Recent History
December 9, 1870
Diabetes Mellitus and its dietetic treatment
Due to constant abuse of mealy crops, Cantani's 9th patient, Mr. Leopolod Lam was fat, and thus needed to go on the rigorous treatment of the meat diet which helped resolve his eyesight which had also clouded over with cataracts.
OBSERVATION IX. - Mr. Leopoldo Lam ... of fat constitution, 60 years old, owner in Naples; constant abuse of mealy crops. Patient for more than two years, cataract for a month, eliminating 6 liters of urine, containing 730 gr. of sugar, and of the specific weight of 1037, with some traces of albumin, according to the analysis of Primavera of December 9, 1870. Subjected to the rigorous treatment, meat diet and lactic acid, he experienced from the first twenty-four hours , an extraordinary improvement: after three days, the polyuria and glycosuria had disappeared. On January 4, the patient noticed an improvement in his eyesight: he resumed eating bread and even sweets, without relapse. On January 18, 1871, the urine weight was 1011: the healing was maintained complete. The patient remained in good health for a few months, then died from acute intercurrent lobar pneumonia.
January 17, 1871
Diabetes Mellitus and its dietetic treatment
The detailed observations of Dr Cantani prove that the carnivore diet cures diabetes if the patient commits to it. Observations 31 - 40 are listed.
OBSERVATION XXXI. The priest Francesco Antonio San Ger- mano, parish priest of Carrano, aged 54, ate almost exclusively on flour. On January 17, 1871, he had 75 gr. Of sugar per liter of urine (plus 10 gr. Of albumin), and on April 5, 51 gr., Of sugar (and 5 gr. Of albumin); submitted to my treatment and received at the clinic, his urine became free of sugar, and remained so, even with a mixed diet, until the last news I received.
OBSERVATION XXXII. Canon Francesco G. de Serra S. Bruno (Catanzaro), 65 years old, great lover of amacés, came on July 12, 1872, with 50 gr. of sugar per liter of urine, with the specific gravity of 1023: let, after a few days of treatment, they weighed 1015 and the sugar had disappeared. The patient continued to be well, even with a mixed diet, but for some time I have not heard from him.
OBSERVATION XXXIII. - Lawyer Michelangelo T., 37 years old, from Trani, lover of flour, diabetic for an undetermined time; on January 17, 1872, his morning urine contained 60 gr. of sugar per liter, and those he had emitted in the evening (the same number of hours after the meal) 160 gr. per liter; after three days of treatment, his urine was free of sugar; I saw the patient again on June 9, 1872, the urine was examined again, and found absolutely normal, although for several months the patient had returned to mixed food.
OBSERVATION XXXIV. Mrs C. 22 year old from S., daughter of a man who died of diabetes. She herself cannot yet be considered diabetic in the truest sense of the word, but whenever she eats a lot of candy she becomes thirsty with polyuria, and at this time her urine contains sugar. It is an intermittent diabetes, which threatens to transform into continuous diabetes, if this lady, warned of the danger did not know how to limit herself much in the use of flour, and did not especially renounce the abuse of sweets. In short, it is a beginning diabetes, it is the beginnings of diabetes, which do not require a rigorous cure, but only a rational diet, not free from flour, but from any excess of bread, pasta, fruit and sweets, a mixed food and sufficiently rich in nitrogen.
OBSERVATION XXXV. - Mr. Vincenzo d'A., Owner, aged 38, from Trigiano (Bari), ill for three years not general and also mental weakness, impotence, thirst, moderate hunger; he lost weight considerably, so as to lose 12 kilograms in about two years. He did eat a little meat, but mostly bread and pasta. Following a consultation in 1869 with a distinguished professor from Naples, he took arsenic, and later strychnine, but to no avail. In October 1870, Doctor Nicola Scarpelli, of Trigiano, subjected him to my curative method, which he did not follow rigorously, however, because he continued to eat a little bread. His condition improved a lot, but as he did not heal completely, he came to me on May 2, 1871, with 16 gr. only sugar per liter of urine, in order to heal itself completely. After only twenty-four hours of rigorous treatment, the urine was free of sugar. I lost sight of this patient too quickly to be sure that the treatment was continued, and to know the final result.
