Vascular troubles in later life : inaugural address delivered before the Midland Medical Society, at Birmingham, on October 28, 1909 / by Sir Lauder Brunton.

  • Brunton, Thomas Lauder, Sir, 1844-1916.
Date:
1909
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Licence: In copyright

Credit: Vascular troubles in later life : inaugural address delivered before the Midland Medical Society, at Birmingham, on October 28, 1909 / by Sir Lauder Brunton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    their formation may be more or less continuous in the intestine, and thus numerous small doses may be absorbed in constant succession, instead of a single dose as in Dr. Dale’s experiment. Now, a constant rise in blood pressure, whatever its cause may be, tends to produce a twofold effect, hypertrophy of the heart and increased resistance in the vessels (52). I have been trying very hard to find out the pathology of the thickening of vessels which tends to occur with advancing age, and I have not been able to arrive at a satisfactory conclusion. I find some pathologists are positive that it is change beginning in the internal coat (53), but there seems little doubt that sometimes an affection of the middle coat is chiefly of importance, and I am quite incompetent to decide on such pathological ques- tions (54). I propose, therefore, to pass them by and simply to accept the fact that thickening does occur, and that in conse- quence the blood pressure tends to rise. Hypertrophy of the heart as a rule accompanies this rise, but how far it is secondary to the increased calls upon the heart’s activity which the rise in pressure causes, and how far it is due to stimulation of the heart by toxins, I do not know. The rise in pressure has recently been shown to have the power of producing degenerative changes in the vessels, rendering them more liable to rup- ture (55). As the vessels become more and more altered, resist- ance to the flow of blood is increased, and the heart becomes more hypertrophied, until at last death occurs either from failure of the heart or from rupture of a cerebral vessel. In his text-book on General Pathology, Thoma says: “ It is usually a cerebral haemorrhage threatening life which leads to the physician being called in to the patient suffering from angio- sclerosis” (56). This book was, however, published thirteen years ago, and much advance has been made since then. Thoma himself says; “ In other cases there are haemorrhages into the retina or frequently recurring haemorrhages from the nasal mucous membrane which cause danger by their severity, profuse menstrual haemorrhages which reveal the beginning of the disease.” In addition to this, there are a number of symptoms such as those I have already mentioned, faintness, palpitation, shortness of breath, fulness in the head, headache, giddiness, transitory aphasia, indecision, and irritability. Some of these symptoms, such as transient giddiness or faintness, may depend