Case of carotid aneurism / by James Duncan.

  • Duncan, James, 1810-1866.
Date:
[1844]
Catalogue details

Licence: Public Domain Mark

Credit: Case of carotid aneurism / by James Duncan. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    small doses of Tart. Antimon., with Sulph. Magnes., to be ad- ministered every two hours. I likewise left instructions with Mr S. to dilate the opening in the trachea, which had not yet quite closed, and reintroduce the tube, if the dyspnoea should return, so as to be at all alarming. 9th, 3 a. m. Had an attack of spasmodic difficulty of breath- ing, but by no means such as to require the introduction of the tube. Noon. Breathing very easy; fluctuation in tumour somewhat more distinct. I at this time thought that an incision might be made into the tumour with advantage, but it was thought safer to delay doing so until next day, if circumstances should not de- mand it earlier. 8^ r. m. Some ounces of decomposed blood were discharged from the mouth, the tumour, at the same time, suddenly collapsing. It was evident from this that the sac of the aneurism had given way internally, and it was likewise evident that it might be opened externally without fear of hemorrhage, the dread of which had prevented us doing so previously. I accordingly made an in- cision of about two inches in length through the most projecting part of the tumour, and turned out as much of the broken down coagula as I could, with some purulent matter, which was present in small quantity, in all, a little more than a table-spoonful, with considerable relief to the patient. I left her in what both Sir George Ballingall, who was present, and myself conceived to be a most satisfactory state ; the respi- ration easy, and the pulse of moderate frequency, and good strength. She was seen by Mr Shand at 12 p. m. She had then been sleeping quietly for an hour, and on waking expressed herself as being perfectly easy. 10th January, 2 a. m. The nurse was alarmed at a sudden change in her respiration. This, from being easy, had become suddenly noisy, and, as was described, croupy. She immediately called Mr Shand, who, in a very short time, was at the bedside, but found the patient dead. Post mortem examination.—This was conducted somewhat hastily, inasmuch as it was done surreptitiously, the friends hav- ing refused permission to inspect the body, and those engaged in the examination being in constant dread of their arrival. The whole anterior part of the neck, from the base of the skull to the origin of the aorta, including part of the upper lobes of both lungs, were removed and laid aside for more careful exami- nation afterwards. Chest.—Sections were made through the lungs at different parts, and not the slightest trace of any morbid appearance was discovered. The trachea and bronchial tubes were perfectly