Notes on clinical medicine / by Willoughby Francis Wade.

  • Wade, Willoughby Francis.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: Notes on clinical medicine / by Willoughby Francis Wade. Source: Wellcome Collection.

    17/18 (page 15)
    that the aneurifm itfelf had exifted for probably not lefs than fix months at the time that I firft faw him ; for that length of time, at all events, he had been fuffering from haemorrhoids, due, it may be prefumed, to the preffure of the tumour upon the pulmonary artery. Upon this fuppofition, we fhould date the communication with the pulmonary artery from the time that he made the violent effort to efcape being run over. I cannot doubt for a moment that the perforation of the right ventricle took place on the morning of the 14th of June. This cafe is of importance as eftablifhing—at leaf!, I am difpofed to think fo—the rational diagnofis of fimilar lefions in future. Granting the corredlnefs of this belief, a great advance has been made in the diagnofis of varicofe aneurifms in general, fince, as before mentioned, this particular fpecies is by far the moft common of the whole clafs. At the fame time it muft be borne in mind that the key to my opinion was the non-condudtion of the fecond murmur to the heart’s apex. We fhould therefore be at a lofs in moft cafes where— 1 ft. aortic, or 2nd. pulmonary regurgitation exifted ; 3rd. the new communication produced no murmur with the fecond cardiac found ; 4th. there alfo exifted an opening into either ventricle; 5th. there was an opening into the left auricle or its appendix. Though we fhould, I think, be faved from error by attention to the phyfical condition of the lungs, as compared with that of the liver, &c.; and, befides, fuch a lefion is of the utmoft rarity. The cafe is both interefting and important, as fhowing with how little inconvenience fuch a lefion may exift. Much ftrefs has always been laid upon thrill as an indication of varicofe aneurifm; and this rightly, when the fite of thrill is local and fo remote from the heart as to preclude the poflibility of a cardiac origin, but not otherwife, fince there feems to be no limit to the amount of thrill producible by fimple valvular lefions. In the prefent cafe the thrill was not employed to prove the exiftence of preternatural communication, though its prefence lent a certain