Report on Diseases of the Chest

F. I. Knight
1874 Boston Medical and Surgical Journal  
499 1r)o roe t in ffebitine. REPORT ON DISEASES OF THE CHEST. By F. I. KNIGILT, M.D. ANGINA PECTORIS. Tins affection has recently excited unusual interest in the professlon, on account of the sudden death of a great statesman, who was known to have been a sufferer from it for a long time. It was, peqhaps, rather unfortunate that the diagnosis of ossification of the coronary arteries, which the newspapers informed us so positively had been made, should have been confirmed, inasmuch as that is
more » ... smuch as that is only one of many organic changes which have been found associated with angina pectoris. Every variety of organic disease of the heart and aorta has been found in different cases, and some cases have seemed to be purely functional. For the details of quite a large number of cases, with autopsies, the reader is referred to an exceedingly interesting paper, by Dr. J. W. Ogle, in the British and Foreign MIedico-Chirurgical Review, Oct. 1870. Heberden, who first accurately described this affection, brought out its nervous character, calling it a cramp of the heart. Romberg calls it hypereesthesia of the cardiac plexus; Bouillaud, neuralgia of the phrenic nerve; and Bamberger, a hypercinesis with hypersesthesia. Laennec thought that the primary affection is seated sometimes in the pneumogastric nerves, and sometimes in the cardiac portion of the sympathetic, and that the brachial plexus becomes implicated. J. Lockhart Clarke (St. George's Hospital Reports, vol. iv.) says that this view of Laennec, in regard to the proximate cause of angina pectoris, has been materially supported by recent inquiries. He refers to the cases of M. Lancereaux, to the researches of Bezold, and to the article of Eulenburg and Guttmann* on the pathology of the sympathetic. In one case of Lancereaux, there was, among other lesions, disease of the cardiac plexus of nerves. The heart itself was healthy; but in the aorta, between the orifices of the coronary arteries, Which were so much narrowed as scarcely to admit the introduction of a stilette, there was a prominent plate, of several centimetres in extent, festooned along its borders, and composed chiefly of a new formation of connective tissue, having a finely arborescent structure, and situated between the internal and middle coats. The external coat was extremely vascular, and the cardiac plexus, which lies on this part of the vessel, participated in the vascularity, while some of its filaments were included in a kind of plasma on the surface of the thickened, external coat. On microscopic examination of the nervous filaments and ganglia, numerous round nuclei were found interposed in masses between the tubular elements, compressing them more or less. The medullary sheaths or white portions of the tubules were grayish and granular. A calcareous mass was found close to the point of recurrence of the left inferior recurrent laryngeal nerve, where it was adherent to the neurilemma. The aortic valves were somewhat thickened near their attached border. All the abdominal organs were healthy,
doi:10.1056/nejm187405210902102 fatcat:qe6b5k5w5zgolfzastv7g7bn3y