A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie.

Date:
1909
Catalogue details

Licence: In copyright

Credit: A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    positive waves appearing at a rate about three times as frequent as that of the left ventricle, as revealed hy the systolic depression in the apical tracing or hy the radial sphygmogram. Further, these small positive waves have a rhythm independent of that of the left ventricle, and thus they can owe their origin only to the beats of the left auricle. We have thus graphic evidence of the two auricles beating together at a rate of about 80 per minute, and likewise of the ventricles beating synchronously about 24 times per minute, and, further, of there being complete dissocia- tion of the auriculo-ventricular rhythm. The only other point in the tracings to which we would refer very brielly are the waves, indicated by the letter s, in the i jugulo-carotid tracing of Plate III. We regard these waves, which must not be confounded with the h wave of Hirschfelder ^ and the & wave of A. G. Gibson,^ as due to the increased pressure in the superior vena cava and jugular vein induced by the rhythmical con- traction of the muscle fibres in the wall of the former vessel. This i explanation of the wave we have already advanced in a former t paper.'* During the past two years our histological investigations i have demonstrated that there is a considerable amount of striated | cardiac muscle in the wall of the superior vena cava, extending as far up the vessel as the line of refiexion of the pericardium. We [ believe that under certain pathological conditions this muscle tissue ,i may undergo such a degree of hypertrophy that its rhythmical i contraction may be manifested, as in the case now recorded, by a positive wave preceding the auricular wave in graphic records 1 taken from the jugular pulsations. From 6th March 1903, when the last seizure, with one excep- i tion, occurred, until the end of his life, this state of complete heart-block persisted. In the spring of 1907 Sir William Gairdner resolved to leave Edinburgh and live in the neighbouring country, and about mid-summer he and his family entered upon their new house at Colinton. Shortly afterwards the end came with great suddenness, but was most characteristic in its peaceful serenity. On 28th June 1907 the annual dinner of the Koyal Infirmary Residents’ Club was held in Edinburgh, and amongst those present was Dr. Yellowlees of Glasgow. Early in the after- noon, Dr. Yellowlees, who had come from Glasgow in advance of the hour of dinner in order to call upon Sir William, spent some ^ Johns Hopkins Hospital Bulletin, 1907, vol. xviii. p. 265. r! ^ The Lancet, 1907, vol. ii. p. 1380. ^ The Practitioner, 1907, vol. Ixxviii. p. 589,