Substernal aneurism : cases and observations on its diagnosis, and relation to disease of the heart / by A. Halliday Douglas.

  • Douglas, Andrew Halliday, 1819-1908.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: Substernal aneurism : cases and observations on its diagnosis, and relation to disease of the heart / by A. Halliday Douglas. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    12/32 page 12
    in diameter. The aneiu-ism had discharged into a large bronchial tube. I do not quote in evidence the often recurring cases of saccular aneurism at the origin of the aorta close to the heart, because it may be argued that their usually early rupture into the pericardium, auricles, etc., does not afford them time to give rise to their effects on the heart. Such cases, however, substantiate the trath of the view I entertain, that mere contiguity of the aneurism does not involve the heart in consecutive disease. Without insisting upon conclusions arrived at, I conclude this part of my paper by submitting the following as considerations arising out of this subject, fitted to advance and simplify our views of the pathology of aneurism and disease of the heart, 1. Hypertrophy of the heart is probably in all cases a secondary lesion, and is the result of nature’s effort to counterbalance a pre- existing hindrance to the circulation. 2. Dilatation of the heart is the natural resolution of local dis- eases which may, in the first instance, excite hypertrophy. Em- barrassment of the circulation, with venosity of the blood, dropsy, etc., usually arises with this consecutive dilatation. 3. Valvular disease of the heart often co-exists with aneimsm of the aorta, especially peripheral aneurism; the sigmoid valves most usually are affected, perhaps from contiguity. 4. In such cases the consecutive condition of the heart does not materially differ from that which occurs in cases of simple valvular insufficiency. 5. A diseased condition of the arterial coats often exists in con- junction with hypertrophy of the heart, as is commonly seen in cases of apoplexy with disease of the cerebral arteries. 6. There is reason to think that the disease of the arterial coats may exist extensively in the system, thougli the aorta and the arteries at the base of the brain usually present its most advanced effects. 7. In this state the aorta is apt to undergo dilatation, constitut- ing usually peripheral aneurism. 8. The diseased state of the arteries destroying their elasticity, the cu-culation is to that extent obstructed, and the left ventricle, under the additional burden, undergoes hypertrophy to compensate the lost tonicity of the arteries. 9. In such circumstances hypertrophy arises in a way analogous to that which occurs in cases of disease of the valves, etc., of the heart. 10. Consequently, hypertrophy of the heart and peripheral aneurism stand associated together as effects of the same diseased condition of the arteries. 11. Consecutive preponderating dilatation may occur in such cases; but the progress to that stage is liable to be hindered by the accidents of hypertrojdiy, as, for example, of cerebral hannor- rhage, which is promoted by the co-existing disease of the arteries. 12. Aneurism of the aorta is often altogether local in its origin.
    digitised image 1
    digitised image 2
    digitised image 3