A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie.

Date:
1909
Catalogue details

Licence: In copyright

Credit: A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    express to him our grateful thanks for much invaluable help in obtaining the photo-micrographs which illustrate the salient features of the case. From the foregoing description of the heart, it is apparent that the organ was hypertrophied; that the coronary arteries were the seat of atheroma; that the mitral and aortic valves were sclerosed and calcareous; and that there was some fibrous transformation of the ventricular musculature. It is further evident that, while on naked-eye examination of the heart the basal portion of the aortic cusp of the mitral valve was markedly indurated, no other gross lesion was detected, either in the auricular or the ventricular septum, which could be satisfactorily regarded as occasioning a loss of structural continuity of the auriculo-ventricular node or bundle. It became necessary, therefore, to make a microscopic examina- tion of this node and bundle, in order to ascertain whether there was any lesion of the primitive cardiac tissue in these situations, and if so, to determine its nature. At the same time, we pro- ceeded to make a histological study of corresponding portions of healthy adult human hearts in order that we might have a clear conception, not only of the position of the auriculo-ventricular node, and the course, bifurcation and ramifications of the auriculo- ventricular bundle, but also of the microscopic characters of these portions of the primitive cardiac tissue. Four healthy hearts were examined. We removed such a portion of the cardiac septum that the block which was to be investigated contained the pars membranacea septi, the adjacent portions of the muscular septa—both ventricular and auricular—together with the central fibrous body, and the attachments of the septal cusp of the tricuspid valve and of the aortic cusp of the mitral valve. This portion of the cardiac septum was found to contain the auriculo- ventricular node, the bundle, and the first portions of its two main branches. In the case of the first healthy heart the block of 1 tissue was cut in a plane which would be a frontal one were the plong axis of the heart vertical. In the case of the remaining 3 three healthy hearts, and also the heart with which we are more jjparticularly concerned, the blocks of tissue were cut in serial Isections from above downwards, and in the horizontal plane, isupposing the long axis of the heart to be vertical. At the :time when we commenced these investigations the only reliable •and detailed information regarding the normal anatomy and jihistology of the auriculo-ventricular node and bundle was that