Case of thoracic aneurism - death - autopsy : remarks on the treatment of internal aneurism / by Henry I. Bowditch, M.D.

  • Bowditch, Henry I. (Henry Ingersoll), 1808-1892.
Date:
[1866], [©1866]
Catalogue details

Licence: Public Domain Mark

Credit: Case of thoracic aneurism - death - autopsy : remarks on the treatment of internal aneurism / by Henry I. Bowditch, M.D. Source: Wellcome Collection.

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

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    L'iver softened. Kidneys soft and flaccid, and under the microscope showed fatty degeneration. The heart was normal, but an aneurism, about two inches in diameter, arose at the back of the arch of the aorta. It had pressed upon the left primary bronchus and caused a thinning of its walls for a space of one and n half or two inches, and in one part a rupture had taken place through a small aperture. The inferior laryngeal nerve was flattened out and nearly lost in the wall of the tumor. Neither of the vessels springing from the arch was obstructed. The aorta throughout its course was atheromatous, and a small aneurism, just commencing, about the size of the top of the thumb, was found a little above the origin of the vessel. A few remarks may be made on the above. The fluid in the chest must have increased during the fortnight after I saw him, for if three pints had existed at my examination the heart would not have been to the left side, but would have been dislocated toward the right, and greater dulness would have been found in the left back. The tubercles at the apex of the right lung, though not suspected from the account the patient gave of his previous life, explained the dulness and absence of respiration under the right clavicle. I suppose that the dulness in the left breast must be explained by the condensation of the lung, owing, perhaps, to the pressure on the bronchial tube leading to it, as Dr. Ellis has described such results to occur in certain cases of aneurism.^ It made the aneurism appear vefy large, whereas it was comparatively small. Only after his death did I have an opportunity of seeing Dr. Tuff- nell's pamphlet, which proposes the revival, with modifications, of Valsalva's method of treatment in cases of internal aneurism. Dr. Tuffnell's pamphlet is entitled The Successful Treatment of Inter- nal Aneurism, illustrated by Cases in Hospital and Private Prac- tice.t I intend to make use of the facts contained in it. I shall present some views of treatment different, in a measure, from those of Valsalva and Tuffnell, while at the same time I shall depend upon both of them for my own suggestions. I think it best, therefore, as introductory to the remarks, to refer to the history of this treatment of internal aneurism. Somewhat more than a century and a half ago, Albertini and Val- salva, professors in the famous and ancient University of Bologna, revolving together one of the directions of Hippocrates for the pro- per way of curing varices—viz., by drawing blood from them and using a dry diet—determined to try that treatment in the cure of inter- nal aneurism. Accordingly, adopting what we must suppose, at least, to have been another precept of Hippocrates—viz., quietness of body during the attempt at cure—they agreed to put all their patients suf- fering from internal aneurism under the three following rules :—1st. Repeated venesection. 2d. A peculiar and very restricted diet. 3d. * See Boston Medical and Surgical Journal, Dec. 4, 1856 ; Nov. 2, 1861. t By Jolliffe Tuffnell, F.R.C.S., M.R.I.A. Churcliill, 1864.