1904 - 5 .] Dr W. T. Ritchie on Complete Heart-block. 1087 
syncopal attacks for four and a half years. Since he first consulted 
me, fourteen months ago, the rate of the arterial pulse has been 
almost constantly 32 to 34 heats per minute, though occasionally 
after physical exercise as frequent as 40 beats per minute. 
In July 1904, tracings, for which I am indebted to Dr Oliphant 
Nicholson, were taken simultaneously from the jugular vein and 
radial artery, by means of Mackenzie’s polygraph and Dudgeon’s 
sphygmograph. Those tracings demonstrated that the right 
auricle contracted more frequently than the left ventricle, and 
that there was dissociation of the ventricular rhythm from the 
auricular. 
I have since obtained many tracings from the patient, by means 
of the Knoll-Hering kymograph. 
Fig. 1 is a reproduction of a portion of the tracings taken 
simultaneously on the 19th May 1905. The upper tracing is from 
the jugular and carotid movements, the middle tracing is from the 
right brachial artery, the lower tracing is from the apex beat of 
the heart. In this and all other tracings the time is recorded by 
Jaquet’s chronograph, recording 0 - 2 of a second. In the jugular 
and carotid tracing, the waves marked with the letter C are 
carotid waves, those marked with the letter A are waves due to 
auricular systoles, and those marked with the letter V are ventri- 
cular waves. 
Fig. 1 shows that the left ventricle contracted rhythmically 
at the rate of 3 2 ’8 beats per minute, and that the right auricle 
contracted at the rate of 59*3 beats per minute. Some of the 
systoles of the left auricle are represented by distinct waves in the 
tracing from the apex beat. In the jugular and carotid tracing a 
ventricular wave occurs after each carotid wave. 
The administration of 90 c.c. of whisky was found to increase 
the frequency of the auricular contractions by 2*95 beats per 
minute, whereas the increase in frequency of the ventricular 
contractions was only 0*4 of a beat per minute. The systolic 
blood pressure, estimated by Gartner’s tonometer, immediately 
after the tracings reproduced in fig. 1 had been taken, was equal 
to 85 mm. Hg. 
In the numerous tracings taken from this patient at intervals 
during a period of fourteen months, there is no evidence of depres- 
