowel.) 



SUPRA-RENAL CAPSULES. (Die 



Nebenniere, Germ. CapsulfB suprarenah-s sen 

 atrabilarice, Lat. Capsules suprarenalcs, atra- 

 bilaires, Fr.) In the bodies of Vertebrata 

 we find a series of organs, which possess a 

 great outward resemblance to the glands, but 

 distinguish themselves from these by the 

 constant absence of a duct. To this class 

 belong the spleen, the thymus, the thyroid, 



thus narrates in his published lectures : " Some 

 years ago I performed this operation (ligature of the 

 subclavian artery in the supra-clavicular space) oil 

 a clergyman, in the presence of the late Dr. Babing- 

 ton and Mr. Travers ; no difficulty whatever oc- 

 curred, but immediately after its completion the 

 patient was seized with a constant hacking cough, 

 as if resulting from convulsive motion of the 

 diaphragm. This scarcely ceased night or day until 

 the sixth day after the operation, when he died. 

 Xo post-mortem examination was permitted; but 

 there can be no doubt, in my mind, that the phrenic 

 nerve had been injured, although it could not 

 possibly have been included in the ligature." Vide 

 Med. Gazette. Lond. Vol. xlii. p. 94. July, 1848. 

 * Le9ons Orales, torn. iv. p. 528. 



and the supra-renal capsules. On account 

 of their great richness in blood-vessels, these 

 organs have been named " blood-glands," or 

 " glands of blood-vessels," or "vascular gang- 

 lia." At present we are tolerably acquainted 

 with the range of their distribution, and the 

 differences of their form in the animal king- 

 dom ; we have, also, some knowledge of their 

 minute structure ; but, on the other hand, 

 their physiological import remains just as ob- 

 scure to the inquirers of the present century 

 as it was to the physicians of ages long gone 



by. 



The supra-renal capsules, glandules supra- 

 renales scu renes succenturiati, seu capsulcc 

 atrabUarifc, form, in the higher Vertebrata, a 

 double organ, which is constantly placed in 

 the neighbourhood of the kidneys; and from 

 this situation they have received their name. 

 So, also, in the lower Vertebrata they of^en 

 occupy the same situation ; but, not unfre- 

 quently, they are broken up into a number of 

 small glandular bodies. In the Invertebratu 

 they are altogether absent. 



We shall successively consider, 1. The 

 larger series constituted by the differences of 

 form of supra-renal capsules in the animal 

 kingdom. 2. Their structure. 3. Their de- 

 velopment. 4. Their physiological relations. 



I. As already mentioned, supra-renal cap- 

 sules occur only in the Vertebrata. But we 

 cannot attribute them to all of these without 

 exception. In the lowest Amphibia and Fishes, 

 these organs have not yet been indubitably 

 recognised. Among the Mammalia, the supra- 

 renal capsules exhibit everywhere essentially 

 the same structure, in spite of many differ- 

 ences of form, size, and situation. 



In Man they possess a half-moon shaped, 

 or triangular and flattened form, with an an- 

 tero-posterior slightly arched surface, and a 

 sharp convex margin. At their bases they 

 are deeply excavated, so that by this part 

 they rest on the upper end of the kidney like 

 a cap. The anterior part of the basis of the 

 supra-renal capsule extends for a considerable 

 distance further forwards on the kidney than 

 the hinder part. The whole organ is included 

 in a covering which consists of closely woven 

 areolar tissue ; and inferiorly, it is attached 

 by a looser areolar tissue to the kidney. At 

 the base of the organ is also found a well- 

 marked fissure, from out of which passes the 

 supra-renal vein, according to Krause's state- 

 ment.* The anterior and posterior surfaces 

 of the supra- renal capsules exhibit an irregu- 

 larly wrinkled appearance, caused by the nu- 

 merous furrows of the areolar tissue. The 

 size of the supra-renal capsules amounts in 

 the adult to 1 I A inches (German) in height, 

 and somewhat less in breadth. The greatest 

 antero-posterior thickness occurs in its lowest 

 part, and amounts from 2^ 4 lines. In their 

 middle the supra-renal capsules are consider- 

 ably thinner, amounting only to 1 T * 2| lines. 

 Their absolute weight is estimated by Meckel 



* Vide Krause's Handbuch der Anatomic, 2. 

 Auflagc, Hannover, 18-li. Band 1. S. 668, 



