THE chief diseases to which bloodvessels are liable and degeneration of their walls with loss of elasticity, and consequent abnormal dilatation. In the veins the condition produced is that known as Varicosis, in the arteries the ultimate result is Aneurism.
In the case of the veins disease is less serious than in the arteries. The internal strain is less severe, and is caused by the downward pressure of the weight of the blood and not by the onward pressure of the heart’s contraction. Then there are the valves of the veins to distribute the force of the blood’s weight. Rupture of a varicose vein is a comparatively rare occurrence considering the commonness of the affection. With aneurism it is altogether different. The distention goes on increasing steadily unless the disease is checked by treatment, and when the strain can no longer be borne by the diseased walls, rupture inevitably takes place, and unless the rupture is exceedingly minute death immediately follows.
Many cases of what is popularly called “breaking a blood-vessel” are of this kind.
But all arteries that are degenerated do not necessarily give rise to aneurism. The case of Andrew M.(XX.), is one in point. In this case the disease of the artery only led to hypertrophy of the heart. In other cases, as in the arteries of the brain, disease may lead to ruptures of greater or smaller extent without the formation of aneurism. In these cases the rupture gives rise to attacks of apoplexy. Aneurism may form on the arteries within the skull, and when it does it is generally fatal before reaching a large size. The most dangerous places in which an aneurism can form cranial cavity. In these localities the arterial wall is comparatively unsupported and the continued pressure of the heart’s contractions soon expands the aneurism to the limits of its distensibility. In the localities where the arterial wall has solid structures to support it in the process of distention, the pressure has to wear them away before it bursts the vessel.
An intra pericardial aneurism-that is, one which springs from that portion of the aorta which is enclosed within the pericardial sac-is, unfortunately, quite impossible to diagnose. It is hardly to be guessed at; as it never reaches a size large enough to be discovered by physical signs.
I will now relate a case in point. The patient was under my care just over a year. She had many symptoms which could not be ascribed to the aneurism and indeed she had a complication of diseases.
CASE XXXIII.-ANEURISM, ETC. RUPTURE WITHIN PERICARDIUM.
Hannah S-, 46, came to my clinic at the Homoeopathic Hospital on the 25th of April, 1885, complaining of the following symptoms :- Burning pain in chest; tightness and burning pain from under scapulae, up the spine and through each breast, first one and then the other. Has had pain in back for years. Has had a dry hacking cough night and day for two months. Has a headache at the vertex as if she had been felled. Catamenia have ceased for fourteen months; she has flushes and perspirations. Sleeps heavily.
She is very nervous, cries at the least thing. Has much worry.
Tongue white, appetite very bad; for drinks she takes tea and also beer. Is gouty.
Treatment Ignat. 3, four times a day.
(She had a sister die of cancer and she fears it herself.
An aunt has severe heart disease. Her mother gave me some additional particulars after death which may be best given here : All her life she was delicate. As a child she suffered much from cough and used to be short of breath. At the age of 21 she was thought to be in a consumption, and a physician who was consulted about her (Dr. Fuller), told her mother to get her away at once to Hastings or the South of France.)
May 9th.-Chest very much better, but has neuralgia badly. Face flushed. Feels well.
Treatment Argent nit. 5, alternately with Ignatia.
June 6th.-Head much better, but feels very weak. Backs of eyes affected. Tongue quite white in morning. Repeat.
August 29th.-She has been at the sea-side. Her head is bad and the pain seems to have affected the eyes, which were much inflamed and red all over last week; now the sight is dim. Has sharp pains in left breast. Has had sixteen abscesses in it in former times.
The pain is sharp, shooting from the region external to the breast to a nodule situated above the centre of the upper edge of the gland, the size of a hemp seed. This nodule is very tender to touch, but it cannot be otherwise distinguished from similar nodules situated along the opposite border. The left breast is very lumpy. She never nursed with her right.
Tongue coated, white as milk in the morning. Bowels confined.
Treatment Bryon. I, four times a day.
