On atheroma and some of its consequences, with their treatment : an address delivered before the Cardiff Medical Society on February 21, 1895 / [Sir T. Lauder Brunton].

  • Lauder Brunton
Date:
1895
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Licence: Public Domain Mark

Credit: On atheroma and some of its consequences, with their treatment : an address delivered before the Cardiff Medical Society on February 21, 1895 / [Sir T. Lauder Brunton]. Source: Wellcome Collection.

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    mass undergo softening, so that an ulcer forms in the interior of the aorta, numerous granules will be discharged into the blood, and will be carried to various organs and there cause embolic infarcts,* arresting more or less completely the circulation in the vessel beyond the part where their course is arrested. Similar consequences may arise from atheroma of medium-sized vessels, and when very small vessels are affected their lumen may be completely obstructed by the gradual thickening of their walls, instead of by sudden arrest of the circulation by an infarct. Yet in these vessels, though the circulation has been gradually diminishing, its final arrest may be comparatively rapid, because of the formation of a thrombus at a point where the lumen of the artery has already been diminished. No organ of the body is free from the risk of vascular obstruction, but the two organs in which the symptoms are most marked and important are the heart and the brain, and the symptoms may, therefore, be divided into two great classes of cardiac and mentai. All the symptoms may again be subdivided, according to their severity, into functional and organic. The term “ func- tional” is in some respects objectionable, for it is very unlikely that any change in the function of an organ takes place without definite organic change, either physical or chemical, in the organ itself. Yet the term may be employed to indicate those slight alterations in function to which, on account of our imperfect knowledge, we are unable to assign an organic cause, but in which the cardiac disturbance is such as to indicate disordered innervation or weakness of the muscular fibre, or both conditions together. The actual weakness of the heart makes itself felt in ready exhaustion and shortness of breath on exertion, while the disordered innervation evidences itself in irregular action, dis- comfort or a feeling of constriction on the chest, or various degrees of pain up to the most severe. The discomfort or pain is generally increased by exercise, and consequently the patient is induced or compelled to give up the active employments or exercise to which he has been accustomed. Emotion has a similar effect to exercise, and the patient is apt to feel a great dislike to anything that calls for mental strain. The condition he suffers from is undoubtedly a complex one, for though the mental faculties are those which are called into play by emotion, * Ziegler, Op. cit., p. 73.
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