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]
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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.

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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    passing into the aneurismal sac before mentioned, which lay in con- tact with the outside of the costal cartilages. Nearer the bifurcation there were three or four small points shghtly elevated, and of an opaque yellowish colour, as if the mucous mem- brane were stretched over some abnormal deposit. The cartilages of the two tracheal rings immediately behind the opening were entirely separated from their perichondrium at the part opposite the aneurismal sac. The abdominal viscera were congested as usual in asphyxiated per- sons, but had no other morbid appearance. The abdominal aorta was not so uneven internally as the thoracic, but presented more distinctly atheromatous opaque deposit in its inner membrane. The first question which suggests itself in connection with this case is, What was the cause of death ? On this point, I think, a consideration of the wdiole circumstances will leave no doubt that the patient died chiefly from laryngeal suffocation, induced by pres- sure of the sac on the recurrent nerve of the left side. The occur- rence of suJBFocation from this cause is too well attested by numerous cases of aneurism and tumours of the chest now on record, to admit of reasonable doubt. The evidence adduced by Dr Hugh Ley upon this subject in his work on laryngismus stridulus, although certainly insufficient to establish his exclusive theory of that disease, is strongly confirmatory of the correctness of the views entertained nearly two centuries ago by Willis as to this source of death in some intra-tho- racic tumours. The experiments of Legallois, and the far more ela- borate and satisfactory ones of Dr John Eeid, have demonstrated, in the most unquestionable manner, the production of laryngeal suffocation by various kinds of interference with the recurrent nerve on one or both sides of the neck. From the experiments we have detailed, says Dr Reid, it is apparent that severe dyspnoea, amounting to suffocation, may arise both from irritation and com- -4?ression of the inferior laryngeal nerves, or the trunks of the pneu- iT^ogastiics. For when both, or even one recurrent nerve, was irri- tated, tlie arytenoid cartilages were approximated, so as in some cases to shut completely the superior aperture of the glottis.^ Sec- tion of thv> yagij also, according to Dr J. Reid, produced sudden and violent atta^i^g of dyspnoea, which generally went off in the course of a very few mv^^^tes, when they did not terminate in suffocation; leaving, howevei, the animals liable to renewed paroxysms on the occasion of a violent struggle, or any exertion tending to hurry the respiration. It is uniiocessary to enter into the physiological details and principles connected \vith these curious results; it is sufficient for the present purpose to oWrve, that they fully explain the nume- rous cases recorded in pathological and practical works from the time of Bonetus, in which tumours nvolving these nerves (in the great ' Physiological, Anatomical, a\\cl Pathological Researches, \}. 120. See also pp. 167 and 272.