Intrathoracic aneurysm / by F. de Havilland Hall.

  • Hall, Francis de Havilland.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Intrathoracic aneurysm / by F. de Havilland Hall. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    33/98 (page 29)
    LECTURE II. Delivered on March Uth. ' Mr. President, Felloavs, and Gentlemen,—The con- dition of the radial pulses may afiEord suggestive information as to the presence of an inti'athoracic aneurysm. The variations met with in the pulse are: (1) complete absence of one radial pulse ; (2) inequality of the two radial pulses in volume, as felt by the finger or demonstrated by the sphygmomanometer ; (3) difference in the character of the sphygmograms ; and (4) delay in pulse at one or other wrist. In spite of the complete absence of the pulse the hand may be quite warm, showing that the blood flows into it as before. The failure of the ptilse may be due to disease at the mouth of a vessel arising from the arch ; pressure on the subclavian artery by the aneurysmal sac ; blocking of the artery by a clot; or lastly, to the effect of the cardiac systole being lost as the blood passes through the sao.. much in the way in which the second bag of a spray apparatus causes the intermittent action of the first bag to become con- • tinuous. In a patient of mine at the Westminster Hospital, at one period of his illness, there was entire absence of the pulse in the arteries of the left arm. Towards the end of the case, however, a feeble pulse was felt in the left radial, due, I believe, to the fact that as fibrin was deposited in the sac, the wall became more rigid, so that the impul.'^e pro- duced by the ventricular systole was not dissipated in the sac, but acted on the blood. If the innominate artery be involved in the aneurysm, the right pulse would be affected and become small oi- imper- ceptible ; if the left subclavian artery, as in aneurysm of the transverse arch, then, of course, it would be the left pulse. But this is not invariable, so that when there is a difference