Atheroma / by W. Ainslie Hollis.

  • Hollis, W. Ainslie (William Ainslie), 1839-1922.
Date:
1894-1896
Catalogue details

Licence: Public Domain Mark

Credit: Atheroma / by W. Ainslie Hollis. 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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    difficult or tedious, these scales of shed epithelium may rest awhile with the other particles, and togetlier with them form a source of irritation to the adjacent tissues, leading to the rapid production of successive layers of mucous scales. If the block is not serious, this cell pro- liferation is doubtless sufficient to re-establish the functional soundness of the membrane. It may often happen, however, that the rapid cell formation may increase the mischief which it in some cases can avert. And when the intruding particles are living, and capable of spontaneous increase, this failure must be the rule. When, moreover, the intruders are endowed with movement, and are actively hostile to the host, his misfortune is their opportunity. If sufficiently minute they may pass through the so-called cement substance beween the epithelial scales into the tissues beyond,^ or they may find their way there through the denuded basement membrane. The horny epithelial layer, as far as my experience serves me, is rarely penetrated by microbes, so long as it is sound; the epithelial-lo^dng parasites, as described by Fok, Euffer, and others, may be exceptional. Furthermore, the intruding particles occasionally consist of finely divided inorganic matter. If the observa- tions of C. Isnard on the causation of arterio-sclerosis are confirmed, we shall find such a substance in lead and its salts, many of which are insoluble. Having in some manner eventually effected an entrance into the mesoblastic tissues, and hence by accident or design into the blood, I shall for awhile leave the intruding particles in order to investigate the clinical histories of the cases appended in the table. Statistics to be of value in atheroma ought to be both voluminous and exhaustive. I cannot hope that the tabulated cases will settle conclusively the etiology, or indeed any other point in the history of this widely distributed disease. My reason for here giving them is that, with two or three exceptions, they represent cases which have come under my own observation. I shall, however, draw attention to a few significant facts, which a perusal of the table elicits. First, there is an exceptional preponderance of males over females in those affected by the disease. There is, again, a considerable number of cases in which a history of one or more attacks of arthritic rheumatism was obtained. This coincides with Isnard’s observation. Tubercular disease, with associated pulmonary or intestinal lesions, accounts for several deaths. ^Malignant disease, including a case of lymphadenoma, is noted in 6 patients. In two of these cases, however, the aorta was converted for a great portion of its length into a rigid calcareous tube, a condition unrecorded in the other tabulated cases. Syphilis is mentioned in three cases only, in one of which it was widely spread. A history of tins disease is often very difficult to elicit from a patient. After giving due weight to this circumstance, I still think it doubtful whether ^ Some witers deny the existence of “cement substance.” Heidenhain has attributed considerable mobility to the hyaline adherent borders of the cells lining the small intestine in vertebrates ; Hardy and M'Dougall in dapbuia ; Greenwood in lumbricus.