. Surgical differentials. al aneurisms, as those which must atpresent be relegated to the internist have aptly been called,present a very characteristic and intricate chain of symptoms,which, it is not in the province of this book to discuss. Aninteresting one, for example, is the dilatation and subsequentcontraction of the pupil in thoracic aneurism. The objective symptoms of surgical aneurism:— Inspection,—A pulsating swelling seen in the course ofan artery. Palpation. Expansile pulsation. Percussion. Flat. Auscultation. Occasionally a bruit. Differential Diagnosis. Again excluding the medic
. Surgical differentials. al aneurisms, as those which must atpresent be relegated to the internist have aptly been called,present a very characteristic and intricate chain of symptoms,which, it is not in the province of this book to discuss. Aninteresting one, for example, is the dilatation and subsequentcontraction of the pupil in thoracic aneurism. The objective symptoms of surgical aneurism:— Inspection,—A pulsating swelling seen in the course ofan artery. Palpation. Expansile pulsation. Percussion. Flat. Auscultation. Occasionally a bruit. Differential Diagnosis. Again excluding the medicalaneurisms, the question of differential diagnosis depends natur-ally on the position of the swelling. Let it be supposed thata swelling has appeared spontaneously in the popliteal spaceof an old syphilitic soldier. It might be a gumma; it mightbe an osteosarcoma; it might be a bursa from one of thenumerous tendons in the neighborhood; it might be an aneur-ism. 7*fc*l/Irrcry /f77?Cr. Vastus Zxt. /Verve ftcrr? 7%r7<+ti<L7 Vc/3* Outer &Ca</ Fig. 3 The relations and, particularly the depth of the popliteal artery, are shownin this figure. Note origin and course of external popliteal nerve. DIFFERENTIAL. 3h Gumma. Sarcoma, Bursa. Aneurism. Slow growth. History of growth. I Probably slow. Growth moderate-ly rapid, but on-set acute. Absent. Often present (asfracture). May be absent orpresent. Disease. Evidence of syph-ilis slow. Absent. Cachexia. Onsetrapid. Absent. Onsetslow. Often present.(Some form ofchronic irrittn) Previous Injury. May be Arterio - sclerosisfrequent. Onset,rapid. Typically present,either acute orchronic. Chancre. Previous Disease. May be metastatic Absent. Arterio - sclerosis,endocarditis, al-coholism, syphilis. Adolesence. Childhood. Age. Early middle age. Adult. Occupation. Negative. If present, not se-vere. Not marked. Negative. Always presentoften intense. Marked. Continuous over
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