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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![The changes present in the kidneys are of great interest, for they seem to me to explain the confusion which still exists in relation to vessel and kidney changes in “ granular kidney.” The changes in the renal artery outside the kidney are as I have already described; while the changes in its branches inside the kidney show a very important modifica- tion of, or divergence from, that description. I found ^hat, inside the kidney, the arteries showed very marked fibrous hyperplasia of their internal coat, going on to complete occlusion of the vessel; that the muscular coat as a Tule atrophied and might practically disappear as the tunica intima thickened; and that the external coat seemed to become denser from a proliferation of its fibrous tissue. As a result of these changes tlie transverse section of an artery, when occlusion was complete, showed like a fibrous globe, which might be indistinguishable from a fibroid glomerulus. The fibrous tissue might be of the hyaline variety with few nuclei; and the change has consecpiently been sometimes re- ferred to as hyaline degeneration. A corresponding change occurs in the nutrient arteries of the brain, and possibly in other organs, which I have not, however, examined. Were this intimal thickening compensatory, in the sense that 1 Tlioma and his followers apply the term, it would cease y with the establishment of equilibrium. This, however, does not happen, the change going on to vessel occlusion. The changes in the kidney vessels have been much studied, and I have given a summary of the leading views propounded on the relations between the renal and vessel changes. It appears to me to be clear that error arose by applying the changes found in the arteries inside the kidney to ali the arteries in the body. The first observer who recognised the true nature of the change in the tunica media of the systemic arteries was Dr. George Johnstone, who named it muscular hypertro])hy, the reverse of the condition which occurred in the kidney; while Gull and Sutton, looking at the intimal changes and at the kidney changes together, introduced the term artcrio-capiUarii fibrosis. ■ These observers made the mistake of applying their observa- \ tions on the kidney to the vessels generally. I’lie result was, that in time the idea of a diffuse arterio-capillary fibrosis](https://iiif.wellcomecollection.org/image/b28036591_0048.jp2/full/800%2C/0/default.jpg)
