Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis.

  • Lewis, Thomas, Sir, 1881-1945.
Date:
[1910?]
Catalogue details

Licence: In copyright

Credit: Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis. Source: Wellcome Collection.

    10/80 (page 312)
    disturbance in all cases of complete irregularity found in com ina ion with the systolic form of venous pulse. He therefore included all such cases under the term “ nodal rhythm.”* Hering'» has recently added evidence of the supraventricular formation of the ventricular impulses. Such is the history of the main steps in the attempt to unravel the problem of the mechanism upon which the symptomatology is dependent, and, for the time being, this brief account will suffice. Papers relating to the subject have been prolific, a mass of detailed knowledge has accumulated, discussion has been unrestrained and speculation has oftentimes exceeded the limit warranted by the facts. Further reference to the work of previous observers will be made more conveniently under the various headings and sub-headings which follow. A GENERAL ACCOUNT OF COMPLETE IRREGULARITY OF THE HEART. The following account of the condition is based uiion a close study of seventy-three cases from all of which simultaneous radial and venous curves, and from thirty of which electrocardiographic curves, have been taken. The clinical polygraph and Mackenzie’s ink polygraph, fitted with specially light writing points and arranged with a considerable reduction in the air content of the transmission apparatus, have been employed in obtaining records of pulsating areas. The electrocardiograms have been obtained with Edelmann’s large pattern of the string galvanometer of Einthoven. During the earlier days when the work was in progress, the electrodes consisted of baths of salt solution in which zinc terminals were immersed, but the greater part of the investigation has been carried out with non-polarisable electrodes consisting of zinc rods immersed in saturated zinc sulphate solution, the last held in a porous jar itself lying in the salt solution. Simultaneous radial or venous and electrocardiographic curves have been secured by adding parts of the Mackenzie polygraph to the galvanometric outfit. The patients were always in the same room with the apparatus while the records were taken. Frequency. Complete irregularity of the heart is a very common condition. During two years of observation lUf cases of persistent^ irregularity of the heart * On tlie Continent the rhytlnn is variously described as “ chronic arhythmia,” “ arhvtlmi^ porpetua,” etc. t I have excluded entirely all cases of irregularity which 1 have seen since the first announcement of my view of the mechanism present in complete irregularity of the heart. For since that date I am unable to affirm that the cases presenting themselves have been impartially chosen It is on this accouivt that the number of cases of complete irregularity from which the conclusions as to the mechanism arc drawn exceed those mentioned in the statistical account which is now given. t By P^istont irregularity I .lonoto caaoa in wl.icl,, from time to time, irregnlarity is a notable toaturo of tbo case. Cases ,n wind, single oxtraaystolos at long intervals, or cases in wliLl, nuine ous extrasystoles have been observed only on one or two occasions have been excluded.