Licence: Public Domain Mark
Credit: Remarks on the heart in debility / 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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![]>y G. A. Gihson, J).Sc., RK.C.P.Ed., Assistant Physician to the Royal Infirmary; Physician to the Deaconess Hospital; and Tjcchirer on Medicine at Minto House, Edinburgh. Several years ago considerable interest was shown in certain discus- sions as to the cause of the clinical facts observed in cases of cardiac debility. The principal subjects under debate at that time were the explanations which had been advanced regarding two of the phenomena commonly observed in feeble conditions of the heart. The first of these, and that the more frequent in its occurrence, is the systolic murmur heard in the second left intercostal space, at or near the pulmonai’y area; the second, not so often presenting itself to the observer, is the systolic impulse seen and felt in the same locality. To the investigation and explanation of these appearances several observers devoted much attention, and, inasmuch as many of the points connected with the ])hysical signs under discussion were virtually settled, it may seem , unnecessary to bring the subject forward again. As one of those, however, wlio took part in the discussions on this question, it seems to me nothing more than simple justice to those whose views then differed from my own to state frankly and candidly the opinions which have been borne in upon me since the time referred to. In attempting to do so, it will be my endeavour to be as brief as possible, and, in particular, to avoid unnecessary reference to older observers. This may be done the more easily as William Eussell has given a very complete ^ and most masterly summary of the views of previous authors in his . work on this subject. For the present purpose it is only necessary to recall a few facts. In order to account for the systolic murmur and accompanying pid- sation sometimes seen in the second left intercostal space, in cases of mitral incompetence, Naunyn advanced the hypothesis that both appear- ances are produced by the backward stream from the left ventricle into the left auricle. According to this view the systolic murmur is of mitral origin, and is conducted by the regurgitant current into tlie dilated left auricular appendix, while the pulsation is caused by the same stream distemling the appendix and thereby producing an impulse](https://iiif.wellcomecollection.org/image/b21969826_0006.jp2/full/800%2C/0/default.jpg)
