Case of aneurism of the aorta arising from the back part of the arch, simulating laryngeal disease, and fatal by suffocation / by W.T. Gairdner.

  • Gairdner, W. T. (William Tennant), Sir, 1824-1907.
Date:
[1851]
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the aorta arising from the back part of the arch, simulating laryngeal disease, and fatal by suffocation / by W.T. Gairdner. Source: Wellcome Collection.

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    affection of the larynx. It is obvious that the part of the aorta most apt to be affected in these cases is the middle or transverse portion of the arch, and particularly its posterior or inferior surface, where it is most removed from the possibility of physical diagnosis. It is also evident that a very small tumour in these situations is enough to give rise to all the symptoms of laryngeal obstruction. Dr Todd correctly remarked, in his clinical lecture upon the case above alluded to as having occurred under his care, that u most observers had attributed these symptoms (those of chronic laryngeal affection) to compression of the trachea and bronchi, and had overlooked the condition of the recurrent nerve.” In the present case, as in that of Dr Todd, u there was the most ample evidence that the pressure upon that nerve occasioned the laryngeal distress.” With regard to the treatment of such cases, the present narrative seems also not devoid of instruction. Had an aneurism been dis¬ covered or strongly suspected in this case, it seems probable that general blood-letting, together with such remedies as would have contributed to control the heart’s action, might have been pursued farther with advantage to the patient; whereas the chronic na¬ ture of the supposed laryngeal affection, and the active treatment to which he had already been subjected, were accepted as sufficient reasons for foregoing these remedies and trusting to blistering, ipecacuan, and the performance of tracheotomy. This operation was absolutely refused by the patient while he had sense and vigour, and the case accordingly adds one more to those in which the operation was performed too late to be of any service; but I think it is impossible not to admit that it would probably have pro¬ longed life had it been performed at any period before the final agony, and that the patient’s sufferings throughout his illness would have been greatly less severe had advantage been taken of one of the earliest threatening paroxysms of dyspnoea to place a tube in the trachea. In a clearly ascertained case of aortic aneurism, such a proceeding could of course only be proposed as a temporary relief from immediate and pressing danger; and even in this point of view it could only be prudently recommended after careful exa¬ mination had ascertained the freedom of the lung and of the air- tubes from any considerable pressure; but under these circum¬ stances, I should certainly not hesitate in offering to the patient the benefit, even though temporary, which this little operation is calcu¬ lated to afford. Much less should I feel justified in withholding it, on the ground of the uncertainty of diagnosis, in cases like the pre¬ sent, where an obvious laryngeal spasm exists, the source of which cannot be discovered, but which is unconnected with any other ascertainable affection of the respiratory passages. For further re¬ marks upon this subject, however, I beg to refer the reader to the following report of the debate on this paper in the Medico-Chirurgi- cal Society. «/