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

  • Douglas, A. Halliday (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.

    13/34 (page 13)
    and lias no tendency to involve tlie heart in associated or consecu¬ tive disease. 13. Such aneurisms are usually saccular, hut they may be peri¬ pheral, and they suggest the probability of localization of the disease of the coats of the artery. 14. Proximity to the heart in such cases does not affect that organ. PART II.—DIAGNOSIS. The cases of substernal aneurism recorded in this part exemplify some of the more usual, and therefore more important conditions in which the disease occurs. They are intended as clinical illustrations of the most reliable indications of the lesion, and the narratives of the cases will be trusted to for the illustration of many of the signs ; while, in the commentaries, some points only will be referred to. No attempt will be made to discuss particular questions, nor the details of the cases ; indeed, the only question considered with any minuteness is the diagnostic value of aneurismal second sounds ; the supreme importance of that subject has induced me to remark on it at some length, under Cases IY. to VIII. The subjects of pain, respiratory obstruction, and tracheotomy, also, are specially referred to ] and Cases X. and XI. are given as instructive instances of the disease masked by co-existing lesions. The cases now to be given chiefly belong to the class which, in the former part of this paper, were designated saccular, and which in general have no essential relation to disease of the heart. The occasional co-existence of peripheral aneurism (dilatation) of the aorta in its slighter degrees, does not interfere with their clinical character as saccular aneurisms. For clinical purposes, it is better to view substernal aneurisms in these classes, founded upon their external figure, rather than to arrange them according to the injury or disorganization of one or several of the coats of the arteries. To prevent misunderstanding, I may define in this place what is meant by the terms peripheral and saccular aneurisms. Peripheral aneurism indicates true aneurism and dilatation of the artery. Saccular aneurism embraces false aneurism, whether it be in the form of a sac or merely a deep pouch, widest at its commu¬ nication with the artery. Perhaps some will question the advantage of such records of cases in which so many particulars necessarily repeat themselves ; but the never-ending variations in the symptoms of substernal aneurisms render the study of recorded cases essential. Indeed, I am persuaded that the most instructive reading on the subject of the diagnosis of substernal aneurism, are condensed narratives of carefully observed cases. No reference occurs to the changes in the pupil of the eye connected with thoracic aneurisms, for the reason that the symptom did not occur in any of my cases. The papers of my friend Dr W. T. Gairdner1 on that subject will repay 1 Clinical Medicine, 1862.