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ROYAL MEDICAL & CHIRURGICAL SOCIETY. TUESDAY, MAY 26TH, 1857.
TUMOUR OF THE NECK.
THIS was a growth of three years’ standing, in a woman aged about twenty-six years, with no great swelling, but otherwise inconvenient and likely to increase if left alone, situated in the right snb-maxillary region, but extending towards the parotideztu. It was removed whilst the patient was under the influence of amylene, by Mr. Fergusson, at King’s College Hospital, on the 16th of May, and found to consist of several enlarged glands. Much care was necessary in this situation, especially as the upper part of the external jugular vein passed
the tumour. As it was, a small branch of the sub-maxilary artery was divided. The boy from whom Mr. Erichsen, at University College Hospital, removed several large glands in the same region, made a good recovery without an untoward symptom; and we may anticipate the same in the above case, as matters are at present progressing favourably. Mr. Erichsen’s case is referred to at page 425. On the 23rd of May a parotidean tumour was removed by Mr. Paget from a young man, which was composed of glandular tissue; it was the size of a small orange. The chief point of interest in these cases is the (lepth at which the tumours lie. near
Medical Societies. ROYAL MEDICAL & CHIRURGICAL SOCIETY. TUESDAY, MAY 26TH, 1857. SIR C. LOCOCK, BART., PRESIDENT, IN THE CHAIR.
the heart fell together like a flabby membranous mass, having no trace of firmness in its texture. The right auricle occupied that portion of the chest, beneath the parietes, where the pulsation was felt; hence the pulsation, the thrill, and the bruit, Both auricles took their origin within the right auricle. were greatly dilated, especially the left, which measured sixteen inches in its widest circumference. The auricles also were reduced to the condition of mere membranous bags, nomuscular tissue being perceptible in them, except in the appendix of the right. The right ventricle was dilated and hypertrophied; the left ventricle somewhat dilated; and the muscular tissue of both ventricles was in an advanced stage of’ fatty degeneration. The tricuspid opening was enlarged, but its valves were also enlarged and capable. The mitral opening was contracted into a hard narrow slit, about one inch long;, the mitral valves being contracted, thickened, and united. The, ’, aortic valves were thickened, but capable. Remarks. -Such a pathological specimen rarely falls under the observation of the physician. That such deviations from a, healthy condition of the heart are, for a long period, compatible with existence, is an interesting fact. The patient, it should be remarked, had both the means and strength of mind sunicient to subject himself to a rigid discipline in diet and exercise, experience having taught him that great suffering resulted from the slightest deviation from the rules prescribed for his guidance. In physical diagnosis, Dr. Markham points out, that the case presents some special points of interest. It demonstrates, that a pulsation felt low in the right thorax, an inch and a half from the right edge of the sternum, may be cardiac, even though the heart be felt at the same time pulsating in the left thoracic region. Again, a heaving pulsation in this latter region does not always indicate hypertrophy of the left : ventricle, for here it was nearly normal in size. The thrill, bruit,, and pulsation arising in the right auricle are strange phenomena. How were they caused ? They occurred duringthe auricular diastole, and probably had, all three, a likeorigin. It does not seem probable that they were produced by tricuspid regurgitation, for the tricuspid valves were large and sound, and the bruit, rough and loud, was not of the soft bellows-blowing kind. Thrill, again, over the right auricle, our best authors tell us, associated with tricuspid regurgitation, is unknown to them. These phenomena, then, may perhaps have had their origin in the rush of blood into the auricle from the venae cavæ-a source of cardiac bruit not recognised in auscultation. The absence of muscular structure in the auricles. proves that the force of the venous current is of itself sufficient. to carry the blood on into the ventricles, unaided by any auricular contractions; and even when, as in this case, the circulation is impeded bya contracted mitral orifice. This case is. very interesting, as showing the extraordinary degree of deviation, from its healthy state, of the heart, with which a longlife is compatible, under certain conditions. It presents, in physical diagnosis, certain unwonted phenomena, little in unison with ordinary experience. It gives us a hint respecting the physiological action of the auricles; and it points out the value of medical art, in prolonging existence, when serious organic change has fallen upon a vital organ. (To be continued.) "
*
A CASE OF DISEASE OF THE HEART, WITH GREAT DILATATION OF THE AURICLES. BY W. 0.
F.R.C.P. MAARY’S HOSPITAL.
MARKHAM, M.D.,
ASSISTANT - PHYSICIAN
TO
ST.
