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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    the sternum, and over a small space a little to the left of it. The respiratory sound was natural. The action of the heart was strong and heaving. Over the precordial region both sounds were heard, the systolic sound being rather distant and coarse. Between the cartilages of the second and third left ribs a single systolic, hollow, rasp-sound was heard; the intensity of this sound diminished in all directions as the ear receded from this point. On regarding it attentively, a slightly elevated spot, rather larger than a shilling, was perceived, which communi- cated a strong single pulsation and a purring thrill to the hand placed on it. One night he expectorated some blood; and a week after his admission, being agitated and excited in con- versation, he suddenly fell back, became deadly pale and in- sensible ; and gasping with slow respiration, whilst his pupils were fixed and dilated, for twenty minutes, he expired. Inspection. On cutting through the cartilages of the left ribs, a quantity of red-coloured serum escaped. The left pleural cavity was found to contain a gallon of the same kind of fluid; and the left lung was imbedded in an enormous clot. The heart was firm and red, and the parietes of the left ventricle were near the base one inch in thickness. The aortic valves were thickened ; and patches of a fibro-cartilaginous consistence and atheroma extended up the aorta. At the commencement of its arch it was dilated into an aneurism, which might have contained a small fist, in which after three or four lines the coats of the vessel seemed destroyed, or at least were not to be distinguished from the indurated lung, which formed a nest for it. At the upper left corner was an opening, communicating with the left pleural cavity, in which was a recent clot. Slightly adhering to the internal surface of the sac, at its upper and anterior portion, was a soft, mottled, laminated, pyriform concretion as large as a date. The arteria innominata was partially, and the left subclavian artery entirely, plugged up with firm clots. Permission was not obtained to remove the diseased parts. The aneurism was in this instance detected before the tume- faction, pulsation, and thrill were observed. The absence of the pulse in both arms led to a close examination of the chest.