97 



conjunction with Professor Spencer Melvin and Dr. J. R, 

 Murray) to have decidedly beneficial effects, both in the 

 way of pi'otection against the onset of persistent fibrillation 

 (for example, against faradic currents one hundred times a3 

 strong as are usually effective) and — in combination with 

 cardiac massage — as regards recovery from the actual 

 attack. These methods are at present only applicable undei 

 experimental conditions. But they give some ground for 

 hope that, with fuller knowledge of the conditions that influ- 

 ence the inception and persistence of fibrillation, much may 

 be possible in the future as regards the warding off of such 

 catastrophic happenings as often bring life to an unexpected 

 and sudden close from failure of cardiac function, occurring 

 often in persons whose hearts are far from being worn out, 

 but on the contrary are endowed with myocardial power 

 amply sufficient not only for quiet existence but not infre- 

 quently for the demands of considerable bodily and mental 

 activity. 



There is reason to believe that in man, as in animals, an 

 undue susceptibility to fibrillation is sometimes a temporary 

 phenomenon depending on circumstances that may be more 

 or less markedly transitory, though no doubt it is very 

 often a persistent condition depending on abnormal changes 

 in the ventricular musculature; in the latter case immunity 

 from sudden death must in large measure depend on avoid- 

 ance of the directly provocative causes of fibrillation in 

 a predisposed heart, such as sudden muscular exertion, 

 especially when accompanied by emotional stress, etc. 



References. 

 ' MacWilliam : British Medical Journal, 1889, i, 6. ' Mackenzie : The 

 Future of Medicine, London, 1919, 178. 'Lewis: The Mechanism and 

 Graphic Registration of the Heart Be^t, London, 1920, 318. * Hering : 

 MUnch. med. Woch., 1912, lix, 750 and 818. 'Halsey: Heart, 1915, vi, 67. 

 •Brouardel and Benham : Death and Sudden Death, London, 1902, 2nd 

 edition. ' MacWilliam : Journ. of Physiology, 1887, viii, 296. ' MacWilliam : 

 Proceedings of the Royal Society, 1918, B, xl, 302. 'Mines: Journ. of 

 Physiology, 1913, xlvi, 349. '» Garrey : Amer. Journ. of Physiology, 1914, 

 xxxiii, 397. " Mayer : Popular Science Monthly, 1908, 471. " Robinson and 

 Bredeck : Arch. Int. Med., 1917, xx, 725. "Smith, F. M. : Arch. Int. Med., 

 1918, xxii, 8. "Hoffmann: Heart, 1911-12, iii, 213. '^^ Heart, 1922, ix, 269. 

 >* Osier: Lancet, 1910, i, 699. i' Lewis: Lectures on the Heart, London, 

 1915, iii. "Nuzum: Arch. Int. Med., 1914, i, 640. "Sapegno: Arch, per 

 le sc. med., 1910, xxxiv, 143. ^° Monckeberg : Untersuch.uber das au.-ventr. 

 Bundle bet Mann, Jena, 1906, 318. " Oppenheimer and Rothschild : Proc. 

 Soc. Exp. Biol, and Med., 1916, xiv, 57. "Carter: Arch. Int. Med., 1918, 

 xxil, 331. "Willius: Arch. Int. Med., 1919, xxiii-xxiv, 431. "Porter: 

 Journ. Exper. Med., 1896, i, 46. ^'Baumgarten : Amer. Journ. of Physiology, 

 1899, ii, 243. "Miller and Matthews: Arch. Int. Med., 1909, iii, 476. 

 " Smith : Arch. Int. Med., 1918, xxii, 8. 



='Allbutt: Diseases of the Arteries, etc., London, 1915, ii, 58. ^» Osier: 

 Allbutt and Rolleston's System of Medicine, London, 1909, vi, 144. 

 =» Russell : Arterial Hypertonus, Sclerosis and Blood Pressure, Edinburgh 

 and London, 1907. "Pal: Gefasskrisen, Leipzig, 1905. »» MacWilliam and 

 Melvin : British Medical Journal, 1914, ii, 777. " MacWilliam and 

 Kesson : Heart, 1913, iv, 279. " MacWilliam and Webster : British 

 Medical Journal, 1923, i, 51. " Gross : The Blood Supply of the Heart, 

 London, 1921. " Jex-Blake : British Medical Journal, 1913, i, 548 and 601. 

 '•Embley: British Medical Journal, 1902, i, 817, 885, 991. ''Laslett: 

 Quart. Journ. of Medicine, 1908-9, ii. 347. »» Allbutt: Loc. cit., p. 475. 

 "Lewis: Heart, 1920, vii, 175. *» MacWilliam : Proc. Roy. Soc, 1918, B, 

 xl, 302. 



