Arteriosclerosis

“ Most cases of arteriosclerosis sooner or later present symptoms referable to the heart. When the organ is hypertrophied and is already working against an enormous peripheral resistance, a slight excess of work put upon it may cause a dilatation of the chambers with the resulting broken compensation. There is dyspnea on slight exertion, possibly some precordial distress, slight edema of the ankles and lower legs and possibly scanty urine. With proper care, a patient with such symptoms may recover, but the danger of another break in compensation is enhanced. The next attack is more severe. ”

“ Arteriosclerosis of the aorta, of the coronary arteries, or of both, is practically always found in cases dying of various cardiac irregularities other than those the result of rheumatic cardiac lesions. It is not that arteriosclerosis causes the cardiac lesions (although the thickening of the walls of the coronary arteries does interfere mechanically with the nutrition of the heart muscle) , but the arteriosclerosis is a part of the tissue reaction in the arteries to some set of causes affecting the whole body. ”

“ It is evident from what has been said that an accurate prognosis in arteriosclerosis is no easy matter. Were arteriosclerosis a simple disease of an acute character there might be grounds for giving a more or less definite prognosis. The most that can be said is that arteriosclerosis is always a serious disease from the time that symptoms begin to make themselves known. The gravity depends altogether on the seat of the greatest arterial changes, and is necessarily greater when the seat is in the brain than when it is in the legs or arms. ”

“ It is after all in the arterioles and smaller arteries that the lesions of arteriosclerosis do the most damage. A point to be emphasized is that the whole arterial system is rarely, if ever, attacked uniformly. That is, there may be a marked degree of sclerosis in the aorta and coronary arteries with very little, if any, change in the radials. On the contrary, a few peripheral arteries only may be the seat of disease. A case in point was seen at autopsy in which the aorta in its entirety and all the large peripheral branches were absolutely smooth. ”

“ In a disease that presents as many vagaries as arteriosclerosis, it is not possible to give a certain prognosis. Unfortunately we do not as a rule see the arteriosclerotic until the disease is well advanced, or even after some of the more serious complications have taken place. By that time the condition is progressive, and while the prognosis is grave the individual may live a number of years. ”

“ Arteriosclerosis comes to almost every one who lives out his allotted time of life. As has been noted within, many diseases and many habits of life are conducive to the early appearance of arterial degeneration. Decay and degeneration of the tissues are necessary concomitants of advancing years and none of us can escape growing old. From the period of adolescence certain of the tissues are commencing a retrograde metamorphosis, and hand in hand with this goes the deposit of fibrous tissue which later may become calcified. ”

“ In the prophylaxis of arteriosclerosis, a rational mode of living is the all-important factor. As a rule, the less meat one eats, the less is the liability of arterial degeneration as age advances. The exceptions to this rule are many, and probably depend upon the character of the "vital rubber" with which the individual begins life. ”

“ There exist two chief agencies for the production of arteriosclerosis: 1. A hyperactivity of the adrenals, causing a rise in blood-pressure. 2. A degeneration of the thyroid gland, which, when normal, antagonizes the first by lowering the blood-pressure. Although from the above-mentioned facts high blood-pressure cannot be considered as the chief cause of arteriosclerosis, still no doubt it certainly contributes to it; for each time that there is a rise in the blood-pressure more blood is forced through the arteries, thereby causing them to dilate ”

“ Yet how often does it happen that individuals, apparently in the best of health, suddenly succumb to an asthmatic or uremic attack, an apoplexy, cessation of the heart beat, or a rupture of the heart due to arteriosclerosis!
In order to arrive at an intelligent opinion in regard to prognosis certain factors must be taken into consideration, chief of which are: the seat of the sclerosis; the probable stage; the existing complications; and, last and most important, the patient himself. The whole man must be studied and even then our prognosis must be most guarded. ”

“ Arteriosclerosis is essentially a chronic progressive disease, and the secret of success in the management of it is not to treat the disease or the stage of the disease, but to treat the patient who has the disease. ”

“ It must not be thought that because the localization of the arteriosclerosis in the peripheral arteries is usually the most favorable condition that it is therefore devoid of ill effects. On the contrary, very serious, even fatal, results may be brought about by interference with the circulation with resultant extensive gangrene of the part supplied by the diseased arteries. The amputation of a portion of a leg, for instance, may relieve, to some extent, an overburdened heart and prove life-saving to the patient, but the neuritic pains are not necessarily relieved. ”

“ To infer the stage of the disease from the feeling of the sclerosed artery, may lead to serious mistakes. Persons with calcified arteries may be perfectly comfortable, while those with only moderate thickening may have many severe symptoms. The keynote is individualization. It is manifestly absurd to treat the laboring man with his arteriosclerosis as one would treat the successful financier. The habits, mode of life, every detail, should be studied in every patient if we expect to gain the greatest measure of success in the treatment. ”

“ We can not ignore the part which heredity plays. The various factors to be considered in the production of the acquired form of arteriosclerosis appear to me to be but contributory factors to a very great extent, the essential and fundamental factor being the quality of arterial tissue with which the individual is endowed.
Arteriosclerosis may occur in infants. Cases have been reported of calcification of the arteries in infants and children. The arteriosclerosis may occur without nephritis or rise of blood pressure. ”

