The Bradshaw lecture on intrathoracic tumours and aneurysms in their clinical aspect : delivered before the Royal College of Physicians of London on November 2, 1911 / by Graham Steell.

  • Graham Steell
Date:
1911
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Licence: In copyright

Credit: The Bradshaw lecture on intrathoracic tumours and aneurysms in their clinical aspect : delivered before the Royal College of Physicians of London on November 2, 1911 / by Graham Steell. 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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    and other haemorrhages from within, may result from the same cause. On the other hand, the sac of an aneurysm (generally of the arch) coming forwards may be the source of actual cutaneous haemorrhage. At first there is usually only blood-staining of the skin, but a local inflammatory condition is often set up, with redness and tenderness, so that, as in a well-hnown case, the patient may regard the red, tender, and possibly elevated spot as a “ boil.” The deposition of flbrin in layers is the great preventive of rupture externally as in other directions, and even when haemorrhage does occur it is often, as Gairdner said, “a mere oozing or succession of oozings filtered through these obstructions.” On the other hand, as I have seen, the issuing stream of blood may spout up a considerable distance above the surface of the chest of the recumbent patient. In a case I witnessed, as a hospital resident, the patient survived the rupture many days. Dr. Walshe recorded a case, indeed, in which the patient “ must have lived for nearly two months with a gradually increasing extent of his chest wall and aorta replaced by lint.” Physical Methods of Diagnosis. Inspection. It will often happen in cases of intrathoracic tumour and aneurysm that the mere inspection of the chests puts the observer almost at once in possession of the diagnosis. It is customary in chest diseases to limit the application of inspection, regarded as a physical method of diagnosis, to the thorax itself, but, specially in the case of intrathoracic neoplasm, it is better to include all that may be obvious to the observer possessing a bearing on the diagnosis under consideration. Thus eiflargement of the lymphatic glands above and below the clavicle or in the axilla may afford valuable evidence of malignant growth within the thorax. The significance of external tumour on the thorax, either from projection of an internal one, or of a superficial and essentially parietal one, requires little comment, care of course being taken to exclude superficial tumours, that have existed for many years and clearly have nothing to do with recent developments. Significant tumours in our present consideration have usually appeared recently, or there may be the scar of a surgically-removed tumour. Intrathoracic aneurysms frequently form local projections, neoplasms less often, and in the latter case independent growth in the chest wall has to be distinguished from projection of internal growth. In the case of aneurysm the seat of projection is usually, as might be expected, the upper part of the thorax often involving the middle line in some degree and extending more frequently to the right than to the left of it. But the projection may be altogether to
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