Atheroma

“ He recommends excision for it. The contents of the atheroma consist of a pultaceous substance surrounded by a membranous tunic, within which are also sometimes found hairs; nay, Philoxenus affirms that he had found animals like gnats and flies. The meliceris also has a membranous coat, and its contents resemble honey. He approves also of the surgical operation for the meliceris and atheroma, but permits to attempt their reduction by means of discutients consisting of such ingredients as ammoniac, ceruse, turpentine, galbanum, vinegar, &c. He makes no mention of septics ”

“ It depends on toxæmia and anæmia; the obvious indication is to purify and enrich the blood. This, at least in respect of gout, glycosuria and corpulence, as we have just seen, must be effected by a thorough reform in every department of personal hygiene. Arsenic and moderate doses of iodides, combined with an excess of alkalis, are calculated to promote the same end. Dr. Mott has shown that atheroma, whether of valves or of vessels, can be traced in many instances to disease of the vasa cordis and vasa vasorum. ”

“ Atheroma is a direct result of an existing chronic endarteritis, the lining membrane of the vessels being invariably involved to a greater or less degree. It is most frequently found in the arteries, although the veins may develop an atheromatous condition when exposed to any source of prolonged irritation. ”

“ As I was able to illustrate after my second lecture by a specimen from the Museum of Charing Cross Hospital, a branch of one of the coronary arteries that has been narrowed by atheroma for an indefinite length of time, with consequent cardiac weakness and discomfort, may any moment become thrombosed rapidly, apparently in consequence of some passing depression or other unfavourable influence, just as in thrombosis of degenerated cerebral vessels. ”

“ In hyperpiesis raised pressure is continuous and tends steadily to increase; in atheroma there are times of high pressure, but as the disease advances the pressure is often normal or subnormal, its gravity depending much on the seat of the atheroma. ”

“ Simple atheroma must not be confused with the lesions of arteriosclerosis. The small whitish or yellowish plaques so frequently seen on the aorta and its main branches, may occur at any age, and have seemingly no great significance. Such plaques may grow to the size of a dime or larger, and even become eroded. They represent fatty degeneration of the intima which, at times, has no demonstrable cause; at times follows in the course of various diseases, and undoubtedly is due to disturbances of nutrition in the intima. ”

“ Arteritis and thrombosis of arteries are rare, and although lesions of atheroma have been discovered in certain chronic diseases, such as tuberculosis, chronic diarrhœa, etc., they are difficult to detect, even on examination per rectum of the bifurcation of the aorta. ”

“ It first appears in the arteries, leading to atheroma, and the typical symptoms of arteriosclerosis. In myxœdematous persons, although they may still be young, we find atheromatous arteries and arteriosclerosis. Impotence is common in myxœdema, especially in advanced cases, and is also found in senility, being more marked the greater the patient’s age. ”

“ If, then, in a person whose age and general physical condition, as shown by the state of the tangible arteries, arcus senilis, complexion, and so forth, render the existence of atheromatous arteries in the brain probable, cerebral symptoms of an ill-defined character arise, it is very probable that they are the result of irregularities in the circulation dependent on atheroma. ”

“ Here again, the arteries of the brain are very generally implicated; atheroma in some degree is almost always present, but is by no means necessarily followed by insanity.
The various and profound modifications of the system which attend the periods of utero-gestation, pregnancy and child-bearing do not leave the nervous centres unaffected. Most women are liable to slight changes of disposition and temper, morbid longings, strange likes and dislikes during pregnancy, more especially during the earlier months ”

“ Usually, at the beginning the symptoms are very obscure. A slight dyspnoea on exertion, or palpitation, or dyspeptic troubles are the chief complaint. The presence of these troubles in a man of fifty years or over, whose heart and kidneys present nothing abnormal, and in whom the smaller arteries of the extremities feel hard and calcareous, may excite the suspicion of atheroma of the aorta. There are no distinctive physical signs. Some writers speak of a short post-systolic murmur over the aorta beyond the valves, which may be audible only when the heart is acting strongly. ”

“ Figures in all vital statistics have shown us that all affections of the circulatory and renal systems are definitely on the increase. "Arterial diseases of various kinds, atheroma, aneurysm, etc., caused 15,685 deaths in 1915, or 23.3 per 100,000. ”

“ Complete rigidity has been observed extending far into the lung. The wall of the vessel may be irregularly dilated and its elasticity diminished. Usually, the disease is in a much milder form, presenting perhaps a small amount of fatty degeneration of the intima, and is not infrequently associated with mitral stenosis or insufficiency (notably the former) , pulmonary fibrosis or emphysema, with accompanying hypertrophy of the right ventricle. No symptoms have thus far been found to be distinctly referable to atheroma of this artery. ”

“ On the other extreme we find the neuralgias of the period of bodily decay: these are of very bad prognosis. A neuralgia which first develops itself after the arteries and capillaries have begun to change decidedly in the direction of atheroma is extremely likely, even if apparently cured for a time, to recur again and again, with ever-increasing severity, and to haunt the patient for the remainder of his days. It therefore becomes exceedingly important, in a prognostic point of view, to assure ourselves as soon as possible whether this arterial degeneration has decidedly commenced ”

“ PRIMARY MENTAL DETERIORATION or PRIMARY BRAIN ATROPHY is a term suggested for a curable impairment of the mind arising from brain-exhaustion in persons, usually men, between the ages of from fifty-five to sixty-five. I have found it in some cases associated with interstitial nephritis and with degenerative disease of the walls of the heart, and have suspected atheroma of the cerebral arteries or possibly endo-arteritis of specific or other origin. It occurs at a time when atrophy of the brain is naturally taking place. ”