OBSERVATION XXXVI. Mr. Giuseppe 1., 45 years old, from Castellamare di Stabia, a great starch lover, recognized as diabetic for about a year, and treated as such for eight months by other Neapolitan doctors and professors, presented himself to Professor Primavera on November 19, 1870, after having followed a diet in which meat dominated for several months: he still had 75 gr. of sugar per liter of urine, and this had the specific gravity of 1032. Professor Primavera recommended that he strictly follow the treatment I instituted, but the patient, always taking certain liberties, we never succeeded in having the urine free from sugar. On March 16, 1871, his urine still weighed 1032, and still contained 75 gr. of sugar per liter. At this moment the cure was applied with all its rigor, and after only fifteen days, the urine was completely deprived of sugar; but the patient, relying too much on this result, returned almost immediately to the use of bread, pasta and sweetened coffee, and resumed the dryness of the mouth, thirst, polyuria: on May 17, his urine contained still 40 gr. of sugar per liter, and their specific weight was 1030. The treatment resumed rigorously, on June 2, the urine weighed only 1020, and the sugar was again entirely absent. I do not know whether the patient has had enough perseverance later on to continue the treatment for a sufficient time to be sure of not having a relapse.
OBSERVATION XXXVII. Mr. Nicola dell 'E., aged 51, judge, from Castellana de Bari, lover of starchy foods, has suffered for three years from thirst, hunger and polyuria, and also from torpor of the limbs, great general weakness and impotence. The presence of sugar in the urine was noted in March 1871, when he began to cough, to have amblyopia; already he had grown extraordinarily thin. The urine examined at this time contained 48 gr. of sugar per liter, and presented the specific gravity of 1028. A distinguished doctor ordered my rigorous diet, more quina and arsenic: the patient was better anyway, and the sugar disappeared from the urine; however digestion was hurting. It was then that the patient came to see me. The addition to the absolute meat diet, 5 gr. of lactic acid per day, made digestion easy, and possible the continuation of the cure. All symptoms improved rapidly, thirst and urine returned to normal, and within days, manly potency returned. On June 16, 1871, the urine was again examined in Naples: it was entirely free of sugar. I learned again in July 1874 that M. dell 'E. was in perfect health.
OBSERVATION XXXVIII. - Madame Cristina P., aged 33, from Salerno, a great friend of sweets, presented on September 14, 1870, for analysis by Professor Primavera, urine with a specific weight of 1038, with 140 gr. of sugar per liter, and diabetic symptoms, especially high polyuria, with thirst and weight loss. She was subjected to the treatment, I do not know for how long. A year ago a doctor assured me that she was doing very well.
OBSERVATION XXXIX. - Doctor Sch., Of Basilicata, aged 40, became diabetic, after having abused flour and sweets, a little also coffee, and after prolonged grief: after noticing the disease in him , he submitted to my treatment: after only four days, the urine was completely free of sugar, and remained such until January 1874, when I heard from one of his parents, a distinguished professor at the Polytechnic School of Naples.
OBSERVATION XL. - The lawyer Domenico B., from Conversano, aged 50, amylivore par excellence, and diabetic for three years, with notable worsening of symptoms for eight months, presented, on April 26, 1872, urine with a specific weight of 1030, and containing 35 gr. of sugar plus half a gram of albumin per liter. The patient undergoing rigorous treatment, his urine was examined again on May 3: it was absolutely free from sugar; the same on May 15 and 30. Since then I have heard of the complete recovery of this patient, although he had long since returned to mixed food.
February 26, 1871
Diabetes Mellitus and its dietetic treatment
Cantani's fourth patient, Mr Saltavore Musdace, was losing weight from diabetes and was eating an almost exclusively starchy diet, and was cured with an all meat diet. His diet even relapsed, again proving that eating starch would cause diabetes.
OBSERVATION IV. - Mr. Salvatore Musdace, 57 years old, from Naples, trumpet of the National Guard. Powerless and losing weight for three years, polyuria of 5 to 6 liters per day, with no known cause, apart from the almost exclusively starchy diet, he entered the Clinic on February 26, 1871; it emitted 3 liters of urine, specific weight 1042; 372 gr. of sugar per day.
After twelve days of rigorous treatment, complete absence of sugar, daily quantity 1,200 cc, specific weight 1022 which fell on May 14 to 1017. This slow decrease in specific weight after the disappearance of sugar is interesting, because it indicates a major combustion of albuminates. We noted here the rapid decrease in sugar, and the persistence of small quantities, after a few days of treatment; this is so in advanced cases: it is only in mild, beginning cases that the sugar immediately disappears completely. This patient is still interesting because of his temperature, which has remained low, 350.7 C., 36 ', rarely 360.5, as long as he has sugar, and 12 to 14 breaths; as soon as the strength returned, the temperature rose to 37 ° and respiration to 16-18.
