Heart disease and aneurysm of the aorta, with special reference to prognosis and treatment.

  • Broadbent, W. H. (William Henry), Sir, 1835-1907.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Heart disease and aneurysm of the aorta, with special reference to prognosis and treatment. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    I have consequently been led to divide thoracic aneu- rysms into two classes, namely Aneurysms of Physical Siyns and Aneiorysms of Syvnotoms, from the predominance of physical signs and symptoms respectively, the former term applying to aneurysms of the ascending aorta and first part of the arch, the latter to aneurysms of the trans- verse and descending portions of the arch. Physical Signs of Aneubysm in general. The most important and conclusive physical sign is pulsation at some part of the chest wall where it is not normally present. We must of course make sure that it is not due to the heart or great vessels being simply un- covered or displaced, as for example by tbe mediastinum being dragged to the right in consequence of retraction of tbe right lung, or by deformity of the chest wall bringing the heart or aorta into contact with the chest wall in some unusual situation. The pulsation may or may not be visible ; when obscure it may sometimes be made more perceptible by pressing firmly on the part and watcliing the hand which is making the pressure; sometimes it can be seen by standing behind the patient and looking over his shoulders; it may be recognizable only during expira- tion ; in doubtful cases the pulsation may sometimes be rendered evident by jalacing the small end of a wooden stethoscope on the spot, one half resting on a rib, the other pressed into the interspace, when the stethoscope will be tilted. Pulsation when visible may be a localized protrusion or a general heave. Generally speaking it is best felt by placing the palm of the hand flat on tlie pulsating area, but it may be necessary to press the fingers well into the intercostal spaces. In estimating the significance of ])ulsa- tion, whether in a tumour within the cavity of the thorax,