Case of carotid aneurism / by James Duncan.

  • James Duncan
Date:
[1843]
Catalogue details

Licence: Public Domain Mark

Credit: Case of carotid aneurism / by James Duncan. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    mour posteriorly, a distinct thrill was felt, and a loud bruit heard synchronous with the dilatation of the carotid artery. Nowhere else was there so loud a sound, or so perceptible a thrill; but a little way from the point mentioned, especially downwards, both vibration and sound were perceived in a slight degree. By apply- ing pressure with the point of the finger over this spot, so as to push the tumour slightly to the left, the bruit and pulsation in the tumour ceased, but the pulsation of a deep-seated vessel coursing the posterior part of the tumour could still be felt. On relaxing the pressure, the pulsation in the tumour immediately returned. The patient was in a highly excited state when admitted into the hospital, and this was so much increased by the visit, that for some time she insisted upon leaving the house ; and it was with considerable difficulty, and only by representing to her in the strongest light the danger of her situation, that she was induced to remain. The pulse at this time was rapid, about 130, but fell afterwards to 110, and was of pretty good strength; the skin was moist; the tongue loaded ; respiration was hurried and noisy, par- ticularly during inspiration, and, when excited, she had occasionally very slight cough; the face was somewhat bloated, the lips ra- ther livid, and the countenance expressive of considerable anxiety. The chest was carefully examined, and no morbid sound eithej in the lungs or heart could be detected. From her excited state, and her expressed determination to leave the hospital, it was im- possible to hold any consultation until the 21st. The propriety of ligature of the carotid was then decided upon ; but it was advised to keep her for a day or two at perfect rest, to allow the state of excitement to subside before operating. Gentle purgatives and small doses of digitalis were administered during the interval. She remained in much the same state until the morning of the 25th, having occasionally slight attacks of dyspnoea, but, on the whole, improving; the respiration becoming less fre- quent, and the pulse gradually sinking to 90. At 4 p. M. on the 25th, she had what appeared to be a spasmo- dic attack of dyspnoea of considerable violence. During the pa- roxysm, the respirations sank to 8 in the minute ; but it lasted only for a minute or two, and the breathing then became tolerably easy. At 6^ p. M. she had another attack, but of longer duration and greater severity. At 7 P. M. she had a third, still more severe than any of the others, and this had continued for some minutes before I arrived, having hurried over to the hospital on hearing what had occurred. I immediately decided upon tracheotomy ; but before this could be accomplished, the patient had become comatose; the respira- tions had sunk to 4 in the minute, and the pulse had become almost imperceptible ; the face was purple, the lips livid, the extremi-
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