Certain clinical features of cardiac disease / by G. A. Gibson.

  • Gibson George Alexander, 1854-1913.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Certain clinical features of cardiac disease / 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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    [3611 hension we are mostly indebted to the observation of Mac- kenzie and Head, who have not merely traced out its distribu- tion in a way previously unapproached, but have furnished an explanation as beautiful as it is complete. The main situ- ation of the pain is in the region of the prsecordia, whence it radiates towards the shoulder and down the arm, as well as, less frequently, up the side of the neck and head. In disease affecting the left side of the heart primarily, the pain is ex- perienced mostly, or solely, on the left side; but, as has been shovm by Morison and myself, when the structural changes are confined to the right side of the heart the painful symp- toms are found in the corresponding areas. The changes in sensibility are found most typically along the course of the distribution of the ulnar nerve and its connections; that is to say, they correspond to the brachial roots connected with the seventh and eighth cervical segments, and the first tho- racic segment, of the cord. One of the modern additions to our knowledge of these nervous symptoms was made by Mac- kenzie, when he directed attention to the fact that there is hypersesthesia over the areas in which subjective pain is ex- perienced. Careful analysis of the phenomena has since his observations were published, fully confirmed their accuracy. It has for some time been recognized that the numbness, which has for long been described by sufferers from the affection, | is oftentimes attended by diminution of sensibility, which may reach such a degree as to attain complete anaesthesia. The explanation of these phenomena, which has been given [362] by Head is most interesting. The sensory impulses arising in connection with the heart or aorta pass to the central ner- vous system by means of the afferent cardiac nerves to the ganglia of the sympathetic system, particularly the middle and inferior ganglia, as well as the stellate ganglion, whence they are transmitted by the rami communicantes to the spinal i cord. The impulses pass thence up the cord to the receptive areas of the brain, but as these, by the course of education, have been taught to associate disturbances in the spinal re- gion which is affected with those areas of the surface of the body with which the sensory spinal nerves are in relation, the source of the disturbance comes to be associated with the F