The diagnosis may he facilitated by examining the extremities by means of the Roentgen rays, as shown by the an nexed illustration, which represents a sciagraph obtained by Carl Beck in the case of a Cuban, 68 years of age, whose forearm is taken in proration, the palm resting on the photographic plate. The radial artery can be recognized just below the bifurcation of the brachial artery, passing along the radial side of the fore arm to the wrist, and winding around the outer side of the carpus. Particu larly interesting is the grading of the shadow according to the degree of calci fication of the artery.
The main general diagnostic points are: increased arterial tension in asso ciation with hard arteries, hypertrophied left ventricle, and accentuated second sound.
We are very apt to pass over the early cases even when they have the four cardinal symptoms—increased arterial tension, thickening of the vessel-well, hypertrophy of the left ventricle, and accentuation of the aortic second sound. Again, in the later stages of the disease, when the secondary changes in the heart and kidney are developed, we are very likely to overlook the primary disease and call the case cardiac or renal as. the case may be. In 25 cases, 24 men and I woman, most of the men being between 50 and 70, none in the thirties, most came for vertigo or headache. Twelve came primarily because of ver tigo. These figures suggest rather au important point in diagnosis, namely_ that a middle-aged or old 111:4 n who com plains of vertigo or constant headache is very possibly the subject of arterio sclerosis. J. L. Morse (Boston Med. and Slow. Jour., Dec. 10, '91i).
Cirasset, when speaking of chronic vertigo, recognizes certain forms, among them the cardio-vascular form or the vertigo due to arteriosclerosis. Mendel ('05) looks upon vertigo as an early sign of arteriosclerosis, and recommends pro longed use of iodide of potasimn and ergotine. Hutchings ('96) states that the prominent symptoms are diminution of the mental activity, vertigo, attacks of syncope, and disturbance of speech. P. T. Kovalevsky (Neurol. Centralb., No. 15, '08).
A new diagnostic sign: In normal adults the heart-sounds are to he heard by careful auscultation over the descend ing aorta, and in health and under the age of forty to fifty years are most plainly appreciable at a point on a level with the spine of the scapula and just to the left of the vertebral column. With advancing years this point moves downward, and, in addition, there is atheroma of the aorta: the sounds are then to be heard with great distinctness and force on a line joining the angle of the scapula to the spinous process of the seventh vertebra. Friedmann (Wiener Woch., June 21, 1900).
The important part played by arterial degeneration in determining cerebral dis orders in later life has led Dr. .Adoll Meyer, of New York, Director of the State Pathological Institute, to inquire into the connection, if any, between the arteriosclerosis and mental disease. Ile concludes that mental disease is not so frequently due to arteriosclerosis as is commonly believed. Observations on the heart and aorta of the insane showe that arteriosclerosis was exceedingly frequent, but mental disorder could be ascribed to such a morbid process only when it affected the blood-vessels of the brain. In man cases of advanced chronic insanity or dementia such a con dition undoubtedly existed. The prog
ress of arteriosclerosis in the brain was associated with loss of memory of the immediate past and attacks of mental confusion and transitory delirium. Such dements were found to be liable to in dulge in petty larceny :111d SPX and they were frequently guilty of attempts to set lire to houses. Alen tal disease occurring in that period of life when arteriosclerosis was most com mon showed, adds Dr. Aleyer. no pecul iarity in its nature and course that could not be fairly accounted for by the commencing, cerebral decadence of later life, which was a prominent feature especially in neurotic subjects. Both senile and presenile decay of brain power was associated with arteriosclero sis. but im special arteriosclerotic in sanity could be said to exist. \\lien arteriosclerosis was with sanity the irrognosis naturally more serious, as there was no special treat ment for such a diseased condition of the arteries of the brain. Editorial (Lancet. Feb. 28. 1002).
Etiology.—Arteriosclerosis is generally a disease of advanced life, but it is not infrequently found in middle-aged or even young subjects. Heredity probably plays an important part in the latter case. Males are affected more often than males. Alcohol, lead, rheumatism, gout, malaria, and syphilis are predisposing causes of this disease. Overwork of the muscles, overeating, and drinking to ex cess are considered by some as leading to sclerosis. Although nephritis may be caused by sclerotic vessels, it is also a means in producing this condition in some cases.
Negroes seem to be particularly sus ceptible to arteriosclerosis. Frank Bill ings (Inter. Med. Mag., May, '95).
Recurring or continued hypertonus leads to hypertrophy of the muscular media of the arteries, under the physio logical law that increased action in mus cle leads to its hypertrophy. This ac counts for the thickened media. The thickened intima is to be explained by the circulation in the blood of deleteri ous substances of various kinds; these substances act on the subendothelial connective tissue, irritate it, and lead to its hyperplasia. Thus is obtained the completed picture of arteriosclerosis. The evolution of the changes occupies a varying time in different persons; in some the hypertonus comes early in life, and in early middle age sclero sis is established. In some there is little physiological error, hypertonus is but an occasional occurrence, and sclerosis appears late in life. The capa bility of the arteries to contract when an excess of toxin is present is seldom lost, and that is the reason why the recognition of it in selerosed vessels is a matter of such great practical impor tance. William Russell (Lancet, June 1, 1901).
Path ology.—Arterioselerosis affects most often the aorta and coronary ar teries, but may be found in almost any part of the arterial system, although it is rare in the hepatic, gastric, and mesen teric arteries. There are two varieties: the circumscribed and diffuse.
The heart is the organ mainly affected. There are three forms: Syphilitic sclero sis attacks the large and medium-sized arteries; sclerosis of the type of granular atrophy,—an affection of the small ar teries and capillaries; the sclerosis of old age,—a general affection of the large and medium-sized arteries. J. NV. Rune berg (Finska Lakaresallsk. Handlingar, July and Aug., 1900).