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.

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    audible in the carotids, most distinctly in the right. Apex of heart, beats at sixth left rib, and a little to the outside of the nipple—the impulse is considerable. Area of cardiac dulness is increased. Over the base of heart the normal cai-diac first sound is partially heai’d, while the second is obscured by a distinct blowing murmur, which continues to be audible over the ventricle. Pulse small and frequent; equal in both radials. Pupils natural, and uniformly equal. Respiratory munnur much less pronounced than usual, but equal over both sides. On the previous day the patient had been bled to ten ounces, with con- siderable relief to the dyspnoea. September 8th.—Diagnosis formed after the examination of yester- day, was, aneurysm of the arch, very probably involving Diagnosis, the innominate, causing direct pressure on the lower por- tion of the trachea, so inducing a considerable share of the dyspnoea. From the frequent and severe paroxysmal exacerbations, I thought it likely that the recurrent, probably on the right side, was also involved in the pressure caused by the dilated vessel. The heart enlarged somewhat, and incompetence, to a certain extent, of the aortic valves. Having failed to perceive any degree of relief to the spasm by the exhibition of several remedies, including the inhalation of chloroform, before leaving the hospital this afternoon I instructed my able and attentive resident physician. Dr. Brydon, that, in the event of a very severe and apparently likely to prove fatal attack of dyspnoea snper- vening, the operation of tracheotomy should be performed. I com- municated the nature of the operation to the poor patient, and explained to him exactly what we expected might be the result in the event of its being performed or otherwise; he entreated that it might be done. During the afternoon he became quiet, and slept for a short time; but a little before 6 p.m. was suddenly seized with most severe spasm, when a modification of the operation of tracheotomy was per- formed by Dr. Inglis, one of the resident sm-geons. No Tracheotomy, unusual difficulty was encountered, and there was little haemorrhage. The operation, according to my directions, was performed higher in the trachea than ordinarily, owing to the pressure exercised upon the passage below, and to avoid all possible risk of wounding the dilated vessel. The cricoid cartilage and two upper rings of the trachea were cut. The patient remained in the sitting posture during the operation, and upon its completion imme- diately manifested the greatest relief. All the resident physicians and surgeons witnessed the operation; and they agi-eed in stating that when seen before the operation the patient appeared to be “ in extremis; ^ and, further, that a remarkable freedom from dyspnoea followed its performance. This improved condition continued. He was seen frequently dm’ing the evening; and at night there was no recurrence of the spasm, and his breathing appeai’ed greatly relieved. He was able to lie with the head lower; and, what is most satisfactory