Angina pectoris / by G. A. Gibson.

  • Gibson George Alexander, 1854-1913.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Angina pectoris / 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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    been seen by those of us who have had the misfortune to see much of this fell disorder. The wide divergences observed cannot be matter for wonder, seeing that the affection is variable in its severity, and the characteristics of the sufferer may be widely different. On closer examination, the pulse is found to yield information of the most widely divergent kind. The arteries may be healthy or sclerosed ; the pressure may be low or high ; the rhythm may be regular or otherwise ; and the rate may be diminished or increased. In regard to these matters, it is probable that some discrepancies which have occurred are due to difficulties of observation, seeing that the physician necessarily abstains as much as possible from disturbing a patient during a period of suffering. But it has fallen to my lot to be able on many occasions to measure the pressure accurately with the sph3'^gmomanometer, and even to take tracings with the sphygmograph during an attack, and the varieties just mentioned have all been recorded. At times the veins of the neck may be seen standing out Hike knotted cords, or wildly pulsating, but in the cases based jupon aortic valvular lesions, the arterial pulsation dominates all tthe cervical features. There is often evidence on inspection, alpation, and percussion, of increase in the size of the heart. The sounds may be largely obscured by murmurs,'particularly n those cases of aortic valve disease just referred to. But at filler times they are clear and ringing, or low and muffled, ccording as dilatation or hypertrophy is in the ascendant, ndoubtedly there is evidence in many cases that the heart is truggling to overtake an obstacle, and frequently of its failure 0 do so. Over the painful areas there is usually hyperaes- hesia, the importance of which has been so thoroughly shown •y Mackenzie ^ and Head.* It may be tested by every means fflich we employ for the estimation of sensibility, and is almost uvariably found to show exaltation to every kind of stimulus, lut a different state of matters occasionally prevails. After lyperaesthesia has existed for some time it is succeeded by aesthesia, which, like the preceding exaltation, is found as egards all kinds of stimuli. Very often there is tenderness of Ue intercostal and cervical muscles with contraction. Medical Chronicle, 1892, Vol. XVI., p. 293; and Lancet, 1895, Vol. I., p. 16. liram, 1893, Vol. XVI., p, i; and i8g^, Vol. XVII., p. 339.