(ATHEROMA)
This is a thickening of the intima of the arteries, due to an
inflammatory increase of the connective tissue, associated with more or
less fatty degeneration and calcification.
Old age, alcohol, lead, gout, syphilis, rheumatism and other
infections, laborious work, overeating, nephritis, and calcareous water
tend to produce the condition. =Excessive eating= and =drinking= are
common causes of both atheroma and chronic renal diseases and should
always be regulated. Physical overwork, chronic intoxications, etc.,
produce hypertension of the vascular system and thus lead to changes
of the vessel walls. A rigid spine is invariably found; this may be
a causative factor in itself, or an associated condition. All of the
above list of causes are important.
=Pathologically=, the arteries are thickened, tortuous and rigid.
The intima may be occupied by rough, calcareous plates. In extreme
cases the sub-endothelial tissue undergoes degeneration and breaks
down in spots, forming “atheromatous abscesses.” The disease may be
=circumscribed= or =diffuse=; in the latter there is a widespread
distribution of the affection. Owing to the general effect, the
heart, liver and kidneys receive less blood and tend to atrophy.
Microscopically, there is found more or less fatty degeneration of the
different coats, and an overgrowth of connective tissue in the intima.
The arteries most frequently affected are the aorta and coronary.
=Symptoms.=—=Circulatory.=—There is a high tension pulse and
accentuation of the second aortic sound. There is also dyspnea, severe
pain in the left side, palpitation, pallor, and the left ventricle
is hypertrophied. =Cerebral.=—Such symptoms as headache, tinnitus,
aphasia, vertigo, syncopal or epileptiform attacks may be present.
=Renal.=—There is an increase in the quantity of urine, which is of a
pale color and low specific gravity; at times it is albuminous. The
disturbance leads to atrophic nephritis. There may be gastro-intestinal
symptoms, as constipation, pain, etc., due to hardening of the
splanchnic vessels. In some cases the peripheral arteries become
obliterated. The veins become hardened.
=Sequelæ= are cardiac dilatation, heart failure, paralysis, apoplexy,
fatty heart, aneurism, contracted or senile kidney, angina pectoris,
and in extreme cases, gangrene of the extremities.
=Diagnosis.=—The characteristic symptoms are hardened arteries,
high tension of the pulse, hypertrophy of the left ventricle and
accentuation of the aortic second sound. The average blood pressure is
from 160 to 180 mm. of mercury, though it may be considerably higher.
=Prognosis.=—Many cases can be greatly benefited by osteopathic
treatment, and at the incipiency the improvement is generally marked.
It usually runs a very chronic course.
=Treatment.=—The treatment must necessarily consist, principally, in
the removal of such conditions as are producing the degeneration.
The rigid spine should be carefully treated by methods (preferably
traction) that overcome the contractures and release the intervertebral
discs. The dorsal and lumbar areas, and the abdominal organs should
receive special attention. Outdoor life and plenty of rest are
important. Alcoholism, gout, rheumatism, syphilis, etc., must be
remedied before there can be much change in the arteries. Freeliving
and all excitement must be stopped. The patient’s cooperation is
invaluable. A milk diet is often beneficial. Besides treatment of
the primary disease, a general treatment will be of much avail in
equalizing and reducing arterial tension. Brunton[105] speaks of
cases of atheroma being cured by exercise and manual treatment to the
rheumatic joints themselves. One, apparently suffering from senile
dementia, was much improved after two years of this treatment applied
to the joints, and showed benefit to the cerebral circulation. The
bowels and kidneys should be kept active, and the general health of the
patient carefully watched. Keeping the skin active by daily baths is an
essential factor in the treatment. Very frequently the disease is not
only retarded, but improved. In high blood pressure venesection may be
of benefit.