The small, contracted, wiry artery of a chronic nephritic may feel like a pipe stem, but if properly felt the mistake will not be made of considering such an artery an unusually sclerosed one. When the wave is pressed out of such a high tension artery, it is found that what seemed to be a firm sclerosed vessel, was in reality an artery tightly stretched over the column of blood.
Ocular Signs and Symptoms
It would not exaggerate too much to say that the examination of the eye grounds with the ophthalmoscope is the most important aid in the early diagnosis of arteriosclerosis. Long before there are any subjective symptoms, changes can be seen in the blood vessels of the retina which, while not always diagnostic, at least call attention to a beginning chronic disease. As I become more proficient in the use of the ophthalmoscope, I am impressed with the importance of the ocular signs of arterial disease. I would urge practitioners to familiarize themselves with this instrument. The electrically lighted instruments on the market now have so simplified the technic that any physician should be able to see the grosser changes which take place in the arteries and veins of the retina and in the disc. Frequently the ophthalmologist is the first to recognize early arteriosclerosis. In the fundus are seen increased tortuosity of the retinal vessels and their terminal twigs with more or less bending of the vessels at their crossings. The arteries are terminal ones, and small patches of retinitis are therefore found. The changes have been divided into (1) suggestive, (2) pathognomonic.
Under (1) are:
(a) Uneven caliber of the vessels,
(b) Undue tortuosity,
(c) Increased distinctness of the central light streak,
(d) An unusually light color of the breadth of the artery.
Under (2) are: