Manual of the physical diagnosis of the diseases of the heart : including the use of the sphygmograph and cardiograph / by Arthur Ernest Sansom.

  • Sansom, Arthur Ernest, 1839-1907.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Manual of the physical diagnosis of the diseases of the heart : including the use of the sphygmograph and cardiograph / by Arthur Ernest Sansom. Source: Wellcome Collection.

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    the walls of the left ventricle were much thinner aad softer atLte? J°Ln ^ed after attlf ang m pectoris and the heart in his case was found to be very smaU and its tlssue pale. Dr. W. T. Gairdner says : « ±>0Z mortem ex^nnnations have generally shown that the heart is ound fl d ratt rig.dly contractedi andtheIes.ona found m the muscular substance of the heart itself are usually such as would confirm the idea of decidedly and permanently I?}™ , e^'^.rfhert^^ disposition to abnormal con- traction. The high tension, then, is due to vascular rather than to cardiac causes ; the left ventricle labours against the obstacle imposed by the firm contraction of the arterioles. In the large class of cases of angina pectoris associated with atheromatous disease of the great arteries, I consider that a strict analogy is established with those cases of epilepsy which are found to depend on local irritation of the nerve centres in the former, owing to irritation of the nerve fibrils involved ' m the wall of the diseased artery, there are periodic explosions expressed by the tight contraction of the arterioles and the consecutive heart-struggles, whilst in the latter the expression ot the maximum of central irritation is an epileptic fit In any case manifesting angina pectoris, I counsel you strongly to obtain, by means of the sphygmograph, evidence of the con- dition of the vessels. I may mention a case in point. I saw in conjunction with my friend Dr. John Bruntou, an old lady of sixty-nine, who suffered from severe pain, referred to the epigastrium and abdomen. This pain might very easily be referred to visceral congestion, but it was to a considerable extent paroxysmal, and there was a marked look of anxiety upon the face with tendency to cold perspiration. The heart sounds betrayed nothing abnormal, but a tracing of the radial gave very important evidence. Not only was there extremely high tension, but the trace bore strongly the characters of aortic obstruction (see tracing of Aortic Obstruc- tion in Part II.). I had no hesitation in concluding that the vessels were extensively diseased, and it seemed to me very probable that the great suffering referred to the epigastric and umbilical regions might be ascribed to disease of the coats of the abdominal aorta. Nitro-glycerine gave relief, and the subsequent history of the case confirmed the diagnosis. Dr. Brunton wrote me : The old lady has gone on tolerably well