Licence: In copyright
Credit: Angina pectoris / by G. A. Gibson. 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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![During recent years several instances have been under my notice in which there were further objective appearances of reflex disturbance brought about through the nervous system. To some of these, confessedly rarer than the symptoms just mentioned, attention was directed by me during last year.^ Prominence of the left eyeball, with retraction of the eyelid, and dilatation of the pupil, were seen by me recently in a most interesting patient. In this case, along with intense hyperges- thesia over the left half of the chest and the outer aspect of the left arm, there was absolute anaesthesia of the radial half of the hand, both on the palmar and dorsal aspects. There was also weakness of all the muscles of the left arm and forearm, particularly of those on the outer and radial sides. All the muscles affected were flabby in tone; the power of grasping was almost entirely lost; but the muscular response both to mechanical and electric stimuli was increased. On measuring the muscles they were considerably reduced in size. Since the publication of my interesting case a remarkable instance of angina pectoris, with lichen planus over the area of distribution of the intercosto-humeral nerve, where the pain was situated, was described by Gasne and Chiray.^ As is well known, the secretions often undergo modification. An abundant flow of urine is common, and increase of saliva is at times also observed. To have a basis for the explanation of these widespreadjjlo t symptoms, we must turn briefly to the nervous connections! «tl between the circulatory organs and the nerve centres. Th afferent impulses passing to the centres in connection with th inhibiting and dilating mechanism proceed by way of the vagu^jici nerve. The afferent impulses of the accelerating and con^ stricting mechanism have their course by the inferior cardia nerve to the inferior cervical ganglion, and thence by the grejj rami to the seventh and eighth cervical segments of the cord| whence they pass by the annulus of Vieussens to the uppe: thoracic segments. There is, however, no experimental pro of afferent nerves arising in the heart and reaching the spina] cord. Judging afferent nerves of the visceral S3^stem by thos belonging to the abdomen, they are always medullated up t siir H'C Brain, 1905, Vol. XXVIII., p. 52 Gazette des llGpitaux, 1905, p. 463. r( •iiij.](https://iiif.wellcomecollection.org/image/b2168909x_0008.jp2/full/800%2C/0/default.jpg)
