98 THE TREATMENT OF DISEASES. 



seen of it externally, but by-and-by it may press out the ribs or breast-bone, and cause 

 a swelling on the front of the chest as big as an egg or a small orange. At first, too, 

 the symptoms to which it gives rise may be very obscure, and its presence can be 

 detected only by a careful examination by a skilful physician. Afterwards, when it 

 comes nearer the surface of the body, comparatively little difficulty will be experienced 

 in recognising its nature. The great thing is not to mistake it for an abscess. An 

 aneurism has before now been opened on the supposition that it was an abscess, the 

 patient quickly bleeding to death. 



Our account of aneurism must of necessity be short, not because it is an unim- 

 portant disease, but because it is essentially unsuited for domestic treatment. Any 

 one who thinks that he has an aneurism should consult a doctor in order that, if it 

 exist, appropriate treatment may be commenced, or that if non-existent the harassing 

 suspicion may be removed. Aneurism occurs most frequently between the ages of 

 thirty and forty. It is met with almost exclusively in men, and especially in 

 individuals whose muscular system is called upon to make sudden, violent, and 

 intermittent exertions, as for instance in those who habitually lead sedentary lives, 

 but occasionally take a change and indulge in sport, such as hunting, rowing, or a 

 long day's shooting. It is comparatively rare in those whose work, although 

 laborious, is steady and continuous. If you are not over thirty, if your work is 

 moderately uniform in character, or if you are a woman, it is extremely unlikely that 

 you have aneurism, whatever your symptoms may be. It must T^e remembered that 

 aneurism in any form is not a common complaint, although it occurs more frequently 

 in Great Britain and Ireland than in any other country. 



The symptoms to which aneurism in the chest may give rise are very variable, 

 and the majority are common to many complaints. Sometimes they are closely 

 simulated by simple indigestion, and it would be difficult for any one not a medical 

 man to distinguish between them. Usually when the tumour is large or is increasing 

 rapidly in size, there is some disturbance of the heart's action, and one or both arms 

 become distinctly dropsical. Sometimes the tumour presses on the wind-pipe, 

 causing shortness of breath, or on the gullet, giving rise to difficulty in swallowing ; 

 sometimes in addition to shortness of breath, there is considerable wheezing, and a 

 particularly troublesome cough. Aneurism usually causes pain either in the back 

 or beneath the breast-bone ; moreover, it generally affects the pulse, rendering it 

 altogether imperceptible or much weaker on one side than on the other. Sometimes 

 it gives rise to spitting of blood, which may be very profuse. It should be under- 

 stood that the existence of two or three of these symptoms would be no indication 

 of the existence of aneurism, and that unless several are distinctly present, they are 

 probably due to some other complaint. 



Even in such a serious disease as aneurism much may be done in the way of 

 treatment. The agents on which more especially we rely are rest and limited diet. 

 By rest we mean not merely abstinence from hard work, but absolute rest in 

 bed in the recumbent posture. In some cases, this has been uninterruptedly 

 maintained for many months, and with the happiest results. Confinement to bed 

 is undoubtedly at first a great hardship to a person who has been accustomed to 

 an active life, but it is wonderful what habit will do, and we have known people. 



