This operations is not generally practised in this country, both on account of its supposed difficulty and the dangerous consequences apprehended. The difficulty has, however, been exaggerated. With moderate care the scalenus anticus muscle may be divided without injuring the jugular vein, phrenic nerve, or scapular branches of the thyroid axis; and, though it be not desirable to tie an artery so close to one of its branches, yet there is every reason to believe that the absence of coagulum on the cardiac side of the ligature does not necessarily preclude the possibility of success. Still it must be borne in mind, that the top of the pleura lies close to and immediately behind the artery in this situation, and may be injured by the aneurism-needle; and again, the ligature in this stage would include the artery close to the origin of the superior intercostal and cervicalis profunda.

The operations was originally suggested by Dupuytren,* and Dr. Auchinloss performed it on the left subclavian artery.