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ON ANEURISM OF THE ARCH OF THE AORTA.
ON
ANEURISM OF THE ARCH OF THE AORTA. BY J. C. BARRY, ESQ., M.R.C.S., L.S.A. PRIVATE G. B-, belonging
Highlanders,
embarked
on
to
a
detachment of H. M. 74th
board the
ship Whirlwind,
at
Indies, for England, came under my care, on the 20th of February, 1857, having been under previous treatment at the military hospital, Jackatalla. His case was stated to be thoracic aneurism. Upon examination, I found the fol-
Cannanore,
East
lowing symptoms :-Heart’s action loud and irregular, more distinct on the right than the left side, especially upon listening with the stethoscope, the same being more evident over the right side, accompanied with bellows murmur. The sternal extremities of the third and fourth ribs of the right side protrude beyond the level of the chest. He has pain over the right nipple; numbness down the right arm; dyspnoea on exertion; slight cough; palpitation; no dysphagia; always violent throbbing on the right side of the chest, especially on exertion; pulse irregular and labouring; tongue brown on the dorsum, red at the ’tip and edges. Ordered, dilute prussic acid, three minims; water, an ounce : to be taken twice a day. Feb. 21st.-No better; bowels costive. Extract of colocynth, six grains; blue-pill and Dover’s powder, of each one grain, in two pills, to be taken immediately. 22nd.-Not at all relieved. To take, tincture of digitalis, ten minims; water, an ounce, twice a day. 23rd.-Is better; has less pain and throbbing over the region of the tumour.
so
BY JAS. B. I
PROWSE, ESQ., M.R.C.S., Clifton.
been in the habit of removing enlarged bursse -by of the lunar caustic, applied in the form of the stick moistened with a little water and rubbed over the whole surface of the enlargement for the space of some minutes. In most cases this treatment will be found effectual where blisters, the tincture of iodine, &c., have been but of litle use, and it will often obviate the necessity of passing setons through the tumour or of removing it by means of dissection. Having in a great number of cases proved the efficacy of this plan, I can confi. dently recommend it for adoption in practice. HAVE
means
July,
1857. _________________
A Mirror OF THE PRACTICE OF
MEDICINE AND SURGERY IN THE
HOSPITALS OF LONDON. Vulla est alia pro eerto noseendi via, nisi quam plurimtts et morborur&, etdisssctionum historias, tam aliortlm proprias, collectas babete et intet secomparare.-MORGAGNI. De Sed. et Caus. 3forb. lib. 14. Prooemium.
KING’S COLLEGE HOSPITAL. SEQUEL TO THE CASE OF STONE IN THE BLADDER IN WHICH,
24th.-Complains of a good deal of cough. Ordered, five grains of compound ipecacuanha powder at bedtime. 25th.-Cough better; other symptoms remain the same. Repeat draught, with fifteen minims of tincture of digitalis. 26th.-Better in health; symptoms the same ; tongue slightly brown; pulse soft and compressible; strong pulsation on the right side of the chest, with bellows murmur most distinct in the infra clavicular region ; cough a little troublesome. 27th.-Feels better. To continue the draught. 28th.-Has pain over the situation of the tumour, with a good deal of pulsation. A mustard poultice to be applied over the region of the tumour. March 1st.-The pain has decreased since the application of the poultice. ‘2nd.-Not
TREATMENT OF ENLARGED BURSÆ BY CAUSTICS.
well,
tumour increased in
size,
and he still has
BESIDES TWO CALCULI, WAS REMOVED.
(Under the
THE MIDDLE LOBE OF THE PROSTATE
of Mr.
FERGUSSON.) WITH a desire to complete our report of this very interesting case, which appeared in a late " Mirror," (THE LANCET, vol. i., 1857, p. 402,) we subjoin the progress of the case up to the period of its termination, which, we regret to say, was fatal. In our report, we stated the patient’s age to have been fiftynine, it was, however, sixty-five. He was of a rheumatic diathesis, and had generally been subject to reddish deposits in his urine, which had frequently contained blood during the last three years, commencing after having walked a great discare
tance. He was submitted to lithotomy on the llth of April, 3rd.-Just the same; bowels costive. Ordered, calomel, and two calculi removed, together with excision of the middle five grains; extract of colocynth, ten grains, to be taken lobe of the prostate, as mentioned in our former report. He directly. Two ounces of wine. a comfortable night, sleeping, however, but little. 4th.-More pain, throbbing, and bulging out of the tumour; passed The following notes are a continuation of the case, as kindly bellows murmur very evident in the infra-clavicular region. To take, dilute prussic acid, four minims; water, an ounce, furnished us by Mr. Christopher Heath, house-surgeon to the twice a day. One pint of soup, and two ounces of wine. I hospital :April 12th.-Complains of pain over the region of the called to see him at five minutes to four o’clock in the afterbladder; clean ; perspires slightly. To have a drauglti; and found him in a of and face state noon, pallid; of twentytongue syncope; lips minims of opium. surface of the body covered with a cold, clammy perspiration; of wound
pain. Repeat the draught.
