Vascular bronchocele and exophthalmos / [J. Warburton Begbie].

  • Begbie, James Warburton, 1826-1876.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Vascular bronchocele and exophthalmos / [J. Warburton Begbie]. Source: Wellcome Collection.

    26/32 (page 192)
    Before adverting to treatment, and mentioning certain general conclusions to which the foregoing observations seem to tend, I desire to communicate very briefly the history of two cases of vascular bronchocele with exophtlialmos, which have recently come under my notice in the Royal Infirmary. Case i.—P. B., £Et. 34, admitted into Ward 15, Royal Infirmai’y, 6th November 1862. Married nine years, and has had one child. Has for a long period suffered from scanty menstruation, with occasional intervals of total absence of the discharge. One of these intervals ex- tended over a period of eleven months. Has enjoyed, on the whole, better health since her marriage than before it. For some months previous to February, 1862, suffered from profuse leucorrhcea, and, after recovering from this, continried in a very weak state. In June had several profuse bleedings from the nostrils, and these attacks, though lessened in severity, have continued to occur till the present time. While so suffering, about June she began to have palpitation of the heart, from the first accompanied by buzzing noises in the head, and severe headache. About a month after the palpitation had commenced she observed a fulness about her neck, and, after the lapse of another month, her friends had remarked an altered expression and prominent appearance of the eyes. Throughout the summer has had frequent looseness of the bowels, and has noticed that the stools often contained portions of undigested food. Has latterly become very nervous and depressed in spirits. On admission, the patient has a decidedly anaemic appearance; the eyes have a prominent aspect, and peculiar wild expression (“ expression sauvage ’* of French writers); the eyes feel hot and tense to the patient, but her sight is unaffected ; there is no peculiaiaty about the pupils, or the muscular apparatus of the eyeballs or eyelids, no orbital oedema. There is a bronchocele of considerable size, more prominent to the right than left side of neck, and much pulsation in the thyroidal and carotid arteries; the jugular and thyroidal veins appear distended. With the stethoscope a loud blowing sound closely synchronous with the systolic action of heart is audible, and when the hand is applied over the tumour a distinct thrill is distinguished. The heart's action is much excited— the beats 120 per minute—the rhythm altered considerably and variously. Region of precordial dulness not extended; soft blowing murmur, with first sound at base; loud bruit de souffle in the arteries of neck, arms, and lower limbs; very loud in abdominal aorta, the pulsation of which is readily seen, and proves distressing to the patient. She is easily agitated, and now somewhat desponding. In this patient’s case I had the first opportunity of combining the general regimenal treatment and the use of iron, as recom- mended by Dr. Begbic, with the employment of belladonna.