4 QUATERCENTENARY STUDIES IN PATHOLOGY 



December 29th, 8'3. Pulse very irregular at 8*30, but regular at 9'i5. In the after- 

 noon pulse tracings were taken every hour. At 1*45 great arhythmia ; 2*45 pulse regular ; 

 3'45 irregular again ; 4*45 irregular ; and this persisted through the rest of the day. 



From December 30th onwards nausea and vomiting stopped, and general 

 improvement. Periods of irregularity became less frequent, and confined almost 

 entirely to the night time. The patient says she wakes up with a start, and heart 

 becomes very irregular at once. 



On January nth, 1902, the heart was very irregular during the night, but after- 

 wards remained regular again until, on January 18th, she was discharged from the 

 hospital and reached home in the evening ; very irregular during the following night. 

 Patient states that she first noticed the irregularity of the heart 20 years ago during an 

 illness, and since then it has occurred whenever she was ill, excited or exhausted. 

 Vomiting, to which she is occasionally subject, is always followed by heart irregularity. 

 The tendency to irregularity seemed to increase about ten years before the operation, 

 as she observed that smaller occasions gave rise to it than previously. For two years 

 after the operation she suffered very little from her heart, but then some over-exertion 

 gave rise to cardiac irregularity again, and for the last year very slight exertion or 

 exposure to extreme heat or cold induces an attack. 



The examination of the heart by the usual clinical methods, during the stay of the 

 patient in hospital, gave no clue to the cause of the irregularity. No enlargement of 

 the cardiac dulness could be made out nor were there any murmurs present, and no 

 objective signs of heart failure were present apart from the irregularity. 



Analysis of the Sphygmograms. 



The pulse tracings were taken with Jacquet's sphygmochronograph 

 recording 1/5 sees. The tracings obtained during the irregular periods 

 were all of the same type, and may be represented by some of those 

 taken on December 29th. The marker above the tracing records the 

 time in 1/5 sees., while the intervals between successive pulses are given 

 below in hundredths of a second. 



Fig. I. — Pulse tracing at 1*45 p.m., December 29th. 



(98) 



