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Arr. I, Observations on the Utility of Bloodletting as the principal Re-
medy in Continued Fever. By Mr John Allan
By Mr Edward Lloyd Knowles
thalmia, &c. By Mr J. Mackesy
tive Anatomy. By James Woodham, Esq.
Delay usuaily recommended, &c. &c. &c. By Mr J. G. Guthrie
ries. By Mr Joseph Hodgson
Nomenclature. By Whitelaw Ainslie, M. D.
Observations on some Čauses of Deafness, with the means of removing them.
By Professor Authenrieth
MEDICAL AND SURGICAL JOURNAL
1. JANUARY 1816.
Case of Carotid Aneurism. (With an Engraving.) By Mr
Estate, 38 years of age, of a robust make and healthy ap-
VOL. XII, NO. 45.
than leave the patient to a certain fate, I ventured (after pointing out the imminent danger) to propose an operation. He, judging, I suppose, from the little comparative pain, that there was no occasion to submit to such hazard, and perhaps indulging a hope that my prognostic might be fallible, would not consent, and from a want of confidence in myself, which in this instance I am not ashamed to acknowledge, and cannot even now deprecate, I did not press it. Palliatives were therefore only recommended, -rest, an avoidance of every thing which might quicken the circulation or determine to the head, such as exercise, crying, coughing, sneezing, or stooping, and withal a gentle pressure on the tumour by a flannel roller. As might have been expected, the disease gradually gained ground, and although it continued soft, fluid, and compressible, in four months it got to a very alarming size. The swelling extended from the ear to the clavicle, over which it rested, became very painful and pointed at three different places. Deglutition was impeded, and his speech affected. He now desired surgical relief, which at this stage was impracticable, and the catastrophe took place on the 15th July 1810, by bursting at the most prominent apex. Although I was sent for on the appearance of blood, and reached his house in a few minutes, I found him speechless and insensible; the hæmorrhage had ceased, but the skin was cold, and the pulse at the wrist scarcely perceptible. To give him the only chance which now remained of preserving life, I run a bistoury up and down the whole length of the sac, while the syncope continued, for the purpose of securing the bleeding artery, but in vain. An immense gush of blood followed. It then poured more slowly and weakly, and with so little impetus, from the loss already sustained, that I could not discover the jets in a sac of great capacity, filled partly with clotted blood and membranous fibres, and in a few moments he breathed his last.
On dissection, I found the common carotid, arising from the subclavian, perfectly sound, until where it branches into the external and internal of that name. Here the disease existed. The sac was deep and of large extent, occupying the whole side of the neck, pushing the muscles to one side, adhering firmly to and bounded by the integuments externally, the thyroid cartilage, os hyoides, and trachea internally, and pressing strongly against the vertebræ behind. It seemed of sufficient capacity to hold 12 or 14 ounces. But to convey a better idea of the nature of the disease, and the probability of success had an operation been judiciously performed, I accompany this with two views, an anterior and posterior one, of the diseased artery, taken by my friend Mr Burke, with great exactness, from the dried preparation.