Atherosclerosis

George Payling Wright was Professor of Pathology at Guy's Hospital when I went there as a student in 1941 and I came to know him in 1943. He was a great man, a great scholar and an inspired teacher. Of unimpressive appearance, it was only when he began to lecture or to explain or to demonstrate that his great abilities became apparent. He influenced his students profoundly, and wholly for the good. None suffered and all who could benefited from his teaching. Much of what he said was prophetic and I have seen it emerge as truth over the last 40 years. He spoke of the blood supply to the tissues, of the structure and function of the vessels which convey the blood to the body cells — the arteries, the arterioles, the capillaries. He said that future generations of doctors would do well to consider in more detail the decisive influence of adequate supply of blood to the tissues on the functions (and indeed the structure) of organs. He mentioned the work of Poisseuille (1843) who had studied the factors that influenced the flow of liquids through tubes. He detailed the formula relating the pressure forcing it onwards, its viscosity, the length of the tube and its radius on the volume that passed in a given time. And of these factors he showed the supreme importance of the bore of the tube, for the flow was found to vary with the fourth power of the radius. What does this mean? A glance at Figure 1 shows the dramatic effect of reduction of the diameter of the vessel on the flow. With increasing age in the population, reduced blood supply has become a problem second only to neoplasia in importance as a cause of morbidity and death. And of the pathological processes causing the reduction it is atheroma that is paramount.