Sudden death / by Herbert French.

  • French, Herbert Stanley, 1875-1951.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Sudden death / by Herbert French. 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.

    19/34 (page 17)
    aas the right auricle. Specimens exemplifying eeach of these accidents I show you here. As an example of the third group of cases, in [vwhich sudden death occurs in a patient who has lhad definite symptoms previously, but in whom ssome other diagnosis than aneurysm has been imade, I will tell you of a mistake which I made \when 1 was house-physician. It was so in- sstructive a mistake that I leai’ned much from it anyself, and I hope you will learn from it, too, II want you to remember that there are aneurysms \which do give rise to symptoms, but those ssymptoms, unless you are careful, you may (attribute to another cause. The most difficult (aneurysm of the aorta to diagnose is one on tthe descending thoracic aorta, beyond the left ii’ecurrent laryngeal nerve, in the posterior (mediastinum below the fifth dorsal vertebra. ^The only tubes it can obstruct there are the (oesophagus and the left bronchus ; as the ooso- jphagus is mobile, it often gets away to one side tand escapes obstruction. The aneurysm usually (causes pain, because it is eroding the vertebrae, Ibut the pain, being felt between the shoulders, iis apt to be discounted on account of the com- imonness with which dyspepsia causes similar ipain under the left scapula or between the (shoulders. With aneurysm, however, it is a ’very constant pain, and it is usually associated ’with a decided tenderness on palpation at some ]particular spot on the left side behind, thus, • differing from the pain of dyspepsia. It is also i important to remembe’’that an aneurysm in the I descending aorta is almost certain to obstruct the lower divisions of the bronchus on the left ! side. The physical signs you get from this are impairment of the percussion note over the lower lobe of the left lung, with deficiency of