Volume 2

The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • Erichsen, John Eric, 1818-1896.
Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

    24/802 (page 8)
    that impair the vital forces ; and it is in this way that phthisis, granular kidneys, chronic gout, constitutional syphilis, &c., have a direct tendency to occasion these degenerations in the arterial coats. It is a favoiirite suppo- sition with many pathologists, that these changes result directly from inflam- matory action ; this certainly does not appear to he the case, but it is by no means improbable that an artery in which the inflammatory process has taken place may thereby have its nutrition so modified as to become more susceptible to early and extensive degeneration, and that the plastic matters thrown out as the result of the inflammation will be especially liable to rmdergo those changes that ultimately result in their conversion into fat and calcareous matter. Some arteries are more liable to these structural lesions than others ; and the relative frequency of the various forms of deposit varies in diiferent arteries. Thus the ascending aorta is most subject to fatty degeneration, whilst the calcareous transformation is most frequently met with ia the arch and abdo- minal portion of the vessel. The arteries of the lower extremities (viz., the femoral, the popliteal, and the tibial) are chiefly affected with calcareous deposits, whilst the fatty are commonly met with in the vessels of the brain ; and some arteries appear to be exeinpt from disease ; thus, Tiedemann states that he has never found the oesoiDhageal arteries ossified. The difference in the liability of different arteries to disease is, no doubt, ia a great measure to be accounted for by the different degrees of development of the longitudinal fibrous coat ia different parts of the arterial system—this being, I believe, in most iastances the primary seat of the affection. Thus, ia the aorta, the coronary arteries, and those of the brain, in which it aboimds, we find these transformations frequent. The distance of the tibials from the centre of circrdation, and the consequent diminished nutritive activity of their coats in old people, may account for the frequency of their degenerations. Those points of the arteries, likewise, upon which the shock of the onward wave of blood is most directly received, are more subject to degeneration than neighbourmg parts of the continuity of the wall of the vessel. This is especi- ally observable at the origins of the arteries that spring from the arch of the aorta, and at the bifurcation of the iliacs. It is also 'not improbable that the increased pressure of the blood upon the coats of arteries that lead to diseased organs, through which the circidation is obstructed, may tend to their degeneration. Sex exercises but little general influence on the liability to disease in the arterial system, though it specially tends to the occurrence of those changes in certain arteries. Thus Bizot states that the arteries of the upper extremity are most frequently diseased in women, and those of the lower in men. Local Effects. — The structural lesions that have just been described produce certaia local effects, often of considerable importance, on the parts which the affected vessels supply with blood. Eor the proper and healthy nutrition of a limb or part to be carried on, two great conditions are required, so far as its arteries are concerned :—1, that the integrity of the structure of the walls of the vessels continue perfect; and, 2, that their channels remain pervious : for, although the arterial system possesses remarkable conservative power in its arrangement and distribution that tend to counteract these effects, yet, by slow degrees, a deterioration of function and disintegration of structure take place in the part immediately supplied by the diseased vessel. Thus, in the limbs, we have all the signs of a defective circulation- coldness of the feet, cramps, and spasms of the muscles ; whilst, in organs, softening of tissue, fatty degeneration, and other evidences of the want of