December loth, 1892, with an aneurism of the right common carotid artery. The history of the case given by the patient
on
was that he was playing with another boy aud got his neck twisted. A few hours after the accident he noticed a small swelling in the neck, right side, at about its centre. The swelling, till his admission into hospital, had very steadily, though slowly, increased in size. Description of tumour oil date of admission.? About the size of an average man's fist, very hard to the touch, and occupying principally the To the touch anterior triangle of the neck. and vision the tumour felt and looked like a glandular tumour (enchondroma), but on closer
examination its
true character was easily ascerand tained, upon the following grounds : (a) tumour pulsated, the pulsations perceptible in all directions ; (b) stethescopic examination elicited a loud and characteristic " bruit ; " (c) both pulsation and " bruit " disappeared when pressure was applied to the artery below the tumour. Su rgeon Major G. A. Hughes, Assistant Surgeon Dr. Man Mohan Dass, and myself having diagnosed the case as one of aneurism of the right common carotid artery, and as the tumour was of large size, very tense, increasing in size, and causing by pressure pain, difficulty of breathing, and partial loss of voice, it was agreed that an operation should be performed. So, on December 17th, with the assistance of Dr. Man Mohan Dass and Surgeon-Major Gr. A. Hughes, I ligatured the common carotid artery -
as
follows
:?
2. Operation and peculiarities connected toith it.?The artery having been exposed by the usual incision below the Omo-hyoid muscle the artery was ligatured with thick silk, both ends of the latter being cut off short. The operation was difficult and complicated, first 011 account of the pressure of the tumour itself, which, as stated above, was very tense, necessitating the greatest care in manipulation; and, secondly, because during the operation, before the artery was considerable vein a
exposed, was accidently opened,?this the greatest anxiety on accouut of the admission of air, but, owing to the haemorrhage aud frothing up of the dark venous blood at every expiration, the discovery of the vessel was rendered extremely difficult. However, after the greatest care aud the expenditure
(middle thyroid) not only caused
% JPitpi of lospital fpctici). aneurism of right common carotid ARTERY.
By J. FAYREK, M.A., M.D., F.R.S.E.
Civil Surgeon> Nuttra. (1)
Description of Tumour and supposed etiology, (2) Operation?Peculiarities connected with it; (3) After treatment anil progress ; H) General remarks. 1.
years,
Genda, Hindu (Khadi), aged about 18 was admitted into the Sadr Dispensary
of considerable time, the vessel was safely secured without further mishap?-on the ligature of the latter, the pulsation, etc.?-in the tumour, of course stopped instantly. As after the operation from the wound was free, and as the com-
oozing
plete
also
closure of it
a
recurrence
always produced of
frothing
bagging, aud a hissing
with
three sutures were inserted, the the wound being left open for of portion drainage, etc. From the time the vein was iu-
sound, only
main
20
INDIAN MEDICAL GAZETTE.
142
jm'ed
to the
date of the
embarrassment
patient's
recovery,
either heart's action noticed. to
or
no re-
[May
1893.
that, owing to tiie collapse o( ihe sac, the upper patent portion of the vessel was occluded, hence a mechanical and permanent stoppage to
mite
spiration were 3. After treatment: course and progress by haemorrhage." 4. General remarks.? (I) Aneurism, as a Assistant Surgeon Dr. Alan Mohan Dass.? "After the operation there was a slight rise of disease, is very uncommon in India; the astiology temperature for about three days, reaching to in tins case seems^both doubtful and insufficient. After this period, however, the tem- There is, however, 110 other history to account 102? F. perature dropped to normal and remained so for its appearance. (2) Injury to a large vein and entrance of air (with the exception of two days, viz., 29th and 30th instant) till the date of his discharge, com- into it. The hissing noise during inspiration pletely cured. "There were no brain symptoms, and frothing up with oozing during expiration sucli as syncope giddiness, hemiphlegia, etc. were most alarming. When admitted he had hoarseness of voice, some(3) Entire absence of brain and lung sympwhat shallow and obstructed breathing, and these toms which are common after delegation of this '
continued for
vessel.
