Volume 1

A dictionary of practical surgery / [Samuel Cooper].

  • Samuel Cooper
Date:
1825
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.

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    only a pulsation, but a tumor as large as the fist, with all the other usual symptoms of an aneurism. On opening the body after death, he was there- fore surprised to find, instead of this disease, a considerable scirrhous tumor in the middle of the mesentery, so closely connected to the large vessels, as to compress the aorta, by the pulsations of which it had been lifted up. (Obs. Anat: ed. 2. No. 9.) Dr. Albers quotes an extraordinary case from Tulpius; the patient, a laborious man, but sub- ject to bilious attacks, was sometimes affected with violent throbbings of the spleen. These were not only very painful, but could be heard at a distance, and their number distinctly counted, when the hand was applied to the part. What seems almost incredible, it is alleged, that Tulpius could hear them at the distance of thirty feet ! Their violence increased, or diminished, accord- ing as the patient was more or less bilious, and sometimes they entirely ceased, when his health improved; but always recurred, as soon as the chylopoietic organs became disordered again. After the patient’s death, permission could not be obtained to open his body. (Twlpii Obs. Medicce. Amst. 1652. lib. 2. cap. 28.) According to Bonetus, pulsations in the left hypochondrium are not unfrequent, and it was his belief, that they were produced by the cceliac artery. He cites several cases of this disorder from other writers, the tenor of which is to prove, that the celiac artery and mesenteric vessels must have been affected, as they were found after death dilated and filled with black blood. (Se- pulchretum Anatomicum, lib. 1. sect. 9. Obs. 9, 25, 27, 30, 38, 42, 44, 45, and 46.) The con- jecture of Bonetus and others, however, respect- ing the frequency of abdominal pulsations from dilatation of the cceliac and mesenteric arteries, by no means coincides with the results of modern observations. Mr. Wilson, whose dissections were numerous, met with only one instance of true aneurism, affecting any of the branches of the aorta, distributed to the abdominal viscera. This case was an aneurism of the left branch of the hepatic artery. (Lectures on the Blood, and on the Anatomy, Physiology, and Surgical Pa- thology of the Vascular System, &c. p. 379. 8v0. Lond. 1819.) Bontius was present at the open- ing of an inhabitant of Batavia, who had been afflicted three years with a disease, the exact na- ture of which could never be made out during life. When the hand was applied above, or below the navel, a pulsation was felt like that of the heart, or an artery, and as forcible as the motion of a child in the womb. It was synchronous to the pulsation of the heart and arteries. Hence, Bontius concluded, that the case was owing to some affection of the heart. The vena cava, in- stead of containing blood, was filled with a me- dullary substance, which, pressing against the aorta, is supposed to have excited the extraor- dinary pulsations in that vessel. The heart was unusually dilated, and flabby. The two ventricles were very large, and filled with dark coloured blood. The liver was of nearly twice its natural size. The gall-bladder resembled that of a bullock, and was filled with viscid bile, nearly as thick as an extract. (Jacobi Bontii de Medi- cina Indorum, libri 4, Lugd. 1718. Obs. 8. pe. 101.) ; Lewenhoek met with an instance of a similar pulsation, which he imputed to irregular action of the diaphragm, the pulse at the wrist not being affected. The disorder lasted three days, during which the functions of the alimentary canal were so much disordered, that the patient was expected to die. (Philosoph. T'rans. from 1719 to 1733, abr. by J. Eames, &¢c. Lond. 1734. vol. 7. p. 683.) Dr. Albers has described the particulars of a case, recorded by Burgeraf, and entitled, «* Diu- turna, magna, et valde molesta pulsatio in epi- gastrio.”” (Vid. Acta Natur. Cur. Norimb. 1740, Vol. 6, Obs. 131.) Burggraf gives his reasons for believing, that, in this instance, the pulsation arose neither from the aorta nor from the coeliac artery ; and suspects that it was caused by a dilatation of that considerable branch of the inferior mesenteric artery, which inosculates with the branch of the superior mesenteric. This idea, however, which was merely surmise, could not be correct, as the patient was cured by taking in the form of pills, every morning and evening, half a dram of a mass composed of equal parts of Gum Ammoniac, extr. Centaur. Minor, and Venice soap. In the valuable essay of Albertinus, on diseases of the heart, as a cause of difficult respiration, there is a passage where he is speaking of the diagnosis of enlargements of the heart, aneurism of the curvature of the aortz, &c., which Dr. Albers cites, as deserving attention in the pre- sent subject. “ Verumtamen extra pectus ubi deficiente solido arcu costarum, tantum difficul- tatis in hae indagine non ostenditur, me satis scio pluries indicavisse ex eo, quod vasis dia- metrum non auctum perceperim validas, assiduas- que arterize cceliacze, vel aortz in abdomine pul- sationes fuisse sine dilatatione, nec judicium meum eventus fefellit.” (De Bononiensi Scien- tiarum et Artium Instituto, atque Academia Comment. Bononie, 1748, T. 1. p. 387.) An example follows from the writings of the celebrated Stérk. After death, the symptoms were found to have arisen from disease of the pan- créas, which weighed thirteen pounds, and con~ tained a large cyst filled with lamellated blood. (Annus Medicus, Vindob. 1760, p. 245.) The subsequent case, somewhat analogous to the former, is from a different author. A man, aged 60, complained of pain in the left side of the abdomen, midway between the um- bilicus and crista of the ilium. Emaciation, weakness, distress of countenance, anorexia, con- stipation succeeded. At length, a large pul- sating tumor was discovered in the epigastric region. The case was now pronounced aneurism - of the abdominal aorta. There was no nausea, nor vomiting, except that some days before death, a quantity of feiid, blackish fluid was twice or thrice voided. No fever. The swelling caused a sense of constriction rather than pain, and the throbbings became more perceptible. ‘The pulse was feeble, but slow and regular. After death, the stomach was found adhering to the liver, pancreas, and abdomen; and a cancerows tumor occupying its internal surface from the duodenum to the insertion of the gear agt the coats of 9 ;