Un système de chirurgie . thedeeper r la croissance de couches de l'intima, et themuscle cancéreuses subissent une dégénérescence graisseuse. Il a été suggéré que la maladie primaire est l'atrophie tunique, et que les changements dans l'intima sont de la nature de l'hypertrophie compensatrice, mais la plupart des autorités arenow ont convenu en considérant la maladie comme essentiellement une chronicendarteritis. La couche externe de l'artère malade est le siège d'avarying degré d'épaississement, fibromes compensatoire qui est greatestwhere les autres couches de l'artère ont été les plus détruits par thedisease. C'est Cet épaississement de la

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A system of surgery . r growth in thedeeper layers of the intima, and themuscle cells undergo fatty degeneration. It has been suggested that the primary disease is atrophy ofthe tunica media, and that the changes in the intima are of thenature of compensatory hypertrophy, but most authorities arenow agreed in considering the disease as essentially a chronicendarteritis. The outer coat of the diseased artery is the seat of avarying degree of compensatory fibroid thickening, which is greatestwhere the other coats of the artery have been most destroyed by thedisease. It is this thickening of the outer coat which preventsrupture of the artery when an ulcer has formed. Effects.—The most constant effect of atheroma is a loss ofelasticity in the artery, which entails a loss of force in the circulation, as the systole of the heart is not supplemented by the elastic recoil ofthe large arteries. The diseased vessel is also liable to yield under thepressure of the blood, and atheroma is therefore of great importance. Fig, 159.—Laminar Calcificationof the Aorta. (.MiddlesexHospital Museum.) 558 DISEASES OF BLOOD-VESSELS. in the causation of aneurysm. In the smaller arteries the thickeningof the intima partially occludes the lumen of the vessel, and insome situations, as in the coronary arteries of the heart, the cerebralarteries, and the arteries of the legs, this may lead to serious conse-quences from impairment of the blood supply. It is stated that theloss of power in the muscular coat of atheromatous arteries interfereswith the due regulation of the local supply of blood, and is one causeof cerebral symptoms in old people with rigid arteries. Exposed calcareous plates may excite thrombosis, and detachedportions, as we have seen, may form emboli; either of these con-ditions may lead to gangrene. Arteries thus diseased are moreliable to rupture under the influence of injury than are supple, healthy vessels; and when the affection is far advanced it interfereswith the repair

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