Congestion
(4) Suppuration of sac with profuse luemorrhage, the blood coming out as it were from a suddenly opened bladder; this simile, I should say, was a good one; ns immediately the bladder" was evacuated."the collapse thereof occluded the patent vessel into which flowed the newly-estab-
some dajs after the operation. of the lungs apprehended, as a result of the operation, with its accidents, did not occur, and the lad made an excellent progress towards recovery; and when he was actually discharged
(January 24th, 1893),
the
tumour
had
entirely
his breathing was natural and unencumbered, and his voice quite clear. "It should be noted that, on December 29th, i.e., twelve days after the operation the incision wouudhad healed up ; the next day, however, a considerable swelling was perceived at the seat of the original tumour, and, at the same time, there was a rise of temperature; suppuration of the sac was apprehended, indeed, from the facts that si?.ce the operation the tumour had been gradually diminishing in size, that all pulsation, etc., had subsided, and that the existing swelling was soft to the touch ; there could be but little doubt as to the nature of the new mischief, and that the surmise was correct. Poultices were applied every four hours, and, on the third day, a large quantity of thin sanious fluid came away from the site of the original incision wound, which being the weakest point had given way. This wound, with a view to free drainage, was kept open during the subsequent progress of the case by the insertion of a piece of lint. " Another complication or accident of interest occurred on January 11th, i.e., 24 days after the operation. While the patient was sitting on a charpoy (bed) in the yard, he suddenly lost a profuse quantity of blood, which he says came out in jets and saturated his dhoti (girdle cloth). " When I arrived I found that the hajinorrhage had ceased, and that it had come away from a small opening in the centre of the tumour, where a small abscess had appeared ; this burst and gave vent to the ha3morrhage. From the small opening purulent matter was oozing. He was put into bed and kept at rest for a week, being very carefully watched all the time. " The haemorrhage was duo to suppuration of the sac, which permitted of the sudden exit of a certain quantity of blood collected in, or washing round, the enclosure, as a result of the newly-
disappeared;
established collateral circulation.
It
was
fortu-
"
lished collateral circulation.
on
was that he was playing with another boy aud got his neck twisted. A few hours after the accident he noticed a small swelling in the neck, right side, at about its centre. The swelling, till his admission into hospital, had very steadily, though slowly, increased in size. Description of tumour oil date of admission.? About the size of an average man's fist, very hard to the touch, and occupying principally the To the touch anterior triangle of the neck. and vision the tumour felt and looked like a glandular tumour (enchondroma), but on closer
examination its
true character was easily ascerand tained, upon the following grounds : (a) tumour pulsated, the pulsations perceptible in all directions ; (b) stethescopic examination elicited a loud and characteristic " bruit ; " (c) both pulsation and " bruit " disappeared when pressure was applied to the artery below the tumour. Su rgeon Major G. A. Hughes, Assistant Surgeon Dr. Man Mohan Dass, and myself having diagnosed the case as one of aneurism of the right common carotid artery, and as the tumour was of large size, very tense, increasing in size, and causing by pressure pain, difficulty of breathing, and partial loss of voice, it was agreed that an operation should be performed. So, on December 17th, with the assistance of Dr. Man Mohan Dass and Surgeon-Major Gr. A. Hughes, I ligatured the common carotid artery -
as
follows
:?
2. Operation and peculiarities connected toith it.?The artery having been exposed by the usual incision below the Omo-hyoid muscle the artery was ligatured with thick silk, both ends of the latter being cut off short. The operation was difficult and complicated, first 011 account of the pressure of the tumour itself, which, as stated above, was very tense, necessitating the greatest care in manipulation; and, secondly, because during the operation, before the artery was considerable vein a
exposed, was accidently opened,?this the greatest anxiety on accouut of the admission of air, but, owing to the haemorrhage aud frothing up of the dark venous blood at every expiration, the discovery of the vessel was rendered extremely difficult. However, after the greatest care aud the expenditure
(middle thyroid) not only caused
% JPitpi of lospital fpctici). aneurism of right common carotid ARTERY.
