Case of Aneurism of the Thoracic Aorta.-Under the care of DR. REDDY. Reported by W. R. SUTHERLAND. P. P., aged 48, of Irish descent, unmarried man, of medium height, strong and muscular, was admitted into the Montreal General Hospital on the 19th April, 1878, complaining of short breath and constant cough (which has a peculiar ring), with pain in right shoulder, side of neck and crown of the head. Pain is much aggravated on attempting to lie down, and a sense of choking comes on so that he has to be propped up in bed. He expectorates large quantities of thin, frothy mucous, with purulent patches through it. Dyspnoea is not worse after exertion; appetite good; voice somewhat hoarse. Family history obscure; but, as far as can be made out, it is good. He has never had syphilis, nor any other disease of any consequence. Was a soldier for twelve (12) years, during which time he saw active service and endured severe hardships. Since his discharge from the army, has been a policeman, porter, and, for the past ten (10) years, caretaker of the armory. Has been a man of regular habits, and enjoyed good health up to January, 1877, when he was first troubled with more or less pain in the right shoulder and side of the head. Cough and hoarseness were not noticed until July, 1877. On examination, the superficial veins of the front of the chest are seen to be moderately distended, one markedly so, running from left axilla across chest to sterno-clavicular articulation. Breathing is almost entirely abdominal. Visible pulsations in both super-clavicular regions and in superficial arteries. Pupils are equal. · Mensuration-During inspiration left side measures 181′. Palpation-Appreciable impulse over first bone of sternum. Percussion gives no decided dullness along upper part of the chest, except a shade over the first bone of the sternum, more marked on the right side. Left lung hyper-resonant in front and behind. Auscultation. Find respiration feeble all over the chest. Vocal resonance somewhat increased over upper part of chest. Loud sonorous râles over front of the chest, and stridulous breathing over both back and front of the chest. Double murmur in first space of both sides, much louder on the right. Heart.-Point of maximum pulsation is at 1st space, to the right of the sternum, and at this spot there is a double sound, also a double murmur, transmitted all through the arch. Systolic, short, soft and flowing. Diastolic, very short and very soft. Both sounds and murmurs are less distinct at 2nd space, audible but less distinct at 3rd, also audible at ensiform cartilage. Inside left nipple is a systolic murmur, followed by a clear second sound without a murmur. Urine-Contains no sugar nor albumen; sp. gr. 1.014. April 21.-Condition is unchanged. Is taking liq. morphia, sii; vin ipecac, 3i; syr. pruni virg., iii; aq. ad 3vi;—dose, a table-spoonful three times a day. May 2.-Passed a bad night; cough was very distressing, being hard and without much expectoration. The pain in his head, neck and shoulders is much worse on damp days. May 7.-Is much weaker, and not as well as usual, though his condition is apparently unchanged. Has been ordered a tonic of quinine and iron. May 29.-Up to this time there was no change to be noticed, except that the veins are more distended; visible pulsation very marked over right sterno-clavic articulation. In addition to the marked impulse over the upper part of the sternum, a thrill can be distinctly felt. Pain is less severe on the right side of the head and neck, but he cannot raise his right arm higher than on a level with his shoulder without experiencing very great pain of a lancinating character just over the coracoid process. Cough is much worse and sputamuco purulent. June 4.-For the past few days he has been troubled with rheumatic pains in his ankles. Yesterday afternoon, had a very severe attack of dyspnoea, which lasted about half an hour. Pulse was 120; temp. 100°. He continued to suffer from dyspnoea and pain in the chest, which he could not localize, until June 12th, when he died after a prolonged attack of orthopnoea. Autopsy, 30 hours after death: Body that of a medium-sized man; rather emaciated. Thorax. Lower lobe of right lung adherent at lower part by soft recent adhesions. Further up there is a plastic lymph, non-adherent, and beyond this, intense congestion of the pleura; the surface of the upper half of the upper lobe alone is healthy. The upper part of the lung is compressed by about one pint of turbid serous effusion. The lower part of right lung, especially at the margins, and for a space of three or four inches, is in a state of pneumonic consolidation-red hepatisation; a small part of it has advanced to the stage of grey hepatisation. On the anterior surface there is an abscess about the size of a filbert, apparently arising from a previous bronchopneumonia. Upper part of lung fairly healthy, Left Lung-Non-adherent; anterior surface