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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    In March he was attacked suddenly with vertigo, incomplete insensibility, and imperfect paralysis of the left limbs and right side of the face. He was bled to 30 oz., and he revived shortly. At this date, a murmur was recognised with the first sound of the heart along the course of the aorta. He rallied for a time from this attack, but soon lapsed into a state of lethargic imbecility and gradually lost ground. He had a good deal of cough, with expectoration. He became subject to paroxysms of dyspnoea, chiefly at night, which gradually became more frequent. Latterly, dyspnoea became permanent, not urgent; and slight oedema occurred. During the earlier paroxysms he was repeatedly cupped with relief; mid tartar emetic was well borne. The impulse at the top of the sternum never increased; and the first-sound murmur was at times wanting. Post-mortem Examination.—The volume of flesh was small. There was slight oedema of the right arm. The heart was bulky, firm, well formed and con¬ tracted ; it weighed 27 oz. The valves were normal. The endocardium of the left ventricle presented a few atheromatous patches. The aorta was roughened internally by atheroma; and it had a diffused pouch-like dilatation at the com¬ mencement of the ascending arch, in the convexity. The circumference measured 4i inches. Hypertrophy was less apparent in the right ventricle than in the left. Both pleurae were partially adherent, and contained a little serum: the right was coated with recent lymph. Lungs gorged. The arteries of the brain were rigid, calcareous. The lateral ventricles con¬ tained two ounces of limpid serum. In the right optic thalamus, there was an old cyst, containing a dark-coloured areolar tissue. The liver and kidneys were healthy. Such cases as this are met with very frequently; and I fancy that the usual explanation of them is, that the aneurism or dilatation of the aorta is the effect of the hypertrophy of the heart. I shall not disturb this view of the case; but it leaves altogether out of view considerations of great interest, which tend to throw additional light on the mutual relations of aneurism and disease of the heart. This case, and innumerable others of the same description, illus¬ trate the twofold reference of cerebral apoplexy to disease of the arteries and to hypertrophy of the heart. I do not think it is necessary to maintain, with Rokitansky, that u the occurrence of haemorrhage in the brain is entirely mechanical,” or that u all the predisposing causes are mechanical; ” but it will be found in a large proportion of cases of apoplexy in which disease of the cere¬ bral arteries exists, that there is also hypertrophy of the left ventricle, and, though their co-existence should prove less frequent than I think it is, still an important and a practical question arises, viz.:—What the mutual relation of the two lesions is. Now, if it can be made out that the arteries of the system at all generally partake in the altered state so often presented by the cerebral arteries in conjunction with hypertrophy of the heart, then it appears to me that an important point is gained in explaining the relations and pathology of hypertrophy, with reference especially to the mutual relation of arterial aneurisms and disease of the heart. I am not aware of any observations that conclusively prove one way or other the state of the systemic arteries in such cases ; but there is a proof in the state of the arterial pulse which will aid us in the inquiry. The importance of a visible state of the arterial pulse as a sign of hypertrophy of the left ventricle was pointed out by