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Show SEeTiox l\'.l DISEAE S OF THE BLOOD V ESSliliS. TABLE UT. 3 t the aorta and the vertebral column; the sac was formed at the expense of the posterior segment of the aorta. to the lel't; the right and anterior segment was. with the exception ol'a considerable dilatation. normal and perfectly permeable to the circulation; all three vascular coats were uninjured in the dilated portion. htit in the injured portion of the tut mor they were totally obliterated and replaced by tibrous structure. This ligure shows the sac opened. on each side ot' the vertebral column by a deep. vertical incision; the st ratilied lamell:e are exposed to view. and the large oritice by which both pockets communicated. The cavity has all the appearance of furnishing a free. communication to the circulating blood with both halves of the tumor. and that the heart, at each ventricular systole. impelled the blood in the sac in a lateral direction. From all appearance the walls ot'the sac were last giving way. and a rup- ture would have taken place. had the patient lived but a short while longer; a perl'oratit‘nn was already lbrmedat (.P.) but etl'usion prevented by the wall ol'the base of the lung. This organ showed incipient ulceration and destruction of its tissue. in that locality. The interiorot‘ the vast saehad all characteristic appearances usually found in well devel- oped aneurismal sacs. Figs. 2. 2. represent theinnominate (T. .l)'. (I), and the right common carotid arteries (opened in trout) pcrl'orated at (\l'.) and communi ‘ating by a large opening with the aneurismal sac. connected with the posteriorportion of these vessels, the internal andexternal carotids (-l. ('. 1., -1. (7. 11). the thyroid (_.l. 7.). lingual (A. 11;). and facial arteries (1". it). The elliptic opening is situated a few lines below the point of division ot' the common carotid. the sac lirmly adherent to this Vessel and the internal jugular vein (: l'. .l. 1.); the pneumogastric was ingrown with the sac and atrophied; the circulation in thx artery was uninterrupted. Fig. 2 shows the opened sac exposing the clotted contents; the internal eoat ol'the artery was completely destroyed, but. the middle and external were intact. Figs. 33. 3. present a case of excessive constriction of the aorta almost immediately below the origin of the subclavian (11'. .1.) Fig. 3. shows the exact caliber of the yes- sel; above and below the stricture there was no change whatever in the vessel; the lel‘t inmaninate, subclavian and carotid arteries were wider than usual. the same was the l case with the first aortic intercostal arteries (.1. 1. 41.) Axia'msyi or 'run TIIHH.\(‘I(‘ Aon'm. (.‘.\si<:.-.\ man of t'orty-one years. at the charity hospital. Subjective symptoms as described by the patient him- selt': "a sense ot‘vcry painl'ul constriction and strangulation. without any intermission, existing in the region of the last ribs". 7 Objective symptoms: Face yellow and waxy appearance; respiration hurried; sutlocation on the slightest bodily movement. also enormously prol'use perspiration; pulse barely perceptible; cold extremities. Percussion ol' chest: in li'ont. pert'ectly clear sound on H/c left upper z'u'o-l/Iirt/s; on the right upper third of the thora.\‘.the same; on lowerthird absoltite dullness right and left; laterally and posteriorly. total dullness all over. l'alpation: Very distinctly palpable heating in the whole anterior portion of the chest; is alsodistinetly visible; the beating constitutes a sudden and strong jerk. which hits upthe whole side ol' the chest, and is connected with a pc- ctiliar push t‘rom left to right. It resembles a strong apexbeat ot‘ a highly hypcrtrophicd heart. and is situated in the right side ot'the chest. -\uscultation: No murmur; upper part. of" chest a clat- tering bruit; a double beating pulse. increasing in intensity downward toward the region ot'the liver. where the jerking heat is strongest. lle lived in this condition twenty-live days. l)ied suddenly on the twenty-sixth day al'ter admission. 'l'ost mortem: .\n enormous tumor titling up two-thirds of the chest cavity; recent pericarditis; very dilated heart. tlattcned in a postero-anterior direction; both lungs com- pressed. and reduced to one-third ot‘ their l'ormer size: pillmonic tissue sot't and intiltrated; and the bronchial mucous membrane coy cred with tubercles. The aneurisuial tumor was single. but consisted of two distinct lobes. hoth connected with the aorta in limit. and the vertebral coltimn behind; the base of the right lung solidly adherent to the tumor; the larger azygosivein ((1. l'. .1.) amlthe right. and let't aortic intercostal arteries( l'. T. -l. L.) were obliterated by pressure t'rom the tumor; the greater and lesser splanchnie nerves (6'. Av. S. .l'.). (1'. .V. H. 1).).«111 the right side, compressed and reduced tothin rib- hons. and totally atrophied; the thoracic duct displaced: Figs. 1. 