healthy; posteriorly hypostatic congestion; apex on section appears acutely congested-crepitant; on pressure, exudes a large amount of frothy serum. Heart-Weighs 330 grammes; substance apparently healthy, also valves, except aortic, which appears to be slightly incompetent. The arch of the aorta is dilated and lengthened so as to form a large fusiform aneurism, involving, chiefly, the transverse portion of the arch. The innominate artery is dilated throughout its whole length so as to form an independent aneurism which sits upon that formed by the arch. The right subclavian and carotid are given off from this sac, but are of normal size and appearance from their origin. The recurrent laryngeal nerves were not observed in the dissection, but it seems probable that the right was in some way interfered with by the innominate portion of the aneurism. NO. LXXIV. 5 Correspondence. PARIS, 12th August, 1878. To the Editor of the CANADA MEDICAL AND SURGICAL JOURNAL: DEAR SIR, -The annual meeting of the British Medical Association, you are aware, has taken place this year at Bath,between the 6th and 9th days of this month. Bath is one of the quietest but pleasantest of towns and seems admirably suited for meetings of that kind. It is not so small but that ample and good accommodation can be afforded for a very considerable number of visitors, and yet not so large but that all shall be conveniently situated towards the rooms and places of meeting. In itself, too, the good old city has much to in terest a visitor, medical or otherwise-Its famous hot springs, in which old Romans bathed and forgot their ills, are still seen boiling and steaming as they rise above the ground-its really beautiful buildings which surround those springs and afford the invalid every desirable luxury in the way of bathing-its noble cathedral, where the Bishop of Bath and Wells opened the meeting by an eloquent sermon to the Association, and queer old houses of almost all possible dates, carrying you back to the time when Dr. Johnson and his faithful boy came to the baths for the good of their constitutions and to enjoy the society of the many beauties of that day who found it "the thing" to go there. Bath is famous for its antiquities, and chief amongst those of great interest are a large number of Roman altars and other remains in wonderful preservation, which have been found here in all directions, and have been preserved in the local Antiquarian Museum. Members of the Association and Medical visitors were made free of all the baths during the meeting, and I assure you the swimming baths, the cutidaria, and the draughts of the ærated water were fully appreciated by a great many. The first evening was chiefly occupied by the President's address—Unfortunately, this year that official was a Dr. Fal coner, a local practitioner, and he had devoted nearly the whole of his paper to extolling the virtues of the healing spring in which it is incumbent upon every true Fathite to believe-it contained, however, nothing new or of any general interest. This was followed on the succeeding day by the address in Medicine, by Dr. Goodridge, Senior Physician of the Royal United Hospital, Bath. It will, I daresay, appear better in print than when ead—the delivery having been painfully defective. It was, however, of excellent quality, and was listened to with much attention. The subject selected was that of the natural production and regulation of heat in the human body, and the pyrexial state. After a survey of the various theories of heat production, it was readily shown how little is really yet known of the true physiology of this subject, and a portion how much less of the various complex processes which result in the production of the pyrexial state. All physicians and workers in practical medicine were exhorted to give this subject all the attention its great importance deserves. Dr. Goodridge would look hopefully forward to the time when, possessed of a true fundamental knowledge of the laws governing heat production and discharge, we shall be able on true scientific grounds to remedy with a degree of certainty hitherto undreamt of, those pyrexial abnormalities which now constitute an often serious part of a great many of the very commonest maladies we are called upon to treat. The same afternoon the sections opened and the medical one was the centre of attraction. It was presided over by Prof. Grainger Stewart, the popular Professor of Medicine of the Edinburgh University. His opening address was devoted to a discussion of certain recent observations by himself and others upon the pathology and relationships of certain of the forms of Bright's disease which have caused him to alter or modify many of his pre-conceived views as expressed in his work on that subject. The daily programme had announced that a discussion upon obstruction of the bowels would be held and would be opened by Mr. Jonathan Hutchinson-It was this which had attracted |