The recovery of this patient persisted when he resumed the ordinary diet: when he left the clinic, after four months of stay, he weighed 5kil, 6, more than when he entered; When he got home, he was obliged to resume a diet almost exclusively composed of starch and grass. Eighteen months later, he had an abscess of the perineum, which healed after operation, and soon after, hunger, weakness and polyuria returning, he spontaneously began to eat meat: then he returned to the Clinic on the 9th. February 1873, presenting 107 gr. of sugar for 1530 cc of urine. After two days of mixed diet, he had 255 gr. of sugar on 2410 cc of urine within twenty-four hours. After only six days of rigorous diet, the sugar disappeared and never came back. On May 13 the patient went out very well cured.
April 1, 1871
Diabetes Mellitus and its dietetic treatment
Cantani tells his seventh patient, the Baron Archpriest Girolamo MdG to "dismiss the last vestiges of flour that the patient had kept in his diet" to cure diabetes. Of note, to begin with, the Archpriest ate vegetables and fruit, eating meat only exceptionally, and still got diabetes.
OBSERVATION VII. Baron Archpriest Girolamo M. di G., from Andiano (Lecce), 52, was sent to me by Doctor Stasi from Spongano, after Doctor Voccoli would have submitted for some time to my cure. Two of his sisters had died of phthisis; himself was thin, prone to intermittent fevers and digestive troubles, which hunting had cured him. At 32, he entered the seminary; soon after was resumed by his acid dyspepsia and coughing up blood; he ate vegetables and fruits, eating meat only exceptionally. When I saw him, he had been suffering from thirst with polyuria for a year; since the same time, he ate and digested well. Voccoli had noticed the presence of sugar, and ordered my treatment; under its influence the health of the patient improved very quickly; the thirst and the polyuria disappeared: the sugar diminished very rapidly. But the bowel pains returned and the sugar increased with each new attack, oscillating between 30 and 40 gr. per liter. Dr Voccoli noted that the glycosuria disappeared left, or nearly four hours after dinner, only to reappear very abundantly three hours before dinner the next day. The gastro-intestinal catarrh treated and improved, the anti-diabetic cure succeeded very well: but the sugar reappeared as soon as the patient ate bread. Through all these tests, the general condition was better: the patient, 61 kilog. and a half, had arrived at 63 kilog. in three months. It was there when I saw it, in April 1871. I did nothing but dismiss the last vestiges of flour that the patient had kept in his diet, and after several months of treatment, he could return to use with impunity, moderate bread. This very intelligent patient still checks the state of his urine daily.
May 8, 1871
Diabetes mellitus and its dietetic treatment
A woman eating only flour, fruit, and pasta comes down with diabetes and cancer and is helped by Dr Cantani with the all meat "rigourous cure"
OBSERVATION X. - Madame M., from Malta, 52 years old. Living almost exclusively on flour, fruit and pasta, suffering for a long time from thirst and polyuria, she has become notably thinner over the past two years; nine months ago diabetes was recognized; the patient was subjected to my treatment, which was not sufficiently rigorously followed. I saw her in consultation with Professor Cesare Olivieri and Doctor JB Sammut, English doctor: we discovered in her a uterine epithelioma. The urine, analyzed by Primavera, gave: 4 liters per day, specific weight 1032, 400 gr. of sugar per day (May 8, 1871). Immediately subjected to the rigorous cure, from May 14 there was no more polyuria, nor thirst, and the urine, with a specific weight of 1026, contained only 25 gr. of sugar per day: on the 22nd, they no longer contained sugar, and weighed only 1026. The urine remained thus, even after the patient had returned to eating sweet fruits, and especially oranges, until the moment of her death, which occurred a long time later, from her uterine tumor.
Ancient History
8000
B.C.E.
Evolutionary and Population Genomics of the Cavity Causing Bacteria Streptococcus mutans
S. Mutans, the bacteria involved in creating cavities likely evolved and expanded with the population growth 10,000 years ago as humans started relying more on starches and sugars.
