Licence: Public Domain Mark
Credit: The lancet. [Nos 316-317]. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![Aneurism of the Arteria Innominata. My first notes of this case were addressee! to Mr. War dr op, and though they contained views opposed to his own, * as to the then state of the aorta, he very candidly publish- ed them in your Journal, t In these notes, taken on the Ctli July, the day before the operation, I g ave an opinion, that there was true aneurism of the AORTA, as well as of the innominata, and that the case must ter- minate fatally, but, perhaps, at a very dis- tant period. The next time I had an opportunity of ex- amining the stale of Mrs. Denmark’s chest, was on the 18tli October. She had been seen in the interval by Mr. Chapman, whose opinions, as expressed by him to Mr. Law- rence, are quoted by Mr. Wardrop in his last report to you. f The following is a copy of the notes of my second examination :— 18th October 1827.—Mrs. Denmark just returned from the country ; certainly im- proved in appearance. She is rather fatter, with a little more colour in her lips, but still looks puffy and cachectic. The wound of the operation has been long healed. The TUMOUR caused by the protrusion of the sternal end of the right clavicle, lias DIS- APPEARED. The pulsation above this bone is now very little perceptible, but this clavicle appears higher on the root of the neck, than the left. The right carotid beats freely. Pulse at the left wrist strong, full, and difficult to be compressed. (96] Feels no pain of any hind, except when she ex- erts the right arm. Sleeps, eats, and digests well. Chest.—There is a tumour at the upper and middle portion of the sternum, appa- rently formed by the yielding forward of this hone. An obscure, deep pulsation is felt in it. Percussion affords a dull sound all over this tumour, and also over the sternal end of the right clavicle, where tenderness is still complained of. The stethoscope discovers a strong im- pulse, with a sharp sound, synchronous with the beat of the radial artery. No impulse is felt over the heart on the left side. Res- piration considerably more embarrassed than at any former examination. Dyspnoea in- * Lancet, No. 202. t Lancet, No. 208. I Lancet, No. 223, creased by exercise, or by eating flatulent food. /Diagnosis.—ANEURISM of the AORTA, in the COMMENCEMENT of its SECOND STAGE. * Iiemarhs.—The progress of the arterial dilatation emerging from the chest, being arrested by the ligature of the subclavian, the ASCENDING AND ARCHED AORTA is nOW expanding, and PRESSING AGAINST the STERNUM. The pressure against the bronchi, now considerable, will probably be relieved by the yielding, or erosion of this bone. In this case, though the pains have been relieved, and the brachio-cephalic trunk perhaps solidified, from the ligature to the giving off of the common carotid, the span of life has, in my opinion, been shortened. Had the dilatation been allowed to proceed along the subclavian, the tho- racic organs would have been left more room. Prognosis.—Death by the progressive ag- gravation of the present symptoms. Third examination.—On last Friday morn- ing, the husband of Mrs. Denmark called upon me, and requested me to see her, stating that she was very ill. I proceeded immediately to her lodgings, examined her carefully, and took the following notes : (Copy) Mrs. Denmark, 7th Dec., 1827. Most distressing dyspnoea, with loud rattle, exactly resembling that of dying people. Pulse 104, and full. Countenance anxious, pale, and puffy. Depression of her usual courage, expectoration of frothy spittle. Heart.—Heard with difficulty over the left precordial region. Percussion.—Souud natural, except where the sternum is elevated at its upper middle portion, towards the right side, and below the sternal end of the right clavicle. In these places there appears to be a solid body, or a bag of liquid with thickened wells underneath. The heart seems dis- placed by being pushed towards the upper * From Mr. Wardrop’s account of the dissection, published in our last number : “Aorta.—The only change to be perceived was, that the coats had a deeper tinge of yellow than natural, rather thicker, and had a few small points of ossification. The size of the artery natural,”—Lan- cet, page 790. '](https://iiif.wellcomecollection.org/image/b22371771_0087.jp2/full/800%2C/0/default.jpg)
