DOI: 10.7925/drs1.ucdlib_280595
title: Aneurism of the arteria innominata

description: Watercolour medical illustration depicting an aneurism in a man. It has the alternative reference number 1097, P1A and 20a on the front. The Richmond Hospital Museum reference is C.e.13. The entry for this in P263/1 pg. 27 reads 'Aneurism of the Arteria Innominata. Martin Fleming aet 45, Dr Hutton'. The typescript note under the illustration reads 'Aneurism of the Arteria Innominata'. The typescript note on the back begins '2. Aneurism of the Arteria innominata'.
description: Scope and content: The full typescript note under the illustration reads 'Aneurism of the Arteria Innominata'. The typescript note on the back reads '2. Aneurism of the Arteria innominata – Mr Hutton presented a preparation and illustrative drawing of a case of aneurism of the innominate, in which the distal operation had been tried. The subject of the case was a man named Fleming, aged 47, who had been in good health up to March, 1841, when he was attacked by pain in the right shoulder and clavicle, and which gradually affected also the neck, ear, and side of the head. This pain, which at first occurred only at intervals, after some time became constant. In June a cough came on, which was dry, and recurred in fits. After this had continued for several days he began to expectorate. These symptoms were succeeded by difficulty swallowing, and severe neuralgic pains. In November his loss of health and strength had become remarkable, and there was then a small pulsating tumour under the cleidomastoid muscle. He was admitted into the Meath Hospital, and there was subjected to Valsalva's method of treatment, but with very little benefit. In April, 1842, he presented himself at the Richmond Hospital; the tumour was then situated close to the sterno-cleidomastoid muscle; there was no soufflet; the right radial artery felt as if its canal was somewhat diminished, and the pulse was somewhat less in it than at the opposite wrist; there was bronchial cough and difficulty of breathing; it was observed that the dysphagia became less as the tumour had risen above the sternum. After his admission to the hospital the pulse at the wrist became gradually smaller, the tumour continued to increase in size, and passed across the middle line of the neck; its longer diameter, which was two inches, lay across the neck, while the diameter from above downwards was but an inch and a half. The patient was quite aware of the fatal tendency of the complaint, and also of uncertainty of averting it by operation, yet he readily consented that the operation should be performed. On the 27th of June the operation was accordingly performed, by tying the right carotid opposite to the cricoid cartilage; he became very faint when the ligature was applied, but after this faintness there set in a strong reaction; the pulse, at the time of the operation, was from 50 to 70. On the next day it had risen to 110, but the tumour, which had collapsed when the artery was tied, did not resume its former dimensions. On the second day after the operation, the tumour appeared still diminished in bulk, and the pulsation in it was less. The fever was gradually subsiding, and the patient gradually getting better in every respect, when he was attacked by bronchitis; for several days after this had been subdued the progress of the case appeared favourable, the difficulty of the breathing became less, and the tumour was becoming smaller. However, on the 22nd day after the operation, there was haemorrhage from the wound to the extent of about six ounces; the haemorrhage was controlled by pressure. In five days after this haemorrhage again appeared, but to the amount of no more than two ounces; a steel collar was then applied, with a pad, in the manner suggested by Surgeon Peile. On the thirtieth day after the operation, the ligature was found loose, and there was considerable discharge from the wound, to an extent far disproportioned to the surface of the sore. On the thirty-sixth day he had an attack of diarrhoea, which was at that time epidemic; unfavourable symptoms gradually supervened. On the thirty-eighth day he had rigors and convulsive motions resembling epilepsy; on the following morning a thick dark-coloured fluid was discharged from the wound, but without jet. On the forty-first day the rigors recurred. On the forty-second, the tumour was evidently increased in size, and the sputa more bloody; from this time the tumour gradually enlarged, and the pulsations in it became more frequent. On the sixth-fifth day there was a sudden enlargement of the tumour, accompanied by syncope. On the seventy-sixth day he died. When the body was examined it was found that there had been no attempt at union in the artery, it had ulcerated through at the situation of the ligature; above this point there was atheromatous deposition in the vessel; the aneurismal tumour contained purulent matter and grumous blood; the coats of the innominate were thickened; the tumour projected into the trachea, and had there been perforated with a very small opening, through which the blood had passed into the trachea and lungs; the lungs were slightly emphysematous; the aorta was not dilated, but there was atheromatous deposit between its coats; the left vertebral artery came off from the arch of the aorta; the left subclavian was healthy; on the right side the carotid was filled by a large conical coagulum of about an inch in extent. In the right subclavian was a coagulum evidently older than that in the carotid; it extended from the origin of the vessel to where the vertebral is given off, but it was previous into the sac of the aneurism; the right subclavian was diseased in the greatest part of its course. The wound made in the operation had become a fistulous opening, and the aneurismal tumour had, by its enlargement, nearly reached the external orifice. – (Museum, Richmond Hospital.)'.
description: Numbering/sequence: Original reference number: 1097.