The practice of osteopathy

Arteriosclerosis

(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.