Four cases illustrative of difficulties in the diagnosis of aneurysm of the aorta / by Geo. S. Middleton, M.A., M.D., F.F.P.S., Physician to the Royal Infirmary and to the Royal Hospital for Sick Children.

  • Middleton, George S.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: Four cases illustrative of difficulties in the diagnosis of aneurysm of the aorta / by Geo. S. Middleton, M.A., M.D., F.F.P.S., Physician to the Royal Infirmary and to the Royal Hospital for Sick Children. 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.

    5/24 (page 21)
    a degree of ankle clonus on both sides. There was no trouble with the bowels or bladder. There was no distinct cardiac apex beat; the dulness was small; the sounds were free from murmur. The pulse num- bered 50, and was of good quality; the radial pulses were equal. The temperature was not febrile. No abnormality was detected on examination of the lungs, the liver, or the kidneys. There was a history of several attacks of ague when abroad; of a hard chancre five years prior to admission; and of a left empyema operated upon by resection of rib (with discharge of some three pints of bloody fluid followed in a fortnight by pus) two and a half years before admission- There was no tubercular family history. The diagnosis was believed to lie between some affection of the vertebrae (caries) and an aneurysm. He was treated by the combined iodides and bromides, and kept under observation for about a month, when he was again trans- ferred to the surgical side. In the end of July he had a rigor, with a rise of his temperature (hitherto generally subnormal) to 101°, the febrile condition lasting for two days. Another rigor, with a temperature of 102°, occurred early in August, but the febrile condition lasted only for one day. He remained in hospital till near the end of August, his pain being relieved by injections of morphine. As nothing had arisen to confirm the diagnosis of aneurysm, a spinal jacket was applied in September, with apparent improvement for a few days, so that he was able to walk about. There was soon, however, a return of the pain with greater severity than ever, and more in front than formerly. He was readmitted under my care on 3rd November, 1896, greatly emaciated and suffering much more severely than during his previous residence. The abdomen was flat, but not retracted; the whole of its left side was dull, with a feeline- of increased resistance which extended some distance O down the anterior aspect of the thigh (Jig. 1). There was little or no undue pulsation of the abdominal aorta, but a systolic murmur was audible over it. A hen lying on his