4:14: DISEASES OF THE GREAT VESSELS. 



anatomical changes are precisely the same, we may assume that the 

 sources of irritation exist, but have escaped our observation. 



Endarteriitis deformans, as we may call chronic inflammation of the 

 intima, according to Virchow, is an extremely common disease of ad- 

 vanced age ; and it is always at the points most exposed to strain or 

 distention, such as the ascending portion and arch of the aorta and 

 the places of origin of the vessels which pass off laterally, that the 

 disease is most apt to occur. In the second place, the malady is most 

 frequently found to affect gouty, rheumatic, or syphilitic persons, as 

 well as drunkards. We are not at liberty, however, to go so far as to 

 suppose that in these cachectic subjects the disease proceeds from 

 the composition of the blood, that an irritant circulates in the latter 

 which excites the internal coat of the artery to the point of inflamma- 

 tion. 



Finally, endarteriitis accompanies hypertrophy of the heart in young 

 subjects who are not cachectic, and here it seems to attack by prefer 

 ence dilated portions of the arteries. These cases furnish strong evi 

 dence of dependence of the disease upon local injury to the vessels. 



ANATOMICAL APPEARANCES. We rarely have opportunity to see 

 purulent and ichorous collections in the tissue of the adventitia. In 

 durated thickening of the cellular tissue, as a residue of chronic in- 

 flammation, is a far more common discovery. At first the calibre 

 of the artery usually is narrowed; afterward it generally becomes 

 widened. 



Inflammation of the tunica media begins with a speckled redness, 

 which has its seat beneath the internal coat. The spots soon become 

 of a whitish or yellow color, are elevated above the inner surface, and 

 resemble small pustules. At first a mere sprinkling of the infiltration, 

 in the form of amorphous granules, takes place upon the tissue, which 

 still remains firm. It afterward liquefies, and pus forms, so that actual 

 abscesses are established in the wall of the artery. 



Chronic endarteriitis commences with relaxation and infiltration of 

 the tunica intima. Two forms of it occur, distinguishable according 

 to the grade of infiltration, and which have often been described as 

 different stages of the same disease. In the first form, that of gela- 

 tinous thickening of the inner coat, a gelatinous, moist, pale-reddish 

 layer seems to lie upon the inner surface of the artery, sometimes in 

 circumscribed spots, sometimes spread over a wider surface. These 

 apparent deposits readily admit of being crushed or displaced in the 

 form of jelly. They consist mainly of a liquid resembling mucus, in 

 which fine elastic fibres and round or spindle-shaped cells He embedded 

 They are immediately connected with the tunica intima, and are cov- 

 ered by its epithelium. 



