Paroxysmal Irregularity of tte Heart and Auricular 



Fibrillation. 



In December, 1901, our attention was drawn by Professor Peterson, 

 Director of the gynoecological clinic in the University of Michigan, to a 

 case of marked irregularity of the heart occurring in his wards. Careful 

 examination of the heart was made, and a large number of sphygmo- 

 graphic tracings were obtained. Unfortunately, we were not acquainted 

 at the time with Mackenzie's methods of taking the venous and liver 

 pulses, and failed to take advantage of this most valuable method of 

 analysing cardiac irregularity. The case is of itself of considerable 

 interest however, and the light which seems to be thrown on it by our 

 experience of irregularity in animal experiments, encourages us to put it 

 on record. 



The history of the case supplied by Dr. Peterson is as follows : — 



Mrs. H. H., widow, aged 64. Admitted to hospital, December 23rd, 1901, for 

 ovarian fibroid ; operation December 24th. Anaesthesia (ether) for i hour and 20 mins. 

 Condition good at end of operation, pulse 90. Nausea persisted throughout the 25th 

 and 26th, the patient vomiting repeatedly, but on the 27th some improvement was 

 noted in this respect. The pulse on the 25th and 26th was 90-100 at the visiting 

 hours, but the nurse stated subsequently that she had noticed frequent irregularities. 



On the 27th the pulse* was 88 at 6 a.m. ; 57 at 8 a.m. ; 53 at 10 ; 86 at noon ; 51 

 at 2 p.m. ; 92 at 4 ; 86 at 6 ; 52 at 8 ; 82 at 10, and 54 at midnight. At 2 p.m. the 

 record states " pulse very irregular." Temperature 98°-99°. 



December 28th. Slight nausea and vomiting occasionally. Pulse weak and 

 irregular. Sphygmograms taken in the afternoon indicate the same irregularities as 

 occurred on the 29th. The attacks of irregularity did not last long. Strychnine 1/30 

 grain every four hours. 



* We attach no importance to these numbers as indicating the true rate of the heart, as 

 it is quite impossible to determine the pulse rate in the type of irregularity shown by the 

 sphygmograms. The numbers given, however, indicate periods of irregularity at 8 a.m. ; 

 2 p.m. ; 8 p.m. and midnight ; while the intervening counts indicate a return to the normal. 



(97) H 



