Case of mixed aneurism of aortic arch, simulating aneurism of left carotid, with remarks / by James G. Wilson.

  • Wilson, James G.
Date:
1855
Catalogue details

Licence: Public Domain Mark

Credit: Case of mixed aneurism of aortic arch, simulating aneurism of left carotid, with remarks / by James G. Wilson. 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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    a success warranting further trials, should in this case be had recourse to, as affording the patient the only chance of escape from a diseased condition of an artery which evidently would soon put a period to his existence. The attempt to produce coa- gulation of the contents of the sac by galvano-puncture was talked of, but was not recommended by any one. The danger and importance of the proposed operation having been duly explained to the patient, he expressed his willingness to submit to any sur- gical procedure which might be productive of any relief. 1 Qth.—Patient having been previously prepared for the ope- ration, with the shoulders elevated, head thrown back, and face inclined to right side, was placed under the influence of chlo- roform. Mr. Watt commenced by making an incision, about a couple of inches in extent, along the tracheal margin of the sterno-mastoid muscle. The platysma, cervical fasciae, and cel- lular tissue were successively divided, and the vessel exposed by careful dissection, with a silver knife and the finger nail. On opening the sheath, the vessel seemed sound, and of natural size. An aneurismal needle, armed with a strong ligature, was intro- duced and passed below the artery from without inwards, just as it emerged from under the omo-hyoid muscle. The ligature happening to break near the vessel on tying the knot, and as suf- ficient reliance could not be placed on it, a second was applied immediately above. The jugular vein did not call lor any special interference, and the different nerves were easily avoided. Little or no blood was lost. The wound was united by stitches, a few strips of adhesive plaster applied, and covered by soft dressings. At 4, p.m. (two hours after the operation), patient declared himself free from pain or uneasy sensation about the head, wound, or tumour, and the size and pulsations of the latter were not sensibly altered. Pulse 112, soft and compressible. At 8, p.m., patient still felt very comfortable, but complained of a slight pain over forehead and both temples, and the left pupil was found more dilated than the right. Pulse 100. Not having slept well the previous night, and not feeling now any disposition to sleep, he was ordered an anodyne draught at bed- time. 17th.—Slept well during the night; headache gone, as also dilatation of left pupil. The size of tumour rather increased, but its pulsations in the distal portion diminished in force. No abnormal sound detected in tumour or chest. Pulse 90, and of moderate strength. 18th.—Is easy and free from pain. The skin over the tumour has begun to assume a yellowish tinge, approaching in appear- ance to that frequently observed in scrofulous abscesses of glands, and the swelling when pressed upon conveys to the finger an ob- scure feeling of fluctuation, similar to that which is found in these abscesses.