Notes on cases of tumour in the mediastinum / by E. Symes Thompson.

  • Symes-Thompson, Edmund, 1837-1906.
Date:
[1865]
Catalogue details

Licence: Public Domain Mark

Credit: Notes on cases of tumour in the mediastinum / by E. Symes Thompson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    teen, applied as an out-patient at the Hospital for Consumption and Diseases of the Chest, at Brompton, suffering from shortness of breath. He had been ill three weeks. On examining the chest, the right side, which moved very- little even on deep inspiration, was bulging and prominent. The intercostal depressions were obliterated; the bulging was most marked anteriorly, in the mammary and infra-mammary regions; there was some redness of skin, and enlarged veins ramified tortuously over the chest and abdomen; several enlarged glands were visible in the pectoral and axillary regions. On percussion the wrhole side was dull, from the clavicle to three inches below the costal cartilages, at which point the edge of the liver could be felt, the dulness extending to the left side of the sternum. The percussion note was not absolutely dull behind, above the angle of the scapula, where vesicular breathing could be heard on auscultation; in front, however, and in the axilla no normal breath-sound could be heard; but a distant bronchial breathing was detected beneath the clavicle and all over the most prominent portion of the chest. No vocal thrill or vibra- tion could be detected anywhere on this side. The apex of the heart was felt beating three inches below and three inches to the outer side of the nipple, where a very distinct systolic murmur was detected. My colleague, Dr. Cotton, who examined the patient with me, inclined to the opinion that this unusual combination of symptoms arose from the presence of a malignant growth in the chest. As the boy could not be at once admitted into the Brompton Hospital, he was sent to King’s College Hospital, where he was taken in under the care of Dr. G. Johnson, who, after some consideration, introduced a grooved needle between the fourth and fifth ribs, an inch external to the right nipple, and drew off fifty-six ounces of serum. The prominence remained as before, but the chest became tympanitic on percussion, with splashing and marked succussion sounds; the dyspnoea con- tinued urgent; pulse, 120; respiration, 32. The lips became blue and feet oedematous. After a few days there was some flattening beneath the clavicle, and the circumference of the chest, which, on admission, was as follows :— On level of nipple, right side, 16 inches; left, 14£ inches; became „ „ 15 „ „ 15 The tympanitic resonance gradually diminished, and the dulness, which, had remained absolute in the sternal region, extended more to the right side; here the bronchial breathing, which ceased on the removal of the fluid, was replaced by loudly- conducted heart-sounds. The dyspnoea and blueness of face varied from day to day, but six weeks after the operation the patient became drowsy and died comatose.