This small book reports the work and thinking of McLetchie concerning the origin and morphologic development of the coronary atheroma. The major theme of this work is that the atheroma is a "thrombogenic evil" and results from the normal reaction to the laying down of fibrin. This material is incorporated into the intima and, under conditions of rapid sequential deposition, there is hypoxia, granular disintegration, and finally, progressive fatty metamorphosis deep in the intima. The phagocytic disposal of this fibrin results in the formulation of foam cells which in turn, invite more fibrin deposition. The conclusion is that "the growth of an atheroma is a proper reaction to a surfeit of fibrinous deposit." What appears to be pathological "is the failure of the physiologic mechanisms to... completely return fibrin to the circulation." The theory is not new but echoes the thinking of Rokitansky and, later, Duguid.
McLetchie brings to this