Vol. 60, 1909 - University of North Carolina at Chapel Hill

EDITORIAL. 99
logically what hitherto has been a puzzle cardia, much though they may differ in
to clinicians. This theoiy assumes that their anatomical foundation. Any and
inflammatory processesof the cardiac plexus every irritation wiihin that circle may cause
are the cause of the affection, and this, in alarm in the heart. In this waj' spinal afmany
cases, has been supported by the fact fections (tabes), injuries to the dorsal
that lesions were found in the nerves of the nerves and the rami communicantes, affeccardiac
plexus. If we consider that both tions of the nervus cardiacus magnus, neuvasoconstricting
and vasodilating fibres of ritic affections of the cardiac and coronary
the coronary area terminate in the cardiac plexus, and finally embolism and tliromplexus
and that these fibres connect with bosis of the coronary arteries, may produce
the spinal cord through the intermediary of the symptom complex of angina pectoris,
the sympathetic ganglia and the rami com- The result will be the same in all cases; in
municantes; if we keep in mind that the the center pain and anguish, in tlie periexcilatioiis,
which start from the centers phery vascular spasm with ischsemia of the
for the vascuhir musculature, proceed from myocardium. A healthy heart will overthe
gray substance to the anterior roots and come such an attack, even though it be
from therethrough the rami communicantes serious, but if the heart muscle is weak and
to the sympathetic, the possibility suggests reduced in efficiency, whether from deficient
itself that the sensory fibres carry thesensa- nutrition or fatty degeneration, myocarditis
tion of pain in a centripetal direction, or adhesions to tlie pericardium, then even
whereas the excitation of the centrifugal a rudimentary vascular spasm in the heart
fibres is manifested as a vascular spasm in muscle may lead to a catastrophe, just as a
the cardiac vessels. This would complete fatty degenerated heart may suddenly cease
a circle, in which not only primary excita- to work without the presence of an acute
tion, but also reflex processes may be mani- ischsemia.
fested in the course of the rami communicantes
through the connection of the spinal
cord with the sympathetic. This system
B1.00D PRESSURE AND UIFC
IMSIJRANOE.
also includes the pneumogastric nerve. The The practice of ascertaining the blood
investigations of Maass have shown that pressure has come to be recognized as of
vasoconstrict(»r fibres for the coronary artery prime importance. Its significance in the
terminate in the pneumogastric nerve, and making up of prognoses has within the past
since it is known that the rami communi- few years been impressed very forcibly upcantes
effect the connection of the sympa- on all genuinely scientific clinicians. Its
theticus with the cervico-brachial plexus, a importance in this respect should be realized
typical stenocardiac attack would be ex- especially in considering the acceptance of
plained by any irritation of that system, applicants for life insurance. Dr. Ralph
In order to bring about a stenocardiac at- (irace, in an article which appeared recenttack
it would therefore be a matter of in- ly in the Xew York Medical Journal, emdifl'erence
whether the causative irritation phasized this idea in forcible terms. To
starts in the end apparatus—that is the estimate correctly the pressure of the blood
sensitive organs of the coronary arteries—in in the vessels the most important evidence
the transit station—thalis the cardiac nerves is attained by the use of the sphygmoma-
—in the rami communicantes, or finally in nometer. Of this instrument there are
the central apparatu.s—that is the spinal many reliable makes, among which might
cord. The irritation of the sensitive con- be mentioned the Janeway, Riva-Rocci, &c.
Jiections v.ould therefore produce pain, and As is well known, blood pressure is estithat
of the centrifugal connections ( vaso- tuated by the force necessary to compress
motor I ischsemia of the myocardium. Ac- the artery and obliterate the pulse wave becording
lo wliich of these components pre- yond the point of compression. This force
vails, tiie polymorphic character of the is measured in millimetres of mercury,
stenocardiac paroxysms and the j)henomena In arteriosclerosis we have a condition in
of radiation would be susceptible of inter- the vessel wall which is best described as
prelation. The anguish could be exjilained diffuse permanent thickening, or a hyperas
being due to the centripetal connections trophy
and to the vagus, owing to an irritation of artery.
of the muscular elements of the
There may be a thickening of the
the oblongata. F.et us keep the complete external coat or of the media, and should
circle before our eyes; the spinal center of be distinguished from atheroma which is a
innervation, the dorsal nerves, the rami focal affection of the arterial wall affecting
communicantes, the cardiac nerves, the separate limited areas, probably of microaortic
plexus and the coronary plexus with organic origin and usually a disease of the
the sensitive terniin.Tl organs in their vas- aged. In simple arteriosclerosis the blood
cular walls. We shall be able to trace to pressure is not greatly raised as the increasone
common basis all the types of steno- ed resistance of the thickened vessel wall is