“ The retrogressive changes of advancing years can not be rightly termed disease, yet it becomes necessary to regard them as such, for the senile changes, as we shall see, may be but the advanced stages of true arteriosclerosis. Much depends on the nature of the arterial tissue and much [33] on the factors at work tending to injure the tissue. A man of forty years may therefore have the calcified, pipe stem arteries of a man of eighty. Our parents determine, to great extent, the kind of tissue with which we start life. The arteries are elastic tubes capable of much stretching and abuse. ”

“ Cases are known where persons of ninety years even had soft arteries, and we have seen persons of eighty whose arteries could not be palpated. When infants and children are seen with considerable sclerosis, it proves that, after all, it is the quality of the tissue even more than the wear and tear, that is the determining factor in the production of arteriosclerosis. It would be well if those who can not bring healthy progeny into the world were to leave this duty to those who can. ”

“ The combination of (1) hypertrophied heart, (2) increased blood pressure, (3) palpable arteries, and (4) ringing, accentuated second sound at the aortic cartilage is, in reality, the picture of advanced arteriosclerosis. If the individual is in good condition much may be done by judicious [211] advice and treatment to ward off complications and prolong life with a considerable degree of comfort. But we should not wait until such signs are found before making a diagnosis and instituting treatment. As in all forms of chronic disease the early diagnosis is all important. ”

“ Phlebosclerosis not infrequently occurs with arteriosclerosis. It is seen in those cases characterized by high blood pressure. Such increased pressure in the veins is due, for example, to cirrhosis of the liver which affects the portal circulation, or to mitral stenosis which affects the pulmonary veins. The affected vessels are usually dilated. The intima shows compensatory thickening especially where the media is thinned. As a rule all the coats are involved in the connective tissue thickening. Occasionally hyaline degeneration or calcification of the new-formed tissue is seen. ”

“ Not always are these persons addicted to drug or liquor habit. Many are rather abstemious in their habits. It is not so often that we see as a victim of arteriosclerosis, the carefree person who laughs his way through life without worrying about the morrow. He is not so prone to arteriosclerosis. Worry is a far more potent cause of breakdown than actual manual work. It is the rule to find thickened arteries among neurasthenics. This may be only part of a generalized degeneration of all tissue in the body. The blood pressure in such persons is usually low. ”

“ Some observers lay great stress on this factor as a cause of arteriosclerosis. The author believes that the rôle played by the absorption of products of perverted intestinal metabolism is an important one. The primary change is an increased tension in the arterioles which later leads to thickening of the coats of the vessels and to the other consequences of arterial disease. A vicious circle is thus established which has a tendency to become progressively worse. ”

“ These arteries are probably the most important ones of our body, for they provide the muscles of the heart with the nourishing blood without which they could not do their work. It is the sclerosis—the hardening—of these arteries which, causing an obstacle to the passage of the blood, is the most frequent cause of rapid death in arteriosclerosis, often in comparatively young people. It is a sad fact, that such a condition, as so often is the case with arteriosclerosis, can exist without exhibiting any marked symptoms of it being present. ”

“ It is fortunate for the arteriosclerotic that mild grades of the disease are compatible with a fairly active life. The disease in this stage may become arrested and the patient may live many years. Not only in the mild grades is this possible. Even patients with advanced sclerosis may enjoy good health provided the organs have not been so damaged as to render them unfit to perform their functions. The frequency with which we see advanced arteriosclerosis at the postmortem table as an accidental discovery, attests the truth of the foregoing statement. ”

“ Probably the most frequently seen result of arteriosclerosis in the leg arteries is the remarkable condition, first described by Charcot, known as intermittent claudication. Persons the subject of this disease are able to walk if they go slowly. If, however, any attempt be made to hurry the step, there results total disability accompanied at times by considerable cramp-like pain. The condition is much more prone to occur in men than in women, and Hebrews seem more frequently affected. ”

“ I feel certain that in such a case many thousands of persons, instead of lying in their dark, cold graves below the earth, could still tread the soil enjoying sunshine and the scent of the flowers. There is no doubt that arteriosclerosis and especially coronary sclerosis could be avoided in many cases, through such an examination, for the onset of arteriosclerosis is generally insidious and slow, especially if it develops in the younger years, when due to syphilis, and thus, if in time recognized, it could be cured. ”

“ In the early stages of the disease before the artery or arteries have had time to become strengthened by proliferation of the connective tissue, there is the danger of aneurysm. Later, the very same protective mechanism leads to stiffening and narrowing of the arteries and hence [220] to increased work on the part of the heart with all of its consequences. Thrombosis is favored, and where atheromatous ulcers are formed, embolism is to be feared.
As the complications and results of arteriosclerosis come to the front every one must be considered by itself and as if it were the true disease. ”

“ No applicant who has palpable arteries or hypertension can be considered a first class risk. It can not be denied that men with arteriosclerosis live to an advanced age and may even outlive those who have apparently normal arteries, but the average life expectancy at any age for an arteriosclerotic is less than that for a normal person. The apparently healthy applicant who learns for the first time when examined for life insurance that he has the early or moderately advanced signs of arterial disease, should thank the agent and examiner for showing him the danger signals ahead. ”

“ Some of the most beautiful examples of arteriosclerosis in this country are seen in the negro. Not only is this [162] disease more frequent in the black race, but the age of onset is much earlier than in the Caucasian. The accidents of arteriosclerosis, viz., aneurysm, cerebral hemorrhage, etc., are more common among the negro males. The etiologic factors that are most often found in the history are the prevalence of syphilis and hard physical labor. ”