Vascular bronchocele and exophthalmos / [J. Warburton Begbie].

  • Begbie, James Warburton, 1826-1876.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Vascular bronchocele and exophthalmos / [J. Warburton Begbie]. Source: Wellcome Collection.

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    the appearance of the latter. The palpitation of the heart is, for the most part, the symptom which chiefly attracts the atten- tion of the patient, and leads her to seek professional advice.^ It is generally vehement, often it is tumultuous, always it is rapid, being precisely of the same nature, though usually more violent, as the palpitation with which we are familiar in ordinary instances of anaemia and chlorosis. That the excited action of the heart is, in the early stage of the disease, altogether inde- pendent of organic change admits of no doubt.^ Again, the accounts of post-mortem appearances, in the fatal cases, which have been investigated by Sir Henry Marsh, Basedow and Dr. Begbie, satisfactorily prove that those changes which result from long-continued functional derangement of the heart are to be met with—chiefly permanent dilatation of its chambers, Avith more or less of hypertrophy. The cardiac disturbance being admitted to be among the earliest of the morbid pheno- mena in this disease, the question presents itself—upon what does this disturbance depend ? That it is essentially neurotic in its nature may be admitted; such disturbed action of the heart as Ave thus find is probably best explained by inter- ference with the cardiac plexus of nerves. That important netAVork is formed by small branches from the pneumogastric, and by branches from the three cervical ganglia of the sympa- thetic ; from the cardiac plexus styled great, and in which at least tAVO ganglia are to be recognised, nerves proceed in intimate ' As is well known, the afEection under consideration occurs more fre- quently in women than men; still, the observations of Dr. Macdonell, Dr. Hegbie, Eomberg, Henoch, and others, have shown that among the latter it can assume its most typical expression. ^ I consider it quite unnecessary to advance any proof of the con-ectness of this statement. By some writers the heart affection has, indeed, been described as organic, and the sufferers from exophthalmos and bronchocele have likewise been regarded as the subjects of cardiac hypertrophy. Trous- seau has specially addressed himself to the refutation of this error. But both Trousseau and Beau, the latter more especially, have admitted the existence in such cases of a temporary hypertrophy, “ h3'pertrophic passa- gere, or rather a general dilatation of the whole cardiac chambers, such as the researches of Larcher, Ducrest, and Blot hav'e shown to occur during pregfnancy. Muscular relaxation with flaccidity is a characteristic feature of anaemia the involuntary muscular structure of the heart is just as likely to suffer as the voluntary muscles from the contact of impoverished blood.