Gangrene of the Hand as an Initial Sign of Cervical Rib

In the November, 1904, meeting of the Chicago Surgical Society, Dr. J. B. Murphy¹ described the removal of a cervical rib in a patient with symptoms resembling a subclavian aneurysm. He said that there was little in the surgical literature concerning this subject, but gave H. Foote, an English surgeon, credit for the first surgical removal of a cervical rib in 1861. Since that time, many surgeons have been confronted with the problem of compression of neurovascular structures in this region by either cervical rib or the scalenus anticus muscle. The patients usually have symptoms for a long time before objective findings are present. However, we have recently seen four patients who have had ischemic necrosis of the skin or gangrene of the hand without previous symptoms of a cervical rib. In none of these patients was a cervical rib suspected, and surgical therapy was therefore delayed. We have