THE subject of the following history came under the observation of the author three days before his death. He was
sixty-nine years of age, and had been subject to cough for forty years. Twenty-six years ago he suffered from dropsy, and his life even was despaired of, on account of the extent of the
dropsical effusions. Fifteen years ago he was told that the dropsy, the s’pasms, the short breath and palpitations from
which he suffered
were
the consequences of disease of the
heart. These particulars showed that for about thirty years the patient had been the subject of organic disease of the heart. Of late years the symptoms of heart disease had in-
creased ;
exertion of any kind
attacks.
was
very
diilicult, and brought
seen by Dr. Markham the last agony was manifestly near at hand. He could not lie down in bed; his breathing was laboured; his pulse rapid and irregular. The scrotum and legs were distended with serum. The heart was felt beating with an extensive heaving impulse in the left lateral thoracic region, and also over the precordial region; the percussion sound over this region was extensively dull. At a point about one inch and a half from the right edge of the sternum, and in the fifth intercostal space, a pulsation, synchronous with the ventricular systole, was visible over a space of about three-quarters of an inch; it communicated a strong thrill to, and forcibly raised, the finger. The stethoscope transmitted a loud bruit when placed over it. It was evident that the heart was much enlarged, andthat there was extensive valvular disease in this case. But what occasioned the pulsation here described ? The thrill and the bruit naturally suggested the idea of an aneurism; but how could an aneurism exist at such a part, and apparently without any connexion with the heart or its great vessels ? On the other hand, that the pulsation had no origin from the heart itself seemed indicated by the fact that the organ was felt beating in the left lateral region of the thorax. It was scarcely conceivable, indeed, under such circumstances, that any portion of the heart could occasion a pulsation so far away to the right edge of the sternum. Necropsy.- On opening the thorax, the pericardium was found so distended as to reach across the chest, almost from side to side; its horizontal contrasted remarkably with its vertical diameter, and could not have been less than eleven or twelve inches. This enormous dilatation was caused by the dilated heart, and particularly by its auricles. On removing the organ, about three pints of blood, fluid and coagulated, escaped from it cavities. When the blood was wholly removed
on severe
spasmodic
When first
PATHOLOGICAL SOCIETY OF LONDON. DR. -
WATSON, PRESIDENT,
.MR. SYDNEY dorrES exhibited
a
IN THE
CHAIR.
specimen of
OBLITERATION OF THE THORACIC
ACRTA, which had been taken by him from the dissecting-room at St. Thomas’s Hospital about eighteen months ago. The subject had been supplied from a workhouse. It was a male, aged about forty-five. No history could be obtained of the illness that caused his death. His lungs, however, bore traces of mischief, and it was ascertained that a short time prior to his death he had been under treatment at Guy’s Hospital for somebronchial disease. The obliteration was situated at the commencement of the descending thoracic aorta, just below the’ junction of the ductus arteriosus with the termination of the arch. In the dried state, it seemed as if merely a constriction of the vessel existed; but in the recent state, the obliteration was seen to be complete, a ligamentous cord, about half an inch in length, uniting the two ends of the vessel. The artery contained a quantity of atheromatous deposit, just above the obliteration; at this point involving nearly the whole circumference of the vessel. The three trunks given off from the arch,
581
THIS was a growth of three years’ standing, in a woman aged about twenty-six years, with no great swelling, but otherwise inconvenient and likely to increase if left alone, situated in the right snb-maxillary region, but extending towards the parotideztu. It was removed whilst the patient was under the influence of amylene, by Mr. Fergusson, at King’s College Hospital, on the 16th of May, and found to consist of several enlarged glands. Much care was necessary in this situation, especially as the upper part of the external jugular vein passed
the tumour. As it was, a small branch of the sub-maxilary artery was divided. The boy from whom Mr. Erichsen, at University College Hospital, removed several large glands in the same region, made a good recovery without an untoward symptom; and we may anticipate the same in the above case, as matters are at present progressing favourably. Mr. Erichsen’s case is referred to at page 425. On the 23rd of May a parotidean tumour was removed by Mr. Paget from a young man, which was composed of glandular tissue; it was the size of a small orange. The chief point of interest in these cases is the (lepth at which the tumours lie. near
Medical Societies. ROYAL MEDICAL & CHIRURGICAL SOCIETY. TUESDAY, MAY 26TH, 1857. SIR C. LOCOCK, BART., PRESIDENT, IN THE CHAIR.
