Practical observations on certain diseases of the chest, and on the principles of auscultation / by Peyton Blakiston.

Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Practical observations on certain diseases of the chest, and on the principles of auscultation / by Peyton Blakiston. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    inserted in it. The greater part of this portion of the sternum was devoid of periosteum, and was much thinned by erosion. The cartilage of the first rib was nearly, and those of the second and third ribs were entirely separated from the sternum, and from their intercostal muscles. Between the second and fourth cartilages was an aperture of the size of a half-crown piece, which led into another sac external to the sternum, eight inches in circumference and an inch and a half in height. In it were some old, reddish coagula, and some recently clotted blood, and it was partially lined within by a smooth membrane. The in- teguments were very thin, and had given way at the spot where the dark purple appearance had been observed during lifetime. The history of this case, coupled with the post-mortem appearances, lead to the belief that the disease commenced by dilatation of the ascending aorta, and was followed by rupture in a fit of passion. When he came under my notice there were evidences of hypertrophy of the heart, and there was a strong presumption in favour of the existence of a sacculated or mixed aneurism approaching the surface of the chest to the right of the upper third of the sternum. This presumption was based on the existence of a purring thrill and dullness on percussion over this spot, on the extent to which the rasp-murmur was heard, and on the fact of its not being exactly synchronous with the impulse of the heart. This was soon converted into certainty by the appearance of a liquid pulsation. The sheath and the pleura seem at length to have given way, and the blood passing forward between the ribs, was bounded for a time by the integuments of the chest alone. The murmur was probably formed in the roughened aorta. Case XV. Aneurism of the pulmonary artery—Constriction of the aorta, ^c. ^c. A thin pale girl, set. 19, a screw-wormer, was a patient of the Birmingham General Dispensary, under the care of Dr. Fletcher, and by his kindness was submitted to my examination. She complained of violent pain in the head, and of some pain in the left side of the chest, great dyspnoea, and troublesome cough.