The successful treatment of internal aneurism : illustrated by cases in hospital and private practice / by Jolliffe Tufnell.

  • Tufnell, Jolliffe.
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: The successful treatment of internal aneurism : illustrated by cases in hospital and private practice / by Jolliffe Tufnell. Source: Wellcome Collection.

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    breathing, form of voice, and character of cough, and from these the site and nature of the tumor. Dyspnoea, too, is a valuable sign, but it must ever be taken into consideration in connection with this fact, namely, that dyspnoea is increased in exact propor- tion to the relative degree of irritability of the air-passages present in each individual case. Thus much may we learn from the conditions of the head, neck, face, and voice. In the chest we have the feelings of the patient to assist us, with the adjuvants of auscultation and percussion; auscultation pointing out the relative state of the respiration upon the con'es- ponding sides of the chest, Avith the absence or presence of bruit; and percussion demonstrating the amount of dulness, if any; which latter, when existing, with absence of respiration at the same spot, is a symptom that should always be most carefully regarded. In the chest we have, however, often a serious obstacle to contend with in the form of bronchitis of chronic character, sometimes affect- ing one lung, but not imfrequently both, interfering considerably with auscultation, and masking the real disease. With reference to bruit de soufflet^ Avhilst its presence may be depending upon other causes than aneurism, its absence is no proof of the non-existence of the disease, for there is frequently no bruit whatever, although there may be an aneuinsm of large dimensions ; Avhilst a largely dilated state of the aorta without saccular develo])- ment, may be productive of bellows murmur ; and if, as occasionally (though rarely) happens, a ring of bone should encircle the com- mencement of the aorta, a sound which has been described as the trumpet bruit* will be loudly and distinctly heard. The form of the opening influences the kind of bruit much more than the size. Thus, in cases where the communication between the aorta and the aneurismal sac is very large (such as two inches in length), the bruit is often less distinct than Avhere the aperture is only just sufficiently large to admit the forefinger of an adult, but perfectly circular and round. The form of soufflet, when it exists in connection with aneurism, may be considered then to depend upon the nature of the opening; thus a smoothly-round opening is found to give a soft blowing sound, whilst a rough and irregular yporture is accompanied by a very rough sovfflvt. Bruit^ too, may * i!y Dr. Coi riguu. C