Muscular cramp, in relation with the phenomena of angina pectoris and 'intermittent claudication of the extremities' / by F. Parkes Weber.

  • Frederick Parkes Weber
Date:
1894
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Licence: Public Domain Mark

Credit: Muscular cramp, in relation with the phenomena of angina pectoris and 'intermittent claudication of the extremities' / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    half an hour or so ; the animal regains its natural appearance, but, if whipped on again, the attack will recommence, and so on. At necropsies upon such horses, obliteration of the main artery of the affected limb (the abdominal aorta in cases where both hinder extremities were affected) has been found, and this obliteration of the arterial channel may be from thrombosis, pressure by a tumor from without, etc., but the precise nature of the cause does not affect the present subject under discussion. Charcot (1858) described similar symptoms in a man. In all cases1 the cause is arterial ischsemia of the affected extremity, due to the obliteration of the main artery supplying it, and the collateral circula- tion, though sufficient when the limb is at rest, is quite insufficient during exertion when an increased blood-supply is demanded. The condition, then, is a premonitory sign indicating the danger of gangrene, and Charcot narrates that one of his patients suffering from this affection subsequently underwent amputation of his leg for gangrene. According to Huchard,2 Dr. Potain was the first (1870) to point out the analogy between claudication intermittente des extremity and angina pectoris, and to strengthen this analogy it may be stated that one of Charcot's patients, suffering from intermittent claudication of an ex- tremity, subsequently died in an attack of angina pectoris. If this analogy be strictly accepted, the coronary ischsemia3 resulting from stenosis of the coronary arteries causes the cardiac muscle to fall into a state of spasm, just as the limb in Charcot's cases of claudication intermittente des extrerniteV' But if angina pectoris is really due to spasm of the cardiac muscle, how is it that the pulse may appear, at least in some cases, unaffected or comparatively little affected during the attack ? Such is the difficulty when the heart is concerned, but even in inter- mittent claudication* of the extremities, in spite of Charcot's cases, per- haps it may be asked if cramp forms a necessary feature. Charcot thought it was allied in nature to rigor mortis, but an earlier observer who apparently alluded to cases of the same nature (though he did not 1 Soc. de Biologie, Comptes-rendus, 1858, vol. v. p. 225 et seq. The part affected was the right lower limb of a man, aged fifty-four, who suffered from aneurism of the right common iliac artery. See also later papers by Charcot and others. 2 H. Huchard: Maladies du Coeur. 2d ed., Paris, 1893, p. 608. 8 On the subject of coronary ischsemia some of Cohnheim's experiments are remarkably interesting. See Cohnheim's Lectures on General Pathology, New Sydenham Society's Transactions, 1889, vol. i. p. 35. After recalling the experiments of Von Bezold, Samuelson, and his own, he states that the ischsemia in such experiments probably produces its baneful effect through the action of the cardiac ganglia. He goes on to point out the difficulties in the way of accepting the coronary theory of angina pectoris. It must be remembered, how- ever, in such experiments that the lesions are acute and affect a previously healthy cardiac muscle. The experiments do not, therefore, necessarily afford an analogy with what takes place when the coronary arteries become gradually stenosed by disease. * This term admits of being used in English, and is, perhaps, as satisfactory as meiopragie, the other term used by Huchard, and which he states that he has borrowed from Dr. Potain (Huchard, op. cit., p. 209).