Substernal aneurism : cases and observations on its diagnosis, and relation to disease of the heart / by A. Halliday Douglas.

  • Douglas, A. Halliday (Andrew Halliday), 1819-1908.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: Substernal aneurism : cases and observations on its diagnosis, and relation to disease of the heart / by A. Halliday Douglas. Source: Wellcome Collection.

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    production that the left ventricle should be in a state of hyper¬ trophy. Perhaps one of the most remarkable illustrations of this is to be found in a case recorded by Dr Law of Dublin.1 The arch of the aorta was dilated to three times its natural cir¬ cumference, and the coats of this artery and those of the great vessels arising from it were converted into an osseous tube. The orifice of a large aneurismal sac existed at the commencement of the descending aorta. The heart was of the natural dimensions, and it was not displaced. It is not to be concealed that there are peculiar difficulties con¬ nected with the demonstration of this subject. The difficulties, too, are increased by the limited number of completed observations which individual physicians have the opportunity of making and recording; and from the difficulty of giving such descriptions of morbid conditions, which cannot be very precisely defined, as to render our observations available to other writers: this is true especially in regard to hypertrophy and dilatation of the heart in their relations and combined proportions. It is not more evident than it is intelligible that, in a great pro¬ portion of cases of aneurism of the aorta, there is no tendency to the production of any disease of the heart, and its occurrence is truly accidental. We have seen that even in instances of peri¬ pheral dilatation this is the case, owing, I believe, to localization of the disease of the artery. And, no doubt, it is for the same reason that, in saccular aneurisms, the heart usually preserves its normal condition, and hypertrophy and dilatation are unlikely to arise, unless there be disease of the valves of the heart, or co¬ existing and extensive disease of the arteries. Moreover, it appears that cases now on record prove beyond dis¬ pute that saccular aneurisms of the ascending aorta, even though they should be close to the heart, do not involve disease of the heart as a necessary consequence. It is scarcely necessary to quote cases illustrative of this view; but I prefer narrating cases already published to giving observations of my own. Dr F. Dobinson communicated to the Pathological Society of London2 the case of a soldier, get. 49, in whom the heart was small. The valves were competent, but the aorta and its semilunar valves were atheromatous, and the coats of the artery were thickened. A saccular aneurism, which burst into the trachea, existed in the ascending aorta; the orifice of the aneurism presented a valve-like and abrupt fold of the coats of the artery. Dr Crisp, in his appendix,3 narrates the case of Mrs Walworth, set. 40, whose case was supposed to be one of tubercular disease. She had frequent haemoptysis, and suddenly she died after profuse bleeding from the mouth. The right lung adhered, and was carni- fied throughout. The heart was small, and the valves healthy. A saccular aneurism, as large as the fist, existed to the right side of the ascending aorta; its orifice was about one inch and a quarter 1 Dublin Journal, 1842, Yol. 21. 2 October 15, 1862. 3 Treatise, p. 392.