Streptococcus mutans is widely recognized as one of the key etiological agents of human dental caries. Despite its role in this important disease, our present knowledge of gene content variability across the species and its relationship to adaptation is minimal. Estimates of its demographic history are not available. In this study, we generated genome sequences of 57 S. mutans isolates, as well as representative strains of the most closely related species to S. mutans (S. ratti, S. macaccae, and S. criceti), to identify the overall structure and potential adaptive features of the dispensable and core components of the genome. We also performed population genetic analyses on the core genome of the species aimed at understanding the demographic history, and impact of selection shaping its genetic variation. The maximum gene content divergence among strains was approximately 23%, with the majority of strains diverging by 5–15%. The core genome consisted of 1,490 genes and the pan-genome approximately 3,296. Maximum likelihood analysis of the synonymous site frequency spectrum (SFS) suggested that the S. mutans population started expanding exponentially approximately 10,000 years ago (95% confidence interval [CI]: 3,268–14,344 years ago), coincidental with the onset of human agriculture. Analysis of the replacement SFS indicated that a majority of these substitutions are under strong negative selection, and the remainder evolved neutrally. A set of 14 genes was identified as being under positive selection, most of which were involved in either sugar metabolism or acid tolerance. Analysis of the core genome suggested that among 73 genes present in all isolates of S. mutans but absent in other species of the mutans taxonomic group, the majority can be associated with metabolic processes that could have contributed to the successful adaptation of S. mutans to its new niche, the human mouth, and with the dietary changes that accompanied the origin of agriculture.
Undoubtedly, one of the major challenges that S. mutans had to overcome as the carbohydrate content of the human diet increased was surviving at low pH. Although S. mutans does not constitute a significant proportion of the oral flora colonizing healthy dentition, it can become numerically significant when there is repeated and sustained acidification of the biofilms associated with excess dietary carbohydrates or impaired salivary function (Burne 1998).
Luxor, Luxor Governorate, Egypt
2475
B.C.E.
The Earliest Record of Sudden Death Possibly Due to Atherosclerotic Coronary Occlusion
WALTER L. BRUETSCH
The sudden death of an Egyptian noble man is portrayed in the relief of a tomb from the Sixth Dynasty (2625-2475 B.C.). Since there is indisputable evidence from the dissections of Egyptian mummies that atherosclerosis was prevalent in ancient Egypt, it was conjectured that the sudden death might have been due to atherosclerotic occlusion of the coronary arteries.
It may be presumptuous to assume that an Egyptian relief sculpture from the tomb of a noble of the Sixth Dynasty (2625-2475 B.C.) may suggest sudden death possibly due
to coronary atherosclerosis and occlusion. Much of the daily life of the ancient Egyptians has been disclosed to us through well-preserved tomb reliefs. In the same tomb that contains the scene of the dying noble, there is the more widely known relief "Netting Wildfowl in the Marshes." The latter sculpture reveals some of the devices used four thousand years ago for catching waterbirds alive. It gives a minute account of this occupation, which in ancient Egypt was both a sport and a means of livelihood for the professional hunter.
The relief (fig. 1), entitled "Sudden Death," by the Egyptologist von Bissing2 represents a nobleman collapsing in the presence of his servants. The revelant part of the explanatory text, as given by von Bissing, follows (translation by the author):
The interpretation of the details of the theme is left to the observer. We must attempt to comprehend the intentions of the ancient artist who sculptured this unusual scene. In the upper half (to the right) are two men with the customary brief apron, short hair covering the ears, busying themselves with a third man, who obviously has collapsed. One of them, bending over him, has grasped with both hands the left arm of the fallen man; the other servant, bent in his left knee, tries to uphold him by elevating the head and neck, using the knee as a support. Alas, all is in vain. The movement of the left hand of this figure, beat- ing against the forehead, seems to express the despair; and also in the tightly shut lips one can possibly recognize a distressed expression. The body of the fallen noble is limp. . . . Despite great restraint in the interpretation, the impression which the artist tried to convey is quite obvious. The grief and despair are also expressed by the figures to the left. The first has put his left hand to his forehead. (This gesture represents the Egyptian way of expressing sorrow.) At the same time he grasps with the other arm his companion who covers his face with both hands. The third, more impulsively, unites both hands over his head. ... The lord of the tomb, Sesi, whom we can identify here, has suddenly collapsed, causing consternation among his household.
In the section below (to the left) is shown the wife who, struck by terror, has fainted and sunk totheflor. Two women attendants are seen giving her first aid. To the right, one observes the wife, holding on to two distressed servants, leaving the scene. . . .
von Bissing mentions that the artist of the relief must have been a keen observer of real life. This ancient Egyptian scene is not unlike the tragedy that one encounters in present days, when someone drops dead of a "heart attack." The physician of today has almost no other choice than to certify the cause of such a death as due to coronary occlusion or thrombosis, unless the patient was known tohave been aflictedwith rheumatic heart disease or with any of the other more rare conditions which may result in sudden death.
