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

  • Begbie, James Warburton, 1826-1876.
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.

    7/10 (page 107)
    pneumogastric. 'Judging from the position of the pulsation and flulness on percussion, I had thought that the nerves of-the right side would be involved; they were, however, free, and those of the left, as is certainly more commonly the case, were stretched, and. The oedema glottidis, if not altogether a new pathological condition in connection with aneurysms at the root of the neek, is certainly a most interesting circumstance. That it did not result from any inflammatory exudation is indeed most probable; and I quite agree with Dr. Haldane in ascribing its production to the compression of the veins at the root of the neck, by the aneurysmal dilatation. The occurrence of the severe laryngeal spasm may now probably he best explained, partly by the affection of the rima, and partly by the stretching of the left recurrent. This case, then, was one of laryngeal stridor, while, at the same time, the trachea was compressed by an aneurysm. In such circumstances, I need scarcely say, the performance of tracheotomy can of course be only expected to give a present relief. Accepting the division of aortic aneurysms with reference to the performance of tracheotomy—or the modified operation of the present case—into three classes—ist, aneurysms directly compressing the air-passage; and, aneurysms exciting laryngeal dyspnoea by pressure, or other interference with the recurrent nerves; 3rd, in which both conditions existed—the case I have detailed belonged to the third class; and, partaking as it did of the nature of both of the others, the question as to the performance of tracheotomy in it must be judged by a consider- ation of all the circumstances connected with it. Had the direct pressure on the trachea been more marked than it was, I am inclined to think that I should not have counselled operating; but while, no doubt, a certain amount of the dyspnoea resulted from it, I felt sure the greater part, paroxysmal in character, Avas the consequence of other interference. It was on that account the operation appeared to me expedient as a “ dernier ressort; ” and we have this consolation, that it changed into a quiet death what would otherwise, in all probability, have been attended by great suffering. The case was rendered still more unfavoi able by the existence of enlargement and valvular disease of the heart; to whieh, indeed, I think the death is to