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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    [362] habits as to alcohol and tobacco did not seem to merit repro- bation. He had been attacked quite suddenly by the symp- toms when on his way to work one morning, and had been compelled to desist from making any further attempts at exertion. The patient presented a healthy appearance with a fresh complexion, but an anxious expression. Inspection of the face showed dilatation of the left pupil, prominence of the left eye, and increased width of the aperture between the lids. The conjunctival reflex was lively in both eyes and the iris rsponded promptly on both sides, both to light and to dis- tance, the left pupil always remaining larger than the right. The pain was distributed over a wide area, extending over a great part of the left half of the chest, and up to the lower part of the neck from the middle line in front to that behind. As regards the arm, there was no pain over the distribution of the ulnar nerve, but it involved all the rest of the left arm down to the wrist. Over the whole of this area there was a high degree of hyperaesthesia; at the wrist there was a region about an inch broad encircling the limb with the exception of the ulnar area; this area was insensitive to painful impres- sions, but the patient could feel perfectly well when he was touched. Below this, with the exception of the region sup- plied by the ulnar nerve, every form of sensibility was com- pletely abolished. In this case, therefore, on the outer aspect there was subjective pain and objective tenderness as far as the wrist, while at and below it, there was, firstly, analgesia without anesthesia, and still lower, both analgesia and an- esthesia. The left arm and forearm were somewhat smaller than those on the right side, and their power was notably dimin- ished. The grip of the left hand was less than half that of the right. The muscle and tendon responses were, on the other hand, considerably greater in the left than in the right arm; and both to faradism and to galvanism, the muscles responded with a very much smaller current than in the case of the right arm. We could not, in this case, be certain that there was any alteration in the nutrition of the skin. There was a certain degree of thickening of the superficial arteries, and the arterial pressure was high; unless m.y mera-