the heart fell together like a flabby membranous mass, having no trace of firmness in its texture. The right auricle occupied that portion of the chest, beneath the parietes, where the pulsation was felt; hence the pulsation, the thrill, and the bruit, Both auricles took their origin within the right auricle. were greatly dilated, especially the left, which measured sixteen inches in its widest circumference. The auricles also were reduced to the condition of mere membranous bags, nomuscular tissue being perceptible in them, except in the appendix of the right. The right ventricle was dilated and hypertrophied; the left ventricle somewhat dilated; and the muscular tissue of both ventricles was in an advanced stage of’ fatty degeneration. The tricuspid opening was enlarged, but its valves were also enlarged and capable. The mitral opening was contracted into a hard narrow slit, about one inch long;, the mitral valves being contracted, thickened, and united. The, ’, aortic valves were thickened, but capable. Remarks. -Such a pathological specimen rarely falls under the observation of the physician. That such deviations from a, healthy condition of the heart are, for a long period, compatible with existence, is an interesting fact. The patient, it should be remarked, had both the means and strength of mind sunicient to subject himself to a rigid discipline in diet and exercise, experience having taught him that great suffering resulted from the slightest deviation from the rules prescribed for his guidance. In physical diagnosis, Dr. Markham points out, that the case presents some special points of interest. It demonstrates, that a pulsation felt low in the right thorax, an inch and a half from the right edge of the sternum, may be cardiac, even though the heart be felt at the same time pulsating in the left thoracic region. Again, a heaving pulsation in this latter region does not always indicate hypertrophy of the left : ventricle, for here it was nearly normal in size. The thrill, bruit,, and pulsation arising in the right auricle are strange phenomena. How were they caused ? They occurred duringthe auricular diastole, and probably had, all three, a likeorigin. It does not seem probable that they were produced by tricuspid regurgitation, for the tricuspid valves were large and sound, and the bruit, rough and loud, was not of the soft bellows-blowing kind. Thrill, again, over the right auricle, our best authors tell us, associated with tricuspid regurgitation, is unknown to them. These phenomena, then, may perhaps have had their origin in the rush of blood into the auricle from the venae cavæ-a source of cardiac bruit not recognised in auscultation. The absence of muscular structure in the auricles. proves that the force of the venous current is of itself sufficient. to carry the blood on into the ventricles, unaided by any auricular contractions; and even when, as in this case, the circulation is impeded bya contracted mitral orifice. This case is. very interesting, as showing the extraordinary degree of deviation, from its healthy state, of the heart, with which a longlife is compatible, under certain conditions. It presents, in physical diagnosis, certain unwonted phenomena, little in unison with ordinary experience. It gives us a hint respecting the physiological action of the auricles; and it points out the value of medical art, in prolonging existence, when serious organic change has fallen upon a vital organ. (To be continued.) "
*
A CASE OF DISEASE OF THE HEART, WITH GREAT DILATATION OF THE AURICLES. BY W. 0.
F.R.C.P. MAARY’S HOSPITAL.
MARKHAM, M.D.,
ASSISTANT - PHYSICIAN
TO
ST.
THE subject of the following history came under the observation of the author three days before his death. He was
sixty-nine years of age, and had been subject to cough for forty years. Twenty-six years ago he suffered from dropsy, and his life even was despaired of, on account of the extent of the
dropsical effusions. Fifteen years ago he was told that the dropsy, the s’pasms, the short breath and palpitations from
which he suffered
were
the consequences of disease of the
heart. These particulars showed that for about thirty years the patient had been the subject of organic disease of the heart. Of late years the symptoms of heart disease had in-
creased ;
exertion of any kind
attacks.
was
very
diilicult, and brought
seen by Dr. Markham the last agony was manifestly near at hand. He could not lie down in bed; his breathing was laboured; his pulse rapid and irregular. The scrotum and legs were distended with serum. The heart was felt beating with an extensive heaving impulse in the left lateral thoracic region, and also over the precordial region; the percussion sound over this region was extensively dull. At a point about one inch and a half from the right edge of the sternum, and in the fifth intercostal space, a pulsation, synchronous with the ventricular systole, was visible over a space of about three-quarters of an inch; it communicated a strong thrill to, and forcibly raised, the finger. The stethoscope transmitted a loud bruit when placed over it. It was evident that the heart was much enlarged, andthat there was extensive valvular disease in this case. But what occasioned the pulsation here described ? The thrill and the bruit naturally suggested the idea of an aneurism; but how could an aneurism exist at such a part, and apparently without any connexion with the heart or its great vessels ? On the other hand, that the pulsation had no origin from the heart itself seemed indicated by the fact that the organ was felt beating in the left lateral region of the thorax. It was scarcely conceivable, indeed, under such circumstances, that any portion of the heart could occasion a pulsation so far away to the right edge of the sternum. Necropsy.- On opening the thorax, the pericardium was found so distended as to reach across the chest, almost from side to side; its horizontal contrasted remarkably with its vertical diameter, and could not have been less than eleven or twelve inches. This enormous dilatation was caused by the dilated heart, and particularly by its auricles. On removing the organ, about three pints of blood, fluid and coagulated, escaped from it cavities. When the blood was wholly removed
on severe
spasmodic
When first
PATHOLOGICAL SOCIETY OF LONDON. DR. -
WATSON, PRESIDENT,
.MR. SYDNEY dorrES exhibited
a
IN THE
CHAIR.
specimen of
OBLITERATION OF THE THORACIC
ACRTA, which had been taken by him from the dissecting-room at St. Thomas’s Hospital about eighteen months ago. The subject had been supplied from a workhouse. It was a male, aged about forty-five. No history could be obtained of the illness that caused his death. His lungs, however, bore traces of mischief, and it was ascertained that a short time prior to his death he had been under treatment at Guy’s Hospital for somebronchial disease. The obliteration was situated at the commencement of the descending thoracic aorta, just below the’ junction of the ductus arteriosus with the termination of the arch. In the dried state, it seemed as if merely a constriction of the vessel existed; but in the recent state, the obliteration was seen to be complete, a ligamentous cord, about half an inch in length, uniting the two ends of the vessel. The artery contained a quantity of atheromatous deposit, just above the obliteration; at this point involving nearly the whole circumference of the vessel. The three trunks given off from the arch,
581