There are different kinds of aneurisms. What is known as a true aneurism is one in which the sac is formed by one or more of the arterial coats.

False aneurism is where there is a rupture of the coats of the blood vessels and the blood is free (or circumscribed) within the tissues. There is an aneurism produced by an ulceration of the internal coat, the blood separating the coats of the artery. This is known as the dissecting aneurism.

Etiology

Aneurism is produced by an accident, as a rule. I have seen a blow on the wrist resulting in an aneurism as large as an ordinary-sized pecan nut. Where there is arteriosclerosis, breaking of the arteries is a common occurrence, because the arteries are brittle.

Syphilis is supposed to cause aneurism of the arteries. If this is true, then the statement should be extended to take in scurvy (scorbutus, or what is more recently called acidosis). Indeed, several years of toxin poisoning can put the subject of gouty diathesis in a physical state where the arteries are hard and brittle, and limy deposits will take place in the valves of the heart and large arteries. This is the constitutional state which favors the development of aneurism. In severe cases of arteriosclerosis the inner coat of the blood vessel, known as the intima, may rupture in several places in the length of the artery. These ruptures will be small, and they lead to a bulging and a gradual production of a small cyst, or sac.

Embolic aneurism is produced by an embolus being lodged in the forks of a blood vessel. The blocking causes a dilation of the proximal side. The embolus does sometimes become limy. Under such circumstances ulceration is liable to take place, and the limy deposit will be thrown out.

Aneurism of the Thoracic Aorta

Arteriosclerosis favors this disease, and, according to the leading authorities, syphilis is recognized as the cause. I presume that there are very few, who treat syphilis in the orthodox way, who are prepared to believe that the treatment has as much to do with the hardening of the arteries and in producing disease of the arteries as the so-called syphilis; but this is true. Nearly all the patients with whom I have had to deal have lived in such a manner as to produce acidosis, or the old-time scurvy; and when scurvy is established in the body it will produce the very conditions that are charged to syphilis. Indeed, the style of living that leads to scurvy, and the treatment given to meet the symptoms that are diagnosed, will produce very much the same results. Aneurisms of the thoracic aorta are most commonly located in the arch, but the aorta is subject to the disease in its entire length. Aneurisms of the ascending portion are often small when a rupture takes place. When the rupture is in the pericardium, death quickly follows.

Those interested in the history and diagnosis of aneurism of the various portions of the thoracic aorta, as well as the abdominal, are referred to the leading textbooks on the subject. Inasmuch as it is a disease which cannot be cured, I see no reason why I should encumber this book with a lot of detail or description that is of no special worth.

Symptoms

All the best authors say that there are no positive symptoms. A tumor may be the cause of the chest-wall giving way, and there is no special pain experienced. It is said that every physical sign may be present without a single symptom. An important, but variable, symptom is pain, It is usually paroxysmal-often very severe when the tumor is eroding the vertebrae or perforating the chest-wall. Pain comes and goes. It often radiates down the left arm or up the neck, and without enlargement the disease might be mistaken for intercostal neuralgia or angina pectoris. Where the tumor presses upon the bronchial tubes, a very distressing cough is liable to be the consequence.

When there is pressure on the recurrent laryngeal nerve, the cough may have a peculiar wheezing sound. This is called "goose-cough." There is difficulty in breathing. In some cases there is loss of voice; in others, wheeziness. In some cases hemorrhage will take place into the bronchial tubes and trachea; in others, into the pleura; and, as stated before, in still others into the pericardium. A considerable percentage of these cases will enjoy pretty fair health, with death painfully imminent all the time. When these cases go, they go quickly. Some have heart symptoms, but it is of a neuralgic character and points to the root of the aorta being affected. Dilation of the pupil is common; this is when the sympathetic nerve is pressed upon. X-ray examination will usually be required positively to diagnose cases that are obscure--those located in the arch and the descending portion.

Treatment

A few years ago there was a coil or gold wire put in the aorta of a patient in Philadelphia. The operation received considerable newspaper notoriety. It was, however, absolutely unworthy of any attention. Such novelties detract from the real purpose and object of what the physician should represent to the people. If the profession would turn teacher instead of doctor, it would be much better, because then such diseases would be prevented, No one will have aneurism of the aorta who has not lived an abominable life for years. He has lived a free and easy life, so far as eating, drinking, and being merry is concerned. Life must be haphazard that will lead to the development of arterial diseases. Preceding such conditions there must be from fifteen to forty years of chronic toxin poisoning. If there were a cure for the aneurism, if it could be obliterated in some way, that would not cure the constitutional derangement and the disease of the arteries which sooner or later will take the patient out of existence prematurely.

The reasonable, rational treatment must be directed to lower the blood pressure, doing everything that can be done to keep down the arterial pressure. If the feeding is proper, and then the environment of the patient corrected so that there will be no unnecessary irritations, excitement, or affairs that irritate the mental nature, etc., he can be put in a very comfortable condition, and may live for a number of years enjoying moderate comfort.