[Reprinted from The Medical News, December 3, 1892.] 
A LARGE AORTIC ANEURISM. 
By F. J. SHADD, M.D., 
HOUSE-SURGEON TO THE FREEDMBN’s HOSPITAL, AND PROFESSOR OF 
MATERIA MEDICA AND THERAPEUTICS AT HOWARD UNIVER- 
SITY MEDICAL COLLEGE, WASHINGTON, D. C. 
The case that I herewith report was under my care 
several times during the past four years. The aneurism 
is one of the largest, if not the largest, on record in the 
Medical Museum, at Washington. 
The pathology of thoracic aneurism has received most 
careful consideration. The subject is of special im- 
portance to the clinician, who often finds it difficult to 
locate the exact portion of the thoracic aorta from 
which the aneurism springs. As a rule, aneurisms of 
the aorta are confined to the ascending portion and to 
the arch. 
Sometimes the carotid, the innominate, and the sub- 
clavian arteries may be severally involved. It is not 
my purpose to write an exhaustive article upon the 
etiology, pathology, and treatment of aneurism of the 
aorta, but it is well to remember that aneurisms are 
divided into (i) true aneurisms, in which all three coats 
of the vessel are involved ; (2) false aneurisms, in which 
only the inner coats are destroyed; (3) diffuse aneu- 
risms, in which the three coats give way and the walls 
of the blood-sac are made up of the surrounding struc- 
tures. The causes of aneurism are various, viz., chronic 
inflammation of the arterial walls, fatty degeneration, 
atrophy, and violent exertion. Among the diseases that 2 
lead to its development may be mentioned rheumatism 
and syphilis. 
The disease is one of middle age, and males are more 
often affected than females, because of the exposure to 
which they are subjected, and the violent exertion in 
which they engage. The diagnosis is often very obscure, 
by reason of the lack of uniformity of the symptoms 
and also from the anatomy of the parts. Sometimes there 
is severe pain in the cardiac region, swelling and throb- 
bing of the vessels, fulness and weight in the chest, in 
addition to marked dyspnea. The position and growth 
of the aneurismal sac often modify the chest-symptoms. 
In the case to which I desire to call attention, a cor- 
rect diagnosis was made when the patient first came 
under my care some four years ago, when the aneu- 
rismal sac was not prominent and many of the symp- 
toms and physical signs were negative. 
The man was first admitted to the Freedmen’s Hos- 
pital October 24, 1888, and was discharged January 15, 
1889. Several times during the past four years he has 
received treatment for the severe pain in the chest and 
shortness of breath. He was last admitted to the 
hospital on August 15, 1892. He died October 1, 1892. 
The tumor had grown much larger and his condition 
was very critical. I learned that the man left Algiers 
in 1861, enlisted as a sailor and had followed the water 
for more than thirty years. His weight was 225 pounds, 
height 5 feet 10 inches ; he had been married fourteen 
years, and had five living children. He stated that his 
age was seventy-eight, and that he was born in Algiers ; 
he also stated that his health was always good until 
after lifting heavy loads on shipboard. One day he 
felt a sharp pain over the heart, after which he had 
asthmatic attacks. The tumor that presented measured 
eight inches vertically, nine inches transversely, and 
eleven inches obliquely. When last admitted the man 
was suffering from marked and persistent asthmatic 3 
attacks which responded to the usual treatment, viz., 
Hoffman’s anodyne and morphine. His general health 
was good and he was remarkably well nourished for a 
person who had been seriously ill for four years. He was 
large and muscular, a man of great strength, a fact 
well demonstrated when we tried to control him dur- 
ing one of the severe paroxysmal attacks that periodi- 
cally recurred. His physical condition was so good 
that even the intense suffering during the many months 
of his former illness had made but slight impression on 
his general health. His mind seemed slightly affected, 
and yet by reason of his foreign accent and some other 
peculiarities common to people of his country, I was 
often at a loss to know how much of his private history 
to believe. Several times he impressed me that there 
must be some cerebral irritation not due to reflex influ- 
ence of the heart-disease. When questioned about his 
parents, he informed me that his father had died ten 
years previously; that he was the twenty-fifth child; 
that his mother was one hundred and fifty years old, 
and was now living. While at the hospital, a year or 
so ago, he would become very violent, would scream 
and run around the ward ; and often he would boast of 
his cannibalistic feats in years past, when American 
citizens appeased his appetite in the wilds of his native 
home. 
During his stay at the hospital the last time he was 
under my especial care. In the paroxysms from which 
he suffered his pain was intense. The last month 
of his life was made as comfortable as possible by the 
judicious use of Hoffman’s anodyne and potassium 
bromide during the day and morphine at night. 
Even under the influence of these drugs he was unable 
to rest in bed, and spent most of his time sitting in a chair 
and leaning over a pillow on the back of another chair, 
thus relieving the lungs of the pressure of the aneurism. 4 
Dyspnea, however, became more pronounced, and 
progressed in intensity until death ensued. 
The post-mortem examination was made by Prof. D. 
S. Lamb, of the Army Medical Museum. I am indebted 
to Mr. J. A. Robinson, Jr., for the report of the examina- 
tion. 
An incision in the middle line below the ensiform ap- 
pendix disclosed an edematous condition of the tissue, 
as well as certain hard abnormal tissues extending from 
the site of the aneurismal sac to near the region of the 
axillary space. 
The lungs were generally adherent. 
Several ribs were found to be eroded in consequence 
of the long-continued pressure by the sac. 
The liver was bound by old adhesions. The organ 
was small; its vessels were congested and their walls 
considerably thickened. 
The left lung was found to be a little edematous. The 
upper portion was divided into three small lobes. Some 
of the bronchi were filled with yellowish pus. 
The heart was enlarged. There was considerable 
thickening of the pericardium from an old pericarditis. 
The aorta was greatly dilated and contained a large 
quantity of soft blood-clot. 
The aneurismal pouch began just above the aortic 
valve and involved the ascending and transverse por- 
tions of the arch of the aorta. The sac contained a mass 
of laminated or striated blood-clot. 
The capsule of the spleen was thickened and adherent 
to the diaphragm. The organ appeared to be enlarged 
and was very dark. 
The left kidney had a small cyst in its cortical sub- 
stance, and on being opened, another small cyst was 
found within it. 
The right kidney was normal. 
The carotid arteries and innominate veins were 
patulous and not interfered with. 5 
The sac detached and lifted out was a foot in 
diameter. 
A large part of the sternum and several ribs on either 
side were entirely absorbed. 
The growth of the pouch being forward, there was no 
pressure on the spine, which appeared normal. 
The calvarium and the cerebrum presented no 
abnormality. 
The cerebellum was anemic; its appearance was 
suggestive of some interference with its nutrition during 
life. This view was strengthened by a decided soften- 
ing and breaking-down of the inferior portion of both 
lobes of the cerebellum. This fact furnished an ex- 
planation of the impairment of coordination that existed 
some weeks before death. No cause for the softening 
was found; this was supposed to have been due to some 
interference with the circulation through the branches 
of the basilar and vertebral arteries. 
The immediate cause of death was suffocation from 
the pressure of an aneurism of the arch of the aorta upon 
the trachea.