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 . ngs from the ascending or transverse arch and hasattained great size. I recall a man whom I treated for monthsfor aortic regurgitation without suspecting the existence of ananeurysm until quite suddenly signs of pressure on the left lungarose. Even then other signs of the aneurysm were not at all dis-tinct, yet were of such a kind as to render its presence certain. Other effects of aortic aneurysm than those already mentionedwill be left for


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 . ngs from the ascending or transverse arch and hasattained great size. I recall a man whom I treated for monthsfor aortic regurgitation without suspecting the existence of ananeurysm until quite suddenly signs of pressure on the left lungarose. Even then other signs of the aneurysm were not at all dis-tinct, yet were of such a kind as to render its presence certain. Other effects of aortic aneurysm than those already mentionedwill be left for consideration under Symptoms. Etiology.—Arteriosclerosis has long been recognised as pre-disposing to the development of aneurysm. It is objected by Ep- 778 DISEASES OF THE HEART pinger that the changes of sclerosis tend to render the vessel morerather than less resisting, an objection that is also recognised byThoma. Consequently the latter points out that aneurysm is likelyto develop during the time of primary degeneration and weaknessof the media, before compensatory thickening of the inner coathas taken place. This will be referred to Fig. 109.—Skiagraph showing Aneurysm of Aorta with Displacement of the HeartDownward and to the Left. Syphilis is an undoubted factor in the causation of aorticaneurysm, and yet wide differences exist in the opinions of writersconcerning the frequency of its relation to this form of vasculardisease. The extremes are represented by M. Schmidt, who findssyphilis present in 29 per cent of cases, and Drummond, who be-lieves that lues is responsible for aortic aneurysm in every in-stance^—i. e., 100 per cent. My experience leads me to look upon M ANEURYSM OP THE THORACIC AORTA 779 Drunmionds opinion as too extreme, and to accept Gerhardts 53per cent as much nearer the truth. Age is a predisposing factor of great importance, since aneu-rysm of the thoracic aorta is undoubtedly more frequent after thanbefore the fortieth year. The deca


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