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However generally distributed arteriosclerosis is, in some regions the disease is more advanced than in others, and in those regions the most serious symptoms will occur. The regions which can stand the disease least well are the brain and coronary arteries, and next perhaps the legs, at the distal parts at least, where the circulation is always at a disadvantage if the patient is up and about.
Such pains are the exception rather than the rule, and are more likely to occur in chronic myocarditis or in coronary disease: in other words, in true angina pectoris. If there is considerable venous congestion there may be more or less frequent recurrent venous hemorrhages. This frequently is an epistaxis, or a bleeding from hemorrhoids, or in women profuse menstruation or a metrorrhagia.
This is because of its resistance to any arrest of the circulation and also because its survival is easily shown by its contractility. By irrigation of the heart and especially of its coronary vessels the period of revival may be much prolonged.
Rotation of the distal phalanx upon its transverse axis produces a condition, with respect to this peculiar impediment, that is equivalent to added and excessive length of the deep flexor tendon. Where there occurs suppuration, by careful inspection of the coronary region, one may early recognize detachment of hoof.
For instance, a fracture of the second phalanx would cause much more lameness than an injury to the lateral ligament of the coronary joint wherein there had occurred only a slight sprain, and though crepitation is not recognized, the diagnostician is not justified in excluding the possibility of fracture, if the lameness seems disproportionate to the apparent first cause.
A heart was "hypertrophied" or "dilated" or perhaps "fatty." It suffered from "pain," "angina pectoris," from some "serious weakness" or from "coronary disease," and that ended the pathology and the clinical diagnosis. This is the age of heart defects; no one can understand a patient's condition now, whatever ails him, without studying his heart.
Probably often a myocarditis and perhaps some fatty degeneration are at the base of such a slowed heart after serious infections. A heart which has not always been slow but has gradually become slow with the progress of hypertension and arteriosclerosis will often disclose on postmortem examination serious lesions of the coronary arteries.
When the disease is actually present, there is nothing to do except for the patient to stop active labor, never to overeat or overdrink, to prevent, if possible, toxemias from the bowels, to keep the colon as clean as possible, and for the physician to give the heart such medicinal aids as seem needed, vasodilators if the heart is acting too strongly, possibly small doses of cardiac tonics if the heart is acting weakly; always with the knowledge that a degenerative myocarditis may be present in considerable amount, or that coronary sclerosis may be present.
Sometimes the pus pushes its way upward and backward between the sensitive laminae and the wall, and makes its appearance at the margin of the coronary band in the region of the quarters or heels. This usually occurs when the tissues beneath the horny frog become bruised or the sensitive tissue pricked by a nail. It is commonly termed "gravelled."
Tiger and Jack burst into the room, and Dal could tell that they knew instantly what had happened. "Coronary," Jack said grimly. Dal nodded. "The question is, just how bad." "Get the cardiograph in here. We'll soon see." But the electrocardiograph was not needed to diagnose the nature of the trouble.
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