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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    relation with the coronary arteries to the organ ; into its sub- stance they are to be traced, and they are there distinguished by possessing in their course minute ganglia, or nervous centres, which have not unreasonably been supposed to regulate the rhythmical movements of the heart. I conceive'that the aberration of cardiac function, which interference with these ganglia best explains, may as readily and probably, on the whole, with greater probability of truth, be accounted for by their originally impaired nutrition, through an impoverished blood, than by the direct operation on them, or on more distant nervous centres with which they are intimately connected, of an injurious cause which cannot with any accuracy be defined, —chiefly spoken of as emotional. Healthy blood is the proper stimulus of the heart as well as of the vessels. Impure blood, unoxygenated, returning to the left side of the heart paralyses the organ, and venous blood, too, stagnates in the pulmonary capillaries. This, indeed, is the primary phenomenon in asphyxia; the depressing influence exerted by such blood on the nervous centres succeeds its retardation in the lungs. A less deteriorated blood tells on the cardiac nerves, and through them the heart is excited to unrhythmical movements. If now we turn to the consideration of the remarkable condi- tion of the vascular system, I believe we shall there find, likewise, satisfactory evidence of its hsemic as well as neurotic origin. The palpitation of the heart is certainly not more characteristic than the violent pulsations of the arteries; it is chiefly in the neck that these are visible; the carotids beat tumultuously, and yield a very loud “ bruit de soufile.” When the hand is applied over the neck, or still more, when both sides of the neck are held in the widely opened hand, the vibratory thrill or purring tremor from the carotids is remark- able. Of the cervical pulsations the patient complains; they are often most distressing to her, and are always greatly in- creased by muscular exertion. With them are associated a sense of fulness in the chest and head, throbbing in the temples, beating in the ears, vertigo, and dyspnoea. Severe dyspnoea, paroxysmal in character, I have only seen in one case, in which the bronchocele was of very large size, and must have in all probability interfered with the recurrent branch of the pneumo- gastric. Unquestionably all these distressing symptoms arc