Practical medicine and medical diagnosis / by Byrom Bramwell.

  • Bramwell, Byrom, Sir, 1847-1931.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Practical medicine and medical diagnosis / by Byrom Bramwell. Source: Wellcome Collection.

    18/164 (page 10)
    thing abnormal by pliysical examination, I pooli-poolied his complaints, and gave it as my opinion that there was nothing seriously the matter witli' him; soon afterwards he died suddenly, and on making a post-morievi examination I found an aneurism of the descending thoracic aorta. It had ruptured into the left pleural cavity, causing instantaneous death. But while anxious to impress you with the fact that due weight should always be given to the symptoms, unless there is some strong reason to the contrary, I must not lead you to suppose that grave symptoms are necessarily present in every serious case; indeed, it occasionally happens that patients die who have manifested no symp- toms, and made no complaints. Absence of symptoms in the presence of serious organic disease is seen more frequently in chronic than acute affections. In this case, for example (fig. 1), in which a small aneurism springing from the base of the aorta, just above the valves has ruptured into the pericardial sac, there were no symptoms during life. The patient was a butcher, who died suddenly in the street. During life he had presented all the appearances of robust and vigorous health; and so far as could be ascertained from his friends, had never made any complaint. Occasionally, but more rarely, we see the same thing in acute affec- tions. The preparation, which I now show you, is a striking illustration of this fact:—A girl, ?et 17, who had previously enjoyed good health, but who had never menstruated, complained of uneasiness in the upper part of the abdomen, and of constipation. The tongue was slightly furred, the pulse a little quick, the bowels had not been relieved for a week, but there was nothing to direct attention to any serious disease within the chest. A dose of castor oil was prescribed. A few days after, I was suddenly summoned to the case, and found the patient dead. She had passed a somewhat restless night, but had got up to breakfast as usual; had suddenly complained of feeling faint, and had fallen back dead. AU the organs were healthy with the exception of the heart. The pericardium was distended with turbid fluid, and both surfaces— the parietal and visceral layers of the sac—are, you will see, coated witli recent lymph (fig. 2, p. 12). The case was one of pericarditis; syncope the cause of death. On inquiry I ascertained that she had waded in the sea a fortnight previously, and for some days afterwards had been a little hoarse. There was no history of rheumatism. So trivial were the symptoms in this severe and acute case, that the patient was able to go about her work, that of a baker's assistant, until two days previous to her death. The case is a very interesting one, being an example of a rare disease—latent pericarditis, whicli was apparently idiopaMc.