pulse at the wrist; and upon listening over the region of the heart, I found it had ceased to pulsate. I kept him in the recumbent position, applied cold water to the head, and ammonia to the nose. At four o’clock he expired. For the last day or two, the bulging out of the tumour had increased, with more pain and throbbing, and he had felt faint at times. Post-mortem examination, at half-past five o’clock A.M., thirteen hours and a hay after death.-Before opening the chest, I particularly observed that there was no bulging out of the ribs on the right side as was observed to be the case before death. Upoa exposing the chest, I carefully explored and found a large aneurism of the arch of the aorta, which had ruptured and discharged itself into the cavity of the chest; it was of great size, and would hold, I should think, fully a quart no
of blood. The coats were much thickened, so that Nature had, as usual in such cases, endeavoured to repair and thicken them, so as to delay as long as possible the fatal issue. I removed a quantity of coagulated arterial blood. There was hypertrophy of the left ventricle of the heart, which was otherwise healthy. The lungs were healthy. He was not at all emaciated; on the contrary, of a stout, full habit of body. Northumberland-place. Wacthn"rno-..-n9p 1857
56
thirst; 13th. -Slept better; pulse 80; complains healthy; slight orchitis has come on. Brandy, eight ounces. 16th.-Memory fails him; had a very bad night; pulse 96. Brandy, twelve ounces. 18th.-Slept better; does not complain of so much pain about the bladder; all the urine passes through the wound. 20th.-Has less pain ; is thirsty; pulse good; appetite bad; bowels constipated. Brandy, eighteen ounces. 23rd.-Tongue moist; looks pretty well; seems comfortable,
but refuses his nourishment. 2:5th.--Has become somewhat exhausted. 27th.-Has slept very little during the night; seems more apathetic, and takes less notice; complains but little; pulse 90,
feeble. 29th.-More exhausted; takes little
nourishment, and.that only occasionally. Brandy, twenty-four ounces. 30th.-Is evidently sinking; pulse feeble and fluttering; tongue dry. The symptoms gradually increased in severity, sank and died at half-past seven P. M. hours after death.-On opening the peritoneal cavity, no morbid appearance presented itself. The left kidney was soft and very much congested. In its pelvis) there was a deposit of lymph about the size of a pea. The
and he
finally
A2ttopV, forty-eight
ANEURISM OF THE ARCH OF THE AORTA. BY J. C. BARRY, ESQ., M.R.C.S., L.S.A. PRIVATE G. B-, belonging
Highlanders,
embarked
on
to
a
detachment of H. M. 74th
board the
ship Whirlwind,
at
Indies, for England, came under my care, on the 20th of February, 1857, having been under previous treatment at the military hospital, Jackatalla. His case was stated to be thoracic aneurism. Upon examination, I found the fol-
Cannanore,
East
lowing symptoms :-Heart’s action loud and irregular, more distinct on the right than the left side, especially upon listening with the stethoscope, the same being more evident over the right side, accompanied with bellows murmur. The sternal extremities of the third and fourth ribs of the right side protrude beyond the level of the chest. He has pain over the right nipple; numbness down the right arm; dyspnoea on exertion; slight cough; palpitation; no dysphagia; always violent throbbing on the right side of the chest, especially on exertion; pulse irregular and labouring; tongue brown on the dorsum, red at the ’tip and edges. Ordered, dilute prussic acid, three minims; water, an ounce : to be taken twice a day. Feb. 21st.-No better; bowels costive. Extract of colocynth, six grains; blue-pill and Dover’s powder, of each one grain, in two pills, to be taken immediately. 22nd.-Not at all relieved. To take, tincture of digitalis, ten minims; water, an ounce, twice a day. 23rd.-Is better; has less pain and throbbing over the region of the tumour.
so
BY JAS. B. I
PROWSE, ESQ., M.R.C.S., Clifton.
been in the habit of removing enlarged bursse -by of the lunar caustic, applied in the form of the stick moistened with a little water and rubbed over the whole surface of the enlargement for the space of some minutes. In most cases this treatment will be found effectual where blisters, the tincture of iodine, &c., have been but of litle use, and it will often obviate the necessity of passing setons through the tumour or of removing it by means of dissection. Having in a great number of cases proved the efficacy of this plan, I can confi. dently recommend it for adoption in practice. HAVE
means
July,
1857. _________________
A Mirror OF THE PRACTICE OF
MEDICINE AND SURGERY IN THE
HOSPITALS OF LONDON. Vulla est alia pro eerto noseendi via, nisi quam plurimtts et morborur&, etdisssctionum historias, tam aliortlm proprias, collectas babete et intet secomparare.-MORGAGNI. De Sed. et Caus. 3forb. lib. 14. Prooemium.
