1(J41 



more the selachian type of arrangement from which they only differ 

 by the constant rap between the oculomotor and trochlear nucleus, 

 the more dorsal position of the trigeminus nucleus and the less dorsal 

 extension of the abducens cells and roots. 



Physiology. "On esophageal 'niscultation and the recordinq of 



esopluKjeal heart sounds". By Dr. C. E. Benjamins. (Commu- 

 nicated by Prof. Dr. H. Zw.aardkjiaker). 



(Coinmuiiicated in the meeting of February 28, 1914). 



When performing an esophagoscopy our notice is surprisingly 

 attracted by distinct considerable pulsations at 32 — 35 cm. from the 

 incisor teeth. Here an expansion may lepeatedly be seen to appear 

 and to disappear rapidly after some complex to-and-fro motions. 

 Anatomically it has l)een shown that in this very j)lace the left auricle 

 is located against the esoj)hagus, from which it is separated only by 

 the pericardium, and, thercfoie, admits of immediate experimentation. 



Following the lead of Raitknberg ') and Minkowski "■') I availed 

 myself of this circumstance by taking along this path cardiograms 

 as illustrated in Fig. 5. The results achieved in this investigation, 

 which was conducted in a way differing from the method generally 

 employed, will be given elsewhere. In this paper I propose to publish 

 my experience about the esophageal heart sounds. 



I first wish to give some preliminary details of the technique 

 of examination. To the extremity of a strong grey india-rubber tube 

 (75 cm. long; 5 m.m. bore; thickness of the rubber I m.m.), gra- 

 duated from 20 — 40 cm., a knob-shaped appendage is fitted. Over 

 this appendage a rubber finger stall (from which the hard rim has 

 been removed) is tied so as to leave an elongation of 3 — 4 cm. 



The subject, whose pharynx had, or had not, been sprinkled 

 beforehand with a spray of a 5 7o cocain solution, to which some 

 drops of adrenalin had been added, swallows the lubricated tube 

 without difïiculty, only being aided a little as at the insertion of a 

 stomach tube. When the tube is inserted as low as + 35 cm. from 

 the labial curve, it is adjusted by means of a T-piece to the binaural 

 stethoscope. (The T-piece has to protect the tympanic membranes 

 the moment the subject displays signs of choking). When he keeps 

 quiet, the T-piece is closed with the finger, so that we hear distinctly 



M Rautenberg. Die Registiiening der Vorliolpiiisation von der Speiseröhre aus. 

 Deutsches Ardi. f. klin. Mcili.'in lUOT. Bd. !)1. S. -J.Jl. 



'■^■. 0. MiNKuWbKi. Die Kegislrieriing der Herzbewegungen uui linken Vurliul. 

 Berl. klin. Wochenschr, 1907. No. -21. 



