On a case of patent ductus arteriosus with aneurism of the pulmonary artery / by James Foulis.

Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: On a case of patent ductus arteriosus with aneurism of the pulmonary artery / by James Foulis. 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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    on until about the 20th September, when she began to complain of sharp cutting pain in the region of her heart; and on stethoscopic examination a loud, continuous, rough friction sound was heard all over the cardiac area. Pericarditis had evidently set in. After her return from the country I did not again hear the remarkable murmurs. They had entirely disappeared; but it was often pos- sible to hear the filiipp, fiupp sounds during the violently wobbling action of the heart. She died on tlie 25th September, thoroughly worn out and exhausted, 22 years of age. Such is the very imperfect history of this case so far, but I am indebted to my friend Dr Wyllie for the following notes taken at his dictation at the post-mortem examination performed on the 27th September 1882:— Description of Body.—Tlie body was 5 ft. 1\ inches in length. Circumference of body just below the level of the mammae was 27f inches. The body was delicately formed, rather emaciated. Mammte rather small. There were evidences of commencing putrefaction, abdomen being distended and tympa- nitic. Skin over the abdominal region being greenish blue in tint. The same tint of skin was seen on the throat. Rigor mortis still slightly present in the legs, but absent in neck and upper extremities. The legs below the knees were somewhat oedematous, pitting on pressure being best marked above the ankles. On proceeding to examine the chest, the skin over the costal parietes was first reflected before the thoracic or abdominal cavities were opened into. The chest wall was then transfixed with four long barbed crotchet needles at the following points:— Needle No. 1 was driven into the second left intercostal space, exactly at middle distance between the two cartilages, at a spot one inch to the left of the sternal margin. Needle No. 2 was inserted in the same intercostal space exactly between the two ribs, but at the distance of ^ inch from the left margin of the sternum. Needle No. 3 was inserted into the tliird left intercostal space, exactly at mid distance between the third and fourth ribs, at a spot \ inch from the left margin of the sternum. Needle No. 4 was inserted in the second right intercosfcil space, mid way between the ribs, at a spot \ inch from the right margin of the sternum. These needles, being thus fixed in position, were driven deeply inwards in a vertical direction, and the costal cartilages were divided in the usual way on each side, and the sternum with tlie attached cartilages and soft parts was removed. The needles, being fixed by their barbed points to the cardiac tissues, were left attached to the heart after the sternum had been removed. On thus removing the sternum the needles which had been inserted to tlie left side of the sternal bone were all found to enter directly into the anterior surface of the pericardial sac without