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Atwood's Pure Cod Liver Oil; Tallman's Isinglass Plaster; Impermeable Piline; Spongio Piline; Genuine English Hat Case; Urinary Cabinets; Clinical Thermometers. JOSEPH T. BROWN & CO., Washington, cor. Bedford Street.. Boston. THE BOSTON MEDICAL AND SURGICAL JOURNAL. VOL. XCIV. - THURSDAY, JANUARY 20, 1876. NO. 3. -- THORACIC ANEURISM TREATED BY ELECTROLYSIS, BY HENRY I. BOWDITCH, M. D. T. A. S., forty years old, was by occupation a chief engineer in the United States navy. His father died of inflamed bowels, his mother of carcinoma uteri. In 1851 he entered the United States navy. In general he had been tolerably well, though never very strong; he had never had any long illness, and did not remember ever having severely strained himself. Previously to calling on me he had for three or four years had a little palpitation. In 1869, while at Norfolk, Va., he felt "run down" and generally unwell. A widower, he married a young wife in January, 1872. A cough appeared in the following spring and lasted about ten days, and then suddenly disappeared. He raised during these days, only a little froth, without blood at any time; but he could sleep only on his right side, since lying on the left side caused cough. During the following summer he considered himself as well as usual. He was able to walk as freely as ever until pulmonary symptoms reappeared three weeks before he called on me. At that time, one morning, when dressing, in the act of straightening his body in order to comb his hair, he was suddenly seized with a violent paroxysm of coughing, which could be relieved by gently bending forward his body; but it was renewed when he placed himself in an erect posture. This condition of things continued ten days, during which he was quite exhausted by the cough; it caused restless nights, and compelled him to lie upon the right side. His appetite, however, continued. He had no hectics. In about ten days the cough was much lessened; but meanwhile, as he expressed himself, "he had lost some flesh" and "all his strength," and "his wind was wholly gone." His wife had heard a kind of "clicking" in the throat, apparently above the collar-bone. He had given up all duty for ten days. At his first visit to my study he was found to be a well-formed man with evident dyspnoea, not of the severest kind. He had a hard, dry cough. His pulse was 84 and not peculiar. He reported that usually he felt the best in the afternoon. Physical Exploration. The superficial veins of neck and chest were distended. A distinct rounded prominence was seen between the right clavicle and the fourth rib. The intercostal spaces, however, were visi ble. The swelling was most prominent at the second rib, and at that part there was a distinct impulse with each motion of the heart. Semibronchial respiration was noted there, without râle. The whole of the prominence was flat on percussion, most so at the centre, and generally a little less sound in the right breast than in the left. Nothing peculiar about the heart. Save in the spot above named the lungs seemed well, front and back. Perhaps the right back had a little less sound on percussion than the left. Laryngoscopic and sphygmographic examinations revealed nothing definitely diagnostic. It appeared to me to be evidently a case of aortic aneurism, projecting from the arch towards the front and pushing forward the ribs. The limited locality in which the impulse was felt, namely, a space about two inches long in the second intercostal space, and the fact that only a very small portion of the lung seemed pressed upon, made the case not inappropriate for the trial of electrolysis. The patient had tried various remedies under other physicians, but had obtained no relief. November 12th. His nights had been troubled by dyspnoea, but he had been more easy when lying in a semi-recumbent position. Pulse 72, smaller, a little irregular, equal in both wrists. Mind clear and calm in anticipation of the operation, which he had consented to, as he felt that it afforded the only possible chance of relief or cure. It was upon that ground alone that I advised the operation. Drs. J. Collins Warren and J. J. Putnam consented to aid me. Dr. Warren introduced three steel needles. I chose the softest and most central part of the tumor as the spot for their introduction. The needles were covered with varnish save at the very points. All were within half an inch from one another, and nearly parallel. They passed readily in about an inch and a half, and the extremities farthest from the chest undulated very visibly and undoubtedly under the influence of the aortic current. To these needles, which represented the positive pole, Dr. Putnam attached twelve and, after some minutes, fifteen cells of the Störer battery, increasing the current gradually from zero. The introduction of the needles caused no pain. At the negative pole was a large pad; it was placed on the left breast on a part corresponding to that in which the needles were placed in the right. A slight pricking sensation was caused under this pad, but no real pain or other discomfort was felt during the fourteen minutes the operation was continued, except that towards the last the patient had pain low in the left back of the chest. Three minutes after this, pain began (fourteen and one half minutes from the commencement of the current), the pulse rose to 92. The needles were still swaying strongly backward and for ward as at the beginning of the operation. Soon the patient became pale, and looked faint; the pulse failed and the hands were cold; evidently serious results were threatening. The needles were immediately withdrawn. Only a drop of sero-sanguinolent fluid escaped at each minute aperture. The pulse was lost a few moments at the wrist. The patient was laid flat in bed and was soon relieved from these untoward symptoms. The needles were all discolored and one was corroded. The patient soon recovered wholly his quiet of body and calmness of mind. He was ordered to remain perfectly at rest; to take beef-tea and milk, with a little brandy, for diet. Some strips of adhesive plaster were applied over the tumor. In a few hours one could not have recognized that the operation had been performed, except that in regard to every symptom the patient had greater comfort than he had had for several days before the operation. November 13th. I found that the relief had continued. The pulse, by report, had been about 84. The patient had had no uncomfortable symptom, only a slight local soreness where the needles were introduced. November 14th. Much the same as the day before, although he had required the paregoric during the night because of his restlessness. He had perceived nothing materially different in his sensations since the operation. His aspect was that of comfort rather than of distress, and his respiration seemed easy. Pulse 86. The tumor was examined through the adhesive plaster; it had a hard, solid feel, very different from the soft pulsation observed before the operation. November 15th. Patient more restless and having some dyspnoea ; opiates needed twice. At the time of the visit he was lying on his right side. Motion caused pain in front and sometimes in the back of the chest. Pulse 72, quiet. November 17th. He was sitting up, looking easy. The previous night he had been almost able to lie on his back. Slight sonorous râle was heard in both lungs. He was desirous of having a second operation. I found the tumor more prominent, apparently from external inflammation. It was more solid, and the impulse was less distinct. The patient being placed, as at the previous operation, in a semirecumbent posture, three needles were introduced as before; there was much less motion of them. Dr. Warren assisted me, Drs. Putnam and Oberly being present also. Twenty cells were at first used, a galvanometer having been previously introduced into the current; the needle showed a deviation of thirty-three degrees. After three minutes twentytwo cells were used. At the fourth minute six more cells were added, causing a deviation of forty-five degrees. The pulse became a little weakened at the fifth minute. At eight and one half minutes the pa |