MULTIPLE ANEURISMS OF THE AORTA 
45i 
Spleen : Very soft and triable, no signs of infarction. 
Liver : Slightly congested, fatty, not definitely nutmeg, no infarcts. 
Right Kidney: Small, renal artery is much smaller than left artery for reason given 
above. Capsule strips easily, cyanotic, several small scars here and there, apparently 
fairly recent embolic infarctions. 
Left Kidney : Compensatory hypertrophy, normal, no infarcts. 
A tabular form will best emphasize the features of this almost unique case :— 
1. Symptoms. The site of the thoracic aneurisms and the relationship of the left 
common carotid artery to the sac, account for the deficient pulsation noted 
in the vessels of the right arm and the neck. During life the vocal cords 
were not paralysed and post-mortem, the evidence of pressure on the 
bronchi was but slight. We suggest that the dyspnoea was due possibly 
to spasm in the larynx, and pressure on the bronchi whilst the aneurism 
was pulsating. The explanation of the pains in the back is obvious. 
We should like to draw attention to the history of the ' legs giving way.' 
One of us (A) has observed a similar condition in another case of 
abdominal aneurism. We suggest a temporary anaemia of the cord as 
the most probable explanation of this phenomenon. 
2. Number of Aneurisms. Several cases of multiple aneurisms are recorded ; 
Mange's with thirty, and Pelletier's with sixty-three, being the most re- 
markable. In both these cases, however, the aneurisms were on the 
peripheral vessels. 
According to Lebert multiple aneurisms occur in about one-sixth of the 
cases. Our case shows more aneurisms on the aorta than any we can 
find recorded, Jonas' case coming nearest with nine. 
We note also that the vessels affected correspond with Lobstein and 
Rokitanski's order rather than with Huchard's, in that the branches 
of the abdominal aorta are involved, whilst the peripheral vessels have 
escaped. 
3. Causation. The patient was a grain porter, age 40. He admitted alcoholism 
but denied syphilis. He had several healthy children, and showed no 
signs of specific disease. His father died from ruptured blood vessel, 
the mother from phthisis. 
Two accepted causes of aneurism or rather of the pulmonary aortitis 
were present : alcoholism and heavy work. 
Syphilis although usually present in multiple cases, and also in those 
below 40 years, may we think be excluded. 
Finally in cases such as this one we have the basis of the so-called aneurismal 
diathesis. 
We are indebted to Dr. Caton and Dr. Carter for permission to report this case. 
