. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. properly speaking, do not form a part of the clinicalhistory of thoracic aneurysms. They may be present nevertheless,and are then the result, in part at least, of the stasis within theportal system and its tributaries occasioned by pressure on thegreat veins in the thorax. All aneurysms of the arch do not occasion appreciable inter-ference with the flow of blood out of the venous system. When,however, an aneurysm attains considerable size it
. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. properly speaking, do not form a part of the clinicalhistory of thoracic aneurysms. They may be present nevertheless,and are then the result, in part at least, of the stasis within theportal system and its tributaries occasioned by pressure on thegreat veins in the thorax. All aneurysms of the arch do not occasion appreciable inter-ference with the flow of blood out of the venous system. When,however, an aneurysm attains considerable size it can scarcely failto affect circulation by mechanical pressure. One or both ofthe vense cavee may be compressed, and to such a degree that thecirculation can only be carried on by means of collateral vessels. Such a condition is admirably shown in Fig. 110, which is takenfrom a photograph kindly furnished me by Dr. Emil Beck. Thisman, aged thirty-seven, was first seen by Dr. Beck in October of1901, at which time his complaint was of cough, dyspnoea and in-ability to lie down. He gave a history of syphilis sixteen years50* 786 DISEASES OF THE HEART. FlO. no.—DiLATATInx OF SUPERFICIAL VeINS SeCONHAHY Ti) PuESSUUE BY ANEURYSM ON Ven^ Cav^. before, for which he received very inadequate treatment. His occu-pation was that of a metal-polisher, which necessitates the puttingforth of considerable, strength in pressing the metal against a ANEURYSM OF THE THORACIC AORTA 78Y polishing wheel. Here, then, were two factors both operative inthe etiology of aneurysm. His one initial symptom of breathlessness on exertion devel-oped slowly, and did not necessitate abandonment of work and thesport of playing baseball until nearly a year after it was firstnoticed. When Dr. Beck examined the patient there was a per-ceptible fulness of the neck and bulging in the aortic area. Thistumour pulsated and gave a systolic bruit. The pulses of the righthalf of the neck and of the corresponding arm were di
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