Two cases of ligature of the left carotid for aneurysm of the arch of the aorta : with the post-mortem specimens of four cases / by Christopher Heath.

  • Heath, Christopher, 1835-1905.
Date:
1903
Catalogue details

Licence: In copyright

Credit: Two cases of ligature of the left carotid for aneurysm of the arch of the aorta : with the post-mortem specimens of four cases / by Christopher Heath. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    in tho first and second right intercostal spaces. The first and second right spaces were bulged, and dull on percussion for a distance of oue inch from the sternal margin, and pulsation of an expansile character could be seen and felt here, and in the episternal notch and right supra-clavicular fossa. The inner ends of both clavicles were projected for- wards by the swelling, especially the right, and each beat of the pulse threw them further forward, and caused a heaving of the upper part of the chest. Some dilated veins lay over the front of the chest, and the jugulars were also distended. Patient had a frequent brassy cough, and the voice was harsh ; but the laryngoscope showed that both cords moved equally. There was marked “ tracheal tugging,” the right pupil was larger than the left (slightly), and the right radial pulse might have been a shade earlier than the left; it was certainly much larger in volume. The pulse was regular, 68 to the minute, high tension, large, collapsing rapidly during diastole in a manner typical of aortic regurgitation. Heart apex-beat heaving in fifth space, in the nipple line. On auscultation a blowing systolic murmur could be heard over the aneurysm; the second sound could be clearly heard in the second right interspace, and along the left border of the sternum a murmur could be heard following the second sound, and running through the whole period of diastole. A blowing systolic murmur could be heard at the apex. The lungs were examined and found healthy. Notes before operation.—During November and De- cember, 1898, and the first half of January, 1899, patient had severe attacks of pain in the shoulders, back, and side of the neck and face. The aneurysm at first became smaller, but during January it increased in size, and definite swelling and pulsation appeared beneath the pectoral just below the right clavicle. During this