“ As age advances the only organ whose weight increases with the number of years, the heart, may become hypertrophied or dilated; its coronary arteries may undergo an alteration; the pericardium thickens, and in fact arterial atheroma and degeneration generally may begin between thirty-five and forty years. ”

“ Examine the arteries and veins, noting contents, thickness and character of walls, size of lumen, changes in the intima, sclerosis, atheroma, calcification, thrombosis, embolism, etc. In death from strangulation or hanging the intima of the carotids may be torn. The aorta is usually examined after the section of the neck-organs. Note size of lumen. In the adult it usually admits the index-finger or thumb. The circumference of the thoracic aorta is 4.5-6 cm.; that of the abdominal aorta is 3.5-4.5 cm. ”

“ Atheromatous degeneration is most common in the large arterial trunks, and the changes are most marked at the arch of the aorta, opposite the flexures of joints, at the mouths of large branches, and at parts where the vessel lies in contact with bone. ”

“ In those advanced in life, however, as has been remarked, the frequent complications with atheromatous disease of the aorta and affections of the liver and lungs must make us more cautious in recommending the course now specified. ”

“ Upon examination, there appeared an evident separation of the broken parts of the bone, which were removed at a considerable distance from each other: the intermediate space was occupied by a tumor of a considerable size: the integuments were of their natural complexion: the tumor had as regular a contraction and dilatation as the heart itself, or the aorta could be supposed to have. ”

“ Malignant adenoma is a disease of the utricular glands which has been classed by some writers as a distinct disease, by others as a form of carcinoma. In it the gland-spaces are much enlarged, irregular, and joined to other gland-spaces. The columnar epithelial cells often fill the whole of the gland-space (Fig. 128) The cells, 222 however, never infiltrate the interstitial tissue, as in cancer. The muscular wall of the uterus appears to be destroyed by atrophy or by fatty degeneration.
The disease is malignant, it extends to the neighboring structures, and it destroys life. ”

“ Atrophy of bone may proceed to such an extent in old people, or in those who for long periods have been bed-ridden, that slight violence suffices to determine a fracture. This most frequently occurs in the neck of the femur in old women, the mere catching of the foot in the bedclothes while the patient is turning in bed being sometimes sufficient to cause the bone to give way. Atrophy from the pressure of an aneurysm or of a simple tumour may erode the whole thickness of a bone, or may thin it out to such an extent that slight force is sufficient to break it. ”

“ The descending part of the thoracic aorta, G*, being at the posterior part of the chest, and lying on the vertebral ends of the left thoracic ribs, will therefore require that we should examine its condition in the living body at the dorsal aspect of the thorax. As the arch of the aorta is directed from before backwards—that is, from the sternum to the spine, it follows that when an aneurism implicates this region of the vessel, the exact situation of the tumour must be determined by antero-posterior examination ”

“ In the vertebræ, it is attended with a painful form of paraplegia, which may involve the lower or all four extremities. On the other hand, the disease may show itself clinically as a tumour of bone, which may attain a considerable size, and may be mistaken for a sarcoma, unless the existence of the primary cancer is discovered.
The cancers most liable to give rise to metastasis in bone are those of the breast, liver, uterus, prostate, colon, and rectum; hyper-nephroma of the kidney may also give rise to metastases in bone. ”

“ An aneurism of the descending aorta, in a great measure one from dilatation, is here represented: the patient also laboured under popliteal aneurism of one limb, and inguinal of the other. He died suddenly, in consequence of the giving way of the internal tumour. The escape of blood into the cellular tissue may even take place to such an extent as to prove fatal in a few hours. The disease may also prove fatal by mere compression, as of the trachea, impeding breathing, and inducing disease of the respiratory organs ”

“ Teratoma, a very rare form of ovarian tumor, is an atypical modification of the dermoid, the teratoma bearing a relation to the dermoid similar to that of carcinoma to adenoma. While in the dermoid the chief mass of the tumor has a cystic character, the cystic cavity containing the secretions from the lining epidermal tissue, the teratoma is for the most part a solid tumor, and the productive activity of the tissue is a cellular hyperplasia. ”

“ A hematoma acts as an irritant, inflammation ensues around it and it is encapsuled by embryonic tissue, which, by organizing into fibrous tissue, forms a blood cyst and gradually absorbs the fluid blood, the cysts contents becoming thicker and thicker. A fibrous scar may remain, and a blood clot, with very much indurated surrounding tissue, giving a hard edge, is noticed after bruises of the periosteum. If serum is not absorbed, hematoidin forms and the fluid becomes clear. ”

“ At other times its form is very irregular, being most prominent at the part where the accumulation of the blood is least resisted. Pulsation in the tumour is distinct from the first, and is painful to the patient; and in the external aneurisms it is so strong as to be perceived by a bystander at a considerable distance. The tumour is at first compressible, and completely disappears on firm pressure being applied, either directly to the sac, or to the artery above, the sac being thereby emptied of its contents, or prevented from being filled. ”

“ In women there may be an old cicatrix in the neck of the womb or a lump in the breast; the circulation has been impaired for several years and now because of the overstimulation that has been going on so long, there is a greatly enfeebled circulation and deposits are taking place. The tumor in the breast becomes cancerous; the scar in the womb takes on malignancy; the arteries harden; the circulation in the spinal cord becomes so impaired that induration is induced followed by ataxia ”

“ Conditions of the liver not infrequently affect the position of the heart. Abscess or hydatid cysts of the left lobe may push the organ up and to the left. More rarely large hepatic tumors drag the diaphragm down, and with it the heart. Very great splenic enlargement, as in leukæmia, may push up the diaphragm and lift the heart.
Other abdominal growths, as large retro-peritoneal and ovarian tumors or aneurism of the abdominal aorta, may occasionally produce the same effect. ”