September 12th.-Pain and soreness nearly all gone; only a pricking left, not stabbing as before. Eyes rather bad. Repeat.
October 10th.-Her back is very bad since the pain left the chest. It extends up the whole spine and there is ringing in the ears. The mistiness of vision is increased.
Treatment Gelsem. 3, four times a day.
October 24th.-Has had no headache for a fortnight. Has much pain up the spine to the nape. Feels the pain in the left breast now and then; occasionally in the right breast also.
Treatment Conium 3, alternately with Gelsem.
At Christmas she was laid up at home with an attack of pleurisy, and she did not attend at the hospital again until April 14th, 1886, upon which date I find the following note:- Eyes much better. The chest has never quite got over the attack of pleurisy. Has cough in the morning; not much phlegm. Is very short of breath.
Examination. Lungs : Increased vocal resonance and fremitus on right side, no friction.
Heart: First sound accentuated at apex. Action hurried.
Treatment Arsen iod. 3x two grains night and morning. Bryonia I, four times a day.
April 21st.-Was very well till yesterday, when she had several spasms of pain in the left side coming on in the afternoon. She attributed this to the cold winds.
Treatment Iodium 2x, Bryon. I, every two hours alternately,
April 28th.-The pain was better till yesterday, when it came on worse, and to-day it is very bad, She has lost rest and is hysterical. The chest is tender. She becomes much distended. The pain is continuous, burning. Has flushes. Tongue white. Appetite very bad. Has much wind. Bowels confined when she takes milk. Pulse frequent.
The pain does not catch the breath as it did. She does not feel it after being in bed four hours. If she moves her right arm, she feels faint at once and then the pain comes on.
Treatment Aconite 1x, one drop four times a day.
May 5th.-Pain came on badly from 11 o’clock this morning. Before this was very free from it. Bowels confined. Pulse 120. Feels quite well in general health. Always had neuralgia worse in morning.
Treatment Calcarea phos. 6x, two grains night and morning. Aconite 1x, four times a day.
May 16th.-Has kept very well up to last night, when the pain was very sharp and left a red spot on the shoulder. Pulse 120.
Treatment Calcarea phos. 6x, two grains night and morning. Bryon. 1, four times a day.
May 26th.-Pain very much better. Has had the easiest time since last October. She can turn on her side now. Pulse 116.
She has a good deal of flatulence, with choking in the throat and hysterical symptoms. Tongue white, appetite poor. Repeat.
This was the last day of her life. Early the following morning the patient’s son came to me in great agitation to say his mother had been taken suddenly with a fit, that she was quite unconscious, “her face having gone different colours.” A quarter of an hour later I was at her house and found her quite dead in the spot where she had fallen. She had taken her breakfast as usual; seemed quite well; had done some household duties and was in the act of making her boy’s bed when she fell. Her mother mentioned that a month before she had had a curious sensation at the heart, which compelled her to throw herself on the bed: she felt as she had never felt before.
I will now give my notes of the Autopsy which took place the day after her death.
Body well nourished. Chest resonant. On opening the chest the right lung was found slightly adherent on inner aspect, emphysematous and oedematous, congested at the base, puckered and somewhat fibroid at apex; bronchi filled with sticky mucus. Left lung less emphysematous than right in upper lobe; emphysema in patches, as if recent, in lower lobe; less congested than right and no oedema; a good deal of bronchial congestion.
Heart: Pericardial sac contains a currant-jelly clot weighing about 3 ounces. Heart firmly contracted; valves on right side healthy. Mitral valve slightly thickened. Aorta much diseased; an aneurism about the size of a Tangerine orange (containing scarcely any organised clot), beginning within the pericardium, had opened by a small rupture into the sac. The muscular substance of the heart was soft and fatty.
On opening the abdomen the omentum was found joined by adhesions to the abdominal wall and pelvic viscera. The liver was much adherent to the abdominal wall. The kidneys showed signs of interstitial nephritis, fibrous spots being evident in the substance of the organ and the capsules adhering. The uterus contained a fibroid tumour the size of a walnut: the ovaries were contracted from chronic inflammation.