THE ATHEROMATOUS PROCESS. 397 



deavoured to show that this kind of inflammatory affec- 

 tion of the arterial coat, is in point of fact exactly the 

 same as what is universally termed endocarditis, when it 

 occurs in the parietes of the heart. There is no other 

 difference between the two processes than that the one 

 more frequently runs an acute, the other a chronic, 

 course. 



By the establishment of this distinction between the 

 different processes which occur in the arteries, the differ- 

 ence of the course they pursue is at once accounted for. 

 Last time I laid an artery before you, on the inner sur- 

 face of which you saw little whitish patches, which were 

 due to simple fatty transformation. To-day you see very 

 extensive patches in the aorta, in which the atheromatous 

 change has taken place. But, as is wont to be the case 

 in changes of this kind, in addition to the specific trans- 

 formation attendant upon the chronic inflammatory pro- 

 cesses going on in the deeper parts, you find on the sur- 

 face also a simply fatty change, so that we have the two 

 processes occurring together. If now we examine athe- 

 romasia a little more minutely, for example in the aorta, 

 where the process is the most common, the first thing we 

 see present itself at the spot where the irritation has taken 

 place, is a swelling of larger or smaller size and not urifre- 

 quently so large as to form a really hump-like projection 

 (Buckel) above the level of the internal surface. These 

 projections are distinguished from the neighbouring parts 

 by their translucent, cornea-like appearance. In their 

 deeper parts they look more opaque. When the change 

 has lasted for a certain time, the first further metamor- 

 phoses do not show themselves at the surface, but just 

 where the internal comes into contact with the middle 

 coat as has been very well described by the old writers. 

 How often have they distinctly contended that the 

 internal coat could be stripped off over the affected spot ! 



