Licence: In copyright
Credit: Arterial hypertonus, sclerosis and blood-pressure. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![maueutly diminished by arteriosclerosis, by atheroma, or by obliterating endarteritis. These changes frequently assume such proportions that a general vessel constriction in the brain would deprive the areas, where vessels were so affected, entirely of their blood supply, and this would inevitably lead to softening. The tliree pathological changes mentioned cause diminution of lumen, and any general constriction of brain vessels would markedly diminisli, and might even completely arrest the circulation through the vessels so altered. In addition to this, the result in some of tlie vessels would certainly be thrombosis, leading to permanent cutting off of blood supply and inevitable softening. The possibility of vessel spasm-contraction leading to thrombosis in sclerosed vessels, or in the atheromatous parts of constricted vessels, is a new view, and yet it naturally suggests itself when constriction is pictured as occurring in vessels which have undergone the permanent anatomical changes mentioned. Realising this, the occurrence of softening, even after relaxa- tion has been induced, is readily explained, on the reasonable assumption that constriction had lasted long enough to permit of thrombosis. It is not necessary to argue that the con- ditions formulated are favourable to thrombosis occurring, for they correspond to those generally recognised as sufficient to produce that condition. Softening or Haemorrhage ? A further point to be considered is the relationship between softening and luemorrhage, this being the ques- tion raised by the phenomena in Cases 73 and 74. In Case 74 we have both clinical history and post-mortem examination to help us to a conclusion. When this patient was admitted to hospital the mental unrest and delirium was unemic in origin, but was not intense enough to prevent the patient recognising ]>eople and answering questions when directly spoken to—he was not unconscious, and yet he was hemiplegic. Active measures were used for the alleviation of the ura-mia, the reduction of blood-ju'essure, and the relaxation t)f his vessels, the result being that he became quieter. In the course of three days the temperature](https://iiif.wellcomecollection.org/image/b28036591_0220.jp2/full/800%2C/0/default.jpg)
