Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis.
- Thomas Lewis
- Date:
- [1910?]
Licence: In copyright
Credit: Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis. Source: Wellcome Collection.
8/80 page 310
![In brief, evidence is forthcoming that of the numerous examples of persistent irregularity of the lieart familiar to clinicians, approximately 50 per cent, are the result of auricular delirium or fibrillation.* Our acquaintance with the facts upon which this final conclusion rests is tlie outcome of the studies of a large body of \vorkers. A retrospective survey of the observations uj)on clinical material permits the recognition of cases, belonging to the category discussed, over a period of many years. Fully possessed of the facts, we may trace the earlier descriptions of the condition along two lines ; and it is mainly upon these separate paths that the course of observation has been pursued, and 2)ursued until quite recent years by distinct investigators. The earliest graphic observations were carried out independently upon the arterial and venous systems. The two paths have converged and finally have met during the last decade. For this union of the facts derived from two separate sources and for the wide range of supplementary knowledge relating to the condition, we are indebted almost exclusively to the introduction of the new graphic methods of examining the cardiac mechanism which are now at our disposal. On the one hand a markedly irregular pulse, especially associated with mitral disease in its later stages, vas the subject of study by mechanical means from the epoch marked by the introduction of the sphygmograph. It is portrayed by Marey'k RiegeP^'’, Sommerbrodt'’ and many other writers. It has been termed the “ mitral pulse,” and has been attributed amongst other causes to “ delirium of the heart.” It has ])assed b} the name of Pulsus arhythmicus (Janowski-’), and by the name Pulsus irregularis (Riegel”'’). It has been identified, in a classic but obsolete nomenclature, with the adjectives irregularis, incegualis, deficiens and iutermittens. On the other hand, a prominent systolic pulsation in the veins of the neck was described by Bamberger', Skoda'’ and others, and was attributed, and has long since been held as due, to tricuspid incompetence. The subjective timing of the venous pulsation was endorsed by Riegel’’, who obtained the first gra])hic records of the movement; but the class of case in which such pulsation is found essentially was not isolated, neither was its full significance grasped, until the more exact and more applicable technique of Mackenzie was introduced. It is since the year 1902, when the “ Study of the Pulse ” was published that chief progress has been made. It is to Mackenzie that we owe the definite co-relation of the two phenomena, gross irregularity of the heart and the systolic venous movement, which he has termed the “ ventricular form of venous pulse.” In the work referred to', this writer first demonstrated their frequent association and ascribed them both to a single underlviim condition, namely, paralysis of the auricle. A year later Hering' descrilhng * Preliminary notieos of tlie observations have ai)i)oarecl^« and exann)leR'~^J^^h7^,i.vos wore de.nonstratod before tlie Medieal Society of London on 13tb December 1')()') and befol H Patl.ologk-al Section of tl>o R.>yal Society of Medicine on 4th January, 1 !no,’at'universiW College](https://iiif.wellcomecollection.org/image/b29000610_0008.jp2/full/800%2C/0/default.jpg)
