Case of aneurism of the aorta arising from the back part of the arch, simulating laryngeal disease, and fatal by suffocation / by W.T. Gairdner.

  • Gairdner, W. T. (William Tennant), Sir, 1824-1907.
Date:
[1851]
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the aorta arising from the back part of the arch, simulating laryngeal disease, and fatal by suffocation / by W.T. Gairdner. Source: Wellcome Collection.

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    was considerably more tinged with blood than that expectorated at any period during his fatal illness. But it is very doubtful whether this increased hemorrhage was from the sac; as I am told that a good deal of blood was drawn into the trachea during the operation. At all events, it is clear that hemorrhage was not connected with the fatal event, nor did it ever form a serious complication,—never amounting to more than was sufficient to give a purplish, and often only a rusty tinge to the expectoration. With this absence of material hemorrhage, it is important to ask, hoiv long the communication of the sac with the trachea had existed before death ? The lungs having presented no symptom of disease, and being found after death free of all serious lesion, it is difficult to suppose that even the small quantity of blood in the sputa had any other source than the aneurism ; and yet we have evidence that, if this be so, the opening must have continued for months, yielding only these small quantities, as the patient distinctly stated that he had at no time coughed up clots of blood. When we consider the nearly com¬ plete occlusion of the sac by coagula, this phenomenon will appear less difficult to understand; at all events, it is far from rare in the histories of aneurisms opening on mucous surfaces, and especially into the air-passages, to find, even after one serious hemorrhage has given evidence of a rupture of the sac, that the hemorrhage reduces itself to a very trifling amount, and sometimes is altogether sus¬ pended. The case of Mr Liston at once suggests itself as an illus¬ tration of this fact. In the only record published of the fatal illness of this distinguished member of our profession, it appears that the first hemorrhage was followed by a period of exemption from symp¬ toms, and that when these recurred, it was in the form of a cough attended with expectoration, which was “ difficult, small in quantity, and of a rusty colour;” no further material hemorrhage occurring till his death, which was from orthopnoea.1 In the remarkable case of abdominal aneurism which I read to the Society last year,2 it is more difficult, owing to the situation of the first opening into the duo¬ denum, to judge of the amount of blood that may at different times have been ejected, and it is highly probable that some bleedings may have taken place unobserved; but it seems in every way prob¬ able that no considerable hemorrhage occurred during twenty-two months, from an aperture which had evacuated gallons of blood in a few days, and which was found very nearly, if not entirely, sealed up after death. Could the aneurism have been discovered during life ? On this point we have the following data;—no dull percussion, abnormal pulsation, or tremor at the upper sternum; no abnormal sound over the heart and great vessels in front or behind; normal and symmetri¬ cal percussion over the lungs in every part; no abnormal respira¬ tory sound over the trachea in front or at the root of the lung be- 1 Lancet, December lltli, 1847. 2 Aneurism of the Superior Mesenteric artery opening into the duodenum, twenty-two months before death.—Mbnthlj/ Journal, vol. x. 1850, p. 83.