By J. FAYREK, M.A., M.D., F.R.S.E.
Civil Surgeon> Nuttra. (1)
Description of Tumour and supposed etiology, (2) Operation?Peculiarities connected with it; (3) After treatment anil progress ; H) General remarks. 1.
years,
Genda, Hindu (Khadi), aged about 18 was admitted into the Sadr Dispensary
of considerable time, the vessel was safely secured without further mishap?-on the ligature of the latter, the pulsation, etc.?-in the tumour, of course stopped instantly. As after the operation from the wound was free, and as the com-
oozing
plete
also
closure of it
a
recurrence
always produced of
frothing
bagging, aud a hissing
with
three sutures were inserted, the the wound being left open for of portion drainage, etc. From the time the vein was iu-
sound, only
main
20
INDIAN MEDICAL GAZETTE.
142
jm'ed
to the
date of the
embarrassment
patient's
recovery,
either heart's action noticed. to
or
no re-
[May
1893.
that, owing to tiie collapse o( ihe sac, the upper patent portion of the vessel was occluded, hence a mechanical and permanent stoppage to
mite
spiration were 3. After treatment: course and progress by haemorrhage." 4. General remarks.? (I) Aneurism, as a Assistant Surgeon Dr. Alan Mohan Dass.? "After the operation there was a slight rise of disease, is very uncommon in India; the astiology temperature for about three days, reaching to in tins case seems^both doubtful and insufficient. After this period, however, the tem- There is, however, 110 other history to account 102? F. perature dropped to normal and remained so for its appearance. (2) Injury to a large vein and entrance of air (with the exception of two days, viz., 29th and 30th instant) till the date of his discharge, com- into it. The hissing noise during inspiration pletely cured. "There were no brain symptoms, and frothing up with oozing during expiration sucli as syncope giddiness, hemiphlegia, etc. were most alarming. When admitted he had hoarseness of voice, some(3) Entire absence of brain and lung sympwhat shallow and obstructed breathing, and these toms which are common after delegation of this '
continued for
vessel.
Congestion
(4) Suppuration of sac with profuse luemorrhage, the blood coming out as it were from a suddenly opened bladder; this simile, I should say, was a good one; ns immediately the bladder" was evacuated."the collapse thereof occluded the patent vessel into which flowed the newly-estab-
some dajs after the operation. of the lungs apprehended, as a result of the operation, with its accidents, did not occur, and the lad made an excellent progress towards recovery; and when he was actually discharged
(January 24th, 1893),
the
tumour
had
entirely
his breathing was natural and unencumbered, and his voice quite clear. "It should be noted that, on December 29th, i.e., twelve days after the operation the incision wouudhad healed up ; the next day, however, a considerable swelling was perceived at the seat of the original tumour, and, at the same time, there was a rise of temperature; suppuration of the sac was apprehended, indeed, from the facts that si?.ce the operation the tumour had been gradually diminishing in size, that all pulsation, etc., had subsided, and that the existing swelling was soft to the touch ; there could be but little doubt as to the nature of the new mischief, and that the surmise was correct. Poultices were applied every four hours, and, on the third day, a large quantity of thin sanious fluid came away from the site of the original incision wound, which being the weakest point had given way. This wound, with a view to free drainage, was kept open during the subsequent progress of the case by the insertion of a piece of lint. " Another complication or accident of interest occurred on January 11th, i.e., 24 days after the operation. While the patient was sitting on a charpoy (bed) in the yard, he suddenly lost a profuse quantity of blood, which he says came out in jets and saturated his dhoti (girdle cloth). " When I arrived I found that the hajinorrhage had ceased, and that it had come away from a small opening in the centre of the tumour, where a small abscess had appeared ; this burst and gave vent to the ha3morrhage. From the small opening purulent matter was oozing. He was put into bed and kept at rest for a week, being very carefully watched all the time. " The haemorrhage was duo to suppuration of the sac, which permitted of the sudden exit of a certain quantity of blood collected in, or washing round, the enclosure, as a result of the newly-
disappeared;
established collateral circulation.
It
was
fortu-
"
lished collateral circulation.
