Case of aneurism of the aorta, with laryngeal spasm, in which tracheotomy was performed : with remarks / [J. Warburton Begbie].

  • James Warburton Begbie
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the aorta, with laryngeal spasm, in which tracheotomy was performed : with remarks / [J. Warburton Begbie]. Source: Wellcome Collection.

    4/10 page 104
    which, after much anxious deliberation, I considered it necessary to authorise the performance of tracheotomy, I am anxious now to submit the details connected with it to the judgment of the members of the Society. W. C—, set. 41, a shoemaker, of very irregular and intemperate habits, was admitted on the evening of September 4th, 1857. Partly from himself, but chiefly from a near relative, who subsequently visited him in the hospital, we received the following details as to his previous his- tory. He had enjoyed good health till within the last twelve months. During that period has been afiected with cough, and Previous uneasiness in the breast, though not with actual pain. History. For three months has felt his strength falling off; and his friends have noticed his appearance during the same time become materially altered. Three weeks ago he went to Fifeshire, in the hopes of being benefited by a change of air. In Kirkcaldy he consulted a medical man, who advised him to return home. On the day of his admission to the Infirmary, he applied at the New Town Dispensary, where, on account of the peculiarity of his voice, the medical officer on duty, without further examination (as he appeared to be much exhausted), recommended him for admission to the hospital as a case of laryngeal ulceration. The patient was first seen, and carefully examined by me, on Monday, September 7th, at noon. He is a slight man, but \vithout any appearance of emaciation. Face pallid; countenance remarkably anxious. Is now suffei-ing greatly from dyspnoea, amounting to orthopncea; respirations are veiy frequent ; expiration cei-tainly prolonged; and during the rapidly Symptoms recurring and very severe paroxysmal exacerbations of the on Admission, dyspnoea, from which he has suffei’ed since his entrance to the hospital, it is also accompanied by marked laryn- geal stridor. Voice evidently considerably altered, being suppressed in character, and husky. Cough, which is also frequent, is short and imperfect; expectorates a very small quantity of viscid mucus; has never spat blood. The veins of the neck, especially on the right side, are considerably distended. The ti'achea in its lower third recedes, and is evidently subjected to pressure, being with difficulty moved by the fingers. Slight degi'ee of fulness over upper sternum, and at the i-ight stemo-clavicular articulation. Pulsation visible above the sternum, at root of neck, and very distinctly felt, especially to the right side. Fremitus perceptible over upper sternum and a little to the light. On percussion, there is impaired resonance—amounting over the sternum itself to decided dulness—from below the middle of the right clavicle to the left stemo-clavicular ai’ticulation. Over the sternum the dulness extends lower than in the sub-clavicular region, and is continuous with the cardiac dulness. Over the upper sternum, and at sternal extremity of right clavicle, there is a distinct prolonged systolic bruit, which is immediately followed by a heavy, almost metallic sound. The bruit is
    digitised image 1
    digitised image 2
    digitised image 3