428 DISEASES OF THE GREAT VESSELS. 



scapuli, subscapularis, transversalis colli, and the intercostals. The in- 

 ternal mammary becomes immensely enlarged, as do the anterior inter- 

 costals which proceed from it. Its terminal branch, the superior epi- 

 gastric, also dilates, and, by its communication with the inferior epi- 

 gastrics, conveys blood to the iliacs. 



Obliteration of the aorta, serious as the malformation appears to be, 

 is, nevertheless, a tolerably endurable one. It may long remain latent, 

 and the patient may attain a very great age (ninety-two years). In 

 other instances, in course of time, palpitation of the heart, distressing 

 pulsation of the carotids, or symptoms of hyperaemia of the brain, may 

 manifest themselves. By-and-by a cachectic condition develops, and, 

 in nearly half the cases reported, death has ensued with symptoms of 

 marasmus and dropsy. Thus we see that an obstruction to circulation 

 as grave even as that presented by obliteration of the aorta may be 

 compensated for, temporarily, by hypertrophy of the heart,' but that it 

 finally becomes imperfect, and that symptoms then set in of retarded 

 circulation, venous engorgement, and impoverishment of the blood, 

 su"ch as we have so often described. In other instances, death, by rup- 

 ture of the heart or aorta, is the result, the walls, probably, always 

 undergoing previous degeneration. 



Diagnosis of this affection is based mainly upon the signs of the 

 anastomotic circulation above described, and upon the absence of pul- 

 sation in the ramifications of the abdominal aorta. In such subjects 

 we see varicose, worm-like, sinuous arteries, and groups of arteries, 

 distinctly pulsating on the back along the shoulder-blade, and upon 

 the arch of the ribs. At a point corresponding to the course of the 

 internal mammary, we hear, near the sternum, a blowing sound, which 

 is audible, also, at all points where the existence of dilated arteries is 

 perceptible to sight and touch. On the other hand, in the tibials, or 

 even in the popliteals and femorals, the pulse is feeble or even imper- 

 ceptible. Bamberger considers that the deformity can always be 

 recognized with certainty from these diagnostic points. Treatment 

 of stenosis of the aorta is entirely analogous to that of stenosis of the 

 aortic orifices, to which we therefore refer. 



OHAPTEK V. 



DISEASES OP THE PULMONARY ARTERY. 



ACUTE inflammation, terminating in suppuration, is quite as rare in 

 the pulmonary artery as in the aorta. The alterations of the tunica 

 Ultima, described by us as chronic endarteriitis, are often absent hi this 

 artery, where the entire aortic system is far advanced in the disease 