Atherosclerosis among the Ancient Egyptians
The most frequent disease of the coronary arteries, causing sudden death, is atherosclerosis. What evidence is available that atherosclerosis was prevalent in ancient Egypt?
The first occasion to study his condition in peoples of ancient civilizations presented itself when the mummified body of Menephtah (approx.1280-1211B.C.), the reported "Pharaoh of the Hebrew Exodus" from Egypt was found. King Menephtah had severe atherosclerosis. The mummy was unwrapped by the archaeologist Dr. G. Elliot Smith, who sent a piece of the Pharaoh's aorta to Dr. S. G. Shattock of London (1908). Dr. Shattock was able to prepare satisfactory microscopic sections which revealed advanced aortic atherosclerosis with extensive depositions of calcium phosphate.
This marked the beginning of the important study of arteriosclerosis in Egyptian mummies by Sir Mare Armand Ruffer, of the Cairo Medical School(1910-11). His material included mummies ranging over a period of about 2,000 years (1580 B.C. - 525 A.D.).
The technic of embalming in the days of ancient Egypt consisted of the removal of all the viscera and of most of the muscles, destroying much of the arterial system. Often, however, a part or at times the whole aorta or one of the large peripheral arteries was left behind. The peroneal artery, owing to its deep situation, frequently escaped the em- balmer'sknife. Otherarteries,suchasthe femorals, brachials, and common carotids, had persisted.
In some mummies examined by Ruffer the abdominal aorta was calcified in its entirety, the extreme calcification extending into the iliae arteries. Calcified plaques were also found in some of the larger branches of the aorta. The common carotid arteries frequently revealed patches of atheroma, but the most marked atheroselerotic alterations were in the arteries of the lower extremities. The common iliae arteries were not infrequently studded with calcareous plaques and in some instances the femoral arteries were converted into rigid tubes. In other mummies, however, the same arteries were near normal.
What is known as Mdnekeberg's medial calcification was also observed in some of the mummified bodies. In a histologic section of a peronieal artery, the muscular coat had been changed almost wholly by calcification. In one of Ruffer's photographic plates, a part of a calcified ulnar artery is shown. The muscular fibers had been completely replaced by calcification.
In the aorta, as in present days, the atherosclerotic process had a predilection for the points of origin of the intercostal and other arteries. The characteristics and the localization of the arterial lesions observed in Egyptian mummies leaves litle doubt that atherosclerosis in ancient times was of the same nature and degree as seen in today's postmortem examinations.
As to the prevalence of the disease, Ruffer ventured to say that the Egyptians of ancient times suffered as much as modern man from arterial lesions, identical with those found in our times. Ruffer was well qualified to make this statement having performed many autopsies on modern Egyptians, Moslems, and other people of the Middle East. In going over his material and examining the accompanying photographic plates of arteries, one can have litle doubt that what Ruffer had observed in Egyptian mummies represented arteriosclerosis as it is known today.
Although the embalming left no opportunity to examine the coronary arteries inl mummified bodies, the condition of the aorta is a good index of the decree of atheroselerosis present elsewhere. In individuals with extensive atheroselerosis of the aorta, there is almost always a considerable degree of atherosclerosis in the coronary arteries. If Ruffer's statement is correct that the Egyptians of 3,000 years ago were afflicted with arteriosclerosis as much as we are nowadays, coronary occlusion must have been common among the elderly population of the pre-Christian civilizations.
Furthermore, gangrene of the lower extremities in the aged has been recognized since the earliest records of disease. Gangrene of the extremities for centuries did not undergo critical investigation until Cruveilhier (1791- 1873) showed that it was caused by atherosclerotic arteries, associated at times with a terminal thrombus.
SUMMARY
The record of a sudden death occurring in an Egyptian noble of the Sixth Dynasty (2625-2475 B.C.) is presented. Because of the prevalence of arteriosclerosis in ancient Egyptian mummies there is presumptive evidence that this incident might represent sudden death due to atheroselerotic occlusion of the coronary arteries.
Cairo, Cairo Governorate, Egypt
1580
B.C.E.
ON ARTERIAL LESIONS FOUND IN EGYPTIAN MUMMIES
Arteries of Egyptian mummies from 1580 B.C.E. to 525 A.D. have extensive calcification of the arteries, the same nature as we see today, and unlikely to be due to a very heavy meat diet, which was always a luxury in ancient Egypt. Instead, the diet was mostly a course vegetarian one.
