The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . ture externally, or into the pharynx or oesophagus ;by asphyxia, from pressure on larynx or recurrent nerve ; or by starva-tion from compression of the oesophagus-Aneurisms of the carotid are usually of slow growth, and may some-times exist for a considerable number of years without giving rise toany special inconvenience: this is more particularly the case when theyare seated at the bifurcation of the artery; when at the root, they aremore likely to be attended by injurious pressure-effects. Dia
The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . ture externally, or into the pharynx or oesophagus ;by asphyxia, from pressure on larynx or recurrent nerve ; or by starva-tion from compression of the oesophagus-Aneurisms of the carotid are usually of slow growth, and may some-times exist for a considerable number of years without giving rise toany special inconvenience: this is more particularly the case when theyare seated at the bifurcation of the artery; when at the root, they aremore likely to be attended by injurious pressure-effects. Diagnosis.—The diagnosis of carotid aneurism is without doubtmore difficult than that of any other form of external aneurism : thebest proof that it is so, may be found in the fact that, of the cases inwhich the carotid artery has been ligatured for supposed aneurism ofit or its branches, in several instances no such disease existed—solidcysts, or other tumors of the neck having been mistaken for aneurism,and this by Surgeons of great and acknowledged repute. DIAGNOSIS OF CAROTID ANEURISM, 97. Fig. 379.—Aneurism of the Summitof the Arch of the Aorta, simu-lating- Carotid Aneurism. The diagnosis of aneurism of the lowerpart of the carotid from i^imilar disease ofother arteries at the root of the neck, as ofthe subclavian, vertebral, and brachio-cepha-lic, and the arch of the aorta, is surroundedby difficulties, which can only be cleared uphy 3i. careful stethoscopic examination of thepart. In some aneurisms of the arch of theaorta, the sac rises up into the neck, so asclosely to simulate a carotid aneurism, as inthe annexed cut (Fig. 379) ; and this greatlyincreases the difficulty of the diagnosis. Insuch cases. Holmes suggests that the effectproduced by carefull}^ applied distal pressuremay aid in the diagnosis. If, after a fewhours, when the collateral circulation shouldbe commencing to enlarge, the sac shows nosigns of diminished tension, tiie case is veiyprobably one of a
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