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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    doubtless the cause of the persistently obstructed expiration during the last fortnight, and to it I ascribe her usual posture,—stooping- forward in bed. The peculiar angina might be connected with the disease of the aorta; but in some cases of dilated hypertrophy of the heart there is an anguish for which we have no other name. It is unnecessary to insist that, in this case, and in many such, not the aneurism, but the valvular disease, with its consecutive hypertrophy and dilatation of the heart, was the source of the obstructed circulation that characterized the case in its leading symptoms and mode of death. Cases have come under my notice which lead me to think that consecutive hypertrophy and dilatation of the heart are more apt to occur in conjunction with dilatation of the aorta (that is, uniform or peripheral aneurism) than in cases of saccular aneurism. It will appear in the sequel that this inquiry involves different questions which have an intimate connexion. There is the question of the capability of the dilated state of the aorta to act mechanically or otherwise on the muscular substance of the heart; and there is that of the relation of the disease of the general arterial system to disease of the aorta and the muscular substance of the heart. The following case illustrates very well the relation of hyper¬ trophy of the heart to disease of the arteries and apoplexy. I take the case as an average specimen of a large class; and though there is difficulty in determining the sequence of the principal lesions, the class of cases affords good ground on which to rest this inquiry. The case presents features of interest in other respects, to which I shall have occasion hereafter to refer. Case II.—Hypertrophy of the Heart; Dilatation of the Aorta; Disease of the Arterial Coats ; Bronchitis; Cerebral Apoplexy. Walter Dairsie, set. 50, a saddler ; admitted under my care in the Royal Infirmary, 11th January 1848. A robust man of short stature, and temperate. He applied for advice on account of dyspnoea ; sense of oppression of the chest; cough, and increasing weakness. Ilis breathing was slightly laboured, and wheezing in expiration. He had no pain. History.—He had been attacked eight months previously with acute chest symptoms after exposure. On recovery, he suffered little for about six months; but then he felt unable for work owing to dyspnoea and debility. He had had an attack of acute rheumatism many years before, but regained perfect health. Physical Signs.—The prsecordial dulness extended from the third left rib, and from the right margin of the sternum five inches in vertical as well as trans¬ verse diameter. The upper part of the sternum was dull on percussion. The impulse of the heart was increased in force, and, at the top of the sternum, there was perceptible a sense of the flap corresponding to the second sound of the heart. The apex cordis beat in the fifth intercostal space nearly five inches to the left of the mesial line. The heart-sounds were free from murmur; the second was intensified, and had a hollow ringing tone most marked over the course of the aorta. The sternal end of the right clavicle pulsated synchronously with the ventricular systole ; the arterial pulse was visible—60 in the minute. The murmur of respiration was mingled with copious purring mucous rattle in the dorsal regions. Progress and Treatment.—He was discharged from hospital, and re-admitted again and again; and took little care of himself when out.