DISCUSSION OF RESULTS.
Nature of the lesions. There can be no doubt respecting the calcification of the arteries, and that it is of exactly of the game nature as we see at the present day, namely, calcification following on atheroma.
The small patches seen in the arteries are atheromatous, and though the vessels have without doubt been altered by the three thousand years or so which have elapsed since death, nevertheless the lesions are still recognisable by their position and microscopical structure.
The earliest signs of the disease are always seen in or close below the fenestrated membrane,-that is, just in the position where early lesions are seen at the present time. The disease is characteiised by a marked degeneration of the muscular coat and of the endothelium. These diseased patches, discrete at first, fuse together later, and finally form comparatively large areas of degenerated tissue, which may reach the surface and open out into the lumen of the tube. I need not point out how completely this description agrees with that of the same disease as seen at the present time.
I have already mentioned the absence of leucocytes and cellular infiltration, and need not therefore return to it here.
In my opinion, therefore, the old Egyptians suffered as much as we do now from arterial lesions identical with those found in the present time. Moreover, when we consider that few of the arteries examined were quite healthy, it would appear that such lesions were as frequent three thousand years ago as they are to-day.
I do not think we can accuse a very heavy meat diet. Meat is and always has been something of a luxury in Egypt, and although on the tables of offerings of old Egyptians haunches of beef, geese, and ducks are prominent, the vegetable offerings are always present in greater number. The diet then as now was mostly a vegetable one, and often very coarse, as is shown by the worn appearance of the crown of the teeth.
Nevertheless I cannot exclude a high meat diet as a cause with certainty, as the mummies examined were mostly those of priests and priestesses of Deir el-Bahari, who, owing to their high position, undoubtedly lived well. I must add, however, that I have seen advanced arterial disease in young modern Egyptians who ate meat very occasionally. In fact, my experience in Egypt and in the East has not strengthened the theory that meat-eating is a cause of arterial disease.
Finally, strenuous muscular exercise can also be excluded as a cause, aa there is no evidence that ancient Egyptians were greatly addicted to athletic sport, although we know that they liked watching professional acrobats and dancers. I n the ca6e of the priests of Deir el-Bahari, it is very improbable, indeed, that they were in the habit of doing very hard manual work or of taking much muscular exercise.
I cannot therefore at present give any reason why arterial disease should have been so prevalent in ancient Egypt. I think, however, that it is interesting to find that it was common, and that three thousand years ago it represented the same anatomical characters as it does now.
FIG. 1.-Pelvic and arteries of thigh completely calcified (XVIlIth-XXth Dynasty).
Fro. 2.-Completely dcifiedprofundaarteryaftersoakinginglycerine(XXIstDynasty). FIQ. 8.-Partly calcified aorta (XXVIIth Dynasty).
Fro. 4.-Calcified patches in aorta (XXVIIth Dynasty).
Fio. 5.-Calcified atheromatous ulcer of subclavian artery (XVIIIth-XXth Dynasty). Fro. &-Patch of atheroma i n anterior tibia1 artery (glycerine). The centre of the patch
is calcified (XXIst Dynasty).
FIG. 7.-Atheroma of brachial artery (glycerin) (XXIst Dynasty).
Fro. &-Unopened ulnar artery, atheromatous patch shining through (glycehne) (XXIst Dynasty). 31
FIG. 9.-Section through almost completely calcified posterior peroneal artery (low power). Van Gieson staining. a,al, n2, Remnants of endothelium and
fenestrated membrane. b, Calcified patches.
Many more are seen.
Same stain. (Leitz, Oc. 1, x &.)
FIG. 10.-Section
FIG. 11.-Section m(Leitz, Oc. 1, x *.)
a,Remains of endothelium.
b, Fenestrated membrane.
c, Muscular coat.
d,f,Membrane coat undergoing degenerntion.
e, Completely degenerated remnants of muscular coat.
atheroniatous patch of n h a r artery. Same stain. (Leitz, (Reference letters the same as in Fig. 11.)
FIG. 12.-Section Oc. 1, x fa.)
through calcified patch of ulnar artery. a,d, Calcified patches.
b, Partially calcified m wular coat. c, Annular muscular fibre.
through atheromatous patch of anterior tibia1 artery. Same stain through
FIG. 13.-Section at edge of atheromatous patch. Hreniatoxylin stain (Leitz, Oc. 1, XTh.1 a,Leucocytes (1). The atheromatous part on the left stains intensely dark with hamatoxylin.