1.. show thespccial connection 01' the tumor with monary artery is most commonly the seat of l'atty change: the some is the case with the inner coats of larger arterial trunks. Small fatty spots are, not perceptible to the naked eye; larger ones have an opaque. white or yellowish appearance. At lirst the surface is smooth. gradually it becomes rough and velvety. The beginning ot'tho process consists ol' the tilting up of the cells with t'at globules. In the further progress ol" the disease the lat. molecules not only occupy the place ot' the cells themselves. but also intiltrate into the intercellular spaces. Soon emigration of round cells from the vessels takes place, they absorb the debris lel't ot' the destroyed cells, and fatty granulated cells are formed from them. In the aorta the elective places ot't'atty alterations are eloseto the semilunar valves, and near the origin ot‘ the arterial trunks; it chietly takes place in old age and in anaemic persons. \Vhen the blood becomes stagnant in the eardio-pulmonic circuit. and the carbonic acid is not sullieiently eliminated from it. then fatty change takes place in the pulmonary artery. The same is the case in the veins. by haematic stasis. In the capillaries t'atty degeneration is, brought about by disturbance ot' L‘lt't‘llltltlt.)ll, usually existing in septic and infectious diseases. Fatty change ot‘the muscular coat of the vessels is more danger- tension ot' the. papillary muscles and the. chordae tendineze. ln consumptive levers murmurs are due to superinduced amemia ot' all the muscles ot'the body. and ot' the heart especially. :lltf/t‘il/L po'lor/s is a symptom ot' functional disturbance of the heart. V. J). Ili/rrfs (lien/rots H/t oily/I'm! pector/s. NI. Bartholomcui lump. Kept.) gives a synopsis ot'angina pectoris: "There are two varieties of this malady; they are conneeted with gout and rheumatism. Their pathological anatomy is not yet. quite known. One is always assoeiated with valvular diseases, and especially aortic. insutlieien- cy;there is much pain and dyspinca, a sense of sullheation. but ; generally without any change in the pulse; and it is liable to pro- duce sudden death. The other is seldom connected with valvular trouble, but mostly with dyspepsia. The pain is not very great. and ot'ten intermits. Danger to life. there is but little; but this disease is ot' tnore t'retpient occurrence than the lirst." [lite/om? ( (lain/t mmlimlc) speaks of neurotic angina, which is due to severe irritation or injury ot'the filaments ot‘ the pnenmogastric. It is mostly attended with great pain,and otteli produces dysputea. ltei'angeinents ot' liver and abdominal disorders seem to produce this form of angina by retlex irritation. ous than that of the endothelium, for extensive and t'atal haemor- rhages take place when any considerable quantity of that tissue is altered. Besides. inliltration with calcareous matter and its substitution tor the muscular tissue may take place to such an extent as to cause rigidity of the vessel, and the circulation therein will become greatly impaired. Fatty degeneration ol‘ the external coat, whether in the vessel alone or associated with the surrounding tissue. it'not very extensive. is seldom dangerous to the general health. The alicrcnt lymphatics ol'ten deposit quite a quantity of. t'at upon the external surface ol' vessels without producing any particular injury. ( l'ire/mir, Lung/mus.) _ Amvloid degeneration is nearly as frequent a vascularlesion as the t'attv change. ln the larger vessels the inner coat, of the smaller and islltzlllcfit the inner aml middle coats are usually altered. There are two terms ot' liyaline degeneration. one taking place in the inner coat of the larger vessels. and consisting ot'a change DISH. SEN OF THE BLOOD l'I'INSELS. l'.\'l‘llttl,t)t.lt‘.\li .\.\'.\'l‘tt.\l Y. All blood vessels are essentially larger or smaller endothelial tubes strengthened on the outside by a greater or lesser quantity ot' muscular and elastic tissue, constituting one or two distinct cov- erings. The vessels may be atl'eeted in til/«er ot' their [I'M/ts I/toItP, in two or three coats;or conjoinfly with the surrounding tissue. The larger YeSScls‘ are generally diseased, independent ot' the parenchyma in which they run: the smaller. aml chietly the smallest, always partake ot'parencltymatous attections. Besides congenital vascular anomalies of pesition, origin, size, etc. which may cause disorders in the body to a greater or lesser degree. and may become of considerable clinical importance. t/II‘t/l-"llttt/tHttrt/Il/ considers mainly acquired disorders or lesions ot' tllc blood vessels. Slit/l1)"lit/'1ill/tf/ilh‘f/V‘IH'I'Htlit‘t‘HtFull/1y;II/lft'ZtI'tl/(VINIH/t oft/a zvsst ls. (teneral marasmus ot' the body is conditioned by a simple atroplnc state ot' most ot' the smaller hlood \'c.<s'cl.'. the same as in simple atrophy ot' an t'n'gan. When a limb is amputated. the vessels ot' the stump shrivel up and atrophy t'rom disuse. ‘ . Atrophic portions of a vessel, or only a part ot' one ot 1ts_coats (the muscular most t'rwpiently). are very commonly t'ound m intlamed or otherwise degenerated states ot vascular tubes. Fatty alterations are the most l'retpicnt in the inner and middle coats. Very seldom in the external. The [utilize ot' the aorta and ot‘thc pul- into a homogeneous connective tissllc. containing but tew (re s. l The earlv stages ot'atlieroma ot'the blood vessels are ot‘ this nature. The other l"orm is I‘onnd in small vessels. forming yet-y close and copious networks. such as the glomcruli in the kidncys and the choroid membrane in the brain. .\ nuclear prolit'cration always precedes these derangeinents. They otten titl'ttl small nodules on the outer coat ot' the capillaries. and frequently produce thrombi . within. t‘alcitication ot' the vascular walls takes place when the nutrition ot' the vessel is itnpaircd. and is generally associated with fatty |
