A practical treatise on the management of diseases of the heart, and of aortic aneurism, with especial reference to the treatment of those diseases in India / by Norman Chevers.

Date:
1851
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the management of diseases of the heart, and of aortic aneurism, with especial reference to the treatment of those diseases in India / by Norman Chevers. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    middle coats were wanting, and where a fibrinous clot was found. One of the pul- monary valves was contracted. The aorta was first a little dilated, and then contracted, particularly where it was joined by the ductus arteriosus. There was also a per- manent communication between the two ventricles. Ambrose Pare has recorded the somewhat doubtful case of a certain tailor, who, by an aneurisma of the arterious vein [pulmo- nary artery], suddenly, whilst he was playing at tennis, fell down dead,—the vessel being broken. His body being opened. Pare found a great quantity of blood poured forth into the capacity of the chest; but the body of the artery was dilated to the largeness of a man's fist, and the inner coat thereof was bony. For which cause Par^, within a while after, shewed it to the great admiration of the beholders, in the Physicians' School, whilst he publiquely dissected a body there.* It is much to be regretted that the details of the following case have not been more satisfactorily given. I quote the account from a periodicalf, having failed to procure a sight of the work in which it was originally published. In September 1814 Dr. Harlan assisted Dr. Parrish in the examination of the body of Captain M , a middle-aged person of robust constitution. His disease had never confined him to his house; and the day pre- ceding his death he called on Dr. Parrish, and complained of dyspnoea and pain in the back of his neck. His symptoms were re- ferred to stricture of the oesophagus ; and Professor Winstar, who was consulted, ad- vised the use of the probang : the patient deferred this operation, and, during the same night, was attacked with increased difficulty of breathing and exacerbation of all his symptoms. A bleeder being sent for, he lost some blood, with temporary relief; but in a short time afterwards he expired in convulsions. The autopsy very unexpectedly developed an aneurism of the pulmonary artery, the sac of which extended so far back as to press upon the oesophagus, and produce symptoms of stricture in that part. There was con- siderable effusion in the lungs, and a lump of coagulated blood in the trachea, near the glottis, which most probably occasioned his sudden death. The effusion was occasioned by the rupture of the aneurismal sac, which was adherent to the air- cells of the lungs. * Book I8t, De Tumoribus, Cap. XXVIII. London edition, fol. IC49, p. 204. t Modlco-Chirurpical Review, .Inly 1839, from Medical and Physical Rrsearclics. by II. Har- lan, M.O. F.R.S. London and Miiladelphia, 1835. Dr. Harlan justly observes that it was fortu- nate the probang was not employed.* Mr. Fearn, of Derby, has recorded-f the case of a patient who died from haemopty- sis, in whom an aneurismal sac of the size of a nutmeg was found jutting into a tubular extremity on the upper lobe of the left lung. The parietes of the sac were thin, and did not contain any fibrinous layers ; a vessel, the size of a small crow-quill, leading from a considerable trunk of the pulmonary artery, was distinctly traceable into the sac. Dr. Peacock has also met with an instance in which a pulmonary branch of the size of a crow-quill was found so dilated at one spot as to be capable of holding a bean. This dilatation was situated within a cavity hol- lowed out in the parenchyma of the lung con- taining blood ; the lining membrane of the vessel was continuous. Several other cavi- ties, containing pus, existed at the upper part of the lung. Dr. Peacock attributes this lesion to the loss of support which the vessel must have sustained, owing to the re- moval of the elastic substance of the lung in its vicinity. He also very justly denies the identity of this lesion with aneurism, as it occurs in the systemic arteries. The preparation numbered 1450° in the collection at Guy's, displays an artery of considerable size, traversing the wall of a phthisical cavity, and presenting two small aneurismal dilatations, one of which has burst into the cavity. The lining of the vomica appears to be unusually thin. Another branch, of equal diameter, occupies another portion of the wall of the excavation; its canal appears to be obliterated. The lesion which destroyed life in the following case appears to have been closely similar to that form of rupture of the proper tonics of the aorta which usually gives rise to dissecting aneurism :—A Pontonier, twenty- one and a half years of age, who had enjoyed good health excepting slight dyspnoea dur- ing three months he had been in the army, after having engaged in carrying wood during the day, was roused in the night by a violent pain at the right of the sternum, with great dyspnoea, which subsided in a few minutes. He afterwards became much relieved. Dur- ing the afternoon of the following day he asked for drink, became pale and collapsed, and died. On examination, a number of * The use of this instrument cannot be too strongly deprecated in doubtful cases of dyspha- gia. I have met with two instances in which the oesophagus was greatly compressed by aneurisms of the descendmg aorta; and in each of which —the structures of tlie oesophagus having be- come completely removed—there remained a large rounded aperture, which was merely closed by thick layers of coagulum. Had a probang been mtroduced in either of tlicsc cases it miihl have nievitably caused instnatancous death, by entering the aneurismal sac. t Lancet, Fob. 6, 1848.