14 



Scientific Proceedings (50). 



diarrhea for a year with several watery stools a day. Otherwise 

 he has been well until three months before admission to the clinic. 



During these three months and subsequently, he has suffered 

 from attacks of dizziness of increasing severity. In one of these 

 attacks he fainted and fell in the street. Muscular effort increases 

 the giddiness. He has had a good deal of headache. He is very 

 drowsy and is annoyed by numbness and tingling of the hands and 

 feet. 



Until the onset of symptoms he had been a heavy drinker. He 

 denies lues and gonnorrhea. The Wassermann test was negative. 

 The blood and urine are normal. The heart is not enlarged. 

 The sounds are faint but clear, and there are no murmurs. The 

 third sound has been distinctly audible at most examinations and 

 has been recorded graphically. The pulse is regular, 40 per 

 minute. Systolic bloodpressure varies between 95 mm. and no 

 mm. and diastolic pressure is usually about 65 mm. The electro- 

 cardiograms show that the heart beat is initiated by the ventricles, 

 the auricular beat succeeding the ventricular after the usual con- 

 duction interval. This is evidenced by the presence of an inverted 

 P between R and T in leads II and III. In lead I, P is of very 

 small amplitude, but can be clearly distinguished on close inspec- 

 tion and stands in the same relation to R and T as in the other 

 leads. 



This interpretation of the electrocardiograms has been con- 

 firmed beyond reasonable doubt by examination with Roentgen 

 rays and fluoroscope. The contractions of the auricle can be 

 distinctly seen. 



We are not yet ready to offer an explanation for the peculiarly 

 slow intrinsic rhythm of the auricles which permits the ventricle 

 to initiate the beat. Neither atropin nor digitalis has any measur- 

 able effect on the condition. The subject is still under observation. 



