Thoracic Aneurism. 161 



tion of the eyeball, if paralyzed ; while the neck and face 

 may be anaemic or flushed from interference with the vaso- 

 motor fibres. Pressure on the intercostals may induce 

 pain in the territory supplied by these nerves, or, possibly, 

 an inflammatory condition of the skin, "herpes zoster." 

 Pressure on the phrenic nerve may cause hiccough if the 

 nerve be irritated only, or one-sided paralysis of the dia- 

 phragm if it be compressed. 



7. Trachea! Tugging can be elicited in the fol- 

 lowing manner: The patient should be erect, with the 

 mouth closed and the chin well elevated. The physician 

 should grasp the cricoid cartilage between the thumb and 

 finger and should make steady pressure upwards, when, 

 if an aneurism be present, a transmitted aortic pulsation 

 may be distinctly felt. This is probably due to the con- 

 nection of the cricoid cartilage with the aorta through the 

 cervical fascia, a layer of which the tracheal overlying 

 the trachea, descends into the middle mediastinum to unite 

 \vith the fibrous prolongation of the pericardium over the 

 ascending aorta, so that, the pulsation of an aortic aneu- 

 rism will cause sudden tension of the tracheal portion of the 

 fascia and produce a "jar" or "tug" which can be felt at 

 the upper attachment of the fascia, viz., at the cricoid car- 

 tilage. 



Tumors of the mediastinum may, like aneurism, cause 

 many of the above symptoms, although there is not 

 the same tendency to exacerbation from exertion in 

 tumors, as there is in aneurism. An enlarged bronchial 

 gland pressing on the vena azygos major, as it arches over 

 the root of the right lung, may dam up the blood in the 

 azygos veins and cause an effusion of fluid into the pleu- 

 ral cavity hydro-thorax. 



The above symptoms are the general results of pres- 

 sure, resulting from an aortic aneurism, but to be more ex- 



