A case of aortic aneurism, in which a communication with the pulmonary artery was recognised during life by physical signs.

Date:
[cbetween 1800 and 1899?]
Catalogue details

Licence: Public Domain Mark

Credit: A case of aortic aneurism, in which a communication with the pulmonary artery was recognised during life by physical signs. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    and fudden (pring; he direftly felt very faint, and was coriipelled to fit down for fome time, but thought no more about it. He had never had any palpitation. His appetite was good, and he flept well. He had a little cough, with expe£l:oration of watery mucus, and flight dyfpnoea on exertion; but the cough was moft troublefome on lying down. Phyfical examination fliowed that the cardiac dulnefs was increafed in the vertical direftion. The apex could be diflinftly feen and felt beating in the fixth intercoftal fpace, and the heart was alfo to be feen beating in the fifth. Over the cartilage of the fourth left rib two loud murmurs were heard, inftead of the ufual cardiac founds; that, with the fecond found, being of a hifling character, and fo prolonged as to continue till the commencement of the next ventricular fyftole. At this fame fpot a very con- fiderable purring tremor accompanied the fecond murmur. The firft murmur was of a loud bellows charadler. Both murmurs were audible as high as the bifurcation of the common carotids, in the back, and over all the upper part of the cheft; they did not feem to be peculiarly propagated towards the left fubclavicular fpace. At the apex of the heart a fingle murmur only, was to be heart, and this evidently attended, or rather replaced, the cardiac firft found ; it could be traced eafily down to the enfiform car- tilage. At the apex, the cardiac fecond found was very diftindl and quite natural; no trace of murmur. I found no venous diftenfion or pulfe. The pulfation of the carotids was very vifible, particularly on the left fide, and marked by fome, though not confiderable, thrill. The heart's adtion was quiet and regular. The only abnormal phyfical fign in the lungs was fome mucous rales at the bafe of each, equally on either fide. Pupils contracted, but mobile; liver enlarged, no idterus ; urine normal. From this combination of phyfical figns, I concluded— ift. That blood efcaped either from the aorta or the pulmo- nary artery during their fyftole, from the loud hifling, prolonged murmur replacing the fecond found at the bafe of the heart. 2nd. That it was probably from the aorta that the blood efcaped, from the propagation of the found up the arteries of the neck, and their vifible pulfation and fenfible thrill.