Syphilis and the etiology of atheroma / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Syphilis and the etiology of atheroma / by F. Parkes Weber. 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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    aneurism, belongs to an earlier period of life. The apparent discrep- ancy may be explained by the more frequent employment of men under fifty in severe labor, and their greater capacity for extreme muscular effort earlier in life, the condition of the arterial wall which favors aneur- ism having been already established. That violent efforts and high blood-pressure are most important factors in the causation of aortic aneurisms there can be no doubt,1 but I be- lieve that the explanation given by Dr. Hayden is not sufficient to account for the discrepancy acknowledged by him between the favorite age for aortic aneurism and the period of greatest frequency of aortic atheroma. It appears to me more natural to conclude that ordinary atheroma is not, after all, the commonest cause of sacculated aneurism of the aorta, but that a localized inflammatory infiltration of the aortic wall2 usually precedes the aneurismal dilatation. There seems to be nothing against the view that such patches of sub- acute aortitis represent sometimes a true tertiary syphilitic process of the nature of a gummatous infiltration, and this view best explains the im- portance of syphilis as an etiological factor in aortic aneurisms. In 1868 Prof. Clifford Allbutt,3 when describing the histological char- acter of the diseased cerebral vessels in a syphilitic man, aged thirty-one years, drew attention to a condition of chronic arteritis with great nuclear and cellular proliferation, which affected all the coats to some extent, but especially the middle and inner coats. He said, The distinction between the coats was in many places lost; iu other places the inner was detached from the middle coat by a nest of nuclei and granules. . . . i Hence the much greater frequency, so often alluded to, of aortic aneurisms in men than in women, and in men who make great muscular efforts than in men who do not. This is con- firmed by the fact that the aortic arch, where naturally the strain is greatest, is the most com- mon site for aneurisms. Strain probably acts likewise as a predisposing cause of atheroma. The arteries of the lower extremities, which are more liable to strain than those of the upper extremities, are likewise more liable than the latter to atheroma ; the pulmonary artery, where the blood-pressure is much lower than in the aorta, is seldom affected by atheroma, except when the blood-pressure in the pulmonary artery is pathologically increased by pulmonary emphysema, disease of the mitral valve, etc. (See S. Wilks and W. Moxon, Lectures on Pathological Anatomy, 3d ed., 1889, pp. 155-57.) Precisely how strain can induce atheroma remains doubtful. A discussion as to whether a chronic inflammatory process plays an inter- mediate part in these cases would be unprofitable, but we may bear in mind that, though moderate functional activity and mechanical movements must be regarded as natural stimu- lants tending to the proper nutrition of the tissues, excessive functional activityand mechan- ical strain may probably cause malnutrition and irritation, giving rise to chronic degenerative and inflammatory changes. It is not then a matter for surprise that strain sometimes helps in the production of atheroma ; the part, however, which it plays in the production of atheroma is probably quite different to the part which it plays in inducing aneurism. In the latter case the usual action of strain is most likely the mechanical thrusting out of a part of the vessel- wall already softened by some true inflammatory process. s The very first stages of a sacculated aneurism of the aorta are, however, not likely often to fall under the notice of the pathological anatomist. 3 Cerebral Disease in a Syphilitic Patient, St. George's Hospital Reports, 1868, vcl. iii. p. 61. What appear to have been miliary gummata had already, in 18B3, been noticed by Dr. S. Wilks in the bloodvessels of the brain in the case of a syphilitic womau, aged 38. See Guy's Hospital Reports, 1803, 3d series, vol. Ix. p. 45.