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Laryngotomy was done with the hope of removing a foreign body, but the man died on the tenth day. A postmortem examination disclosed the existence of an aberrant right subclavian artery in the posterior mediastinum, and this was the seat of a traumatic aneurysm that had ruptured into the esophagus.
The chest is the superior, or in quadrupeds the anterior, cavity of the trunk of the body: it is divided into two cavities by a membranous partition, termed 'mediastinum; and separated from the abdomen, or cavity which contains the liver, spleen, pancreas, and other abdominal viscera, by the 'diaphragm, which is of a musculo-membranous nature.
He showed no signs of hemoptysis, and although in great pain, was able to give commands after reception of the wound. In this case, the ball had evidently entered within the right nipple, had passed between the lungs, through the mediastinum, emerging slightly to the right of the spine.
We have observed a case of lympho-sarcoma above the clavicle, in which excision of all that was removable, followed by the insertion of a tube of radium for ten days, was followed by a disappearance of the disease over a period which extended to nearly five years, when death resulted from a tumour in the mediastinum.
For instance, the mediastinum, the sutura sagittalis, the scrobiculus cordis, the marsupium cordis, the chambers of the heart, the velum palati, the trochanter, the rima glottidis, the fontanelles, the alæ of the nose, all have their present names, not from original Latin expressions, but from the translation of Arabic terms.
The senile are passing through the twilight into the night; while infants are traversing through the dawn into the day. Hence it is that the diagnosis of injury and disease in the extremes oflife is beset by especial difficulties, since the entire body is as silent as are the brain, the pericardium, the mediastinum, and other symptomless areas.
Logical and progressive conclusions drawn from experience, and based upon the local enlargement which the physicians previously consulted have apparently failed to perceive, lead me to diagnose the presence of a tumour in the mediastinum, extending its claws into the lungs, and seriously impeding their action and the action of the heart.
A review of the literature previous to this century shows the names of Arcaeus, Brunner, Collomb, Fabricius Hildanus, Vogel, Rhodius, Petit, Guerin, Koler, Peters, Flebbe, and Stalpart, as authorities for instances of this nature. In one of the journals there is a description of a man who was wounded by a broad-sword thrust in the mediastinum.
Notwithstanding subsequent pneumothorax and extensive pleuritic effusion, the patient made a good recovery at the end of the fourth week and at the time of report it was still uncertain whether the needle remained in the heart or had wandered into the mediastinum.
Diemerbroeck is said to have dissected a human subject in whom the diaphragm and mediastinum were apparently missing, but such cases must be very rare, although we frequently find marked deficiency of this organ. Bouchand reports an instance of absence of the right half of the diaphragm in an infant born at term.
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