1915 The Lancet  
a disordered central nervous ] system can any disease of the heart cause instant death ? Even in complete heart-block the ventricle, if robust, still bears the burden of rhythm. , It may be replied that disturbance of myocardial function causes hyper-irritability at segmentary centres of the thoracic cord, and as a result of this morbid condition the symptoms indicated above appear. But apart from the fact that dendritic connexion between the myocardium proper and segments of the thoracic cord
more » ... s not open to proof, this statement merely affirms that the predisposing cause of the seizure really lies in the central nervous system, and that the remote cause of the seizure is to be found in the myocardium. The hypothesis that the myocardium is the seat of the predisposing cause is therefore an absurdity. The same method of argument is applicable to all the other alternative propositions. A confirmatory symptom is present during seizures and at intervals between them-viz., patches of algesia are found in the distribution of intercostal and spinal accessory nerves. Strands of the brachial plexuses in the posterior cervical triangle and branches of the plexuses in the arms are tender upon pressure. This symptom appears in regions where pain is never felt and at seasons when the patient is at rest and when seizures are in abeyance. In a certain case examinations have been made by me on frequent occasions during an illness of three years' duration, and in no instance has this symptom been entirely absent. But algesia shifts its ground from day to day-patches appear in a zonal area, remain in evidence for a few hours, disappear and reappear. Charts showing the distribution of patches of algesia are never found alike upon two days in succession. Precisely the same characteristics are noticed even at intervals when no seizures are occurring. It is etident that it is not the seizure which makes the patch, but that neurosis of segmentary centres determines both patch and seizure. Hence we are in a position to infer that a state of neurosis at segmentary centres is the predisposing cause of seizures, and that vagal inhibition is the cause of death. This conclusion is important because segmentary neurosis is the predisposing cause of diseases belonging to the class of the paroxysmal spasmodic disorders associated with the musculature of the alimentary canal. In members of this class seizures occur in connexion with food-taking and gastro-cesophageal hypertonus; they also occur from mental and emotional excitement and from muscular effort ; in them both visceral and parietal layers of muscle are engaged in spasm. Consequently they resemble the anginal seizure in other features besides that of predisposing cause. A neurosis attended by intercostal hyperalgesia ensues when dendritic fibres belonging to the affected centre traverse pressure zones of hyperplasias, aneurysms, new growths, and pericardial and pleuritic adhesions. Hence these diseases as well as gastric disorders may be regarded as potential remote causes of anginal pains and seizures. I am, Sir, yours faithfully, H. WALTER VERDON.
doi:10.1016/s0140-6736(00)80730-8 fatcat:pwf5egwiuzgtrfi7knsx27xbpy