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

  • Tufnell, Jolliffe.
Date:
1864
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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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    occur in connection with anoiirism, yet so existing; as to be mis- taken for tlie soiijfiet depending upon valvular disease. Thus aneurism of the heart itself, emanating from the vicinity of the left auriculo-ventricular opening, and pressing forwards, may cause sym])- toms common to the narrowing of the left auriculo-ventricular opening, and fi-om the far greater frequency of the latter affection the bruit and frcniisnement, which are really dependent upon aneurism, may be mistaken for that of valvular disease. Sonfflef, then, taken per se, is not a symptom of diagnostic value as great as when it occurs in combination with other abnormal condi- tions of the thoracic cavity: such as undue pulsation, dyspnoea at intervals, oppression of the precordial region, with difficulty of swallowing solid food. 'J'hese, in combination Avith bruit, point to the true nature of the disease. Of every symptom, however, there is none so peculiar to the disease as pulsation. Now, Avhen this occurs to a considerable extent, when the pulsation of the heart is very distinct (the organ itself not being enlarged), it may be owino- to the aneurism springing from the aorta about the junction of the thoracic and abilominal portions, the aneui-ism projecting forward the heart itself. Again, when the pulsation is distinctly felt in the anterior and posterior surfaces of the chest at the same time, the possibility is suggested of Uyo aneurisms co-existing. With re- ference to pulsation, however, it is true that pulsating cancer of the lung may be taken for aneurism of the aorta in the ascending or descending portions of its aich; but the progress of cancer is so much more rapid than that of aneurism, that in a short time its trae nature will become manifest, in addition to the other general symptoms which characterize malignant disease. In cases of abdominal pulsation we have to consider the possi- bility of the tumor being other than aneurismal, and we may find tumors receiving pulsation from the aorta behind to be dependent upon various causes; thus scirrhus of the mesentery, scrofulous disease of the mesenteric glands, or collections of hardened faeces in the pouches of the colon, may exist; but here, in all these ca?es, the absence of lateral dilatation will assi-st us materially in forming our diagnosis. There is one point, however, that cannot be too strongly commented upon or borne in mind, and that is, that all the stethoscopic phenomena of aneurism that accompany aneurism of aorta, such as bruit de soufflet, stridor and dysphagia, do at times intermit, and, for a while, subside.