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A CASE OF ANEURISMAL VARIX
147 were
enlarged.
The
girl
herself stated that
as
long
as
she
could remember there had been a peculiar "beating"" in the leg. At first the swelling was confined to the thigh ; but it
In connexion with these two cases may be mentioned a prein the museum of St. George’s Hospital (series vi., prep. 242) taken from a man whom we had frequent opportunities of examining during life. The following account is extracted from the museum catalogue :-" There is enormous dilatation of the veins from the shoulder to below the elbow. The axillary vein is many times its proper size ; the superficial veins and venae comites are greatly enlarged, and a close plexus of veins has been developed in the substance of all the muscles on the anterior part of the arm. The arteries are perfectly natural. The arm during life was greatly swollen; the superficial veins were enlarged, the position of their valves being marked by slight swellings. The biceps could be felt larger than natural, in consequence, as was supposed, of the formation of veins in its interior. The disease had begun four years before the patient’s death. He woke from sleep with a sensation of numbness in the right side of the body; this was followed by aching pains in the arm. There was as yet no swelling; but six months later he had a similar attack, after which the arm was found to be increased in size. He afterwards had several attacks of the same nature, after each of which the enlargement became greater. While under treatment he caught typhus, of which he died."
paration
extended to the leg, and finally to the foot. It caused her little inconvenience unless she walked some distance or stood for a long time, and then the veins became much bigger. Latterly, however, some of the veins near the ankle had given way, and had bled profusely several times; and it was for this she sought admission into the hospital. Her mother also stated that she had always been a delicate child, and as an infant had suffered from hydrocephalus. On admission, the right lower extremity was found to be much enlarged, being not only increased in circumference, but at least two inches longer than the left. The superficial veins were much dilated, and stood out in the form of large convoluted and tortuous cords under the skin; they were quite soft, and could easily be emptied of their contents; there was no pulsation in them. The femoral vein could also be felt to be much enlarged in the groin, and in it could be perceived a distinct vibratory thrill, which could be traced up to the junction of the two iliac veins in the vena cava, but no thrill could be felt in this latter vessel. A very loud continuous blowing sound could be traced up the vein to the same spot. She seemed a weak, anaemic girl, with an overhanging forehead. There was a loud systolic murmur at the apex of the heart. On the lower part of the outer side of the leg was a large scab, where the bleeding came from. A few days after admission hare-lip pins were placed under all the veins which could be seen running in the direction of the point of haemorrhage, and the vessels were then compressed by ROYAL MEDICAL AND CHIRURGICAL SOCIETY. a twisted suture placed over the needles. The needles were TUESDAY, JAN. 22ND, 1867. allowed to remain in twenty-eight days. They caused very DR. JAMES ALDERSON, F.R.S., PRESIDENT. little irritation, but gradually produced consolidation in the veins. She was subsequently discharged, very much in the same DISLOCATION OF THE SIXTH FROM THE SEVENTH CERVICAL state as when admitted, the thrill and bruit remaining just the VERTEBRA FORWARDS WITHOUT FRACTURE; IMMEDIATE same. PARAPLEGIA; DEATH ON TWENTY-FIRST DAY. The symptoms in this case render it probable that a comBY M. BERKELEY HILL, M.B., F.R.C.S., munication existed somewhere between the arterial and venous ASSISTANT-SURGEON TO UNIVERSITY COLLEGE HOSPITAL. the thrill and bruit terminated while fact that the circulation, IN this case, during life and even after death, until the abruptly at a spot where a large artery and vein are in close were laid bare, no deformity of the spinal column injured where the iliac the common relation-namely, artery (on right could beparts The paraplegia involved all the parts detected. iliac to vein, appears side) lies upon and crosses the common seventh vertebra. There was no irritation of the point to this spot as the place of communication. That the below the life. After death, which took place on the opening was congenital seems also probable, as the enlargement spinal cord duringthe cord was found softened and compressed twenty-first day, of the thigh and the dilated state of the veins were noticed at much blood, as well as flattened by the dislocated arch of by of disease and there was no thinned birth, probability having the coats of, or of an accident to, such deep structures. More- the sixth vertebra forcing it against the body of the seventh. The urine was at first alkaline, and loaded with mucus and over, the fact that she suffered from hydrocephalus proves there was an unhealthy state of the system, which may, and pus ; but at the end of the first week it was restored to its natural condition by continuous