CASE OF ANEURISM OF THE LEFT INTERNAL CAROTID ARTERY WITHIN THE CRANIUM, DIAGNOSED DURING LIFE, AND TREATED SUCCESSFULLY BY LIGATURE OF THE LEFT COMMON CAROTID ARTERY
Authors: R. W. Coe
Journal: BMJ (1855)

whoa he was admitted on the 24th.Complains of great uneasiness, and inability to swallow even his saliva; has not taken any food for the last eighteen hours.At a con- sultation held at 11 A.M., it was decided that the carotid should be ligatured, which was at once proceeded with.On placing him in the usual position for tying the root of the left carotid, an incision was made across the sterno- clavicular articulation of the left side, commencing about three inches on the clavicle, and reaching one and a half on the upper part of the sternum; an oblique one, about an inch and a half, was made along the margin of the sterno-mastoid, falling into the former; the skin, platysma, and cervical fascia, were successively divided; the attach- ment of the sterno-mastoid was scparated close to the sternum and clavicle; the sterno-hyoid and sterno-thyroid were partially divided, and held aside; the sheath was ex- posed and opened on the inner side; and the artery secured in the usual way.On tightening the ligature, pulsation ceased in the tumour, which soon diminished in size.A bit of wet lint was placed over the wound, and the patient put into bed.He was able to swallow a little milk in about two hours after the operation. 6P.;u.Is very com- fortable; says he is much easier than he was before the operation.One small vessel was tied, and the wound brought together with sutures.He takes beef-tea, jelly, milk, etc. March 28th.Did not sleep last night; swallows much better.The tumour is less aud harder; there is no pulsa- tion in it.He can open the eye better, and the congestion is diminishing.Pulse 90, good volum%.. Respiration still stertorous, 24 in the minute.Tongue covered with white fur.Says he feels better.March 29th.The sutures were taken out, and the edges of the wound kept in contact by strips of plaster.It has partially united at the ends.Sleeps well, and says he is comfortable.The tumour has shrunk considerably, and the larynx is gradually returning to its position.Bowels not open; urine escapes involuntarily; the catheter was passed, and about twenty ounces of urine were drawn off.March 30th.Seems to be going on well; catheter used twice daily.Sleeps well, and takes plenty of liquid nou- rishment; a slight oozing of pus from the wound.Pulse 80; says he is comfortable, but has a slight cough.March 31st.Not so well; tongue furred; pulse 100, with a slight jerk.Urine highly ammoniacal; bowels not open.Wound does not look so well; there is a blush around it, and more discharge; has slept, and takes his nourishment.April 1st.Is worse; pulse 120; hard; tongue much furred; is restless and uneasy.Urine ammoniacal.Had but an indifferent night.Countenance depressed and anxious.Ale, one pint.Beef-tea, milk, etc., as before.10 P.M.Is evidently worse; the face is more anxious.Pulse 120; feeble.Has not taken so much nourishment to-day.Does not appear to swallow so well.The sac is shrinking, and the larynx is returning more to its place.Wine, ten ounces, to be given at intervals.Liq.opii sed.nIxx; sp.ntiier.sulph.co.uIxx; mist.campb.§j.M. Fiat haustus statim sumendus.April 2nd.Slept tolerably well in the night.-Has taken the wine, etc., but there is no improvement in his condition; he has the glassy eye, subsultus tendinum, and pinched features; tongue dark brown and furred; pulse 130; very feeble; skin and feet especially cold.Mist.vini Gallici 3j, omni horA sumendam.Wine and beef-tea at intervals.