Cases of aneurism of the aorta, treated by the iodide of potassium / by Byrom Bramwell.

  • Bramwell, Byrom, Sir, 1847-1931.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Cases of aneurism of the aorta, treated by the iodide of potassium / by Byrom Bramwell. 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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    State on Admission.—Patient is of middle bciglit, dark hair, light brown eyes, complexion pale, mucous membranes amiemic. He is somewhat emaciated. He complains of pain and beating in the right breast, palpitation, shortness of breath on going up stairs or up a hill, and occasional cough. The pain is constant. At times it is very severe, shooting through to the back, up to the shoulder and down the right arm to the tips of the fingers. Tor several nights past it has been intolerable, and has prevented all attempts at sleep. On Inspection.—slight pulsating prominence is seen Ijetween the second and third right costal cartilages. A double impulse and systolic thrill are felt over the prominent area, which is the size of a five-shilling piece. Pain and tenderness on pressure are com- plained of over the prominence, and at a spot between the superior angle of the right scapula and the spine. On Percussion, there is absolute dulness over a space two inches square. The centre of this area is the pulsating prominence. There is also impaired percussion over the inner half of the right infraclavicular and over the upper sternal region, (See Plate I. Fig. 1.) On Auscultation, a double impulse and soft systolic murmur are audible over the aneurism. The respiratory murmur and vocal resonance are absent over the dull area. There is impaired per- cussion between the superior angle of the right scapula and the spine. A double sound is audible over the same spot. The Pupils vary in size, the right being sometimes larger, some- times smaller than the left. There is also right-sided unilateral sweating of the head and face. The patient states that he has noticed this for nine years. The Respiratory Murmur and vocal resonance are weaker in the right than in the left lung. The voice is hoarser than it used to be. There is slight difficulty in swallowing. Tfie Cardiac Apex can be felt in the sixth left interspace, three inches below the nipple. Cardiac dulness extends transversely from the left border of the sternum to the left nipple, a distance of 3f inches. Vertically it measures 4J inches, extending from the fourth to the seventh rib. A soft systolic murmur is audible at the apex. The pulmonary sounds are not accentuated. The aortic second sound is very loud over the mid-sternum at the level of the nipple. It is much louder at this spot than over the aneurism itself. The pulse numbers 74, is regular, equal in the two wrists, slightly visible and jerking. The other Systems and Organs are normal Treatment.—He was ordered half-drachm doses of the iodide of potassium three times a day, rest in bed, and a subcutaneous injection of morphia at bed-time. Sulsequent Progress of the Case.—22d January.—Re, is now almost free from pain, and able to sleep without the opiate.