The international encyclopaedia of surgery; a systematic treatise on the theory and practice of surgery . ending aorta; theouter case, that is, the harder part of thebone resists the rodent action for a cer-tain time, but when this is once brokenthrough, absorption is very quick; aneu-risms have more than once, after eatingaway the vertebral body and the adja-cent intervertebral substance, burst intothe spinal canal. But most limb-bones,being more dense, are with more diffi-culty attacked ; hence, in such a maladyas subclavian or popliteal aneurism, theclavicle or femur is less often foundexca
The international encyclopaedia of surgery; a systematic treatise on the theory and practice of surgery . ending aorta; theouter case, that is, the harder part of thebone resists the rodent action for a cer-tain time, but when this is once brokenthrough, absorption is very quick; aneu-risms have more than once, after eatingaway the vertebral body and the adja-cent intervertebral substance, burst intothe spinal canal. But most limb-bones,being more dense, are with more diffi-culty attacked ; hence, in such a maladyas subclavian or popliteal aneurism, theclavicle or femur is less often foundexcavated. Sternum, ribs, and costal car-tilages are frequently eroded over thespace on which a thoracic aneurism ispressing. The pressure and caries pro-duce pains which are often very severe,and of a character which must be distin-guished from those of nerve pressure ; Aneurism of the thoracic aorta, eroding vertebra they are generally more distinctly local- Tf- ^ J^ °^ ^°^^^ ^^^ vertebral % ?,- , . 11- bodies. (From a preparation in Charing Cross Hos- ized, and are burnmg and aching. pjui Museum.). Differential Diagnosis. Both intrinsic and extrinsic symptoms of aneurism have a certain marginof ambiguity which care in examination must eliminate. I would mostespecially insist on this element of care. Certain fortunately rare cases, evenof limb aneurism, present difficulties which may baffle the most searchingand skilful investigation; but by far, by very far, the larger number ofdisastrous mistakes which have been made in dealing with aneurisms, havebeen due to insufficient caution, as when, for instance, a surgeon, with mis-placed self-confidence, plunges his knife into a painful, fluctuating, and appa-rently to his hasty palpation, a nonpulsatile tumor, even though it may lie•close to a large artery. Care and caution in such cases are the points uponwhich I would lay the greatest stress ; no swelling in the course of, or over, alarge artery ought to be opened without a prev
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