Cardiac arrhythmia in relation to cerebral anaemia and epileptiform crises / by Alfred Webster, M.D., Fellow of the Faculty of Physicians and Surgeons, Glasgow.

  • Webster, Alfred.
Date:
[1901]
Catalogue details

Licence: In copyright

Credit: Cardiac arrhythmia in relation to cerebral anaemia and epileptiform crises / by Alfred Webster, M.D., Fellow of the Faculty of Physicians and Surgeons, Glasgow. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    ' 'I ' second icat&l ij: I 'metiy;] ^sarytopH OriliD? r.;j S I'H iciDi: X' I s, 'vlicli latestk:^ irtecl, aid: 1 was k':' rat the H 1D1( lotdifc.' ihe deGiili.' ,tetliesiii-j' cerebral circulation is affected the presence of these feeble systoles is of no importance, as their existence neither increases nor lessens the cerebral anaemia. With regard to the cardiac condition, however, the presence of these feeble beats is of great importance. In the present case these feeble systoles were accompanied by sounds which were so difticult of appreciation that they frequently escaped observation, and on one occasion a most experienced and skilful auscultator failed to detect them until the time of their occurrence was indicated by small waves on the sphymogram, and this notwithstanding the fact that they were believed to be taking place. Bristowe, Stokes, and Tripier all describe these feeble beats. Broadbent has also observed them. Tripier would seem to indicate that they might be due to right-sided contraction alone; and his description in one case is very similar to our own, when one powerful systole was followed by a single feeble one. With regard to the occurrence of these feeble beats, Bristowe, at the end of the report of his case, makes the following statement:—“ Apparently the action of the heart is quite regular in its rhythm ; these intermediate impulses felt at the base of the heart, are they due to the action of the auricle or to the contraction of the relaxed and empty ventricle ? ” In our own observations, when it was first discovered that these feeble sounds had their point of maximum intensity situated in the region of the sternum, at a level of the fourtli, fifth, and sixth ribs, we were inclined to the possibility of their being due to a right-sided contraction. This idea was supported by the fact, tliat during the feeble systoles the second sound was not heard over the aortic area, from which we inferred that the aortic valves were not closing, whilst both sounds were audible over the pulmonic area. (With regard to the description of these sounds. Tripier suggests that tliey seemed to originate in another heart. Our own impression would be that they resembled the muffled ticking of a watch, or they might be likened to the sounds of a slowly- beating foetal heart.) This view, however, was not tenable for obvious reasons, the chief one being that we had demonstrated oscillations in the column of blood in tlie radial artery. It