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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![considerably thickened, as they may be, liave come to be looked upon as having undergone permanent structural thickening, for which nothing can be done, and which do not therefore call for furtlier consideration from the clinician. There is of course no difticulty in determining when an artery, such as the radial or temporal, is thickened : the finger trained “ to feel the pulse ” has no difficulty, and there need be no dubiety in the mind of the observer as to the accuracy of his observations, for it is as easy to distinguish between degrees of thickening in arteries as it is in rubber tubes. AVith a little practice, once attention is drawn to the matter, the smallest degrees of liypertonus are recognised hy the increase in the thickness of the wall of tlie artery. This varying thickness has escai)ed observation, owing to so mucli attention liaving been given to tlie consideration of blood- pressure or of tension. Thickened arteries are recognised by all physicians, and are, as is well known, of common occurrence; the real diffi- culty arises in determining whether the wall be tliick from hypertonic contraction, true sclerosis, or perhaps even from atheroma. Atheroma is of relatively rare occurrence in the radial and temporal arteries; its occurrence is confined to aged people, and is nsnally associated with areas of calcareous infiltration wliich ai;e easily distinguished. Sclerosis is, on the other hand, common after middle life. Before middle life it is fair to assume that uniform thickening is mainly hypertonic, unless there be discoveralde one or other of the two great causes of early sclerosis, namely, chronic kidney disease or syphilis, to which I think may be added a third, namely, the use of malt and other li(i[uors. The size of the vessel aids in the differentiation : an ordinary sized or a some- what large vessel with a thick wall is usually structurally tliickened; a small vessel with a relatively thick wal 1 is usually only hy])ertonic. Fig. 15 was taken from a section of an artery which, until a. few days before death, was soft and nntliickened. Some days l)efore death it became definitely tightened u]>, and the figure closely corresponds with the impression maile on the finger before death took place.](https://iiif.wellcomecollection.org/image/b28036591_0056.jp2/full/800%2C/0/default.jpg)
