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January 18, 1908


JAMA. 1908;L(3):188-189. doi:10.1001/jama.1908.25310290024002e

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History.  —J. A. P., justice of the peace, aged 91, visited me in March, 1907, for shortness of breath and vertigo.

Examination.  —Examination of the heart revealed the following: The systolic contractions were irregular; a pause amounting to the length of three or four contractions would occur following about six normal contractions. During this pause faint contractions could be heard, the pulsations from which did not reach the wrist. No murmurs were heard, but the heart sounds were not pure; they were what would lead one to suspect fatty degeneration of that organ. Pulse, 40; irregular, indicating the pause very plainly. Audible impulses at heart area numbered 66; visible pulsations in the neck, 90. Blood pressure, by the Riva Rocci, 9 cm. cuff; sphygmomanometer was 129 mm. and was peculiar in that some of the pulse beats ceased long before others; the last to stop occurring about every ten seconds

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