drainage of the bladder. possibly would, have retarded development. The author referred to the opinions of McDonnel and others This case recalls to our mind another, which occurred in this in favour of trephining the arches of the vertebrae in cases of or five in four the disease years ago, which, however, hospital displaced vertebras with paraplegia, and stated the reasons was not congenital, but probably the result of thinning of the coats of the veins, and a communication between them and which dissuaded him from attempting it in this instance. These were-the situation of the injury being so high up in some superficial arterial branch in consequence of forced the vertebral column; the inability to ascertain with exactness, marches in a hot climate. during life, the amount of the injury to the spinal column; the small probability of the auxiliary muscles of respiration A CASE OF ANEURISMAL VARIX. their motor power after the cord had been released regaining (Under the care of Mr. HENRY LEE.) from pressure; and the possibility of so severe an operation immediate death by displacing the phrenic nerve, or Joseph K-, aged fifty-nine, a pensioner, was admitted on March 18th, 1862. He stated that ever since he was a boy by the shock it would involve to the exhausted patient. he had suffered from varicose veins. For many years he was Mr. HOLTHOUSE would have expected, from the manner in in India, where he had a great deal of forced marching. About which the accident happened-the forcible flexion of the spinal fifteen years ago he noticed that the veins of the abdomen column,-that the displacement would have been backwards, were enlarged ; he had never suffered any inconvenience from and that the anterior portion of the cord would have been the them, but they had gradually increased in size. He had never part injured. He had seen cases of separation of the bodies had inflammation or suffered pain in the veins of the leg. of the vertebral from each other, but they had occurred from When admitted there was found to be on the left side of the forcible extension of the spine, and were accompanied with abdomen a peculiar swelling, extending along the whole length fracture of the transverse and oblique processes. It was rare of the rectus muscle, from the ensiform cartilage to the groin ; to find so much separation as occurred in this case without it was extremely tortuous and convoluted, and resembled a fracture. The case was not an encouraging one for the operacoil of small intestine laid on the muscle, being of about half tion of trephining the spine, because, assuming the anterior the calibre of this tube. It was perfectly movable on the part of the cord to be injured, removal of pressure posteriorly muscle. On listening with the stethoscope, a distinct, con- could not remedy the damage to the part in front. Then in tinuous bruit could be heard, exactly resembling the humming cases of recovery it was difficult to say how much credit was of a bee. There was also a distinct thrill. The superficial to be given to the operation, for patients sometimes recovered veins in both legs were varicose, and the internal saphena on without any operation. Mr. Holthouse mentioned the case of the right side appeared to communicate with the enlarged a patient of his own, who lived twelve months after a fracture veins of the abdomen. On making pressure on the veins at of the upper dorsal spine. this spot they became much more turgid, and the bruit was Mr. WM. ADAMS said the case was interesting and well lost; not so, however, on making pressure at the upper part of described. It was a rare case, as one of dislocation without the mass. fracture; and one of great value as regarded the question of soon
Medical Societies.
causing
enlarged.
The
girl
herself stated that
as
long
as
she
could remember there had been a peculiar "beating"" in the leg. At first the swelling was confined to the thigh ; but it
In connexion with these two cases may be mentioned a prein the museum of St. George’s Hospital (series vi., prep. 242) taken from a man whom we had frequent opportunities of examining during life. The following account is extracted from the museum catalogue :-" There is enormous dilatation of the veins from the shoulder to below the elbow. The axillary vein is many times its proper size ; the superficial veins and venae comites are greatly enlarged, and a close plexus of veins has been developed in the substance of all the muscles on the anterior part of the arm. The arteries are perfectly natural. The arm during life was greatly swollen; the superficial veins were enlarged, the position of their valves being marked by slight swellings. The biceps could be felt larger than natural, in consequence, as was supposed, of the formation of veins in its interior. The disease had begun four years before the patient’s death. He woke from sleep with a sensation of numbness in the right side of the body; this was followed by aching pains in the arm. There was as yet no swelling; but six months later he had a similar attack, after which the arm was found to be increased in size. He afterwards had several attacks of the same nature, after each of which the enlargement became greater. While under treatment he caught typhus, of which he died."
