Arhythmia of the heart : a physiological and clinical study / by K. F. Wenkebach ; translated by Thos. Snowball.

  • Wenkebach, Karel Frederik, 1864-1940.
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: Arhythmia of the heart : a physiological and clinical study / by K. F. Wenkebach ; translated by Thos. Snowball. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    thetic, are capable of exerting on tlie heart, was early discovered. In accordance with the above-described conception of the origin of the regular movement of the heart, it was thought necessary to look for the working-point of the inhibitory and accelerator influ- ences of these nerves in the intra-cardial nervous system. In this way it was possible to draw up a plan of the cardiac movements that Avas easily understood : a more or less independent intra-cardial nervous system produces the motor stimuli for the con- tractions of the heart and regulates the appropriate contraction in the different parts of that organ. The cardiac nerves, that arise in the central nervous system, have a positive and negative influence on the intra-cardial system, and are therefore in a position to change the action of the heart according to the necessities of the moment; an opportunity was therefore also given for the most varied reflex action on the heart, such as one meets with in experiment in so many different ways. The physiological and pharmacological ex- periments of Ludwig Traube and his school, for example, were all based on this plan, and even at the present day the efl'ect of cardiac poisons is for the most part analysed from this conception of the heart's action. The heart-muscle would therefore be a passive instrument on which the nervous system plays : the mistakes in playing would first of all have to be referred to the player, the nervous system, although it is possible that injurious influences may also affect the instrument itself, viz., the heart-muscle. Through the influence of the physiological researches of the last decade this theory of the neurogenic origin of the heart's action has been opposed by the view that this source of rhythmical move- ment is to be found in the heart-muscle itself; in other words, this action is of myogenic origin. At first this view was met by the strongest opposition from physiologists, but now it is receiving more and more attention and support, and although the controversy has not decreased in vehemence, the number of opponents has decidedly diminished, and even in clinical circles the myogenic theory has found more and more advocates, and has advanced very materially the pathology of the heart. With all due acknowledgment of the valuable researches of Gaskell, Bowditch, and others, it is to Engel- mann that belongs the honour of having originated the new theory of the heart's action. Engelmann has re-arranged and endeavoured to explain the facts long ago discovered by older investigators such as Traube, Ludwig, Hering, Marey, and Kronecker; he has extended