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October 17, 1903


JAMA. 1903;XLI(16):969. doi:10.1001/jama.1903.02490350025006

In spite of the fact that this remarkable clinical condition was described by Adams in the Dublin Hospital Reports as early as 1827 and much more fully by Stokes in his article entitled, "Observations on Some Cases of Permanently Slow Pulse," in the Dublin Quarterly Journal of Medical Science in 1846, too little attention has been paid to it by the profession at large—so little noticed, indeed, that many good practitioners of to-day scarcely know what is meant by the term.

The disease, or rather symptom complex—for the anatomic lesions are not constant nor the etiology uniform—is, however, by no means an infrequent one, and it is characterized by a group of symptoms which permit it to be easily recognized. The patient suffers from attacks of syncope, often described as "apoplectic attacks," associated with a very slow pulse rate—28 or 30 beats to the minute. The slow pulse may be

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