Excerpt from Three Cases of Pressure Upon the Recurrent Laryngeal Nerve From Different Causes: With Fixation of the Left Vocal Band in Phonatory Position

Aneurism of the arch of the aorta and of the left subclavian artery with fixation - spastic immobility - of the left vocal band in the phonatory position. Mr. X. Y. Z., aet forty-four, formerly a cor poral of artillery, and Since June, 1865, a machinist, applied N ovem ber 15, 1885, at the Philadelphia Polyclinic on account of great dyspnma said to have been but of six months duration, although shortness of breath had existed for fully five years, eventually aecom panied with frequent cough, and expectoration of frothy white mucus. Coughing produced great pain within the left side of the thorax. Pain in the left side and in the back had commenced about ten years before, and was always reproduced by excitement, although there was no consciousness of cardiac palpitation. Pains in the epigastric and cardiac areas had existed almost continuously for five years. These were followed by pains radiating along the left arm and up the left side of the neck into the head, where they had remained con tinuous for the last six months. Dizziness in walking had been pro duced for some months, compelling interruptions for rest. Dizziness was nearly as bad on standing. About five years before, the voice began to undergo change. It was now weak and diphthonic, the higher pitched tone being metallically shrill and squeaky. Respira tion was embarrassed spasmodically on exertion, but during rest in the sitting position was fairly quiet at a rate of from twenty to twenty-four per minute. The patient felt much better in the open air than in a room. The pulse was about 86 per minute at the right wrist and over a pulsatile, expansile tumor below the clavicle and second rib of the left side, but it was almost imperceptible and apparently irregularly intermittent at the left wrist. The pupils were equally dilated.

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