Notes on cases of tumour in the mediastinum / by E. Symes Thompson.

  • Symes-Thompson, Edmund, 1837-1906.
Date:
[1865]
Catalogue details

Licence: Public Domain Mark

Credit: Notes on cases of tumour in the mediastinum / by E. Symes Thompson. 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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    with paregoric to quiet the cough. The aching at the shoulder ] lessened, the tumour became less prominent, and after three 1 weeks the patient returned to work, though he had much cough I and dyspnoea, with occasional difficulty of swallowing and san- i guinolent expectoration. In January, 1859 (three weeks afterwards), the superficial epigastric and infra-mammary veins were very large, tortuous,! and freely inosculating. No pulsation was appreciable in the I tumour, but an impidse was to be felt through it, and the two | sounds of the heart were to be heard with the stethoscope. The 1 dulness on percussion extended from the sternal notch three 1 inches in a vertical and three in a transverse direction. Breath I sounds almost equal in the two lungs. Bight radial pulse I slightly stronger than left; apex of the heart beating three I inches below the nipple, between the seventh and eighth ribs. About a month afterwards, this patient was admitted into ] another metropolitan hospital, where, in the absence of history, I the case was very naturally regarded as one of mediastinal tumour, probably cancerous. There can, however, I think, he ! little doubt that it was really an aneurism of the thoracic aorta ; undergoing spontaneous cure. I cannot leave this case -without remarking that rest in bed, so as to avoid all exertion, with simple unstimulating food, is followed not unftequently by marked improvement in cases of aneurism, and that our prognosis should not be invariably hopeless. Most of us have met with one or two instances in which undoubted aneurisms have ceased to extend, and then gradually undergone contraction, and tins without any very special medication. Lymph is poured out by the aneurismal.. sac; and if, from the quietness of the circulation, it has once an opportunity of becoming fully organized, it may withstand ; the full expansile influence of the blood-current. In September, 1863, a patient died in the Brompton Hospi- tal, thought to have a tumour in the mediastinum of a cancerous • character. Paroxysms of dyspnoea occurred on exertion, and ‘ there was rhonchus all over the chest, with a loud clanging; cough. The heart sounds were feeble, and there was no murmur, I pulsation, dulness, or dysphagia, nor any history ol rheumatism or of a blow on the chest. The autopsy showed an enormous dilatation of the arch of the aorta pressing against the sternum, trachea, and recurrent laryngeal nerves. The lungs were emphyse- ; matous at the edges. _ _ . ,,, A case the exact converse of this is detailed in Dr. Fullers work “ On Diseases of the Heart and Large \ essels,” in which a mediastinal cancer gave rise to a prominent pulsating swelling- on the side of the sternum, with a rough systolic murmur heard