paration
extended to the leg, and finally to the foot. It caused her little inconvenience unless she walked some distance or stood for a long time, and then the veins became much bigger. Latterly, however, some of the veins near the ankle had given way, and had bled profusely several times; and it was for this she sought admission into the hospital. Her mother also stated that she had always been a delicate child, and as an infant had suffered from hydrocephalus. On admission, the right lower extremity was found to be much enlarged, being not only increased in circumference, but at least two inches longer than the left. The superficial veins were much dilated, and stood out in the form of large convoluted and tortuous cords under the skin; they were quite soft, and could easily be emptied of their contents; there was no pulsation in them. The femoral vein could also be felt to be much enlarged in the groin, and in it could be perceived a distinct vibratory thrill, which could be traced up to the junction of the two iliac veins in the vena cava, but no thrill could be felt in this latter vessel. A very loud continuous blowing sound could be traced up the vein to the same spot. She seemed a weak, anaemic girl, with an overhanging forehead. There was a loud systolic murmur at the apex of the heart. On the lower part of the outer side of the leg was a large scab, where the bleeding came from. A few days after admission hare-lip pins were placed under all the veins which could be seen running in the direction of the point of haemorrhage, and the vessels were then compressed by ROYAL MEDICAL AND CHIRURGICAL SOCIETY. a twisted suture placed over the needles. The needles were TUESDAY, JAN. 22ND, 1867. allowed to remain in twenty-eight days. They caused very DR. JAMES ALDERSON, F.R.S., PRESIDENT. little irritation, but gradually produced consolidation in the veins. She was subsequently discharged, very much in the same DISLOCATION OF THE SIXTH FROM THE SEVENTH CERVICAL state as when admitted, the thrill and bruit remaining just the VERTEBRA FORWARDS WITHOUT FRACTURE; IMMEDIATE same. PARAPLEGIA; DEATH ON TWENTY-FIRST DAY. The symptoms in this case render it probable that a comBY M. BERKELEY HILL, M.B., F.R.C.S., munication existed somewhere between the arterial and venous ASSISTANT-SURGEON TO UNIVERSITY COLLEGE HOSPITAL. the thrill and bruit terminated while fact that the circulation, IN this case, during life and even after death, until the abruptly at a spot where a large artery and vein are in close were laid bare, no deformity of the spinal column injured where the iliac the common relation-namely, artery (on right could beparts The paraplegia involved all the parts detected. iliac to vein, appears side) lies upon and crosses the common seventh vertebra. There was no irritation of the point to this spot as the place of communication. That the below the life. After death, which took place on the opening was congenital seems also probable, as the enlargement spinal cord duringthe cord was found softened and compressed twenty-first day, of the thigh and the dilated state of the veins were noticed at much blood, as well as flattened by the dislocated arch of by of disease and there was no thinned birth, probability having the coats of, or of an accident to, such deep structures. More- the sixth vertebra forcing it against the body of the seventh. The urine was at first alkaline, and loaded with mucus and over, the fact that she suffered from hydrocephalus proves there was an unhealthy state of the system, which may, and pus ; but at the end of the first week it was restored to its natural condition by continuous drainage of the bladder. possibly would, have retarded development. The author referred to the opinions of McDonnel and others This case recalls to our mind another, which occurred in this in favour of trephining the arches of the vertebrae in cases of or five in four the disease years ago, which, however, hospital displaced vertebras with paraplegia, and stated the reasons was not congenital, but probably the result of thinning of the coats of the veins, and a communication between them and which dissuaded him from attempting it in this instance. These were-the situation of the injury being so high up in some superficial arterial branch in consequence of forced the vertebral column; the inability to ascertain with exactness, marches in a hot climate. during life, the amount of the injury to the spinal column; the small probability of the auxiliary muscles of respiration A CASE OF ANEURISMAL VARIX. their motor power after the cord had been released regaining (Under the care of Mr. HENRY LEE.) from pressure; and the possibility of so severe an operation immediate death by displacing the phrenic nerve, or Joseph K-, aged fifty-nine, a pensioner, was admitted on March 18th, 1862. He stated that ever since he was a boy by the shock it would involve to the exhausted patient. he had suffered from varicose veins. For many years he was Mr. HOLTHOUSE would have expected, from the manner in in India, where he had a great deal of forced marching. About which the accident happened-the forcible flexion of the spinal fifteen years ago he noticed that the veins of the abdomen column,-that the displacement would have been backwards, were enlarged ; he had never suffered any inconvenience from and that the anterior portion of the cord would have been the them, but they had gradually increased in size. He had never part injured. He had seen cases of separation of the bodies had inflammation or suffered pain in the veins of the leg. of the vertebral from each other, but they had occurred from When admitted there was found to be on the left side of the forcible extension of the spine, and were accompanied with abdomen a peculiar swelling, extending along the whole length fracture of the transverse and oblique processes. It was rare of the rectus muscle, from the ensiform cartilage to the groin ; to find so much separation as occurred in this case without it was extremely tortuous and convoluted, and resembled a fracture. The case was not an encouraging one for the operacoil of small intestine laid on the muscle, being of about half tion of trephining the spine, because, assuming the anterior the calibre of this tube. It was perfectly movable on the part of the cord to be injured, removal of pressure posteriorly muscle. On listening with the stethoscope, a distinct, con- could not remedy the damage to the part in front. Then in tinuous bruit could be heard, exactly resembling the humming cases of recovery it was difficult to say how much credit was of a bee. There was also a distinct thrill. The superficial to be given to the operation, for patients sometimes recovered veins in both legs were varicose, and the internal saphena on without any operation. Mr. Holthouse mentioned the case of the right side appeared to communicate with the enlarged a patient of his own, who lived twelve months after a fracture veins of the abdomen. On making pressure on the veins at of the upper dorsal spine. this spot they became much more turgid, and the bruit was Mr. WM. ADAMS said the case was interesting and well lost; not so, however, on making pressure at the upper part of described. It was a rare case, as one of dislocation without the mass. fracture; and one of great value as regarded the question of soon
Medical Societies.
causing