Vol. 60, 1909 - University of North Carolina at Chapel Hill

ion ceosed rather abruptly above at the
evel of the ductus arteriosus. Considerable
jnd-arteritis was present, with nodular
hickeningsof the iutima, but without ulcerition.
About an inch above the aortic
)rifice the inner and middle coats had been
cm by a transvere rent, extending almost
lompleti-ly round the vessel. From the
nular rent, a second rent proceeded in an
ipward vertical direction in the posterior
part of the vessel. Towards the pulmonary
irtery this ruptured part of aorta was seen
;o be eovered by a recent clot, and a dissectng
aneurysm, the size of a small walnut,
lad formed in this situation, burrowing into
he sheath which is common to the twn
vessels. There was a small hole in the
iheath of the dissecting aneurysm indicating
;he rupture into the pericardium. The
meurysra was not manifestly due either U>
;ongeiiital syphilis or to the action of niicr..
jrganisms. The dissecting aneurysm prol
ibly originated at tlie time of the onset c;
pain in the chest, which was fourteen d;n -
jefore death.
Treatment of Chronic Degenerative
Lesions oi tlie Heart and Aorta.
James Harr says that the ultimate causes
ot theses degenerative lesions are frequently
set down to toxins in the blood, but he has
^ihown that at least in a large number
of these cases there is an increase in
the eiTete material iu the blood as evidenced
l)y tlic lower freezing point. Of all toxic
coTiilitions perhaps syphilis is the disease
most frequently associated with these
ch;niL;es, and Ur. Bramwell thinks that it
acts through the vasa vasoruni, thus impairing;
the nutrition of the vessel. Among
the other toxic agents he mentions typhoid
j
ABSTRACTS
you can depend upon it that the cardiac
muscle is still fairly healty and the aorta
fairly elastic. You should therefore lessen
their work by devoting your attention to the
periphrey. Vasomotor relaxants are here
of not much value except as temporary expedients.
If the patient have gouty kidneys,
the purin bodies and other nitrogenous
elements of food should be cut down
and there should be a free administration
of the bonzoates. If there is too much lime
fever, intestinal toxins, septicemia, influenza,
gout, myxedma, diabetes, lead, ergot,
and other pressor agents, as caffeine, theobromide,
digitalis, adrenalin, purin bodies.
The general opinion would seem to be that
in the system, all milk foods and jellies
should be eliminated from the diet, and de-
these toxic agents act directly on the walls calcifying agents should be freely used.
of the aorta, producing the 'degenerative The action of the skin should be encour-
lesif)ns, but it is his opinion that they act aged and graduated exercises should be
indirectly by raising and maintaining the taken. With high systolic and moderate
blood -pressure at a higli level, thusdestroy-
,ing the elasticity' and imijairing the nutrition
of the vessel walls. Were it otherwise
the iiulmonary artery would be affected as
or low disastolic pressure the elasticity of
the aorta is becoming impaired. When there
is a difference of mm. of mercury it is high
time to think of effecting repairs. The pa-
the aorta, which is not the case. The detient should be kept on a light, dry, nonpendent
arteries of the lower extremities stimulating diet, with little or no salt. De-
have a higher blood-pressure than in the calcifying agents as a rule are useful and
upper extremities, and the former are usually
much more affected with sclerotic changes
moderate catharsis should be produced.
When there is a high systolic and a low
• than the latter. He then considers how this disastolic pressure, a dilated heart, and high
'high blood-pressure in the aorto is main- intraventricular disastolic pressure, the diet
tained. If the systolic and disastolic pres- should be dry and nitrogenous if the kid-
Isures be both high, with a geutle gradient, neys are healthy; the bowels should be kept