The international encyclopaedia of surgery; a systematic treatise on the theory and practice of surgery . pulses of the right radial,and of the carotid and itsbranches, are altered, weak,and compressible. These signs are such as we meet with in the form of disease which affectsthe upper part of the trunk, and either commences in or tends to carotidcomplication. But cases occur in which the tumor lies more outward in theepisternal notch, and in which it may be felt along a certain distance of theclavicle, the symptoms being those of innominate and subclavian aneurismcombined. The pressure sympt
The international encyclopaedia of surgery; a systematic treatise on the theory and practice of surgery . pulses of the right radial,and of the carotid and itsbranches, are altered, weak,and compressible. These signs are such as we meet with in the form of disease which affectsthe upper part of the trunk, and either commences in or tends to carotidcomplication. But cases occur in which the tumor lies more outward in theepisternal notch, and in which it may be felt along a certain distance of theclavicle, the symptoms being those of innominate and subclavian aneurismcombined. The pressure symptoms of innominate aneurism are very variable: some-times slight, sometimes remarkably severe. If the high form of the diseasebe on the inner aspect of the artery, there is at first a constant, teasing cough ;this afterwards gives place, as the tumor grows, to dyspnoea, with paroxysmsof coughing and breathlessness that seem about to prove fatal, until relievedby discharge of mucus or muco-pus. No venous pressure is demonstrableuntil the disease has attained considerable dimensions. When the tumor lies. Area of pulsation in early innominate aneurism. TREATMENT OF ANEURISMS AT ROOT OF NECK. 509 outside the episternal notch, there is at first an abnormal voice, tending tobreak into falsetto, afterwards want of tone, and then aphonia, with a ten-dency to swallow the w^-ong way; and about this time congestion of theleft arm and of the left side of the head and neck. There is no dyspnoeauntil the tumor has become large. The low form of innominate aneurism^ as it is usually combined with aorticdisease, must be considered with that subject hereafter; but it will be well topoint out here some remarkable peculiarities in the pressure are respiratory complications—paroxysmal metallic cough withoutaphonia, and marked dyspnoea. But the point to be especially remarked isthis: the pulsation, dulness, abnormally loud heart-sound, etc., are on and tothe right of the middle line
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