The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . and its pressure-effectswill be little obvious. When the aneurism arises from the terminationof the arch, or the descending aorta, it may often attain a considerableamount of development without any very obvious pressure-effects beinginduced. Aneurisms that are situated within the concavity of the archnecessarily give rise to very severe eflfects, by the compression theymust exercise upon some one or other of the very important structuresthat are spanned by and included within the aortic arch. Wh
The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . and its pressure-effectswill be little obvious. When the aneurism arises from the terminationof the arch, or the descending aorta, it may often attain a considerableamount of development without any very obvious pressure-effects beinginduced. Aneurisms that are situated within the concavity of the archnecessarily give rise to very severe eflfects, by the compression theymust exercise upon some one or other of the very important structuresthat are spanned by and included within the aortic arch. When theanterior part of the aorta, is affected, the aneurism may attain a veryconsiderable bulk, even coming forward so as to project and pulsatebetween the intercostal spaces, without any very noticeable pressure-effects being induced. But when the posterior luall of the artery is theseat of the disease, then severe symptoms are earlj set up by the com-])ression and erosion of tlie structures Ijing contiguous to the arteryand along the spine (Fig. 3*72). When the upper part of the aortic arch. Fig. 372.—Erosion of IntervertebralSubstance by a small Aneurism of De-scending Aorta pressing backwards. Fig. 373.—Aneurism of Descending Aorta, eroding andtraversing Vertebr®. is the seat of aneurism, a peculiar train of cerebral sjmptoras, such asvertigo, insensibility, or defective vision, may be induced by its inter-ference with the circulation throug-h the carotids. The pressure-effects that need chiefly engage our attention are:—1,Pain; 2, Dyspnoea; E, Dysphagia; and 4, (Edema. 1. Pain is usually one of the earliest symptoms of intrathoracicaneurism, and is frequently of great value in a diagnostic point of view,as it is often most marked when the other s^mptoms are the least de-veloped. It is generally more severe in sacculated than in fusiformaneurisms, and when the posterior rather than the anterior aspect of thevessel is the seat of disease. The pain, as has been pointed
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