KING’S COLLEGE HOSPITAL. SEQUEL TO THE CASE OF STONE IN THE BLADDER IN WHICH,
24th.-Complains of a good deal of cough. Ordered, five grains of compound ipecacuanha powder at bedtime. 25th.-Cough better; other symptoms remain the same. Repeat draught, with fifteen minims of tincture of digitalis. 26th.-Better in health; symptoms the same ; tongue slightly brown; pulse soft and compressible; strong pulsation on the right side of the chest, with bellows murmur most distinct in the infra clavicular region ; cough a little troublesome. 27th.-Feels better. To continue the draught. 28th.-Has pain over the situation of the tumour, with a good deal of pulsation. A mustard poultice to be applied over the region of the tumour. March 1st.-The pain has decreased since the application of the poultice. ‘2nd.-Not
TREATMENT OF ENLARGED BURSÆ BY CAUSTICS.
well,
tumour increased in
size,
and he still has
BESIDES TWO CALCULI, WAS REMOVED.
(Under the
THE MIDDLE LOBE OF THE PROSTATE
of Mr.
FERGUSSON.) WITH a desire to complete our report of this very interesting case, which appeared in a late " Mirror," (THE LANCET, vol. i., 1857, p. 402,) we subjoin the progress of the case up to the period of its termination, which, we regret to say, was fatal. In our report, we stated the patient’s age to have been fiftynine, it was, however, sixty-five. He was of a rheumatic diathesis, and had generally been subject to reddish deposits in his urine, which had frequently contained blood during the last three years, commencing after having walked a great discare
tance. He was submitted to lithotomy on the llth of April, 3rd.-Just the same; bowels costive. Ordered, calomel, and two calculi removed, together with excision of the middle five grains; extract of colocynth, ten grains, to be taken lobe of the prostate, as mentioned in our former report. He directly. Two ounces of wine. a comfortable night, sleeping, however, but little. 4th.-More pain, throbbing, and bulging out of the tumour; passed The following notes are a continuation of the case, as kindly bellows murmur very evident in the infra-clavicular region. To take, dilute prussic acid, four minims; water, an ounce, furnished us by Mr. Christopher Heath, house-surgeon to the twice a day. One pint of soup, and two ounces of wine. I hospital :April 12th.-Complains of pain over the region of the called to see him at five minutes to four o’clock in the afterbladder; clean ; perspires slightly. To have a drauglti; and found him in a of and face state noon, pallid; of twentytongue syncope; lips minims of opium. surface of the body covered with a cold, clammy perspiration; of wound
pain. Repeat the draught.
pulse at the wrist; and upon listening over the region of the heart, I found it had ceased to pulsate. I kept him in the recumbent position, applied cold water to the head, and ammonia to the nose. At four o’clock he expired. For the last day or two, the bulging out of the tumour had increased, with more pain and throbbing, and he had felt faint at times. Post-mortem examination, at half-past five o’clock A.M., thirteen hours and a hay after death.-Before opening the chest, I particularly observed that there was no bulging out of the ribs on the right side as was observed to be the case before death. Upoa exposing the chest, I carefully explored and found a large aneurism of the arch of the aorta, which had ruptured and discharged itself into the cavity of the chest; it was of great size, and would hold, I should think, fully a quart no
of blood. The coats were much thickened, so that Nature had, as usual in such cases, endeavoured to repair and thicken them, so as to delay as long as possible the fatal issue. I removed a quantity of coagulated arterial blood. There was hypertrophy of the left ventricle of the heart, which was otherwise healthy. The lungs were healthy. He was not at all emaciated; on the contrary, of a stout, full habit of body. Northumberland-place. Wacthn"rno-..-n9p 1857
56
thirst; 13th. -Slept better; pulse 80; complains healthy; slight orchitis has come on. Brandy, eight ounces. 16th.-Memory fails him; had a very bad night; pulse 96. Brandy, twelve ounces. 18th.-Slept better; does not complain of so much pain about the bladder; all the urine passes through the wound. 20th.-Has less pain ; is thirsty; pulse good; appetite bad; bowels constipated. Brandy, eighteen ounces. 23rd.-Tongue moist; looks pretty well; seems comfortable,
but refuses his nourishment. 2:5th.--Has become somewhat exhausted. 27th.-Has slept very little during the night; seems more apathetic, and takes less notice; complains but little; pulse 90,
feeble. 29th.-More exhausted; takes little
nourishment, and.that only occasionally. Brandy, twenty-four ounces. 30th.-Is evidently sinking; pulse feeble and fluttering; tongue dry. The symptoms gradually increased in severity, sank and died at half-past seven P. M. hours after death.-On opening the peritoneal cavity, no morbid appearance presented itself. The left kidney was soft and very much congested. In its pelvis) there was a deposit of lymph about the size of a pea. The
and he
finally
A2ttopV, forty-eight