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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    nerves going to these superficial areas. Hence it is that the [862] pain in angina pectoris centers so largely in the ulnar distribu- tion. The explanation of the anaesthesia is, undoubtedly, that long-continued over-use of any nervous structure is apt to lead to exhaustion and paralysis. It has been shown by Eichhorst and myself that wasting of the muscles, and changes in the texture of the skin are to be made out at times in the regions associated with the pain- ful symptoms. It has, further, been demonstrated by myself that when muscular atrophy is found the myotatic irritability may be increased, exactly as is the case in arthritic muscular atrophy, while the electric reactions show a distinct increase, both as regards faradism and galvanism. The eyes occasionally show alterations, to which it is my wish to direct your attention. The eye on the side to which the pain is mainly, or entirely, confined, may be more promi- nent than its fellow; while the aperture between the eyelids may be increased in width, and the pupil may at the same time be dilated. The explanation of these symptoms is very simple. If there be sufficient stimulation of the sympathetic system to reach the first cervical ganglion, the impulses may pass from it to the nervous filaments which control the muscle of Muller at the back of the orbit, to those which innervate the unstriped fibers of the levator palpebrse superioris, and to those which cause contraction of the radiating fibers of the iris. In this way protrusion of the eyeball, elevation of the upper lid, and dilatation of the pupil result. These varying changes may be found in varying degrees, more or less of them being associated in any given case; at times many, or even all of them, may be present in the same individual, and in order to illustrate these remarks, let me refer very briefly to a most interesting patient who was under my care a few years ago, when Dr. H. A. Stewart, who is at , present attached to this medical school, was my house phy- sician. The patient was a man of middle age, engaged in the ' hard work of an unskilled laborer, who came into my ward ' complaining of agonizing pain in the breast and left arm. He was found to have no evil hereditary tendencies, while ^ his past history showed no specific disease of any kind. His 1