On gunshot wounds of arteries, traumatic hemorrhage, and traumatic aneurism / by John A. Lidell.

  • Lidell, John A.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: On gunshot wounds of arteries, traumatic hemorrhage, and traumatic aneurism / by John A. Lidell. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    nothing remarkable in the appearance of the wound. The patient's general condition was good. He did not look as if he had suffered from hemorrhage. The bowels were consti- pated : ordered a saline purge together with a spare diet, and, with a view to lessen the tendency to secondary hemorrhage, he was directed to remain quiet in bed, to exert himself as little as possible, and to have ice applied constantly over the injured artery. He was also directed to take morphine at night if necessary to procure rest. Under this treatment the patient progressed without an un- favorable symptom ; the wound cleaned itself and closed up in a satisfactory manner, and we congratulated the patient in that he was likely to get well without suffering the terrible second- ary hemorrhage, which frequently attends gunshot wounds of the axillary artery. The limb continued to be completely par- alyzed as to motion, but sensation had gradually been restored to the fingers, hand, and fore-arm. On the 12th of July (morning) we noticed the appearance of a small rounded circumscribed swelling of the size of an egg, at the seat of injury to the artery. The scar of the anterior orifice of the gunshot wound was exactly on the summit of the convexity of the swelling, as the patient lay in bed. The tumor was tense in feel, and pulsated distinctly and synchron- ously with the heart. There was, however, an entire absence of the aneurismal thrill and aneurismal bruit. By compress- ing the subclavian artery against the first rib, the tumor be- came soft, much less in size, and ceased to pulsate : on with- drawing compression the tumor speedily filled up, became tense, and pulsated again. Patient stated that during the pre- ceeding night he felt something give way in his left arm-pit while attempting to change the position of that arm by the aid of the right hand. During the day the aneurism increased rapidly in size, and in the evening was fully twice as large as when first noticed in the morning. July 13—The aneurism continued to increase steadily in size, and in the evening was about half as large as the clenched first. July 14—The aneurism had grown but little since previous day ; it was still rounded, distinctly circumscribed, and some- what oval in shape : by compressing the subclavian, it ceased to pulsate, became soft and much shrunken, but the prior con- dition of things was restored speedily on withdrawing com- pression ; as on a previous occasion, there was still no thrill or bruit. Diagnosis: circumscribed traumatic aneurism of the axillary artery. From the entire absence of pulsation in all the arte- ies beyond the aneurism, which existed even at the time of admission to hospital, and the complete want of thrill and bruit in the aneurism itself, we believed that the aneurism had