The successful treatment of internal aneurism : illustrated by cases in hospital and private practice / by Jolliffe Tufnell.

  • Tufnell, Jolliffe.
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: The successful treatment of internal aneurism : illustrated by cases in hospital and private practice / by Jolliffe Tufnell. Source: Wellcome Collection.

    14/46 (page 8)
    I did not see tliis patient again until December, 1857, wlicn lie called upon me to request my advice for an irritable ulcer of the leg. Upon questioning him, he said that the aneurism never troubled him now, that he was quite well as regarded it, and had been regularly working at his trade as a die-cutter and steel engraver since March, 1855. When stripped, the first point that attracted notice was the enlargement and tortuous condition of the abdominal and pectoral cutaneous veins; the epigastric, circumflex, and mammary having assumed the condition of large venous trunks, ad illustrated in the portrait annexed, which has been reduced from a drawing of life-size taken by Mr. Connolly of Dublin. The tumor next engaged my attention. It projected to the right of the sternum, nearly midway between the clavicle and nipple, where it presented a bulging prominence the size of a small saucer, making this side contrast strongly with the hollow intercostal spaces and marked ribs upon the left. No pulsation was visible in the tumor, even when any testing object, such as a portion of white paper, was placed upon it. To the hand it felt dense, and the cardiac impulse against the interior of the sac was unheeded by the patient. The sound on percussion Avas dull over a very large space around the heart, Avhllst to the ear a double sound was given intermediate in time to the contractions of the heart. Upon deep inspiration this portion of the chest did not expand. The heart's sounds were audible over a very large portion of the chest, and the pulsation, aneurlsmal and cardiac, Avas communicated to the hand or ear for a space of fourteen Inches in an oblique line from the right clavicle down to the left hypogastric region. His general appearance indicated a barrier to the return of blood to the right side of the heart. There was some congestion of the face, which was increased on stooping, with puffiness of the neck to a slight degree. There was no interference by pressure upon the trachea, nor oesophagus. He had some slight cough and expectoration, and occasionally after coughing felt pain in the tumor, but not at any other time. There was no interference with either the carotid or radial pulses, and the circulation was equal upon both sides. He stated that he lay at night upon the right side to sleep, and could not upon the other. He had been regularly Avorking at his trade, and one of his most recent acts had been the cutting of a new seal for the College of Surgeons in Ireland; and it is a point of interest