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.

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    presence of ankle clonus tended to the diagnosis of caries of the vertebrae, but the absence of motor and sensory paralyses, etc., seemed to show that there was no pressure on the cord, and the excessive severity of the pain was in itself an argu- ment against caries of the vertebrae. The diagnosis ultimately had to rest upon our knowledge that aneurysm of the aorta is frequently the cause of such pain as was complained of here, the absence of evidences of any other effective cause, and, ultimately, the occurrence of internal haemorrhage. The pulsation that was present when he came under observation was of the kind met with in many affections, being a simple pulsation and not excentric; and even this pulsation dis- appeared as the case advanced, no doubt masked by the great haemorrhage. Even the pulsation in the tumour that formed in the back was not excentric, but it was suggestive of the presence of blood in the pleural cavity and therefore a valuable aid. The systolic murmur present was too widely spread to be of much assistance, but the fact that it increased in intensity as the case progressed might have been regarded as significant. Attention should be directed to the prominence of pain as a symptom in this case. For a long time it constituted the only complaint, and after the first few months, when it was occasionally absent for some weeks at a time, it became per- sistent, but liable to paroxysms. Its severity was extreme, and was no doubt in large part due to erosion of the vertebrae, but in a considerable measure also to the site of origin of the aneurysm, as it is known that aneurysms about the crura of the diaphragm are intensely painful. The total duration of the case would, at first sight, seem easily determined, as the statement of the patient, a very intelligent man, definitely assigned the origin of the disease to a strain in May, 1895. Such a duration, 18 months, is unusually short, especially when we take into account the long periods of rest in bed with iodide of potassium, by which he was treated. The questions may, therefore, be raised whether the strain in 1895 did not simply aggravate an aneurysm already existing; and, if so, whether the bloody