Erb has reported a large series of intermittent limp (claudication) from his private practice. He finds that the large majority of the cases occur in men. The abuse of tobacco was evidently the main etiologic factor in about half of the cases. Repeated exposure to cold and the abuse of alcohol were responsible for most of the other cases. Curiously enough he finds that a history of syphilis was present in only a small proportion of his cases. It is his firm conviction that intermittent limping—which he thinks should be called angiosclerotic dysbasia—is frequently incorrectly diagnosed. It is mistaken for other troubles and treated wrongly. As gangrene may develop this is particularly dangerous. The affection generally develops gradually, although he has seen cases where the onset was rather acute. The partial or complete lack of the pulse in the foot is the one striking sign, together with the varying behavior of the pulse, its disappearance when the feet are cold and its return after a warm foot bath or under other treatment. Signs of general arteriosclerosis were present in nearly every case. When there is a tendency to the development of intermittent limp he finds that a valuable sign is the manner in which the leg blanches when it is lifted repeatedly while the patient is recumbent and becomes hyperemic later when placed horizontally. In health this change occurs more rapidly.
CHAPTER IX.
SYMPTOMS AND PHYSICAL SIGNS
Special
Our conception of arteriosclerosis as a degenerative process affecting the vascular tree rather than a disease, removes the possibility of discussing special symptoms. As a matter of fact, we know of very few organs where even profound pathologic changes in the vascular system produced during life any symptoms which could be laid to these arterial changes. Kind nature has given to us such an excess of organs of every kind that the destruction of large portions of any organ seems to affect the function but little. So only particular groups of organs, which show symptomatic changes as the result of arteriosclerotic processes, will be discussed. It is realized that this may not give Teutonic completeness to the discussion, but it certainly saves paper and has a distinct practical value to the long suffering reader.
Although arteriosclerosis is a disease which affects the whole arterial system, it nevertheless never reaches the same grade all over the body. The difference in the structure and functions of the various organs determines to great extent the eventual symptomatology. Endarteritis obliterans of a small sized artery in the liver or leg would lead to no marked symptoms, as the circulation is so rich that the anastomoses of the blood vessels would soon establish a collateral circulation that would be perfectly competent to sustain the function of the part. Quite different would it be should one of the small arteries of the brain, the lenticulo-striate, for example, which supplies the corpus striatum, become the seat of a thrombosis or embolism caused by arteriosclerosis. The arteries of the brain are terminal arteries and the blood supply would be cut off entirely with a resulting anemic necrosis of the part supplied by the artery and a loss of function of the part. What would be of no moment in the leg or arm might prove even fatal in the brain.
The further symptomatology, therefore, of arteriosclerosis depends entirely on the organ or organs most affected by the interference with the blood supply. The following groups may be recognized:
1. Cardiac.
2. Renal.
3. Abdominal.
4. Cerebral.
5. Spinal.
6. Local vasomotor effects.
7. Pulmonary.